Emergency Department Environment Research Articles

Emergency Department Environmental Responses to COVID-19 Pandemic: A Qualitative Study.

Objective: This study aimed to document and empirically evaluate the physical environment strategies used by emergency departments (EDs) to address the challenges posed by the COVID-19 pandemic; and to develop recommendations for managing future crises. Background: Emergency departments made significant environmental modifications in responding to the COVID-19 pandemic but these modifications and the decision-making processes were seldomly studied. Methods: In this in-depth qualitative case study, a multidisciplinary research team conducted semistructured interviews with 11 professionals of various roles in environmental responses to the pandemic at a large urban ED in the U.S. Qualitative content analysis generated codes and code categories from the data as well as a conceptual framework. Design documents and photographic documentation were used to cross-check the interview data. Results: The ED faced challenges in making rapid changes with limited information and resources. Physical barriers separating patients, air filtration, airflow control, and alternative care spaces were key physical environmental strategies implemented. Among them, the physical separation of patients was perceived to be most effective, followed by air quality control measures. Interviewees recommended flexibility in building design (self-contained zones, negative pressure and air filtration in all patient rooms, pandemic mode of air ventilation system), and an all-inclusive bottom-up decision-making process. Concerns included ventilation, security, communication strategies, and workplace ergonomics. Conclusion: The physical environment constitutes an important part of ED pandemic response and the proactive preparation for future crises. Hospitals should consider the ED environment's role in pandemic response, including ventilation capability, security visibility, and functionality for staff.

A trial of a chat service for patients and their family members in an emergency department

BackgroundEffective communication between patients and healthcare providers in the emergency department (ED) is challenging due to the dynamic nature of the ED environment. This study aimed to trial a chat service enabling patients in the ED and their family members to ask questions freely, exploring the service’s feasibility and user experience.ObjectivesTo identify the types of needs and inquiries from patients and family members in the ED that could be addressed through the chat service and to assess the user experience of the service.MethodsWe enrolled patients and family members aged over 19 years in the ED, providing the chat service for up to 4 h per ED visit. Trained research nurses followed specific guidelines to respond to messages from the participants. After participation, participants were required to complete a survey. Those who agreed also participated in interviews to provide insights on their experiences with the ED chat service.ResultsA total of 40 participants (20 patients and 20 family members) sent 305 messages (72 by patients and 233 by family members), with patients sending an average of 3.6 messages and family members 11.7. Research nurses resolved 41.4% of patient inquiries and 70.9% of family member inquiries without further healthcare provider involvement. High usability was reported, with positive feedback on communication with healthcare workers, information accessibility, and emotional support.ConclusionsThe ED chat service was found to be feasible and led to positive user experiences for both patients and their family members.

Patient influx to emergency departments at two Norwegian university hospitals from 2012-21.

The increase in patient visits to emergency departments is a global challenge. We wished to survey patient inflow and patient composition over time at two Norwegian university hospitals. A retrospective, descriptive study of patient contacts (patients ≥16 years of age) in the emergency departments of Haukeland University Hospital, Bergen, and St Olav's Hospital, Trondheim University Hospital in the period 2012-21. Data were retrieved from patient records and the patient administration system. A total of 585780 patient contacts were included. The number of patient contacts in the emergency departments was 30696 in 2012 and 40396 in 2021 at Haukeland University Hospital, and 18967 in 2012 and 28822 in 2021 at St Olav's Hospital. The largest increase during the study period appeared to be in the age group 67-79 years, with an increase of 57% (from 6190 to 9691) at Haukeland University Hospital, and 77% (from 3849 to 6817) at St Olav's Hospital. The proportion of patient contacts that ended in hospitalisation was 82% in 2012 and 74% in 2021 at Haukeland University Hospital, and 87% in 2012 and 61% in 2021 at St Olav's Hospital. Of the patients that were admitted, the median age was 65 years, while the median age of those who were discharged from the emergency department was 48 years at Haukeland University Hospital and 52 years at St Olav's Hospital. The study showed an increase in patient contacts in the emergency departments at Haukeland University Hospital and St Olav's Hospital over a period of ten years. The number of older adults in the population will continue to increase in the years ahead, and the need for urgent care assessments will correspondingly increase. It is important that the health services are aware of changes in patient influx and patient composition in order to ensure patient safety and the working environment of emergency departments in the future.

