Investigating Efforts to Recognize and Reduce Bystander Reluctance in the Utilization of Naloxone for Opioid Overdose Reversal
Faculty Information
Name:
Joel Rowe
Email
rowejc@ufl.edu
Phone
(352) 265-9111
Faculty Department/Division
Emergency Medicine
This project is primarily:
CQI
Research Project Description:
According to the CDC’s National Center for Health Statistics, in 2023 alone, over 107,543 people died from overdose. Whereas encountering a life-threatening overdose can arise unexpectedly in any context, rapid and effective responses by bystanders can save lives. This interdisciplinary, collaborative project provides educational resources and tools (including Naloxone) that coalesce evidence-based information, content expertise and impactful interaction to address priority needs raised by our whole community regarding the opioid crisis.
Do you align with our commitment to combat the opioid crisis, to improve health outcomes and to address health disparities while engaging the community with innovative and inclusive strategies? If so, you’ll enjoy the projects we’re working on this year. You (MSRP student) will receive guidance in reviewing the literature, analyzing survey data, with the goal of presenting and publishing your findings. Under the co-mentorship of Dr. Joel Rowe and Dr. Sarah Vas, you will have opportunities to engage the community and to participate in Bystander Overdose Action Team workshops.
We hope to hear from you.
Joel Rowe, MD and Sarah Vas, MD
Does this project have an international component or travel?
No
Do you align with our commitment to combat the opioid crisis, to improve health outcomes and to address health disparities while engaging the community with innovative and inclusive strategies? If so, you’ll enjoy the projects we’re working on this year. You (MSRP student) will receive guidance in reviewing the literature, analyzing survey data, with the goal of presenting and publishing your findings. Under the co-mentorship of Dr. Joel Rowe and Dr. Sarah Vas, you will have opportunities to engage the community and to participate in Bystander Overdose Action Team workshops.
We hope to hear from you.
Joel Rowe, MD and Sarah Vas, MD
ED Multi-Visit Patients: Assessing the Efficacy of Case Management
Faculty Information
Name:
Dr. Marsha Lewis
Email
marshalewis@ufl.edu
Phone
(325) 265-5911
Faculty Department/Division
Emergency Medicine
This project is primarily:
Clinical
Research Project Description:
Background:
Multi-visit patients (MVP) within our health system are defined as individuals with 10 or more emergency department (ED) visits within a rolling 12-month period. These patients often use a disproportionate amount of healthcare resources, impacting ED throughput, hospital admissions, and overall healthcare costs.
Common characteristics of patients with frequent ED utilization include high chronic disease burden, mental health disorders and substance abuse. Recognizing the multifaceted needs of these complex and vulnerable patients, UF Health established a multidisciplinary MVP Taskforce. This taskforce aims to reduce inappropriate and preventable ED utilization by addressing the unmet clinical, behavioral, and social needs of MVPs.
Hypothesis:
Case management by a multidisciplinary team is an effective intervention to reduce ED visits, hospital admissions, and associated costs and improve social and clinical outcomes for multi-visit patients.
Study Design:
This is a retrospective chart review using data from the electronic health record system of adult multi-visit patients presenting to the ED from 2017–2024.
Data Collection:
De-identified Variables:
- Demographics:
- Age, sex, race, comorbidities.
- Housing status, insurance type.
2.ED Metrics:
- Total ED length of stay (LOS).
- Time and mode of arrival.
- Triage Emergency Severity Index (ESI).
- Chief complaint and disposition.
3.Inpatient Metrics:
- Inpatient LOS.
- 30-day readmission rates.
4.Outpatient Metrics:
- Primary care provider (PCP) status.
- Number of primary care and specialty clinic visits.
5.Resource Utilization:
- Number of labs, imaging studies, consults, and admissions.
6.Cost Analysis:
- ED charges, inpatient charges, total hospital charges.
Primary Outcomes:
-Reduction in ED visits and hospital admissions.
Secondary Outcomes:
-ED throughput metrics (e.g., LOS).
-Resource utilization.
-ED and inpatient charges.
Quality Improvement Focus:
This study will evaluate the impact of case management interventions on MVPs. Findings will inform recommendations to optimize care for this population and improve efficiency within the ED.
Role of Medical Student:
- Conduct a literature review on frequent users of the ED.
- Assist in data collection from the electronic medical records
- Perform statistical analyses to evaluate intervention outcomes, including:
- ED metrics
- Resource utilization
- Cost analysis
4.Gain hands-on experience with clinical research methodologies.
