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@mdaware.orgOct 7, 2026, 8:43 PM

@arjunvenkatesh.bsky.social on all things boarding- why the ED is busy

it’s hospital capacity (also related to nursing home & hospital nursing staffing)

#ACEP26

Dr. VWhat is
Boarding?
In
Boarding nt Boarding
Hospital Capacity CrisisRapid
Root Cause Analysis
Health System
Failure
Hospital Capacity
Crisis
Catalyst
Emergency Department Crowding: The Canary in the Health Care System
HICAGO 26
Health System Factors
Decreasing
Primary
Carel
Ambulatory
Capacity
Financial structures/ incentives
Decreasing Post-Acute care capacity
(SNF, LTAC,
etc.)
Hospital Capacity
Crisis
Decreasing
Inpatient Capacity
(* Beds)
Lack of acute care access (Addiction, Psych)
@www.evidencetriage.comOct 7, 2026, 6:21 PM

The wait is almost over!

Come see Rory and Ryan recap the year in Annals of Emergency Medicine at 3:30 in McCormick W183A! #ACEP26

A picture of the Annals of Emergency Medicine journal cover.
@netec.orgOct 7, 2026, 1:53 PM

There’s still time to see NETEC at the American College of Emergency Physicians conference! Stop by Booth #2116. #ACEP26

📸 Anna Yaffee, MD, presented on system-wide HCID PPE training across hospital points of entry.

Miss us at ACEP? Find us next at:
🫁 CHEST — Booth #498
🦠 IDWeek — Booth #944

@mdaware.orgOct 6, 2026, 9:19 PM

audience member asks about potential hope in partnering with MAHA to advance public health:

@drdebhoury.bsky.social :
the MAHA *people* are generally reasonable (<10% are antivax) but the MAHA leaders are conflicted (selling supplements etc) or lying about data (RFKjr) [para]

#ACEP26

@mdaware.orgOct 6, 2026, 9:15 PM

inspiring talk from @drdebhoury.bsky.social at #ACEP26

Dr. HouryWE KNOW HOW TO DO THIS.
Lead like a doctor.
See clearly. Decide. Bring the team. Speak up. Reassess. Build.
Debra Houry, MD, MPH
www.debhoury.com
https://www.linkedin.com/in/debhoury/
@mdaware.orgOct 6, 2026, 9:12 PM

we can’t just restore, we need to rebuild stronger & better

@drdebhoury.bsky.social #ACEP26

WHAT GIVES ME HOPE
The goal is not simply to rebuild what existed
RESTORE WHAT WORKED
LEARN FROM WHAT DIDN'T
BUILD SOMETHING STRONGER
PHNIX
What should we build next?THE CHARGE
What physicians can build now
RELATIONSHIPS AND TRUST
Build them before the crisis.
ADVOCACY
Connect policy to patients.
TRANSLATION- NOT DOCTOR SPEAK
Make evidence usable and human.
ALTERNATIVES
Create what the system lacks.
@mdaware.orgOct 6, 2026, 9:10 PM

we need federal public health, we need leadership from physicians & institutions

@drdebhoury.bsky.social #ACEP26

Physician leadership is a repeatable practice
SEE
FRAME
ACT
REASSESS
Name reality
Define the decision
Move with purpose
I'm an E.R. doc, so I handle stress pretty well. But this was like being in a mass disaster nonstop for eight months!
Debra Houry, tomer chie medic aficer
Change courseWe still need strong federal public-health institutions
SURVEILLANCE
REFERENCE LABS
RESEARCH
50-STATE COORDINATION
TRUSTED GUIDANCE
TIME
States and health systems cannot replace a national backbone.
What Gives Me Hop
About the Future of Publid
Health in the U.S.
• ADD TIME ON GOODLEMedicine is stepping forward-not stepping away
EVIDENCE + VOICE
Physicians, medical societies, and independent experts are protecting access, developing guidance and tools, and leading with scientific integrity.
@mdaware.orgOct 6, 2026, 9:06 PM

“know when to call the code”

@drdebhoury.bsky.social #ACEP26

HABIT 7
Know when to call the code
遊。溶2
BENE
@mdaware.orgOct 6, 2026, 9:04 PM

“if I do/don’t do this, will I be able to sleep at night?”