Experiences of individuals presenting to the emergency department for mental health reasons: A systematic mixed studies review.

Emergency departments the world over have seen substantial increases in the number of individuals presenting for mental health reasons. However, we have a limited understanding of their experiences of care. The aim of this review was to systematically examine and synthesise literature relating to the experiences of individuals presenting to emergency department for mental health reasons. We followed Pluye and Hong's seven-step approach to conducting a systematic mixed studies review. Studies were included if they investigated adult mental health experiences in emergency department from the users' perspective. Studies describing proxy, carer/family or care provider experiences were excluded. Sixteen studies were included. Thematic synthesis identified three themes and associated subthemes. Theme 1 - ED staff can make-or-break and ED experience - comprised: Feeling understood and heard; Engaging in judgement-free interactions; Receiving therapeutic support; Being actively and passively invalidated for presenting to the ED; and Once a psych patient, always a psych patient. Theme 2 - Being in the ED environment is counter-therapeutic - comprised: Waiting for an 'extremely' long time; and Lacking privacy. Theme 3 was Having nowhere else to go. The experiences described by individuals presenting to emergency department for mental health reasons were mostly poor. The results illustrate a need for increased mental health education and training for all emergency department staff. Employment of specialist and lived experience workers should also be prioritised to support more therapeutic relationships and emergency department environments. In addition, greater investment in mental health systems is required to manage the current crisis and ensure future sustainability.

Psychometric validation of a patient-reported experience measure for older adults attending the emergency department: the PREM-ED 65 study

IntroductionOptimising emergency department (ED) patient experience is vital to ensure care quality. However, there are few validated instruments to measure the experiences of specific patient groups, including older adults. We...

Improving management of intravenous maintenance fluids in the emergency department of a university hospital.

Intravenous (IV) fluid therapy is a known source of iatrogenic complications. Guideline implementation can be used to educate and guide physicians on adequate fluid management. In the emergency department (ED), a complex and interruption-driven environment, workload is high and active documentation is required to facilitate audits of fluid management quality. Fluid management was evaluated in the ED records of adult non-critically ill patients admitted to a tertiary care center before (PRE: 1/12/2016-31/3/2017) and after (POST: 1/12/2018-31/3/2019) implementation of an educational intervention aiming to optimize IV fluid therapy in November 2018. First, the appropriateness of the 24-hour IV maintenance fluid prescription was evaluated, as prescribed by the emergency physician. Second, factors associated with appropriate prescribing were assessed, as well as the quality of fluid management documentation practice. Prescription appropriateness and documentation quality were evaluated retrospectively using a structured audit instrument and additional review by experts. A total of 237 patients (2.3%) were included in the PRE-intervention group and 253 patients (2.4%) in the POST-intervention group. The expert panel evaluated 214 prescriptions in 82.3% of patients (PRE: 99, POST: 115), and appropriateness increased significantly (19.2% vs. 61.2%, p=0.002). A higher odds of an appropriate IV maintenance fluid prescription was determined, attributed to the intervention (adjOR=2.580; 95% CI 1.363-4.884) and in patients having a prehospital intervention (adjOR=1.914, 95% CI 1.022-3.586). Appropriateness of fluid management documentation did not significantly improve after the implementation of the intervention (15.6% vs. 16.2%, p=0.858). The IV fluid prescriptions' appropriateness was significantly higher after guideline implementation. However, documentation quality of fluid management was poor in the studied ED records. Active stewardship programs are warranted to further monitor fluid management quality in the ED.

