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Chad S Kessler

Professor of Medicine
Medicine, General Internal Medicine
VA Medical Center, Box 104427, Durham, NC 27710
VA Medical Center, Box 104427, Durham, NC 27710

Selected Publications


Continuing the transformation: charting the path for the future delivery of Veteran emergency care.

Journal Article Acad Emerg Med · April 2023 Important changes in the delivery of Veteran emergency care in the early 2000s in the Department of Veteran Affairs (VA) emergency departments and urgent care clinics substantially elevated the role of emergency medicine (EM) in Veteran health care. Focuse ... Full text Link to item Cite

Community Urgent Care Use Following Implementation of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act.

Journal Article Med Care · June 1, 2021 BACKGROUND: Effective June 6, 2019, Veterans Affairs (VA) began offering a new urgent care (UC) benefit that provides eligible Veterans with greater choice and access to care for the treatment of minor injuries and illnesses in their local communities. OBJ ... Full text Link to item Cite

Does academic practice protect emergency physicians against burnout?

Journal Article JACEP Open · February 1, 2021 Burnout is a complex syndrome thought to result from long-term exposure to career-related stressors. Physicians are at higher risk for burnout than the general United States (US) working population, and emergency medicine has some of the highest burnout ra ... Full text Cite

Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy.

Journal Article JAMA Netw Open · October 1, 2020 IMPORTANCE: In 2018, the Veterans Health Administration (VHA) implemented the Veterans Affairs (VA) Suicide Risk Identification Strategy to improve the identification and management of suicide risk among veterans receiving VHA care. OBJECTIVES: To examine ... Full text Link to item Cite

Feasibility Study of a Quasi-experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments.

Journal Article Acad Emerg Med · August 2020 BACKGROUND: The Veterans Health Administration (VHA) Opioid Safety Initiative (OSI) was implemented in 2013 and was associated with a 25% relative decrease in the dispensing of opioids. Although emergency department (ED) providers play a role in the initia ... Full text Link to item Cite

Changes to the ACGME Common Program Requirements and Their Potential Impact on Emergency Medicine Core Faculty Protected Time.

Journal Article AEM education and training · July 2020 The Accreditation Council for Graduate Medical Education (ACGME), which regulates residency and fellowship training in the United States, recently revised the minimum standards for all training programs. These standards are codified and published as the Co ... Full text Cite

Discharge Information and Support for Patients Discharged from the Emergency Department: Results from a Randomized Controlled Trial.

Journal Article J Gen Intern Med · January 2020 BACKGROUND: Little research has been done on primary care-based models to improve health care use after an emergency department (ED) visit. OBJECTIVE: To examine the effectiveness of a primary care-based, nurse telephone support intervention for Veterans t ... Full text Link to item Cite

Variability in opioid prescribing in veterans affairs emergency departments and urgent cares.

Journal Article Am J Emerg Med · June 2019 OBJECTIVE: The Veterans Health Administration (VHA) is the largest integrated health care system in the U.S., serving approximately 2.5 million Veterans in the Emergency Department/Urgent Care Centers (ED/UCC) each year. Variation in opioid prescribing by ... Full text Link to item Cite

Erratum: Incorrect and missing author initials in affiliations and authorship information (American Journal of Managed Care (2019))

Journal Article American Journal of Managed Care · January 1, 2019 In the Trends From the Field article, “Risk Stratification for Return Emergency Department Visits Among High-Risk Patients,” published in the August 2017 issue of The American Journal of Managed Care®, an author's initials were incorrect in the Author Affi ... Cite

Emergency physician evaluation of PA and NP practice patterns.

Journal Article JAAPA · May 2018 UNLABELLED: The unprecedented surge in physician assistants (PAs) and NPs in the ED developed quickly in recent years, but scope of practice and practice patterns are not well described. METHODS: We conducted two cross-sectional electronic surveys of the A ... Full text Link to item Cite

Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke.