5.Contribute to the preparation of a manuscript and poster presentation
Does this project have an international component or travel?
No
Recalibrating the HEART Score: Integrating Delta Troponin to Enhance Risk Stratification of Acute vs. Chronic Myocardial Injury
Faculty Information
Name:
Dr. Brandon Allen
Email
brandonrallen@ufl.edu
Phone
(954) 675-4321
Faculty Department/Division
Emergency Medicine
This project is primarily:
Clinical
Research Project Description:
Background:
The HEART score is a widely validated tool for risk stratification in patients presenting with chest pain. While the integration of high sensitivity troponin (hs-cTn) assays has improved the score’s diagnostic capabilities, it does not explicitly account for the dynamic change (delta) in troponin levels. Delta troponin—defined as the change in troponin concentrations between two time points—is a critical parameter for distinguishing acute myocardial injury (AMI) from chronic myocardial injury.
By recalibrating the HEART score to include a delta troponin component, this project aims to improve its ability to stratify patients with chest pain, distinguishing those with acute myocardial injury requiring urgent intervention from those with chronic, non-acute elevations. This enhancement could further refine decision-making for disposition, reduce unnecessary admissions, and optimize resource utilization in the emergency department (ED).
Hypothesis:
Incorporating delta troponin into the HEART score will improve its sensitivity and specificity in distinguishing acute from chronic myocardial injury, thereby enhancing its clinical utility in risk stratification for chest pain patients.
Methods:
Data Collection:
Extract retrospective data of ED patients presenting with chest pain and undergoing hs-cTn testing over the last 2 years.
Include baseline troponin, delta troponin (e.g., 0-hour and 1- or 2-hour values), patient demographics, clinical features, ECG findings, and 30-day major adverse cardiac events (MACE) outcomes.
Recalibration of the HEART Score:
Modify the HEART score by incorporating a delta troponin parameter.
Use statistical methods (e.g., logistic regression and machine learning) to determine the optimal delta thresholds and scoring weight for acute vs. chronic injury.
Development of a New Scoring Model:
Create and validate an enhanced scoring system that integrates delta troponin into the recalibrated HEART score.
Compare the performance of the new model to the original HEART score in terms of sensitivity, specificity, and predictive value for MACE.
Data Analysis:
Evaluate the diagnostic accuracy of the recalibrated HEART score and the new scoring model using receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and calibration plots.
Validation:
Test the recalibrated score and new scoring model in subgroups, including elderly patients and those with chronic kidney disease, to assess generalizability and robustness.
Role of Medical Student:
The medical student will take on an integral role in the project, developing research skills while contributing to the refinement of clinical decision-making tools. Their responsibilities include:
Data Management:
Assist with data extraction, cleaning, and organization from the institutional database.
Literature Review:
Conduct a comprehensive review of delta troponin in the context of acute vs. chronic myocardial injury and its potential application in risk stratification tools.
Statistical Analysis:
Work closely with the research team to learn and apply statistical techniques, including ROC curve analysis and logistic regression.
Scoring Model Development:
Collaborate in developing and testing the recalibrated HEART score and the new delta troponin-based scoring system.
Dissemination of Findings:
Co-author research reports, abstracts, and presentations for dissemination at conferences and program research events.
Does this project have an international component or travel?
No
Evaluating Resource Utilization for Chest Pain Patients in ED Lobby Triage: Telemedicine vs. Standard Care
Faculty Information
Name:
Dr. Brandon Allen
Email
brandonrallen@ufl.edu
Phone
(954) 675-4321
Faculty Department/Division
Emergency Medicine
This project is primarily:
Clinical
Background:
Chest pain is one of the most common and resource-intensive chief complaints in emergency departments. Managing these patients efficiently while ensuring safety is a critical challenge, especially with increasing ED crowding. Telemedicine has been incorporated into some ED triage processes to expedite initial assessments, but its impact on resource utilization and care delivery for chest pain patients in the lobby has not been thoroughly evaluated.
This project aims to assess differences in resource utilization, ED metrics, and clinical outcomes between chest pain patients triaged through telemedicine versus those receiving standard triage care in the ED lobby. The findings will help identify whether telemedicine offers value in optimizing resource use and improving care efficiency for this high-risk patient population.
Hypothesis:
We hypothesize that chest pain patients triaged via telemedicine will have reduced ED lobby wait times and comparable resource utilization (e.g., labs, imaging, admissions) and clinical outcomes when compared to those triaged through standard care.
