Emergency Department Health Professionals Research Articles

Assessment of inter-rater reliability of screening tools to identify patients at risk of medication-related problems across the emergency department continuum of care

BackgroundFollowing a national multicentre study, two emergency department (ED) screening tools were developed to determine risk of medication-related problems; one for use at ED presentation and another at ED discharge to the community. This study aimed to determine the inter-rater reliability amongst ED health professionals when applying these screening tools to a series of case scenarios. MethodsA prospective, cross-sectional study was undertaken in the ED of a major metropolitan hospital. Twelve case scenarios were developed following ED observation of a range of patients, which were incorporated into a questionnaire and distributed to 50 health professionals. Inter-rater reliabilities of each explanatory variable of the screening tools and overall assessment were calculated using Fleiss’ multi-rater kappa. ResultsThe questionnaire was completed by 15 doctors, 19 nurses and 16 pharmacists. Fleiss’ kappa showed an overall inter-rater reliability for the ED presentation tool of 0.83 (95% CI 0.83–0.84), indicating near perfect agreement. Fleiss’ kappa for the ED discharge tool was 0.83 (95% CI 0.83–0.85), which also showed near perfect agreement. ConclusionsThe screening tools produced favourable inter-rater reliability amongst ED health professionals. These results have important implications for ensuring consistency of ED decision-making in screening patients at risk of developing medication-related problems.

Management of traumatic dental injuries: a survey of paediatric emergency department health professionals

ObjectiveTo assess paediatric emergency department (PED) health professionals’ confidence, experience and awareness in managing traumatic dental injuries (TDIs).DesignA cross-sectional online survey.SettingPED at Alder Hey Children’s Hospital and Birmingham Children’s Hospital.Results94...

Factors Associated With Emergency Department Health Professionals' Attitudes Toward Family Presence During Adult Resuscitation in 9 Greek Hospitals.

Different cultural context results in variability in health professionals' attitude toward family presence in the emergency department (ED) during resuscitation. Knowledge about emergency department health professionals' (EDHPs') attitude toward family presence during resuscitation (FPDR) in Greece can contribute to the understanding of cultural and value-related obstacles and opportunities to implement this practice. It would be useful for Greek health professionals when they have to care for citizens from other countries in which guidelines for FPDR exist to understand their difference in behavior and reaction and be more tolerant. To explore Greek EDHPs' experiences, concerns, and benefits regarding FPDR and determine the contributing factors that are associated with their positive or negative attitude about the process. A convenience sample of 305 health professionals working in the ED of 9 general hospitals of the National Healthcare System in northern Greece participated in a cross-sectional study (response rate, 87.6%). Positive experience of FPDR was encountered in 65.9% of EDHPs. Only 2.3% reported that they work in EDs where FPDR is allowed. Hospital regional location, previous positive experience of FPDR, and competency in supporting family members during FPDR were independently associated with a positive attitude toward FPDR. Greek EDHPs are not ready to accept FPDR practice. The establishment of formal policy similarly to resuscitation guidelines and family-centered training courses are needed to mitigate negative beliefs. Attempts to enhance positive attitude should include educational interventions providing knowledge on the benefits of FPDR.

A Survey to Guide the Emerging Role of Allied Health Teams in a Regional Tertiary Hospital Emergency Department

