Emergency Department Health Care Research Articles

Burnout Syndrome in Emergency Department Healthcare Providers In Aljouf Region

Background: Burnout refers to job dissatisfaction caused by work-related stress. The aim of this study was to explore the prevalence, risk factor, protective factors of burnout among emergency department healthcare providers in Al Jouf region hospitals. We aimed to investigate the psychological impact of burnout, how it weighs down on mental health and physical health, and ways to prevent it. Burnout syndrome is emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA) among individuals who work with people. Methodology: This study used a self-administered online questionnaire distributed through data collectors by sending the link to participants. A pilot study will be conduct on 10 subjects to estimate the time needed to fill the survey and test the logistics and its comprehensibility. A self-administered MBI-HSS was used to collect data on burnout in terms of emotional exhaustion, depersonalization and low personal accomplishment. Study period from March 2021– January 2022. Results: We found burnout to be multidimensional such that different variables were associated with one or more aspects of burnout. Majority of respondents felt emotionally drained from work a few times a week. Low personal accomplishment results are caused by factors such as age, marital status, smoking, psychological/ psychiatric disorders. The results showed that the highest mean and standard deviation for MBI-HSS subscale scores for risk burnout was found in emotional exhaustion. The majority of participants (71.28%) had high prevalence of high depersonalization. 84.43% of participants were not burnt out. Conclusion: Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment which arises in response to chronic stress in jobs where individuals work with people. Workers at the emergency department were more susceptible to burnout. Different factors are associated with burnout. Demographic factors of age, sex and marital status were significant in the study. Social and organizational solutions in preventing and alleviating this syndrome are recommended to address emotional exhaustion, depersonalization and low personal accomplishments.

Modelling new service development using Kano, QFD and mathematical programming in an emergency department healthcare unit

Modelling new service development using Kano, QFD and mathematical programming in an emergency department healthcare unit

The lived experiences of health care professionals regarding visiting restrictions in the emergency department during the COVID-19 pandemic: A multi-perspective qualitative study.

To explore the lived experiences of emergency department (ED) healthcare professionals regarding visiting restrictions during the COVID-19 pandemic. A qualitative phenomenology study. Semi-structured interviews were undertaken. Participants consisted of 10 physicians, 20 clinical nurses, and three managers, who were purposefully selected from two EDs in China between April and July 2021. Colaizzi's approach guided data analysis. Four themes arose: (i) burden moral injury, (ii) higher workload to provide and support patient- and family-centered care, (iii) dissatisfied and unsafe healthcare service for patients and families, and (iv) tailoring strategies to provide family-centered care. This study explored the lived experiences of ED health care professionals regarding visiting restrictions during the COVID-19 pandemic. Noted challenges included communicating with families and ethical decision making. Strategies that support ED clinician welfare, and communication with families are warranted if visiting policy restrictions are continued or re-introduced.

Longitudinal Study Comparing Mental Health Outcomes in Frontline Emergency Department Healthcare Workers through the Different Waves of the COVID-19 Pandemic.

As countries transition from the COVID-19 pandemic to endemic status, healthcare systems continue to be under pressure. We aimed to quantify changes in depression, anxiety, stress and post-traumatic stress disorder (PTSD) between 3 cohorts (2020, 2021 and 2022) of our Emergency Department (ED) healthcare workers (HCWs) and those who had worked through all 3 phases of the pandemic; and identify factors associated with poorer mental health outcomes (MHOs). In this longitudinal single-centre study in Singapore, three surveys were carried out yearly (2020, 2021 and 2022) since the COVID-19 outbreak. Depression, anxiety and stress were measured using DASS-21, and PTSD was measured using IES-R. A total of 327 HCWs (90.1%) participated in 2020, 279 (71.5%) in 2021 and 397 (92.8%) in 2022. In 2022, ED HCWs had greater concerns about workload (Mean score ± SD: 2022: 4.81 ± 0.86, vs. 2021: 4.37 ± 0.89, vs. 2020: 4.04 ± 0.97) and perceived to have less workplace support (2022: 4.48 ± 0.76, vs. 2021: 4.66 ± 0.70, vs. 2020: 4.80 ± 0.69). There was overall worsening depression (27.5% in 2020, 29.7% in 2021 and 32.2% in 2022) and stress (12.2% in 2020, 14.0% in 2021 and 17.4% in 2022). Healthcare assistants as a subgroup had improving MHOs. ED HCWs who were female and had psychiatric history, were living with the elderly, and had concerns about their working environment, workload and infection had poorer MHOs. This study will guide us in refining existing and devising more focused interventions to further support our ED HCWs' wellbeing.