Journal Article JAMA Neurol · April 1, 2018 IMPORTANCE: The timely delivery of guideline-concordant care may reduce the risk of recurrent vascular events for patients with transient ischemic attack (TIA) and minor stroke. Although many health care organizations measure stroke care quality, few evalu ... Full text Link to item Cite

Transition of Care from the Emergency Department to the Outpatient Setting: A Mixed-Methods Analysis.

Journal Article West J Emerg Med · March 2018 INTRODUCTION: The goal of this study was to characterize current practices in the transition of care between the emergency department and primary care setting, with an emphasis on the use of the electronic medical record (EMR). METHODS: Using literature re ... Full text Link to item Cite

Asymptomatic Hypertensive Urgency at a VA Emergency Department.

Journal Article Fed Pract · March 2018 Management of asymptomatic hypertension in a primary care setting rather than in the emergency department showed similar outcomes and was more cost-effective. ... Link to item Cite

Risk stratification for return emergency department visits among high-risk patients.

Journal Article Am J Manag Care · August 1, 2017 OBJECTIVES: To compare 2 methods of identifying patients at high-risk of repeat emergency department (ED) use: high Care Assessment Need (CAN) score (≥90), derived from a model using Veterans Health Administration (VHA) data, and "Super User" status, defin ... Link to item Cite

Transitions of Care in an Era of Healthcare Transformation.

Journal Article J Healthc Manag · 2016 In the practice of modern emergency medicine (EM), transitions of care (TOC) have taken a prominent role, and during this time of healthcare reform, TOC has become a focal point of improvement initiatives across the continuum of care. This review includes ... Link to item Cite

Residents' Perspectives on Rewards and Challenges of Caring for Ambulatory Care Patients Living With Chronic Illness: Findings From Three Academic Health Centers.

Journal Article Acad Med · December 2015 PURPOSE: To elicit residents' perspectives on rewards and challenges of caring for ambulatory patients with chronic illness and ways to improve their education in caring for these patients. METHOD: The authors conducted a qualitative study with internal me ... Full text Link to item Cite

Continuing the transformation: charting the path for the future delivery of Veteran emergency care.

Journal Article Acad Emerg Med · April 2023 Important changes in the delivery of Veteran emergency care in the early 2000s in the Department of Veteran Affairs (VA) emergency departments and urgent care clinics substantially elevated the role of emergency medicine (EM) in Veteran health care. Focuse ... Full text Link to item Cite

Community Urgent Care Use Following Implementation of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act.

Journal Article Med Care · June 1, 2021 BACKGROUND: Effective June 6, 2019, Veterans Affairs (VA) began offering a new urgent care (UC) benefit that provides eligible Veterans with greater choice and access to care for the treatment of minor injuries and illnesses in their local communities. OBJ ... Full text Link to item Cite

Does academic practice protect emergency physicians against burnout?

Journal Article JACEP Open · February 1, 2021 Burnout is a complex syndrome thought to result from long-term exposure to career-related stressors. Physicians are at higher risk for burnout than the general United States (US) working population, and emergency medicine has some of the highest burnout ra ... Full text Cite

Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy.

Journal Article JAMA Netw Open · October 1, 2020 IMPORTANCE: In 2018, the Veterans Health Administration (VHA) implemented the Veterans Affairs (VA) Suicide Risk Identification Strategy to improve the identification and management of suicide risk among veterans receiving VHA care. OBJECTIVES: To examine ... Full text Link to item Cite

Feasibility Study of a Quasi-experimental Regional Opioid Safety Prescribing Program in Veterans Health Administration Emergency Departments.

Journal Article Acad Emerg Med · August 2020 BACKGROUND: The Veterans Health Administration (VHA) Opioid Safety Initiative (OSI) was implemented in 2013 and was associated with a 25% relative decrease in the dispensing of opioids. Although emergency department (ED) providers play a role in the initia ... Full text Link to item Cite

Changes to the ACGME Common Program Requirements and Their Potential Impact on Emergency Medicine Core Faculty Protected Time.