@drdebhoury.bsky.social #ACEP26

Your sleep-at-night test is a leadership tool
Can I explain the decision?
Did 1 use the evidence honestly?
Did I protect the people I serve?
@mdaware.orgOct 6, 2026, 9:02 PM

ER docs advocate *constantly*

because we see things first

because we have to

@drdebhoury.bsky.social #ACEP26

We are advocates: for the patient, the system, our communities
Speaking up is not separate from our clinical duty when policy, access, or systems determine whether our patients can be healthy.
@mdaware.orgOct 6, 2026, 8:58 PM

clear, simple communication without jargon, and data *with a story*

refocus on what matters — work together to achieve shared priorities

@drdebhoury.bsky.social #ACEP26

Clear communication is a clinical intervention, not just in crises
WHAT WE KNOW
WHAT WE DON'T
WHAT HAPPENS NEXT
Would your neighbor or family member understand?
WRITES HISTORYWhen the system gets complicated, return to the patient
WHO IS AFFECTED?
WHAT DO THEY NEED?
PATIENT
WHY SHOULD YOU CARE?
The patient is the compass.
@mdaware.orgOct 6, 2026, 8:56 PM

we shouldn’t be the smartest people in the room, we should work with experts and apply the best expertise

#ACEP26

The best leader is rarely the smartest person in the room
NURSE
TECH
PATIENT
SHARED PICTURE
EMS
PHARMACIST
@mdaware.orgOct 6, 2026, 8:54 PM

Decisions cannot wait for perfect information

do the best we can with the data we have and adapt to new evidence

@drdebhoury.bsky.social #ACEP26

Decisions cannot wait for perfect information
DOMESTIC MALARIA
Florida
Morbidity and Mortality Weekly Report
FIRST CLADE Ib MPOX IN THE AMERICAS
First Clade Ib Monkeypox Virus Infection Reported in the Americas - California,
November 2024
Weekly / February 13, 2025 / 74(4):44-49
ACT • LEARN • ADAPT
@mdaware.orgOct 6, 2026, 8:50 PM

7 leadership habits for EM or anything from @drdebhoury.bsky.social at #ACEP26

A PHYSICIAN'S LEADERSHIP HABITS
Seven habits travel from patients to politics
1 TRIAGE


2 DECIDE

3 USE THE TEAM

4COMMUNICATE

5 CENTER THE PATIENT

6 ADVOCATE

7 CALL THE CODE
@mdaware.orgOct 6, 2026, 8:49 PM

@drdebhoury.bsky.social EM as leadership

Colin C. Rorrie, Jr. Lecture at #ACEP26

Dr. Deb HouryLEADING LIKE A DOCTOR
Lessons from patients, public health, and moments of crisis
Debra Houry, MD, MPH
Colin C. Rorrie, Jr. Lecture | ACEP 2026The emergency department is a leadership laboratory
01
02
03
Uncertainty
Interdependence
Consequence
Act before every answer is available.
No one succeeds alone.
Decisions become real quickly.
@mdaware.orgOct 6, 2026, 8:35 PM

ACEP supports POCUS education to *diagnose early pregnancy loss*, not just “rule out ectopic”

#ACEP26

ACEP Council 2026 Updates
Resolution 46: Strengthening ACEP Educational Resources and Guidelines on the Ultrasonographic Diagnosis of EPL
ACEP should request the Emergency Ultrasound Section to explore including early pregnancy loss into the evaluation of first trimester pregnancy during the next revision cycle of the ACEP Ultrasound Guidelines.
ACEP should assign an appropriate committee to collaborate with the Emergency Ultrasound Section, the Reproductive Health Section, and other relevant committees and sections as needed to develop and publish a clinical resource on the ultrasonographic diagnosis of early pregnancy loss in the emergency department.
cientific Assembl
CHICAGOLC
@mdaware.orgOct 6, 2026, 8:33 PM

“manual vacuum aspiration is a life-saving procedure for patients in hemorrhagic shock and we should teach this like we teach pericardiocentesis” (para)

#ACEP26

@mdaware.orgOct 6, 2026, 8:31 PM

ACEP supports reproductive health carre training for residents, including early pregnancy loss care

#ACEP26

ACEP Policy Supports SRH in the ED
American College of Emergency Physicians®
ADVANCING EMERGENCY CARE.__
POLICY
STATEMENT
Approved September 2024
Emergency Physicians' Role in the Medication and Procedural
Management of Early Pregnancy Loss
Origially approved
September 2024
The American College of Emergescy Physicians (ACEP) affems eat carly pregnancy loss (loss of a pregnancy before i3 weeks getabco) is a corason and potentially life-threatening emergescy department diagposis. Earty propascy loss is addressed brough medical masagement, procodural managemest (including surgery and manual uterine aspiratics), asdice expectant
mans2emee4
**NEW** ACEP supports EM residency programs exploring the integration of medication and procedural management of early pregnancy loss into their curricula in conjunction with entities overseeing emergency medicine scope of practice and core competencies.
Scientific Assemb
CHICAGO26
@mdaware.orgOct 6, 2026, 8:31 PM

reproductive care resources for ED docs:

FemInEM
Access Bridge
UCSF Hotline
ACEP!