Recognition and management of patients with frailty in the emergency department.

In the UK, around 10% of adults aged over 65 years and around one quarter to a half of adults aged over 85 years have frailty. Early identification of frailty can improve patient outcomes, so it is vital that emergency department (ED) healthcare professionals, including nurses, understand and can recognise the signs and symptoms of this health state. This article describes frailty and outlines the relationship between common presenting complaints in older people in the ED and frailty syndromes. The article summarises some commonly used frailty screening tools that have been validated for use in acute and emergency care settings and details a frailty screening tool used in the authors' hospital. The authors also outline some important principles of management of patients with frailty in the ED.

Patient Satisfaction With Quality of Care at the Kingdom of Saudi Arabia.

Background The emergency department (ED) is the first contact of many individuals who require acute health services. This study was the first to be conducted among patients in different regions of Saudi Arabia to determine patient satisfaction with emergency healthcare services using the Arabic version of theEchelle de Qualité des Soins en Hospitalisation (EQS-H). Methodology This cross-sectional study was conducted among 2,997 patients admitted to the ED in different hospitals in different regions of Saudi Arabia. The study was based on a self-reported questionnaire validated to assess the satisfaction of patients with ED healthcare services calledEQS-H. In this study, we used an Arabic version of the questionnaire. Statistical analyses were performed using R version 3.6.3. Results The study was conducted among 2,997 patients (36.7% males and 63.3% females). Regarding region, respondents from the central region represented one-third of the sample (31.7%), followed by respondents from the western, eastern, and southern regions (24.1%, 16.9%, and 14.6%, respectively). Statistical analysis showed that the average percentage score for the clarity of information was significantly higher in the central region than in other regions and was lowest in the eastern region. Individuals aged 26-35 years (B = -2.54 and P < 0.05), male sex (B = -1.63 and P < 0.05), Saudis (B = -3.81 and P < 0.05), longer ED length of stay (LOS) (B = -2.19 and P < 0.001), worse perceived health state, and lower life satisfaction scale scores were significantly associated with lower levels of satisfaction with ED services. Perceived improvement is the strongest predictor of satisfaction. Conclusion Moderate satisfaction levels were reported in both the clarity of information domain and relationship with staff domain among patients admitted to EDs in different regions of Saudi Arabia, with better results in the central region.

Abstract 14095: Factors Influencing Timely Recognition and Treatment of Severe Hypertension in Pregnancy

Background: Severe hypertension is an obstetric emergency. Timely identification and management can reduce risk of serious events. Aims of our study were to 1)assess whether severe hypertension is being recognized and managed within the recommended time frame and 2)evaluate the factors that are associated with timely identification and treatment of severe maternal hypertension. Methods: A retrospective study of pregnant and postpartum women presenting with severe hypertension to tertiary care hospital between 1/1/19 to 12/1/19. Main outcome measures were ‘time to repeat blood pressure check(TTC)’ and ‘time interval between confirmation of severe hypertension and initiation of pharmacotherapy(TTT)’. We examined the association of the type of hospital unit, time of day of presentation and race/ethnicity with the outcome measures. Results: A total of 656 women were included in the study. Median time for repeat blood pressure check was 16 minutes. Only 46.2% of women had a repeat blood pressure check within 15 minutes. Median interval between confirmation of severe hypertension and initiation of therapy was 38.5 minutes. 63.3% of women were treated within the recommended time frame of 60 minutes. Both timely blood pressure re-check(15.6% vs 51.4%, p &lt; 0.001) and initiation of treatment(38.5% vs 70.8%, p &lt; 0.001) were significantly lower in the emergency department (ED). TTC(57.9% vs 31.4%, p &lt; 0.001) and TTT(86.4% vs 42%, p &lt; 0.001) were significantly better in the labor and delivery unit. Time of day(day 51.6% vs night 57.3%, p = 0.15) and race/ethnicity(black 57.1% vs non-black 51.6%, p = 0.16) were not associated with delay in repeat blood pressure check. However, black race(46.2% vs 28.6%, p = 0.018) was associated with delayed initiation of therapy compared to non-black patients. Conclusions: We found both the rates of timely identification and treatment of severe maternal hypertension in the ED were lower compared to other units. This points to need for continuous education of ED healthcare providers about timely recognition and management of severe maternal hypertension. We also found racial disparities in timely initiation of therapy, thus demonstrating the need for standardization of protocols.