Seeking Care for Children with Intellectual and/or Developmental Disabilities in the Emergency Department: A Mixed Methods Systematic Review of Parents' Experiences and Information Needs.

The objective of this review was to explore parents' experiences and information needs regarding management of their child with an intellectual and/or developmental disability (IDD) in the emergency department (ED). We searched six electronic databases and grey literature to identify primary studies in English published since 2000. We synthesized quantitative and qualitative outcome data simultaneously using a convergent integrated approach and used a Mixed Methods Appraisal Tool (MMAT) to assess methodological quality of the included studies. Nine articles derived from seven studies were included (3 qualitative, 3 quantitative, 1 mixed method). Four main themes related to parents' self-reported experiences were identified: 1) appropriateness of the ED to manage and support their child; 2) acknowledgement/recognition of their child's IDD and incorporation of those considerations into overall care and management; 3) managing and navigating the ED environment; and 4) decision to disclose their child's condition when visiting the ED. Two articles provided data relevant to information needs, highlighting parents' desire to have resources supporting ED orientation and access to services within and outside of the ED setting. From the limited number of studies, it was evident that parents wanted better communication with healthcare providers and a greater understanding by ED staff around physical space settings needed to support their child. Resources supporting ED staff and parents to communicate effectively and work together can ensure that children with IDDs care needs are met. Further research into understanding parents' experiences and information needs related to managing a child with an IDD in the ED is needed to guide the development of effective resources.

Patterns of Musculoskeletal Disorders among Staff Nurses in the Emergency Department in Saudi Arabia: A Cross-sectional Study

Background: The physically demanding and high-stress environment of Emergency Departments (EDs) significantly contributes to the heightened risk of musculoskeletal disorders (MSDs) among ED nurses. Despite this known association, there is a lack of comprehensive understanding of the prevalence rates and contributing factors within ED settings in Saudi Arabia, necessitating further investigation.Purpose: This study delves into the prevalence and potential predictors of MSDs among nurses in this critical healthcare setting.Methods: A cross-sectional survey was conducted in March 2023 using convenience sampling of 177 ED nurses across 16 public hospitals in Hail, Saudi Arabia. The Nordic Musculoskeletal Questionnaire was employed, with SPSS analyses covering frequency and percentage of pain prevalence via cross-tabulation, and logistic regression to identify risk factors.Results: Over the past year, 68.9% of participants reported lower back pain affecting normal activities in 55.4% of cases. Neck pain was more likely in individuals aged 20-29 and former smokers accounting for 47.6% of the variance (p=0.001). Shorter shifts under 8 hours reduced neck pain risk, whereas a schedule with 50% of night shifts heightened the risk, contributing to 28.4% of the variance (p=0.001). Nurses aged 40-49 and those with significant childcare duties faced higher shoulder pain risk (p=0.024), and adult caregiving duties was linked to upper back pain explaining 40.6% of the variance (p=0.017). No significant links were found for other musculoskeletal pains.Conclusion: The study reveals a significant prevalence of MSDs among the evaluated ED nurses, significantly influenced by specific demographic and work-related factors. Addressing these through ergonomic interventions, optimal scheduling, and wellness programs is crucial for nurse well-being and patient care. Future research should focus on creating holistic wellness programs that support nurses musculoskeletal health.

Academic Detailing as a Health Information Technology Implementation Method: Supporting the Design and Implementation of an Emergency Department-Based Clinical Decision Support Tool to Prevent Future Falls.