Journal Article AEM education and training · July 2020 The Accreditation Council for Graduate Medical Education (ACGME), which regulates residency and fellowship training in the United States, recently revised the minimum standards for all training programs. These standards are codified and published as the Co ... Full text Cite

Discharge Information and Support for Patients Discharged from the Emergency Department: Results from a Randomized Controlled Trial.

Journal Article J Gen Intern Med · January 2020 BACKGROUND: Little research has been done on primary care-based models to improve health care use after an emergency department (ED) visit. OBJECTIVE: To examine the effectiveness of a primary care-based, nurse telephone support intervention for Veterans t ... Full text Link to item Cite

Variability in opioid prescribing in veterans affairs emergency departments and urgent cares.

Journal Article Am J Emerg Med · June 2019 OBJECTIVE: The Veterans Health Administration (VHA) is the largest integrated health care system in the U.S., serving approximately 2.5 million Veterans in the Emergency Department/Urgent Care Centers (ED/UCC) each year. Variation in opioid prescribing by ... Full text Link to item Cite

Erratum: Incorrect and missing author initials in affiliations and authorship information (American Journal of Managed Care (2019))

Journal Article American Journal of Managed Care · January 1, 2019 In the Trends From the Field article, “Risk Stratification for Return Emergency Department Visits Among High-Risk Patients,” published in the August 2017 issue of The American Journal of Managed Care®, an author's initials were incorrect in the Author Affi ... Cite

Emergency physician evaluation of PA and NP practice patterns.

Journal Article JAAPA · May 2018 UNLABELLED: The unprecedented surge in physician assistants (PAs) and NPs in the ED developed quickly in recent years, but scope of practice and practice patterns are not well described. METHODS: We conducted two cross-sectional electronic surveys of the A ... Full text Link to item Cite

Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke.

Journal Article JAMA Neurol · April 1, 2018 IMPORTANCE: The timely delivery of guideline-concordant care may reduce the risk of recurrent vascular events for patients with transient ischemic attack (TIA) and minor stroke. Although many health care organizations measure stroke care quality, few evalu ... Full text Link to item Cite

Transition of Care from the Emergency Department to the Outpatient Setting: A Mixed-Methods Analysis.

Journal Article West J Emerg Med · March 2018 INTRODUCTION: The goal of this study was to characterize current practices in the transition of care between the emergency department and primary care setting, with an emphasis on the use of the electronic medical record (EMR). METHODS: Using literature re ... Full text Link to item Cite

Asymptomatic Hypertensive Urgency at a VA Emergency Department.

Journal Article Fed Pract · March 2018 Management of asymptomatic hypertension in a primary care setting rather than in the emergency department showed similar outcomes and was more cost-effective. ... Link to item Cite

Risk stratification for return emergency department visits among high-risk patients.

Journal Article Am J Manag Care · August 1, 2017 OBJECTIVES: To compare 2 methods of identifying patients at high-risk of repeat emergency department (ED) use: high Care Assessment Need (CAN) score (≥90), derived from a model using Veterans Health Administration (VHA) data, and "Super User" status, defin ... Link to item Cite

Transitions of Care in an Era of Healthcare Transformation.

Journal Article J Healthc Manag · 2016 In the practice of modern emergency medicine (EM), transitions of care (TOC) have taken a prominent role, and during this time of healthcare reform, TOC has become a focal point of improvement initiatives across the continuum of care. This review includes ... Link to item Cite

Residents' Perspectives on Rewards and Challenges of Caring for Ambulatory Care Patients Living With Chronic Illness: Findings From Three Academic Health Centers.

Journal Article Acad Med · December 2015 PURPOSE: To elicit residents' perspectives on rewards and challenges of caring for ambulatory patients with chronic illness and ways to improve their education in caring for these patients. METHOD: The authors conducted a qualitative study with internal me ... Full text Link to item Cite

The 5Cs of Consultation: Training Medical Students to Communicate Effectively in the Emergency Department.

Journal Article J Emerg Med · November 2015 BACKGROUND: Effective communication is critical for health care professionals, particularly in the Emergency Department (ED). However, currently, there is no standardized consultation model that is consistently practiced by physicians or used for training ... Full text Link to item Cite

Emergency medicine in the Veterans Health Administration-results from a nationwide survey.