Recognising risk, influencing reality and mental healthcare in a regional emergency department.

Mental health presentations to EDs continue to rise with associated challenges increasingly understood and well documented. Despite growing evidence of current and ongoing systemic issues contributing to this increase, there continues to be a lack of administrative engagement to address ED attendance, with avoidance and diversion strategies initiated during the COVID-19 pandemic no longer prioritised, despite growing need. Clear and well-documented reports of ED overcrowding and bed boarding is evidence that things need to change. Moreover, if innovative action is not taken, the risk and reality is that long waits, poor outcomes and exposure to unsafe conditions will continue. This is broadly unacceptable to consumers, their carers and the broader ED network. Delayed action in seeking alternative solutions only reinforces the risk and reality that people experiencing mental health concerns have 'Nowhere Else To Go'.

Inhaler technique in a pediatric emergency department: Impact of an education intervention among healthcare professionals.

Inhaler technique (IT) knowledge among healthcare providers is poor. The aim was to improve Pediatric Emergency Department (PED) healthcare providers' IT technique by carrying out an education intervention and sustain it for 6 months. Open-label, quasi-experimental, prospective, and unicentric study. Healthcare professionals working at the PED were enrolled. The study was developed in three phases: baseline evaluation and education intervention (P1) and reevaluation 1 month (P2) and 6 months (P3) after the education intervention. Participants fulfilled an eight-question theoretical test. Practical skills were evaluated by demonstrating IT in all three phases. The education intervention consisted in a verbal explanation of IT followed by a demonstration of IT with metered-dose inhaler using a mannequin. A total of 84 healthcare providers (medical residents, nurses, and nursing assistants) were involved. In the theoretical questionnaire, the mean score at baseline was 4.4/8 (SD 1.7) improving to 6.3/8 (SD 1.2) in P2 and 6.47/8 (SD 1.1) in P3. In the IT evaluation for children <7 years old, the score improved from 5.7/7 (SD 1.3) to 6.5/7 in P2 and 6.7/7 in P3 (p < 0.001). For children >7 years old, the mean score of IT at baseline was 3.1/10 (SD 4), which improved to 7.4/10 (SD 3) and 8.2/10 in P2 and P3, respectively (p < 0.001). Only professional category influenced results at baseline. Healthcare providers' theoretical knowledge and practical skills on IT are low. The education intervention performed is a useful strategy to ameliorate IT among healthcare providers.

A validated Screening instrument for Child Abuse and Neglect (SCAN) at the emergency department

The objective of this study is to develop and validate a screening instrument for the recognition of child maltreatment in the emergency department (ED). Existing data on screening questions and outcomes (diagnosis of child maltreatment) from three large observational screening studies at eight different EDs in the Netherlands were harmonized. A multivariate logistic regression was performed to develop the Screening instrument for Child Abuse and Neglect (SCAN). The SCAN was validated by performing a cross-validation and calculating the discriminative ability. A total of 24,963 patients were included. Out of the potential screening questions the following questions were included in the final instrument: is the injury compatible with the history, and does it correspond to the child’s developmental level? (aOR 10.40, 95% CI 5.69–19.02), was there an unnecessary delay in seeking medical help? (aOR 3.45, 95% CI 1.73–6.88) and is the behaviour/interaction of the child and parents (carers) appropriate? (aOR 14.67, 95% CI 7.93–27.13). The SCAN had a pooled AUC of 0.75 (95% CI 0.63–0.87) in the cross-validation. The question “Are there other signals that make you doubt the safety of the child and/or family?” (available in only one of the original datasets, OR 182.9; 95% CI 102.3–327.4) was by consensus added to the final SCAN.Conclusion: This validated and brief Screening instrument for Child Abuse and Neglect (SCAN) is designed to improve early recognition of child maltreatment in the ED. A positive screening result of the SCAN warrants a thorough work-up for child maltreatment, including a top-toe examination, if necessary additional diagnostics and adequate safety measures.What is Known:• Screening instruments increase the detection of possible cases of child maltreatment in the emergency department and support health care professionals to identify these cases.• The application of different screening instruments led to the need for one brief validated instrument.What is New:• This study presents a validated and brief Screening instrument for Child Abuse and Neglect (SCAN), consisting of four questions.• The SCAN supports professionals in detecting signals of child maltreatment, and a positive screening result should lead to a thorough work-up, including a top-toe examination, complete history, additional diagnostic tests and consultation of a child abuse expert.

