Geriatric ED Quality Improvement
Dr. Carpenter was first-author of the 2014 document “Geriatric Emergency Department Guidelines” that has been endorsed by the American College of Emergency Physicians and Society for Academic Emergency Medicine. He has spoken about Geriatric emergency care internationally, including at the Institute for Healthcare Improvement and on Sirius XM’s Doctor Radio.
Dr. Carpenter published a feasibility assessment of a student volunteer-based geriatric syndrome-screening model that did not rely upon nurses or physicians. He has explored evolving ED models of care for geriatric adults and U.S. healthcare policy implications. He co-authored a response to the Institute of Medicine’s report on the future of emergency care, which neglected geriatric emergencies.
Dr. Carpenter also co-authored the core geriatric competencies that every U.S. emergency medicine residency graduate must demonstrate at the conclusion of their post-graduate training. Follow Dr. Carpenter’s Geriatric emergency medicine news on Twitter @GeriatricEDNews.
International Consortium in Emergency Geriatrics
Dr. Carpenter was a founding member of the International Consortium in Emergency Geriatrics in 2014, which highlights international challenges and collaborative opportunities surrounding the pre-hospital, ED, and post-ED management of an aging society.
AGEM Journal Club
With over 5000 biomedical publications every day and no specific “Journal of Geriatric Emergency Medicine”, Dr. Carpenter recognized a void in the geriatric emergency medicine secondary-peer reviewed literature (secondary peer-reviewed = pre-filtered using medical librarian-assisted search strategies, end-user assessment of clinical relevance to daily practice using the reliable and valid BEEM Rater instrument, summary and commentary by geriatric EM experts, posting of synopses online). In conjunction with SAEM Academy of Geriatric Emergency Medicine and ACEP Geriatric Section, he developed “AGEM Journal Club” which are distributed to members of these two groups and archived online. Ultimately, Dr. Carpenter hopes to formally assess the efficacy of this product to inform busy clinicians of practice-enhancing research and facilitate practice adaptation/evolution when appropriate.
Diagnostic Systematic Reviews
Recognizing a relative absence of diagnostic research in the emergency medicine literature in 2010, Dr. Carpenter proposed a new series entitled “Evidence Based Diagnostics” for Academic Emergency Medicine.
He was the primary author for the first manuscript in this series and has served as the Decision Editor for the series ever since. Along with three co-authors from Harvard and George Washington University, Dr. Carpenter transformed the series into a textbook entitled “Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules, 2nd Edition ”
Journal Club Efficacy Study
Early in his tenure at Washington University, Dr. Carpenter was invited to spend a few days with Dr. David Sackett, the grandfather of Evidence Based Medicine at the Trout Research Centre. He used this exposure to develop a novel Journal Club format for graduate and continuing medical education. Dr. Carpenter co-founded BEEM (Best Evidence in Emergency Medicine). He serves as faculty at McMaster University’s Evidence Based Clinical Practice workshop and Co-Chair of the UCSF Evidence Based Diagnostics course, as well as Director of Evidence Based Medicine at Wash U since 2003 and Chair of the Society for Academic Emergency Medicine Evidence Based Medicine Interest Group from 2013 to present. He also first-authored the only CORD-based descriptive study to assess the expectations of EM residency EBM curricula. Based upon this CORD survey, Dr. Carpenter has been co-PI of a longitudinal, multicenter study to assess EBM knowledge acquisition across various EM residency training programs. He also co-authored a seminal manuscript to link EBM curricula with clinical application of new evidence in graduate medical education. Dr. Carpenter has published the only EM textbook chapter on organizing an effect Journal Club curriculum.
All of the Journal Club vignettes, search strategies, critical appraisals, and synopses since 2005 are archived online and discoverable by the TRIP database. In addition, he has translated multiple Wash U Journal Club synopses into peer-reviewed manuscripts:
- Lytics for acute ischemic stroke
- Steroids to prevent migraine relapse
- Pulmonary embolism risk-stratification
- Blood pressure lowering for intracranial hemorrhage
- MEDS score for sepsis risk stratification
- Pediatric UTI diagnosis
- Diabetic foot ulcer diagnosis
- Syncope risk assessment
Diagnostic Research Methods
As a co-founder of BEEM and co-Chair of the UCSF Evidence Based Diagnostics courses, Dr. Carpenter has developed innovative methods to teach clinicians, peer-reviewers, journal editors, biomedical industrialists, and policy makers how to recognize and interpret various forms of bias in diagnostic research, including incorporation bias, reliability assessment, and likelihood ratios. Dr. Carpenter has also published and presented work on the cognitive psychology of clinical decision-making. He served as the unofficial SAEM representative at the first “Preventing Overdiagnosis” conference at Dartmouth in September 2013 and interviewed in multiple venues about the evolving science of diagnostic research. He is currently working on diagnostic methods manuscripts describing the conduct and reporting of diagnostic systematic reviews, as well as how to obtain and use interval likelihood ratios with his UCSF co-author Dr. Michael Kohn.
Dr. Carpenter is an active participant in the Washington University Network for Dissemination and Implementation Research (WUNDIR), as well as the CRTC Dissemination and Implementation Research Core. In an attempt to reach the vast array of community physicians, Dr. Carpenter served as Chief Clinical Editor for EP Monthly from 2007 thru 2011, a “throw-away” journal received by over 34,000 practicing clinicians many of whom use it as their sole source of professional development information. In this role, he edited every submission for every issue of EP Monthly and authored over 40 EBM-based essays on topics like information overload, the future of EM research, and the secrets to health skepticism.
Prior research indicates that the average healthcare provider must read 26 manuscripts in the Annals of Emergency Medicine in order to find one that applies directly to their clinical practice. In conjunction with BEEM and Becker Medical Librarians Cathy Sarli and Susan Fowler, Dr. Carpenter has developed the only filter with published reliability and validity to screen the 5000 biomedical publications appearing on PUBMED daily to identify the 4-6 manuscripts that change or enhance practice each month. The potential for this new filter for rural emergency physicians is depicted below, but the implications extend to all practicing EM physicians.
Dr. Carpenter has worked closely with BEEM colleague Dr. Ken Milne to develop and promote “The Skeptics Guide to Emergency Medicine”, an exciting social media approach to promoting dissemination science using podcasts, Twitter, and Facebook with hundreds of followers in less than one year.
He has published numerous manuscripts describing Dissemination and Implementation (D&I) research nomenclature, research methods, and resident education. Dr. Carpenter served on a NIH panel to develop CONSORT-like publication guidelines for D&I research in October 2013.
Adult Septic Arthritis
Published extensive diagnostic systematic review for septic arthritis which generated significant attention from leading EM secondary peer-review sources, including EM:RAP, EM Abstracts, and EP Monthly.
Prospective trial underway to quantitatively assess the diagnostic accuracy of synovial lactate (both D- and L- isomers) for adult septic arthritis, as well as the correlation of synovial lactate with synovial WBC count and the accuracy of clinician gestalt and synovial fluid PCR. Study conducted in conjunction with Laboratory Medicine, Infectious Diseases, and Orthopedic Surgery.
Journal of Rural Emergency Medicine
Co-founding editor of new journal to provide rural emergency medicine practitioners with a voice in the peer-reviewed literature (http://jorem.org/index.php/jorem)
Authored first manuscript in first issue of JREM, entitled “Evidence Based Medicine and the Rural Emergency Physician”