Purpose: A multidisciplinary allied health team has worked in The Townsville Hospital Emergency Department for seven years. Patients are referred to the allied health team by medical and nursing staff with the aim of reducing patient admission and improving patient outcomes. However, the type and number of referrals received by the allied health team suggest there is a lack of detailed interdisciplinary knowledge by the referrers. Therefore, the Emergency Department Allied Health Team surveyed other emergency department health professionals to ascertain their knowledge of allied health roles. The results will be used to develop education sessions to fill gaps in knowledge. Methods: A cross-sectional survey consisting of 22 true/false statements and demographic questions was developed by the Emergency Department Allied Health Team. Questions described some of the common triggers for referral to physiotherapy, occupational therapy, social work, and pharmacy staff in the emergency department at the Townsville Hospital. The survey was distributed opportunistically to nursing, medical and physician assistant staff at handover or education sessions. Descriptive statistics were used to describe the data and comparisons used chi squared tests. Results: The response rate for the survey was 63% (n=154), including 52 doctors (65%), 95 (59%) nursing staff, 3 physician assistants (100%), and 4 who did not state their discipline. Preferred responses were low for questions about occupational therapy’s ability to do home visits up to four weeks post emergency department discharge (37.7%), physiotherapists’ necessity to perform mobility assessments (24.7%), identifying APINCH acronym as mnemonic for high risk drugs (35.7%) and the correct application of “close the gap” prescriptions (27.9%). Staff with more experience and prescribers were more likely to give the preferred response. Conclusions: Some gaps exist in doctors’, nurses’, and physician assistants’ knowledge of the roles of allied health in an emergency department. The knowledge gap decreases as staff experience in emergency departments increases. Therefore, for the allied health team in our emergency department to work at full scope of practice, these knowledge gaps need to be addressed. Our challenge now is to provide sustainable education on the role of allied health in a busy emergency department full of shift working and rotating staff being pulled by a myriad of contrasting priorities.

P168: Critical dynamics study of burnout in emergency department health professionals in New Brunswick: revisiting 6 years later

Introduction: Emergency Department (ED) staff burnout correlates with psychological coping strategies used by Emergency department health professionals (EDHPs). Staff at two urban referral EDs in New Brunswick took part in a survey of burnout and coping strategies after one ED experienced an influx of new physicians and a newly renovated ED in 2011. Six years later, ED crowding and EDHP staffing problems became prevalent at both EDs. We compared levels of burnout at two urban referral EDs to determine if burnout and coping worsened over time. Methods: An anonymous survey of all EDHPs at 2 urban referral EDs was performed in 2011 and in 2017. A demographics questionnaire, the Maslach Burnout Inventory (MBI, measuring emotional exhaustion, depersonalization and personal accomplishment), and the Coping Inventory for Stressful Situations (CISS, measuring task-oriented, emotion-oriented, and avoidance-oriented coping styles) were collected. Descriptive statistics and linear regression models examined relationships over time and between the two hospitals. Results: Burnout scores were similar both at the two facilities and in 2011 (n=153) and 2017 (n=127). There were no differences between samples or EDs for important factors. Emotion-oriented coping was associated with higher levels of burnout, while task-oriented coping was inversely correlated with burnout. Experiencing professional stress was a significant predictor of emotional exhaustion, while those working longer years in their current department had higher emotional exhaustion and depersonalization. By 2017, both EDs had experienced significant nursing staff turnover (50%) compared to 2011. Conclusion: Burnout scores remained consistent after 6 years at these two urban referral EDs. Given the evidence that increased years of service is associated with increased burnout, high staff turnover rate at both EDs could explain how scores remained constant. Staff turnover may represent a way these ED systems cope in a challenging environment. In 2017, task-oriented copers continued to score lower while emotionally-oriented copers showed higher burnout risk, and experiencing professional stress remains a strong predictor of burnout.

An analysis of the relationship between burnout, socio-demographic and workplace factors and job satisfaction among emergency department health professionals