271 Association Between Extreme Crowding and Wellness on Shift in a Pediatric Emergency Department

271 Association Between Extreme Crowding and Wellness on Shift in a Pediatric Emergency Department

Remote Biometric Monitoring of Patients With COVID-19 With Exertional Hypoxia Treated With Supplemental Oxygen

Remote Biometric Monitoring of Patients With COVID-19 With Exertional Hypoxia Treated With Supplemental Oxygen

Interprofessional clinical event debriefing-does it make a difference? Attitudes of emergency department care providers to INFO clinical event debriefings.

Debriefing is increasingly used in clinical environments. Surveys indicate staff support for debriefing clinical events, but little is known about the specific effects of debriefing on healthcare workers in the workplace. INFO (Immediate, Not for personal assessment, Fast facilitated feedback, and Opportunity to support and ask questions) is a charge nurse facilitated clinical event debriefing program implemented in 2016 and currently used in five Emergency Departments (ED) in Calgary, Alberta, Canada. There have been more than 840 documented INFO debriefings. Thirty interprofessional ED healthcare workers were recruited through posters and email to take part in voluntary one-on-one interviews using a standardized question script that asked participants about their experience with INFO debriefing assessments. Specifically, participants were asked to provide demographic information, give feedback about their involvement in INFO clinical debriefings, impact of debriefings on their clinical practice, stress levels and wellbeing. Interviews were transcribed and analysed using NVivo software. Forty-five healthcare workers replied to the initial recruitment methods with fifteen not responding to follow-up communication. Overall, staff satisfaction with INFO debriefing was highly rated. A qualitative thematic analysis to saturation approach was used to analyse the data. Five main themes were identified: 1.Effect of debriefing on clinical practice and patient care. 2. Psychological safety and teamwork. 3. Emotional acknowledgment after critical events. 4. Managing work stress in the ED. 5. Barriers to debriefing. In this study, debriefing in the ED helped interprofessional healthcare workers manage stress, provide improved patient care and teamwork while acknowledging emotions. This study specifically involved INFO, however, there are similarities that make our findings applicable to other clinical event debriefing programs. We believe this study provides further evidence supporting debriefing in clinical care areas.

Seroprevalence of SARS-CoV-2 in Emergency Department Healthcare Workers at Sírio-Libanês Hospital, Brazil.

COVID-19 has spread rapidly worldwide. Information on its prevalence and factors associated with infection are important for protecting both professionals and patients in healthcare centers. This study evaluated the seroprevalence of antibodies against SARS-CoV-2 and its association with the degree of exposure and use of personal protective equipment by healthcare professionals dedicated to the treatment of patients with flu-like illnesses in the emergency room. The research team included an analysis of healthcare professionals who underwent enzyme-linked immunosorbent assay serological testing for SARS-CoV-2 between May 28 and June 26, 2020, in the emergency room of Sírio-Libanês Hospital in São Paulo, Brazil. Participants answered individual questionnaires on occupational information, medical health history, and factors associated with exposure to the novel coronavirus. The questionnaire variables were compared based on the serological results. Of the 164 study participants, 96 (58.54%) reported at least 1 flu-like symptom and 42 (25.61%) presented serology results that were compatible with SARS-CoV-2 infection. The asymptomatic declared group accounted for 62 participants; of these, 8 (12.90%) had positive serology results (neutralizing antibody and IgG) for SARS-CoV-2. Data analysis showed a positive correlation with duration of work, safety in wearing and reusing personal protective equipment, and presence of anosmia, and showed a negative relationship with duration of mask use. Our findings suggest that the perception of symptoms by healthcare professionals is not a good screening parameter for the diagnosis of an infectious disease with respiratory symptoms, such as COVID-19. The main influencing factor for the control of infection is the elaboration of workflows and safety protocols based on simple and clear rules as well as investments in team training.