Methods:
Study Design:
Retrospective cohort study of adult ED patients presenting with a chief complaint of chest pain from 2020–2022.
Data Collection:
Obtain de-identified data, including:
Demographics: Age, sex, comorbidities.
ED Metrics: Lobby wait time, time to provider, total ED LOS, time to disposition.
Resource Utilization: Number of labs, imaging studies (e.g., chest X-rays, CTs, cardiac stress tests), and admissions.
Outcomes: Disposition (admission, discharge, transfer), 72-hour return visits, mortality.
Triage Modality: Telemedicine vs. standard triage.
Patient Stratification:
Stratify patients into two cohorts based on triage modality:
Telemedicine Triage: Patients receiving initial assessment and medical screening via telemedicine.
Standard Care Triage: Patients receiving in-person lobby triage and initial assessment.
Outcome Measures:
Primary Outcomes: Lobby wait time, time to provider, resource utilization (labs, imaging, admissions).
Secondary Outcomes: ED LOS, 72-hour return visits, patient disposition.
Statistical Analysis:
Compare metrics between the telemedicine and standard triage groups using:
T-tests or Mann-Whitney U tests for continuous variables.
Chi-square tests for categorical variables.
Adjust for confounders (e.g., patient age, comorbidities) using multivariate regression.
Quality Improvement Focus:
Identify patterns of over- or under-utilization of resources in telemedicine vs. standard triage.
Develop recommendations to optimize resource use for chest pain patients in the ED lobby.
Role of Medical Student:
The medical student will contribute to this QI-focused research project while gaining valuable skills and experience. Their responsibilities include:
Data Preparation:
Assist with data extraction and cleaning from institutional databases.
Data Analysis:
Under supervision, conduct statistical analyses to evaluate resource utilization and ED metrics.
Literature Review:
Perform a review of existing literature on chest pain triage, telemedicine, and ED resource utilization.
QI Recommendations:
Collaborate with the research team to draft practical recommendations for improving telemedicine triage workflows.
Dissemination:
Co-author abstracts, posters, or presentations for conferences and institutional QI meetings.
Research Goals:
This project seeks to evaluate the impact of telemedicine on resource utilization and care efficiency for chest pain patients in the ED lobby. By identifying differences in metrics and outcomes, the study will inform strategies for optimizing telemedicine workflows and improving QI initiatives for high-risk patients.
Does this project have an international component or travel?
No
Optimizing Care Delivery for Low-Acuity ED Patients: A Comparison of Telemedicine vs. Standard Triage
Faculty Information
Name:
Dr. Brandon Allen
Email
brandonrallen@ufl.edu
Phone
(954) 675-4321
Faculty Department/Division
Emergency Medicine
This project is primarily:
Clinical
Background:
Emergency departments frequently encounter lower-acuity patients classified as Emergency Severity Index (ESI) levels 4 and 5, who often have non-urgent conditions. These patients contribute to ED crowding and resource strain, making their management a key focus for quality improvement initiatives. Telemedicine has emerged as a tool for expediting initial assessments, but its impact on metrics such as wait times, ED length of stay (LOS), and resource utilization for low-acuity patients remains unclear.
This project will evaluate the effect of telemedicine triage on key ED metrics and resource utilization compared to standard care for ESI 4 and 5 patients. The study will also explore whether telemedicine helps streamline care for this population while maintaining safety and patient satisfaction.
Hypothesis:
We hypothesize that telemedicine triage for low-acuity ED patients (ESI 4 and 5) will result in reduced lobby wait times, shorter ED LOS, and more efficient resource utilization (e.g., fewer diagnostic tests) compared to standard triage without compromising patient outcomes.
Methods:
Study Design:
Retrospective cohort study of adult ED patients classified as ESI 4 or 5 from 2020–2022.
Data Collection:
Collect de-identified data, including:
Demographics: Age, sex, insurance status, presenting complaint.
ED Metrics: Lobby wait time, ED LOS, time to provider, discharge rates.
Resource Utilization: Labs, imaging, procedures, prescriptions.
Outcomes: 72-hour return visits, escalations of care (e.g., ESI upgrade, hospital admission).
Triage Modality: Telemedicine vs. standard triage.
Patient Stratification:
Stratify patients into two groups based on triage modality:
Telemedicine Triage: Patients receiving an initial telemedicine assessment.
