Catherine A Marco

Medical University of Ohio at Toledo, Toledo, Ohio, United States

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Publications (114)

  • Catherine A. Marco · Kerryann Broderick · Rebecca Smith-Coggins · [...] · Andrea B. Coombs
    Article · Jun 2016 · The American journal of emergency medicine
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    C.A. Marco · J.M. Baren · M.S. Beeson · [...] · K.B. Joldersma
    [Show abstract] [Hide abstract] ABSTRACT: The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2016 annual report on the status of US emergency medicine training programs.
    Full-text Article · May 2016
  • Catherine A. Marco · Arvind Venkat · Eileen F. Baker · [...] · Joel M. Geiderman
    [Show abstract] [Hide abstract] ABSTRACT: Prescription drug monitoring programs are statewide databases available to clinicians to track prescriptions of controlled medications. These programs may provide valuable information to assess the history and use of controlled substances and contribute to clinical decisionmaking in the emergency department (ED). The widespread availability of the programs raises important ethical issues about beneficence, nonmaleficence, respect for persons, justice, confidentiality, veracity, and physician autonomy. In this article, we review the ethical issues surrounding prescription drug monitoring programs and how those issues might be addressed to ensure the proper application of this tool in the ED. Clinical decisionmaking in regard to the appropriate use of opioids and other controlled substances is complex and should take into account all relevant clinical factors, including age, sex, clinical condition, medical history, medication history and potential drug-drug interactions, history of addiction or diversion, and disease state.
    Article · May 2016 · Annals of emergency medicine
  • Chadd K. Kraus · Catherine A. Marco
    [Show abstract] [Hide abstract] ABSTRACT: The process of shared decision-making (SDM) is an ethical imperative in the physician-patient relationship, especially in the emergency department (ED), where SDM can present unique challenges, because patients and emergency physicians often have no established relationship and decisions about diagnosis, treatment, and disposition are time-dependent. SDM should be guided by the ethical principles of autonomy, beneficence, non-maleficence, justice, and the related principle of stewardship of finite resources. The objective of this paper is to outline the ethical considerations of shared decision-making in the ED, in the context of diagnostic evaluations, therapeutic interventions, disposition decisions, and conflict resolution and to explore strategies for reaching decision consensus. Several cases are presented to highlight the ethical principles in SDM in the ED. SDM is an important approach to diagnostic testing in the ED. Achieving agreement regarding diagnostic evaluations requires a balance of respect for patient autonomy and stewardship of resources. SDM regarding ED therapeutic interventions is an important component of the balance of respect for patient autonomy and beneficence. While respecting patient autonomy, emergency physicians also recognize the importance of the application of professional judgment to achieve the best possible outcome for patients. SDM as an ethical imperative in the context of ED disposition is especially important because of the frequent ambiguity of equipoise in these situations. Unique clinical situations such as pediatric patients or patients who lack decisional capacity merit special consideration.
    Article · May 2016 · The American journal of emergency medicine
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    [Show abstract] [Hide abstract] ABSTRACT: Emergency physicians frequently interact with law enforcement officers and patients in their custody. As always, the emergency physician's primary professional responsibility is to promote patient welfare, and his or her first duty is to the patient. Emergency physicians should treat criminals, suspects, and prisoners with the same respect and attention they afford other patients while ensuring the safety of staff, visitors, and other patients. Respect for patient privacy and protection of confidentiality are of paramount importance to the patient-physician relationship. Simultaneously, emergency physicians should attempt to accommodate law enforcement personnel in a professional manner, enlisting their aid when necessary. Often this relates to the emergency physician's socially imposed duties, governed by state laws, to report infectious diseases, suspicion of abuse or neglect, and threats of harm. It is the emergency physician's duty to maintain patient confidentiality while complying with Health Insurance Portability and Accountability Act regulations and state law.