IntroductionBurnout among emergency medical practitioners and personnel negatively affects career satisfaction and job performance and can lead to mental health issues, including anxiety, depression, and suicide. PurposeThis study investigated the relationship between the perceptions of burnout and job satisfaction of those working in two different hospital's emergency departments assessing the effect of burnout dimensions and additional factors (age, position, marital status, annual income, employment type, gender, patient encounters, and household economic well-being) on job satisfaction. This study addresses a gap in the literature of the relationships between a) burnout and job satisfaction of emergency department's health care personnel (physicians, nurses, technicians) and b) the factors that are associated with emergency department employees' job satisfaction. MethodA cross-sectional survey of two hundred and fifty participants was interviewed, using validated instruments (the Maslach Burnout Scale and the Minnesota Satisfaction Questionnaire). Participants include 38 physicians, 89 nurses, and 84 medical technicians, and 39 information technicians. The Maslach Burnout Inventory Scale, which assesses emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA), and the Minnesota Satisfaction Questionnaire (MSQ), which assesses intrinsic satisfaction (IS), extrinsic satisfaction (ES) and overall satisfaction (OS), were used for data collection. ResultsStudy findings indicate that significant relationship exists between burnout and job satisfaction; annual income and household economic-well-being had a positive association with job satisfaction, whereas gender, age, education, marital status had no significant effect on any form of satisfaction. Moreover, this study reveals that emotional exhaustion (EE) is a significant predictor of all three dimensions of job satisfaction while depersonalization (DP) had no significant showing. ConclusionResults of this study suggest that it is not yet clear which factors are salient contributors in demonstrating the relationship between burnout and job satisfaction. This study may draw attention to a better understanding of this relationship will help enable health care administrators to design and implement tools to help increase job satisfaction and decrease burnout as a combined goal rather than treat each issue separately.

Evidence based pediatric care closer to home: A mixed methods evaluation of a clinical pathways-based emergency outreach program

Objective: While specialized pediatric care is not feasible in all Emergency Department (ED) settings, enhanced system capacity is needed to appropriately address pediatric emergency care needs. Our objective was to evaluate an innovative clinical pathway (CP) based regional ED outreach program within community EDs.Methods: This mixed-methods design includes pre/post chart audits, qualitative interviews, ED site audits, and website utilization metrics. The study was conducted in community-based hospital EDs within the region. ED nurses, physicians and administrators from eight hospitals participated in the study. The ED outreach program involved implementation of 3 CPs addressing common pediatric emergency presentations: asthma, croup and gastroenteritis. Primary outcomes from chart audits included presence of a CP-related document filed in relevant patient charts and the proportion of patients who received appropriate care as per the severity-based CP recommendations. Secondary outcomes included documented assessments of condition severity, use of specific treatments and hospital metrics.Results: ED health professionals value the outreach initiative and CPs. Site audits confirmed ED presence and knowledge of CP tools. However several adoption barriers were identified, including time, perceived threats to physician autonomy and infrequent opportunities for use. Chart audits demonstrated site-dependent, variable uptake of CP resources into ED workflows. In total, 1,274 health records were audited, with the following pre/post breakdowns: 203/211 (asthma), 131/193 (croup) and 291/245 (gastroenteritis). We could not evaluate our primary outcomes due to infrequent documentation of condition severity. Significant post-implementation improvements were demonstrated in gastroenteritis management. Median length of stay remained unchanged (asthma) or increased (croup, gastroenteritis). ED site was an important predictor of some asthma treatments and LOS for asthma (p < .001), croup (p = .01) and gastroenteritis (p < .001).Conclusions: CP documents were available in EDs, but may not be utilized as fully intended. Site heterogeneity may account for lack of significant change in several outcome variables.

An exploration of patient-reported experiences of aspects of integrated care in New South Wales