Clinical decision support (CDS) tools that incorporate machine learning-derived content have the potential to transform clinical care by augmenting clinicians' expertise. To realize this potential, such tools must be designed to fit the dynamic work systems of the clinicians who use them. We propose the use of academic detailing-personal visits to clinicians by an expert in a specific health IT tool-as a method for both ensuring the correct understanding of that tool and its evidence base and identifying factors influencing the tool's implementation. This study aimed to assess academic detailing as a method for simultaneously ensuring the correct understanding of an emergency department-based CDS tool to prevent future falls and identifying factors impacting clinicians' use of the tool through an analysis of the resultant qualitative data. Previously, our team designed a CDS tool to identify patients aged 65 years and older who are at the highest risk of future falls and prompt an interruptive alert to clinicians, suggesting the patient be referred to a mobility and falls clinic for an evidence-based preventative intervention. We conducted 10-minute academic detailing interviews (n=16) with resident emergency medicine physicians and advanced practice providers who had encountered our CDS tool in practice. We conducted an inductive, team-based content analysis to identify factors that influenced clinicians' use of the CDS tool. The following categories of factors that impacted clinicians' use of the CDS were identified: (1) aspects of the CDS tool's design (2) clinicians' understanding (or misunderstanding) of the CDS or referral process, (3) the busy nature of the emergency department environment, (4) clinicians' perceptions of the patient and their associated fall risk, and (5) the opacity of the referral process. Additionally, clinician education was done to address any misconceptions about the CDS tool or referral process, for example, demonstrating how simple it is to place a referral via the CDS and clarifying which clinic the referral goes to. Our study demonstrates the use of academic detailing for supporting the implementation of health information technologies, allowing us to identify factors that impacted clinicians' use of the CDS while concurrently educating clinicians to ensure the correct understanding of the CDS tool and intervention. Thus, academic detailing can inform both real-time adjustments of a tool's implementation, for example, refinement of the language used to introduce the tool, and larger scale redesign of the CDS tool to better fit the dynamic work environment of clinicians.

Clinical decision-making processes among graduate nurses, specialist nurses and nurse practitioners A collaborative international study.

To explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Clinical decision-making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles. In accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis. Three themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches. The results highlight the differences in decision-making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision-making. The results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders.

Healthcare workers’ safety and emotional exhaustion: Exploring the impact of violence and trust in emergency departments

Background In the challenging and often high-stress environment of emergency departments (EDs), healthcare workers (HCWs) frequently encounter a concerning issue of workplace violence (WPV). This study delves into the effects of WPV management and safety on the emotional well-being of ED HCWs. Methods Data collected between 15 March 2023 and 15 May 2023 from 186 HCWs across Obstetrics and Gynecology, Pediatrics, and Adult EDs are analyzed. The survey includes the Safety and Confidence Scale (SCS) to gauge HCWs' perceptions of violence and the Job-Related Emotional Exhaustion Scale (JREES). Results Key findings highlight the prevalence of various forms of WPV in the ED, such as verbal violence (77.4%), threats, and insults (68.8%), with patients and their relatives identified as the primary perpetrators. Male HCWs scored significantly higher on the Violence Management and Safety (VMS) scale compared to their female counterparts. Conclusions In summary, within the demanding ED setting, this study sheds light on the profound impact of WPV on HCWs' emotional exhaustion and their overall sense of safety. It underscores the urgent need to build trust and bolster support mechanisms to alleviate emotional exhaustion among HCWs. Addressing WPV in the ED is paramount for the mental well-being of healthcare workers, particularly when faced with violence from patients and their families.

Assessment of patient’s satisfaction towards Adult Emergency department service at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021.