Standard Triage: Patients undergoing traditional in-person triage.
Outcome Measures:
Primary Outcomes:
Lobby wait time, ED LOS, and resource utilization (e.g., labs, imaging, prescriptions).
Secondary Outcomes:
72-hour return visits, escalation of care rates, and patient safety outcomes.
Statistical Analysis:
Compare metrics between telemedicine and standard triage groups using:
T-tests or Mann-Whitney U tests for continuous variables.
Chi-square tests for categorical variables.
Adjust for potential confounders (e.g., age, presenting complaint) using multivariate regression models.
Quality Improvement Focus:
Analyze resource utilization patterns to identify areas of overuse or inefficiency.
Provide actionable recommendations to optimize workflows and reduce unnecessary diagnostic testing for low-acuity patients.
Role of Medical Student:
A medical student will actively participate in this QI-driven research project while developing essential research skills. Responsibilities include:
Data Preparation:
Collaborate with the research team to extract, clean, and organize data from institutional databases.
Data Analysis:
Under supervision, perform statistical analyses to evaluate the impact of telemedicine triage on ED metrics and resource utilization.
Literature Review:
Conduct a review of telemedicine applications in ED triage for low-acuity patients.
QI Recommendations:
Assist in drafting recommendations for improving telemedicine workflows in low-acuity care delivery.
Presentation and Dissemination:
Co-author abstracts and posters for conferences and institutional QI meetings.
Research Goals:
This project aims to assess the impact of telemedicine on ED care delivery for low-acuity patients, with a focus on improving efficiency while maintaining safety. The findings will inform strategies for integrating telemedicine into ED workflows to better manage ESI 4 and 5 patients.
Does this project have an international component or travel?
No
Assessing Efficiency, Effectiveness, and Safety in the Clinical Decision Unit (CDU): A Quality Improvement Analysis
Faculty Information
Name:
Dr. Brandon Allen
Email
brandonrallen@ufl.edu
Phone
(954) 675-4321
Faculty Department/Division
Emergency Medicine
This project is primarily:
Clinical
Research Project Description:
Research Project Description
Background:
The UF Health Clinical Decision Unit (CDU), opened in August 2024, provides observation services to selected emergency department (ED) patients requiring short-term management and diagnostic evaluation. The CDU aims to reduce hospital admissions, improve patient throughput, and ensure patient safety while offering high-quality care.
This project will evaluate the unit’s performance since its inception by assessing operational efficiency (e.g., length of stay, unit occupancy), clinical effectiveness (e.g., diagnostic accuracy, discharge rates), and patient safety (e.g., adverse events, return visits). The findings will support ongoing quality improvement initiatives and help optimize CDU operations.
Hypothesis:
The Clinical Decision Unit has improved ED throughput and patient flow, achieving high rates of efficiency and effectiveness while maintaining patient safety.
Methods:
Study Design:
Retrospective cohort analysis of all CDU patients from August 2024 through June 2025.
Data Collection:
Gather de-identified data on:
Demographics: Age, sex, presenting complaint, comorbidities.
Operational Metrics: CDU occupancy rates, CDU LOS, ED boarding times, and time to CDU arrival.
Effectiveness Outcomes: Admission rate, discharge rate, and diagnostic clarity (e.g., cases requiring further inpatient evaluation).
Safety Metrics: Adverse events (e.g., ICU transfers, mortality), protocol compliance, and 14-day return visits to the ED or hospital.
Patient Stratification:
Stratify data by diagnosis (e.g., chest pain, syncope, low-risk VTE), time of admission (day vs. night), and CDU protocol adherence.
Outcome Measures:
Efficiency:
CDU occupancy (goal: 0.9 patients/bed/day).
CDU LOS stratified by protocol.
Reduction in ED LOS and inpatient admissions for CDU-eligible patients.
Effectiveness:
Diagnostic accuracy and clarity of patient disposition.
Successful discharges (goal: 70–90% discharge rate).
Safety:
ICU transfers and in-unit adverse events.
14-day return visits and protocol compliance rates.
Statistical Analysis:
Use descriptive statistics to summarize CDU metrics.
Compare subgroups using t-tests or chi-square tests (e.g., CDU vs. inpatient outcomes for similar diagnoses).
Assess trends in performance over time with linear regression models.
Quality Improvement Focus:
Identify areas for improvement in patient flow, resource utilization, and protocol adherence.
Develop actionable recommendations to enhance CDU operations and address inefficiencies.