    Full-text Article · May 2016 · Annals of emergency medicine
  • Catherine A Marco · Robert P Wahl · Francis L Counselman · [...] · Earl J Reisdorff
    [Show abstract] [Hide abstract] ABSTRACT: Objective: As part of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) Program, ABEM-certified physicians are required to pass the Continuous Certification (ConCert(™) ) examination at least every 10 years. With the 2015 ConCert(™) Examination, ABEM sought to better understand emergency physicians' perceptions of the benefits of preparing for and taking the examination and the career benefits of staying ABEM-certified. Methods: This was a prospective survey study. A voluntary post-examination survey was administered at the end of the 2015 ABEM ConCert(™) Examination (September 21-26, 2015). Physicians were asked about the benefits of preparing for the examination and maintaining ABEM certification. Examination performance was compared to perceptions of learning and career benefits. Results: Of the 2,601 on time test takers, 2,511 respondents participated (96.5% participation rate). The majority of participants (92.0%) identified a benefit to preparing for the ConCert(™) Examination, which included reinforced medical knowledge (73.9%), increased knowledge (66.8%), and making them a better clinician (39.4%). The majority of respondents (90.8%) identified a career benefit of maintaining ABEM certification, which included more employment options (73.8%), more positively viewed by other physicians (56.8%), and better financial outcomes (29.8%). There was a statistically significant association between the perception of knowledge reinforcement and examination performance (p<0.001). There was also a statistically significant association between the perception that staying certified created more career opportunities and examination performance (p<0.001). Conclusions: Most emergency physicians identified benefits of preparing for and taking the ABEM ConCert(™) Examination, which included reinforcing or adding medical knowledge and making them better clinicians. Most physicians also found career benefits to remaining ABEM certified, which included greater employment choices, higher financial compensation and higher esteem from other physicians. The belief that preparing for and taking the examination reinforced medical knowledge was associated with better examination performance. This article is protected by copyright. All rights reserved.
    Article · Mar 2016 · Academic Emergency Medicine
  • Catherine A. Marco · Robert P. Wahl · Francis L. Counselman · [...] · Earl J. Reisdorff
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: To maintain certification by the American Board of Emergency Medicine (ABEM), physicians are required to pass the Continuous Certification (ConCert) examination at least every 10 years. On the 2014 ConCert postexamination survey, ABEM sought to understand the manner in which ABEM diplomates prepared for the test and to identify associations between test preparation approaches and performance on the ConCert examination. Methods: This was a cross-sectional survey study. The survey was administered at the end of the 2014 ConCert examination. Analyses included chi-square and linear regression to determine the association of preparation methods with performance. Results: Of the 2,431 on-time test-takers, 2,338 (96.2%) were included. The most commonly used study approach was the review of written materials designed for test preparation (1,585; 67.8%), followed by an online training course (1,006; 43.0%). There were 758 (32.4%) physicians who took a single onsite board review course, while 41 (1.8%) took two or more onsite courses. Most physicians (1,611; 68.9%) spent over 35 hours preparing for the ConCert examination. The study method that was most associated with favorable test scores was the review of written materials designed for test preparation (p < 0.001). Attending an onsite preparation course was associated with poorer performance (p < 0.001). There was a significant association between no additional preparation and failing the examination (chi-square with Yates correction; p = 0.001). Conclusions: A substantial majority (97.8%) of physicians taking the 2014 ABEM ConCert examination prepared for it. The majority of physicians used written materials specifically designed for test preparation. Reviewing written materials designed for test preparation was associated with the highest performance.
    Article · Jan 2016 · Academic Emergency Medicine
  • Catherine A Marco · Christopher Fagan · Catherine Eggers · [...] · James E Olson
    Article · Nov 2015 · The American journal of emergency medicine
  • Catherine A Marco · Scarlett Michael · Jamie Bleyer · Alina Post
    [Show abstract] [Hide abstract] ABSTRACT: Background: Do-not-resuscitate (DNR) orders are an important means to communicate end-of-life wishes. Previous studies have demonstrated variable prevalence of DNR orders among hospitalized trauma patients. Objective: This study was conducted to identify the prevalence and type of DNR orders among trauma patients and to identify associations of DNR orders with injury severity, length of stay, and whether CPR was performed in cases of cardiac arrest. Methods: In this retrospective study, medical records were reviewed for 263 trauma patients at Miami Valley Hospital in Dayton, Ohio, in 2014 with a DNR order. Results: Among 3394 trauma patients in 2014, 263 (8%) patients had a DNR order. Participants were 43% male and 57% female. The mean age was 76 (range, 16-90+) years. The most common mechanisms of injury included fall (n = 214, 81.4%) and motor vehicle collision (n = 16, 6.1%). Most DNR orders in this patient population were instituted during the hospitalization (n = 176, 67%). The most common types of advance directives included DNR order (n = 224, 85.2%), living will (n = 124, 47.2%), and durable power of health care attorney (n = 126, 47.9%). A minority of patients died during hospitalization (n = 100, 38.0%). Among patients who were deceased, 14 (14.0%) had CPR performed. Conclusions: Among trauma patients with DNR orders, most DNR orders were instituted during the hospital admission. Most deceased patients with DNR orders did not have CPR performed during the hospital stay.