Background: The emergency department is the first point of contact for patients to receiveprimary care, and it is considered the first therapeutic unit in the hospital for treatingpatients.Objective:To assess adult Emergency Department service patient satisfaction at theUniversity of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021.Methods: A cross-sectional study design was employed. A systematic random samplingtechnique was used to select the study participants. The study period was from July 15 toSeptember 15, 2021. Data were collected using a standard Brief Emergency DepartmentPatient Satisfaction Scale. Data was entered in Epidemiological Information version 7.2.1.0and exported to statistical software for Social Science version 20 for further analysis.Descriptive statistics were used to describe the distribution of data.Result: Of the 196 participants approached, 195 completed the questionnaire, with aresponse rate of 99.5%. Of the respondents, 92 (47.2%) with [95% CI: (40.0-54.4)] weresatisfied with the emergency care services provided, whereas 103(52.8%) with [95% CI:(45.6-60.0)]. In the five categories of services, respondents' satisfaction rates with theemergency department staff, emergency department environment, physician care, generalpatient satisfaction, patients’ family satisfaction, and the overall components ofsatisfaction were 50.3%, 42.1%, 48.7%, 57.4%, 65.1%, and 47.2% respectively. The meanwaiting time until seen by a physician in the emergency department was 61 minutes witha standard deviation=75.7 ranging from 2 minutes to 6 hours.Conclusion: According to this study, overall patient satisfaction with adult Emergencydepartment service at the University of Gondar Comprehensive Specialized Hospital waslow. Concerning the five domains of patient satisfaction measurement, the highestsatisfaction level was recorded with the patient's family satisfaction, and the lowestsatisfaction level was documented in the emergency department environment. The meanwaiting time until seen by the doctor was 61 minutes, with a standard deviation of 75.

Investigating the Feasibility of Using a Wearable Device to Measure Physiologic Health Data in Emergency Nurses and Residents: Observational Cohort Study.

Emergency departments play a pivotal role in the US health care system, with high use rates and inherent stress placed on patients, patient care, and clinicians. The impact of the emergency department environment on the health and well-being of emergency residents and nurses can be seen in worsening rates of burnout and cardiovascular health. Research on clinician health has historically been completed outside of clinical areas and not personalized to the individual. The expansion of digital technology, specifically wearable devices, may enhance the ability to understand how health care environments impact clinicians. The primary objective of this pilot study was to assess the feasibility and acceptability of using wearable devices to measure and record physiologic data from emergency nurses and resident physicians. Understanding strategies that are accepted and used by clinicians is critical prior to launching larger investigations aimed at improving outcomes. This was a longitudinal pilot study conducted at an academic, urban, level 1 trauma center. A total of 20 participants, including emergency medicine resident physicians and nurses, were equipped with a wearable device (WHOOP band) and access to a mobile health platform for 6 weeks. Baseline surveys assessed burnout, mental health, and expectations of the device and experience. Participants provided open-ended feedback on the device and platform, contributing to the assessment of acceptance, adoption, and use of the wearable device. Secondary measures explored early signs and variations in heart rate variability, sleep, recovery, burnout, and mental health assessments. Of the 20 participants, 10 consistently used the wearable device. Feedback highlighted varying experiences with the device, with a preference for more common wearables like the Apple Watch or Fitbit. Resident physicians demonstrated higher engagement with the device and platform as compared with nurses. Baseline mental health assessments indicated mild anxiety and depressive symptoms among participants. The Professional Fulfillment Index revealed low professional fulfillment, moderate workplace exhaustion, and interpersonal disengagement. This pilot study underscores the potential of wearable devices in monitoring emergency clinicians' physiologic data but reveals challenges related to device preferences and engagement. The key takeaway is the necessity to optimize device and platform design for clinician use. Larger, randomized trials are recommended to further explore and refine strategies for leveraging wearable technology to support the well-being of the emergency workforce.

Experiences of delivering and receiving mental healthcare in the acute hospital setting: a qualitative study

BackgroundRecent investment in UK liaison psychiatry services has focused on expanding provision for acute and emergency referrals. Little is known about the experiences of users and providers of these services. The aim of this study was to explore the experiences of users of acute liaison mental health services (LMHS) and those of NHS staff working within LMHS or referring to LMHS. A secondary aim was to explore the potential impact of a one-hour service access target on service delivery.MethodsCross-sectional qualitative study. Individual interviews were audio-recorded, transcribed verbatim and interpreted using framework analysis.ResultsService users reported mixed experiences of LMHS, with some reporting positive experiences and some reporting poor care. Most service users described the emergency department (ED) environment as extremely stressful and wished to be seen as quickly as possible. Staff described positive benefits of the one-hour access target but identified unintended consequences and trade-offs that affected other parts of the liaison service.ConclusionsThe assessment and treatment of people who attend ED with mental health problems needs to improve and particular attention should be given to the stressful nature of the ED environment for those who are extremely agitated or distressed.