Role of Medical Student:
The medical student will be deeply involved in this quality improvement project, gaining hands-on experience with clinical data analysis and operational research. Responsibilities include:
Data Management:
Assist in extracting, cleaning, and organizing data from institutional databases.
Data Analysis:
Work under supervision to analyze CDU metrics and outcomes, generating reports and visualizations.
Literature Review:
Conduct a review of best practices and benchmarks for observation unit performance.
Quality Improvement Recommendations:
Collaborate with faculty to identify actionable strategies for enhancing CDU efficiency, effectiveness, and safety.
Dissemination:
Co-author abstracts, posters, and presentations for institutional and national QI meetings.
Research Goals:
This project will assess the impact of the CDU on ED operations, patient care, and safety metrics, providing actionable insights to guide ongoing improvements. Findings will help establish performance benchmarks and refine the CDU’s operational and clinical protocols.
Does this project have an international component or travel?
No
Evaluating the Financial Impact of the Clinical Decision Unit (CDU): Bed Hours Saved and Cost Efficiency
Faculty Information
Name:
Dr. Brandon Allen
Email
brandonrallen@ufl.edu
Phone
(954) 675-4321
Faculty Department/Division
Emergency Medicine
This project is primarily:
Clinical
Research Project Description:
Research Project Description
Background:
Emergency department (ED) crowding is a pervasive issue that increases costs, lengthens wait times, and reduces patient satisfaction. Observation units such as the Clinical Decision Unit (CDU) have been implemented to mitigate these challenges by shifting low-acuity or observation-appropriate patients from ED beds to a more cost-efficient setting.
The CDU at UF Health, opened in August 2024, aims to decrease ED boarding times, improve patient throughput, and reduce unnecessary admissions. This project will assess the financial impact of the CDU, specifically focusing on the cost of ED bed hours saved, opportunity cost reductions, and the overall return on investment (ROI). Inspired by prior studies on admissions holding units, this analysis will provide valuable insights into the CDU’s economic value to the health system.
Hypothesis:
The CDU reduces ED boarding times, increases patient throughput, and generates significant cost savings by reallocating care to a lower-cost setting while maintaining quality and safety.
Methods:
Study Design:
Retrospective analysis of financial and operational data from August 2024 through June 2025.
Data Collection:
Collect de-identified data on:
Operational Metrics: CDU occupancy rates, CDU and ED LOS, and time to CDU transfer.
Financial Metrics: Personnel costs per patient bed-hour (ED vs. CDU), ED revenue, and CDU-specific expenses (e.g., staffing, supplies).
Opportunity Cost Savings: Number of ED bed hours freed, additional patients treated, and estimated revenue from increased ED throughput.
Cost Analysis:
Calculate the cost per patient bed-hour in the CDU vs. the ED.
Determine the total hours of ED bed space saved by CDU utilization.
Estimate revenue gains from additional ED patients treated due to freed bed hours.
Outcome Measures:
Primary Outcomes:
Financial cost savings (reduction in ED bed-hour cost per patient).
Opportunity cost recovery (additional revenue from increased throughput).
Secondary Outcomes:
CDU-specific cost efficiency (occupancy rate, costs per patient discharged).
ROI of the CDU based on incremental revenue vs. CDU operating costs.
Statistical Analysis:
Use descriptive and inferential statistics to evaluate financial and operational performance.
Perform sensitivity analyses to account for variability in costs and reimbursement rates.
Quality Improvement Focus:
Identify operational inefficiencies or underutilized capacity in the CDU.
Propose actionable recommendations for maximizing financial and operational benefits.
Role of Medical Student:
The medical student will actively contribute to the project, gaining exposure to healthcare finance and quality improvement initiatives. Responsibilities include:
Data Management:
Assist in extracting and analyzing operational and financial data.
Cost-Benefit Analysis:
Collaborate with the team to calculate cost savings and opportunity costs.
Literature Review:
Conduct a review of economic studies on observation units and their impact on healthcare systems.
Recommendations Development:
Work with faculty to draft recommendations for optimizing CDU efficiency and financial performance.
Dissemination:
Co-author abstracts and presentations for institutional QI meetings and national conferences.
Research Goals:
This project aims to quantify the CDU’s financial impact on ED operations by analyzing cost savings, bed hours saved, and opportunity cost reductions. Findings will support future financial planning and operational improvements while demonstrating the value of observation units in addressing ED crowding and inefficiencies.
Does this project have an international component or travel?
No