    Article · Sep 2015 · The American journal of emergency medicine
  • Catherine A Marco · Andy Davis · Sylvia Chang · [...] · James E Olson
    Article · Sep 2015 · The American journal of emergency medicine
  • [Show abstract] [Hide abstract] ABSTRACT: This study sought to answer the question, "Can police officers administer intranasal naloxone to drug overdose victims to decrease the opioid overdose death rate?" This prospective interventional study was conducted in Lorain County, OH, from January 2011 to October 2014. Starting October 2013, trained police officers administered naloxone to suspected opioid overdose victims through a police officer naloxone prescription program (NPP). Those found by the county coroner to be positive for opioids at the time of death and those who received naloxone from police officers were included in this study. The rate of change in the total number of opioid-related deaths in Lorain County per quarter year, before and after initiation of the NPP, and the trend in the survival rate of overdose victims who were given naloxone were analyzed by linear regression. Significance was established a priori at P < .05. Data from 247 individuals were eligible for study inclusion. Opioid overdose deaths increased significantly before initiation of the police officer NPP with average deaths per quarter of 5.5 for 2011, 15.3 for 2012, and 16.3 for the first 9 months of 2013. After initiation of the police officer NPP, the number of opioid overdose deaths decreased each quarter with an overall average of 13.4. Of the 67 participants who received naloxone by police officers, 52 (77.6%) survived, and 8 (11.9%) were lost to follow-up. Intranasal naloxone administration by police first responders is associated with decreased deaths in opioid overdose victims. Copyright © 2015. Published by Elsevier Inc.
    Article · May 2015 · American Journal of Emergency Medicine
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    [Show abstract] [Hide abstract] ABSTRACT: The 2014 outbreak of Ebola Virus Disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged US emergency departments to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to US acute care facilities, ethical questions have been raised in both the press and medical literature as to how US emergency departments, emergency physicians, emergency nurses and other stakeholders in the healthcare system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to US emergency physicians, emergency nurses and other stakeholders in the healthcare system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to US emergency departments in how they approach preparation for and management of potential patients with EVD. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
    Full-text Article · Mar 2015 · Academic Emergency Medicine
  • Joel M Geiderman · Catherine A Marco · John C Moskop · [...] · Arthur R Derse
    [Show abstract] [Hide abstract] ABSTRACT: Ambulance diversion is a common and controversial method used by emergency departments (EDs) to reduce stress on individual departments and providers and relieve mismatches in the supply and demand for ED beds. Under this strategy, ambulances bound for one hospital are redirected to another, usually under policies established by regional emergency medical services systems. Other responses to this mismatch include maladaptive behaviors (such as "boarding" in "hallway beds") and the development of terminology intended to normalize these practices, all of which are reviewed in this article. We examine the history and causes of diversion as well as the ethical foundations and practical consequences of it. We contend that (1) from a moral viewpoint, the most important stakeholder is the individual patient because diversion decisions are usually relative rather than absolute; (2) decisions regarding ambulance diversion should be made with careful consideration of individual patient preferences, local and state emergency medical services laws, and institutional surge capacity; and (3) authorities should consider the potential positive effects of a regional or statewide ban on diversion. Copyright © 2014 Elsevier Inc. All rights reserved.