Journal Article Am J Emerg Med · July 2015 STUDY OBJECTIVE: We describe emergency physician staffing, capabilities, and academic practices in US Veterans Health Administration (VHA) emergency departments (EDs). METHODS: As part of an ongoing process improvement effort for the VHA emergency care sys ... Full text Link to item Cite

Building capacity in VA to provide emergency gynecology services for women.

Journal Article Med Care · April 2015 BACKGROUND: Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecolo ... Full text Link to item Cite

Professional e-mail communication among health care providers: proposing evidence-based guidelines.

Journal Article Acad Med · January 2015 E-mail is now a primary method of correspondence in health care, and proficiency with professional e-mail use is a vital skill for physicians. Fundamentals of e-mail courtesy can be derived from lay literature, but there is a dearth of scientific literatur ... Full text Link to item Cite

Discharge information and support for veterans Receiving Outpatient Care in the Emergency Department: study design and methods.

Journal Article Contemp Clin Trials · November 2014 BACKGROUND: An explicit goal of Patient Aligned Care Teams (PACTs) within the Veterans Health Administration is to promote continuity of care in primary care clinics and thereby reduce Emergency Department (ED) utilization; however, there has been little r ... Full text Link to item Cite

A survey of handoff practices in emergency medicine.

Journal Article Am J Med Qual · 2014 This study aimed to assess practices in emergency department (ED) handoffs as perceived by emergency medicine (EM) residency program directors and other senior-level faculty and to determine if there are deficits in resident handoff training. This cross-se ... Full text Link to item Cite

New antiplatelet agents prescribed to patients with ischemic heart disease: Implications for treatment of stroke

Journal Article Current Treatment Options in Neurology · January 1, 2014 Stroke continues to be a significant public health problem worldwide. Despite a number of clinical trials testing various therapeutic agents, we are still left with a small armamentarium of options. Aspirin, clopidogrel and combination aspirin-dipyridamole ... Full text Cite

Inadequate postgraduate training of skin and soft tissue infections in an era of community-associated methicillin-resistant Staphylococcus aureus.

Journal Article J Investig Med · August 2013 BACKGROUND: Since 2002, the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) has been steadily increasing and CA-MRSA may now account for most community-based SSTIs. Although cons ... Full text Link to item Cite

An inventory of VHA emergency departments' resources and processes for caring for women.

Journal Article J Gen Intern Med · July 2013 BACKGROUND: More women are using Veterans' Health Administration (VHA) Emergency Departments (EDs), yet VHA ED capacities to meet the needs of women are unknown. OBJECTIVE: We assessed VHA ED resources and processes for conditions specific to, or more comm ... Full text Link to item Cite

I'm clear, you're clear, we're all clear: improving consultation communication skills in undergraduate medical education.

Journal Article Acad Med · June 2013 Requesting and providing consultations are daily occurrences in most teaching hospitals. With increased attention on transitions of care in light of the recent scrutiny of duty hours, consultations and other interphysician interactions, such as handoffs, a ... Full text Link to item Cite

An algorithm for transition of care in the emergency department.

Journal Article Acad Emerg Med · June 2013 OBJECTIVES: The objective of this study is to present an algorithm for improving the safety and effectiveness of transitions of care (ToC) in the emergency department (ED). METHODS: This project was undertaken by the Council of Emergency Medicine Residency ... Full text Link to item Cite

Assessing systems-based practice.

Journal Article Acad Emerg Med · December 2012 The conceptual definition of systems-based practice (SBP) does not easily translate into directly observable actions or behaviors that can be easily assessed. At the Academic Emergency Medicine consensus conference on education research in emergency medici ... Full text Link to item Cite

Assessing practice-based learning and improvement.

Conference Acad Emerg Med · December 2012 Assessment of practice-based learning and improvement (PBLI) is a core concept identified in several competency frameworks. This paper summarizes the current state of PBLI assessment as presented at the 2012 Academic Emergency Medicine consensus conference ... Full text Link to item Cite

Assessing medical knowledge of emergency medicine residents.