An exploration of person-centredness among emergency department physiotherapists: a mixed methods study

Purpose There is a growing number of primary contact physiotherapists based in United Kingdom emergency departments (ED) who are expected to deliver person-centred practices. Perceptions of physiotherapists working in these high-pressure environments on person-centredness are currently unknown. A mixed methods exploration of person-centredness among ED physiotherapists targeted this knowledge gap to inform future clinical practice. Methods Online survey and semi-structured interviews followed a convergent mixed methods design with sequential explanatory features. Data sets were analysed separately using descriptive statistics and thematic analysis, respectively, before merged analysis using joint display. Results Twenty-six surveys and 11 in-depth interviews were completed. The three overarching themes of ED patients, ED physiotherapists, and ED environment were generated. Themes were integrated and analysed alongside quantitative survey findings. This produced three novel contributions that further our understanding of person-centred practices among ED physiotherapists. Conclusion ED physiotherapists were mindful of an apparent, yet unspoken struggle between the competing philosophies of biomedicine and person-centredness. The results here support entering a patient’s world as a person-centred approach to help navigate the line between what an ED attender wants and the clinical need of their visit.

Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review.

Given the aging population and growing burden of frailty, we conducted this scoping review to describe the available literature regarding the use and impact of frailty assessment tools in the assessment and care of emergency department (ED) patients older than 60 years. A search was made of the available literature using the Covidence system using various search terms. Inclusion criteria comprised peer-reviewed literature focusing on frailty screening tools used for a geriatric population (60+ years of age) presenting to EDs. An additional search of PubMed, EBSCO, and CINAHL for articles published in the last 5 years was conducted toward the end of the review process (January 2023) to search specifically for literature describing interventions for frailty, yielding additional articles for review. Exclusion criteria comprised articles focusing on an age category other than geriatric and care environments outside the emergency care setting. A total of 135 articles were screened for inclusion and 48 duplicates were removed. Of the 87 remaining articles, 20 were deemed irrelevant, leaving 67 articles for full-text review. Twenty-eight were excluded for not meeting inclusion criteria, leaving 39 full-text studies. Use of frailty screening tools were reported in the triage, care, and discharge decision-making phases of the ED care trajectory, with varying reports of usefulness for clinical decision-making. The literature reports tools, scales, and instruments for identifying frailty in older patients at ED triage; multiple frailty scores or tools exist with varying levels of utilization. Interventions for frailty directed at the ED environment were scant. Further research is needed to determine the usefulness of frailty identification in the context of emergency care, the effects of care delivery interventions or educational initiatives for front-line medical professionalson patient-oriented outcomes, and to ensure these initiatives are acceptable for patients.

Maintaining a safe environment in emergency department waiting rooms.

Increasing demand, overcrowding and insufficient resources have led to situations where patient care is delivered in emergency department (ED) waiting rooms. For nurses undertaking triage in the ED waiting room, overcrowding is challenging, particularly in terms of assessing patients in a timely fashion, monitoring patients for clinical deterioration and ordering investigations. Additionally, long waiting times and a lack of information can lead to communication breakdowns with patients and, at times, patient confrontations with ED staff. This article explores the effects of the busy environment in ED waiting rooms on patients and staff such as triage nurses and waiting room nurses.

GridlockED as an Intervention for Nurses (GAAIN) Study.