#ACEP26

feminem
Supporting Women in Emergency Medicine
(Scientific Assemby
CHICAGO26
FemInEM
CLINICAL RESOURCES
Contraception Initiation
Evidence-based guidance on starting. switching, and counseling patients on contraceptive methods atross clinical settings.
Early Pregnancy Loss (EPL)
Clinical resources for diagnosing, managing. and supporting patients experiending early pregnancy loss.
Ectopic Pregnancy
Practical guidance on the evaluation. diagnosis, and management of ectopic pregnancy with a focus on patient safety.
Medication Abortion
Up-to-date clinical protocols and best practices for providing medication abortion care.
Medication Abortion (MAB) in
Urgent Care Toolkit
回
A practical toolkit for Integrating medication abortion into urgent care settings.i"BRIDGE
Treatment. Equity. Connection.
EсHICAGо26
Access Bridge
Gile Start Costracepten Care In Cha Emergency Depe
BRIDGEReproductive Health Hotline
Staffed by UCSF board-certified OB/GYN and FM with specialized expertise in SRH
Provides clinical information to U.S.-based healthcare providers M-F 7a-4p PST / 10a-7p EST
1-844-REPROHH or 1-844-737-7644ACEP: EPL Resource Page
Treatment Options for Miscarriage
= Miscarriage Management In the ED - PPT
# Earty pregnancy loss management in the ED - compare the sdvantages.
disadvantages, and efficacy of the three options TEAMM - POE
Medication Management of Miscarriage - Medication Management Protocols
= Early Pregnancy Loss (EPL): Emergency Dept. Manegement- Protocol (Combined Mifepristone and Misoprosto) - PDF
# Earty Pregnancy Loss (EPL): Emergency Dept. Management: Protocol
(Misoprostol Only) - PDF
Mifepristone for miscarriage care - How to get mifepristone on formulary at your hospital if it's not yet avallable
# Mifepristone forEPL on formulary- PDF
Manual Uterine Aspiration (MUA) Management of Miscarriage
# Policy and Procedure for MUA for Early Pregnancy Loss - PDF
#MUA Procedural Steps and Equipment List - PDF
# Patient Consent Form for Procedural-MUA Management of Earty
Pregnancy Loss (RHAP) - PDF
E MUA Procodural Competency Checklet for Performing Procedure - POF
@mdaware.orgOct 6, 2026, 8:24 PM

mifepristrone is under attack, despite being standard of care for early pregnancy loss, making medical care difficult

#ACEP26

SACOG I Clinical
Early Pregnancy Loss
Practice Bulletin O | Number 200 1 November 2018
асерснісAсо26
EPL Treatment
Protocol for the Medical Management of Early Pregnancy Loss
Misoprostol 800 micrograms vaginally, with one repeat dose as needed, no eurier than 3 hours after the fast dose and typicaly within 7 days if thare is no response to the fast dose
A dose of mifepristone (200 mg orally) 24 hours before misoprostol simielstration should be coesidered when milepistons is
available
Prescriptions for pain medications should be provided to the patient.
Women who are Rh(0) negative and unsensitized should receive (D)-mune globulin within 72 hours of the first misoprostol administration.
Follow-up to document the complete passage of tissue can be acoomplished by ultrasound exam hation, typicaly withie 7-16 days. Serial serum 8-hCG measurements may be used Instead in setting where ultrasonography is unavallable: Patient-reported symptoms also should be considered when determining whether complete expulsion has occurres.
If medical mananement fals, the patient may opt for expectant management, for a time determined by the woman and her obstetrician-synecologist or other gynecologic provider, or suction curettage.Restrictions can affect access to the standard of care
OCHICAGO26
Abortion medication is legal in 37 states and Washington, DC, with restrictions in 16 states.
Status of abortion medication by state, May 2020
Aa of Mary 2 2024, no clinice physicaly opertong in Masour
AR
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