Journal Article Acad Emerg Med · December 2012 The Accreditation Council for Graduate Medical Education (ACGME) requires that emergency medicine (EM) residency graduates are competent in the medical knowledge (MK) core competency. EM educators use a number of tools to measure a resident's progress towa ... Full text Link to item Cite

Establishing an emergency medicine education research network.

Journal Article Acad Emerg Med · December 2012 This project was developed from the research network track at the 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine (EM). Using a combination of consensus techniques, the modified Delphi method, and qualitati ... Full text Link to item Cite

Assessing professionalism: summary of the working group on assessment of observable learner performance.

Journal Article Acad Emerg Med · December 2012 Professionalism is one of the six Accreditation Council on Graduate Medical Education (ACGME) core competencies on which emergency medicine (EM) residents are assessed. However, very few assessment tools exist that have been rigorously evaluated in this po ... Full text Link to item Cite

The current state of core competency assessment in emergency medicine and a future research agenda: recommendations of the working group on assessment of observable learner performance.

Journal Article Acad Emerg Med · December 2012 In 2012, the Accreditation Council for Graduate Medical Education (ACGME) introduced the Next Accreditation System (NAS) for residency program accreditation. With implementation of the NAS, residents are assessed according to a series of new emergency medi ... Full text Link to item Cite

Assessing interpersonal and communication skills in emergency medicine.

Journal Article Acad Emerg Med · December 2012 Interpersonal and communication skills (ICS) are a key component of several competency-based schemata and key competency in the set of six Accreditation Council for Graduate Medical Education (ACGME) core competencies. With the shift toward a competency-ba ... Full text Link to item Cite

Assessing patient care: summary of the breakout group on assessment of observable learner performance.

Journal Article Acad Emerg Med · December 2012 There is an established expectation that physicians in training demonstrate competence in all aspects of clinical care prior to entering professional practice. Multiple methods have been used to assess competence in patient care, including direct observati ... Full text Link to item Cite

In-training practice patterns of combined emergency medicine/internal medicine residents, 2003-2007

Journal Article Western Journal of Emergency Medicine · November 1, 2011 Introduction: This study seeks to evaluate the practice patterns of current combined emergency medicine/internal medicine (EM/IM) residents during their training and compare them to the typical practice patterns of EM/IM graduates. We further seek to chara ... Full text Cite

PeRLs: changing the way we view lectures.

Journal Article Acad Emerg Med · November 2011 Full text Link to item Cite

Predicting patient patterns in veterans administration emergency departments

Journal Article Western Journal of Emergency Medicine · May 1, 2011 Veteran's Affairs (VA) hospitals represent a unique patient population within the healthcare system; for example, they have few female and pediatric patients, typically do not see many trauma cases and often do not accept ambulance runs. As such, veteran-s ... Cite

The use of sodium polystyrene sulfonate in the inpatient management of hyperkalemia.

Journal Article J Hosp Med · March 2011 BACKGROUND: Limited data exist on the precise dose of sodium polystyrene sulfonate (SPS) needed for specific potassium concentrations in the management of mild to moderate hyperkalemia in an inpatient hospital setting. METHODS: A retrospective cohort study ... Full text Link to item Cite

Effective out-of-operating room airway management for physicians not traditionally trained in airway management

Journal Article Journal of Investigative Medicine · January 1, 2011 Background: There is a dearth of literature about the safety and practicality of intubation performed by an internal medicine (IM) or any other nonanesthesia,2 nonemergency physician. Objectives: The objectives of the study were to describe abbreviated air ... Full text Cite

The need for education in ultrasonography.

Journal Article Med Teach · December 2009 Link to item Cite

Off-service resident education in the emergency department: outline of a national standardized curriculum.

Journal Article Acad Emerg Med · December 2009 Although many residency programs mandate at least one rotation in emergency medicine (EM), to the best of our knowledge, a standardized curriculum for emergency department (ED) rotations for "off-service" residents has not been developed. As a result, the ... Full text Link to item Cite