Introduction: Increase in complex chronic diseases, development of systematic pathways of care and specialisation of healthcare providers poses challenges to ensure coordinated and continuous care for patients. Integration of care is an objective for various healthcare systems. The aim of this study is to assess the variation in patient-reported experiences of aspects of healthcare integration in New South Wales (NSW) public hospitals. Methods: The results were drawn from 17,746 respondents to the NSW Adult Admitted Patient Survey (AAPS) [January to June 2013] and 13,230 respondents to the NSW Emergency Department Survey (EDS) [April to September 2013]. Respondents had been patients of a medium or large public hospital in the given timeframe. Analysis was carried out on a selection of approximately 25 questions from each survey that addressed relevant themes such as integration of patients into care, integration of care between healthcare professionals, integration of care within hospitals and integration of care upon arrival and discharge. Results were weighted to the hospital population of age group and stay-type. Results: Whilst all measures showed variation between hospitals, some measures had a wider range of results, such as admitted patients’ reporting that they were ‘definitely’ involved in decisions about their care and treatment [mean: 59.4%, range: 46.2% 79.9%] and Emergency Department patients’ not receiving contradictory information from Emergency Department health professionals [mean: 72.8%, range: 44.6% 86.1%]. In NSW overall, there was also variation in results related to the different themes of integrated care. Some were rated more positively (such as information-provision and communication with patients), whilst others tended to show less positive ratings, including those around involvement of the patient in the ‘treatment team’ and to some extent, the integration of care between healthcare professionals. The individual measures that were rated most positively in NSW were provision of the ‘right amount’ of information to admitted patients about the medication they were taking home [91.5% of respondents] and World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116660– http://www.ijic.org/ Emergency Department health professionals providing the ‘right amount’ of information to a patient about their condition or treatment [85.6% of respondents]. Conclusion: Patient-reported experiences of care within and across different stages of the patient pathway can provide a complementary tool in evaluating the delivery of integrated care. These findings point to issues that could be targeted to improve the delivery of integrated care within the NSW public hospital sector. Limitations: The surveys used for this study were not developed specifically with integrated care in mind. While certain questions were included with the aim of measuring integrated care, the surveys may not include all relevant measures. Suggestions for Future Research: Further assessment on how to best balance the number of patient-reported measures by aspects of integrated care remains to be done.

Patient experience in the emergency department: inconsistencies in the ethic and duty of care.

To understand how people who present on multiple occasions to the emergency department experience their health professionals' moral comportment (ethic of care and duty of care); and to understand the consequences of this for 'people who present on multiple occasions' ongoing choices in care. People (n = 34) with chronic illness who had multiple presentations were interviewed about the role that emergency departments played within their lives and health-illness journey. Unprompted, all participants shared views about the appropriateness or inappropriateness of the care they received from the health professionals in the emergency departments they had attended. These responses raised the imperative for specific analysis of the data regarding the need for and experience of an ethic of care. Qualitative description of interview data (stage 3 of a multimethod study). The methods included further analysis of existing interviews, exploration of relevant literature, use of Tronto's ethic of care as a theoretical framework for analysis, thematic analysis of people who present on multiple occasions' texts and explication of health professionals' moral positions in relation to present on multiple occasions' experiences. Four moral comportment positions attributed by the people who present on multiple occasions to the health professionals in emergency department were identified: 'sustained and enmeshed ethic and duty of care', 'consistent duty of care', 'interrupted or mixed duty and ethic of care', and 'care in breach of both the ethic and duty of care'. People who present on multiple occasions are an important group of consumers who attend the emergency department. Tronto's phases/moral elements in an ethic of care are useful as a framework for coding qualitative texts. Investigation into the bases, outcomes and contextual circumstances that stimulate the different modes of moral comportment is needed. Findings carry implications for emergency department care of people who present on multiple occasions and for emergency department health professionals to increase awareness of their moral comportment in care.

Australian Emergency Department health professionals’ reasons to invite or not invite Family Witnessed Resuscitation: A qualitative perspective

BackgroundDebate continues regarding the effectiveness of Family Witnessed Resuscitation and little is known about the reasons why staff invite family presence. AimExplore why health professionals invite or not invite Family Witnessed Resuscitation. DesignDescriptive qualitative study. MethodThree open-ended questions enabled 114 clinicians to describe why they would or would not invite family presence. Data were analysed using qualitative data analysis. ResultsFour themes representing factors that influenced staff decision to invite or not invite Family Witnessed Resuscitation were identified: motivating factors, personal choice, staff judgment, and organisational factors. Motivating factors described reasons to invite family presence, and staff and organisational factors were reasons to not invite family presence. ConclusionFamily presence can be beneficial for staff and family and is likely to be motivated by family-specific factors where this choice is appropriate for all stakeholders. Participants described factors that can impact on the appropriateness of inviting family presence and these need to be considered before an invitation is extended. Relevance to practiceTo support all parties throughout the process it is imperative that a skilled support person be available to the family and that written policies and guidelines be available for staff.