GridlockED (The Game Crafter, LLC) is a serious game that was developed to teach challenges that face nursing and medical professionals in the emergency department (ED). However, few studies have explored nurses' perceptions of the utility, fidelity, acceptability, and applicability of the serious game modality. This study examined how ED nurses view GridlockED as a continuing education platform. This single-center observational study explored how nurses engage with and respond to Grid-lockED. The convenience sample included participants recruited from a local continuing nursing education day. Participants completed a presurvey, engaged in a full game play session with the GridlockED game for approximately 45 minutes, and immediately completed a post-game play survey. Of the 48 participants (11 male, 37 female; 44 of 48 were RNs), most (91%) agreed that the workflow reflected in the game was equivalent to the flow in a typical ED. Almost all (96%) found the cases in the game reflective of real ED patients, and most (92%) found the game a useful educational tool to prepare new nurses to transition into the ED environment. The GridlockED game shows potential as a serious game to support nursing education, particularly for new ED nurse orientation and transition to ED practice. [J Contin Educ Nurs. 2024;55(5):231-238.].

Hospital health care workers’ use of facial protective equipment before the COVID-19 pandemic, implications for future policy

Prepandemic routine use of facial (respiratory and eye) protective equipment (FPE) by health care workers was suboptimal. Understanding factors affecting routine use would facilitate escalation to high level use during infectious disease emergencies. This study explored health care workers FPE-related knowledge, attitudes and behaviors. Mixed methods were used in a respiratory ward and adult and pediatric emergency departments (EDs), prior to the COVID-19 pandemic. Study design and thematic analysis were based on the theoretical domains framework. Emergent themes were categorized, using the COM-B behavior model, into capability(C), opportunity(O) and motivation(M), which influence behavior(B). 22 emergent themes, representing factors influencing FPE use, were mapped to theoretical domains framework domains. Personal experience and departmental cultures influenced motivation. Compared with respiratory ward staff, ED clinicians were less knowledgeable about FPE; the unique ED environment and culture inhibited opportunities and motivation for FPE use. Eye protection was infrequently used. Optimal FPE use is challenged by ED care models and settings. Changes are needed to translate pandemic-related improvements into routine care of other respiratory infections. This study identified key determinants of FPE behavior. A review of context-specific FPE guidance for ED by infection prevention and control professionals would help to promote practicable, sustainable compliance.

Abstract 18827: Emergency Department Threat Perceptions and PTSD Symptoms After Suspected Stroke

Introduction: Stroke is a leading cause of death, physical, and psychological disability in the United States. One in four stroke survivors develop significant PTSD symptoms (PTSS), which can influence disease outcomes. It is important to identify factors that increase early psychological distress and subsequent PTSS development, such as threat perceptions in the emergency department (ED). Understanding the relationship between ED threat and PTSS may help identify areas for improving early stroke care. The purpose of this study was to determine whether ED threat perceptions influence PTSS development at 1-, 6- and 12-months after suspected stroke. Methods: The sample consisted of patients (n = 203, 48% female, 59.4 ± 15.5 years) who presented to the ED of an academic medical center for suspected stroke. ED threat was assessed in-hospital using the ED Threat Perceptions questionnaire, and PTSS were assessed at 1-, 6- and 12- months post-stroke using the PCL-5 tool. Linear regression was used to assess the association between ED threat and PTSD symptoms, adjusting for demographics, depression, chronic disease severity (Charlson index), and stroke severity (NIHSS). Results: In unadjusted analyses, ED threat perceptions were associated with higher PTSS at 1- (β=0.42, 95% CI [0.16-0.68] p=0.002), 6- (β=0.32, 95% CI [0.07-0.58], p=0.013), and 12-mo (β=0.44, 95% CI [0.15-0.72], p=0.003), independent of demographics, stroke severity, and depressive symptoms when expressed continuously. In nested models, addition of ED threat perceptions to a model including demographics and stroke severity significantly improved the model (Δ-2 log likelihood = 7.15, df=1; p=0.007), indicating independent effects in the association of ED threat perceptions with PTSD symptoms beyond stroke severity. Conclusions: ED threat perceptions were associated with higher PTSS at 1-, 6-, and 12-months after suspected stroke even after accounting for clinician-measured stroke severity. This suggests that early threat perceptions contribute to PTSD risk above and beyond the physical impact of the event. These results indicate the importance of the ED environment and provide a target for future interventions to minimize the development of PTSD symptoms post-stroke.