    Article · Dec 2014 · American Journal of Emergency Medicine
  • Catherine A Marco · Terry Kowalenko
    Article · Dec 2014 · American Journal of Emergency Medicine
  • Jeffrey Kline · Catherine A. Marco
    Article · Nov 2014 · Academic Emergency Medicine
  • C. Marco · F. Counselman · R. Korte · [...] · E. Reisdorff
    Article · Jul 2014
  • Catherine A. Marco · Francis L. Counselman · Robert C. Korte · [...] · Earl J. Reisdorff
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: The initial step in certification by the American Board of Emergency Medicine (ABEM) requires passing a multiple-choice-question qualifying examination. The qualifying examination is typically taken in the first year after residency training. This study was undertaken to determine if a delay in taking the qualifying examination is associated with poorer performance. The authors also examined the relationship between in-training examination scores and qualifying examination scores. Methods: This was a pooled time-series cross-section study. Primary measurements were initial qualifying examination scores, the timing of the qualifying examination, and in-training examination scores. The three groups, based on qualifying examination timing, were immediate, 1-year delay, and ≥2-year delay. In-training examination scores were analyzed to determine the relationship between intrinsic ability, examination timing, and qualifying examination scores. For analysis, a generic pooled ordinary least-squares dummy variable model with robust standard errors was used. A pre hoc level of significance was determined to be α < 0.01. Results: There were 16,353 qualifying examination test administrations between 2000 and 2012. In-training examination scores were positively correlated with qualifying examination scores (p < 0.001). The group pass rates were 98.9% immediate, 95.6% 1-year delay, and 86.6% ≥2-year delay. After controlling for in-training examination scores, delay taking the qualifying examination of 1 year was associated with a decrease in score of -0.6 (p = 0.003). A delay in taking the qualifying examination ≥2 years was associated with a decrease in score of -2.5 points (p < 0.001). Conclusions: After accounting for innate ability using in-training examination scores, delay taking the qualifying examination was associated with poorer performance. This effect was more pronounced if the delay was ≥2 years.
    Article · Jun 2014 · Academic Emergency Medicine
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Night shift work is an integral component of the practice of emergency medicine (EM). Previous studies have demonstrated the challenges of night shift work to health and well being among health care providers. Objective: This study was undertaken to describe the self-reported experience of emergency physicians regarding night shift work with respect to quality of life and career satisfaction. Methods: The 2008 American Board of Emergency Medicine (ABEM) Longitudinal Study of Emergency Physicians (LSEP) was administered by mail to 1003 ABEM diplomates. Results: Among 819 participants in the 2008 LSEP Physician Survey, most participants responded that night shift work negatively influenced job satisfaction with a moderate or major negative influence (58%; n = 467/800). Forty-three percent of participants indicated that night shifts had caused them to think about leaving EM (n = 344/809). Most participants responded that working night shifts has had mild negative effects (51%; n = 407/800) or major negative effects (9%; n = 68) on their health. Respondents were asked to describe how working night shifts has affected their health. Common themes included fatigue (36%), poor quality of sleep (35%), mood decrement/irritability (29%), and health maintenance challenges (19%). Among participants in the 2008 LSEP Retired Physician Survey, night shifts were a factor in the decision to retire for 56% of participants. Conclusions: Emergency physicians report negative impacts of night shift work, including fatigue, poor quality of sleep, mood decrement, irritability, and health challenges. Night shifts have a negative influence on job satisfaction and can be a factor in the decision to retire. (C) 2014 Elsevier Inc.
    Article · May 2014 · Journal of Emergency Medicine
  • [Show abstract] [Hide abstract] ABSTRACT: In 2001, “The Model of the Clinical Practice of Emergency Medicine” was first published. This document, the first of its kind, was the result of an extensive practice analysis of emergency department (ED) visits and several expert panels, overseen by representatives from six collaborating professional organizations (the American Board of Emergency Medicine, the American College of Emergency Physicians, the Society for Academic Emergency Medicine, the Residency Review Committee for Emergency Medicine, the Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association). Every 2 years, the document is reviewed by these organizations to identify practice changes, incorporate new evidence, and identify perceived deficiencies. For this revision, a seventh organization was included, the American Academy of Emergency Medicine.ResumenEn 2001 se publicó por primera vez el “Modelo de Práctica Clínica de la Medicina de Urgencias y Emergencias.” Este documento, el primero de su tipo, fue el resultado de un extenso análisis práctico de las visitas al servicio de urgencias y varios grupos de expertos, supervisado por los representantes de seis organizaciones profesionales colaboradoras (la American Board of Emergency Medicine, el American College of Emergency Physicians, la Society for Academic Emergency Medicine, el Residency Review Committee for Emergency Medicine, el Council of Emergency Medicine Residency Directors y la Emergency Medicine Residents' Association). Cada dos años, se revisa el documento por estas organizaciones para identificar los cambios en la práctica clínica, incorporar nueva evidencia e identificar las deficiencias percibidas. En esta revisión, se incluye una séptima organización, la American Academy of Emergency Medicine.
    Article · May 2014 · Academic Emergency Medicine
  • [Show abstract] [Hide abstract] ABSTRACT: The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency programs and the residents in them. We present the 2014 annual report on the status of US emergency medicine training programs.
    Article · May 2014 · Annals of Emergency Medicine