Analysis of self-initiated visits for cervical trauma at urgent care centers and subsequent emergency department referral

BackgroundFollowing trauma involving the cervical spine (c-spine), patients often seek care at urgent care centers (UCCs) or emergency departments (EDs). PurposeThe purpose was to assess whether UCCs could effectively image acute self-selected c-spine trauma without referral to the ED as well as to estimate costs differences between UCC and ED imaging assessment. Materials and methodsThis retrospective study identified patients receiving c-spine imaging at UCCs affiliated with a large academic hospital system from 5/1/-8/31/2021. Patients receiving c-spine X-rays with an indication of trauma following low acuity injury, at UCCs were compared to patients receiving any c-spine imaging in the main campus ED. Medical record numbers were cross-referenced to identify patients receiving imaging at both a UCC and ED within 24 h and within 7 days. Work relative value units (wRVUs) for each UCC and ED imaging type were calculated. For the hypothetical scenario of patients presenting to the ED in the absence of UCC, patients were assumed to receive c-spine computed tomography (CT) without contrast per “usually appropriate” designation by the American College of Radiology Appropriateness Criteria®. ResultsAmong 143 self-selected, low acuity, patients who received c-spine X-rays at UCCs with an indication of trauma, one required referral to the ED within 24 h and two required referrals to the ED within 7 days. During the 4-month study period, 105.94 wRVUs ($3696.25) were saved by performing a c-spine X-ray in an UCC instead of a CT in the ED, extrapolated to 317.82 wRVUs ($11,088.74) per year. Using the average total costs of an UCC visit versus an ED visit, a total $145,976 was estimated to be saved during the study period or $437,928 per year. ConclusionOffering access for patient-initiated visits at UCCs for low-acuity c-spine trauma may help reduce the need for an ED visit, reducing imaging and healthcare visit costs. Summary statementUrgent Care Centers (UCCs) reduced the need for an Emergency Department (ED) referral visit in nearly 100% of self-selected, low acuity, patients with cervical trauma. Key results•Only 1.4% of patients required referral to an ED after a UCC visit for acute cervical trauma in this specific population.•In our system, UCCs are estimated to result in a savings of $437,928 over the course of a year in reduced ED visit costs, and $11,088.74 in wRVUs for this specific population.

Rural health disparities in health care utilization for dementia in Minnesota.

We visualized rural-urban differences in inpatient hospitalization and emergency department (ED) health care utilization (HCU) for older adults with dementia to understand the HCU of rural versus urban older adults in Minnesota and to examine in greater detail the variability of HCU in rural areas. For 3 older adult age groups, we utilized Healthcare Cost and Utilization Project (H-CUP) datasets from 2016 to 2018 to profile hospital admission rates, and ED visit rates related to dementia stratified by rurality and regions. Rates were visualized by spatial interpolation method. We then used logistic regression analysis adjusted by multiple covariates to evaluate rural-urban differences of the chance of having a dementia diagnosis in HCU. Minnesota rural areas showed 17.6% lower age-adjusted rate (AAR) of dementia mortality than urban areas. AARs of ED visits for dementia were 12.4% higher in rural ZIP codes, whereas AARs of hospitalization were 24.7% lower. After controlling for neighborhood-level risk factors, such as income, education, health behaviors, and provider access, the odds ratios of having dementia diagnosis are 12% lower if an ED visit patient lives in rural as opposed to an urban area (OR = 0.88, P<.0001). In comparison to AAR, the fully adjusted data showed larger rural-urban predictors of having dementia diagnoses in hospitalizations and ED utilizations and demonstrated differences between AAR of ED visit and odds ratios of having dementia diagnosis. A regional comparison revealed that dementia ED visits were higher for Northeast MN compared to Minnesota's largest metropolitan region.

Participatory Action Research on perceptions, concerns and needs of health professionals in an emergency department from Argentina

To explore perceptions, concerns and needs of healthcare professionals in an emergency department (ED) from Argentina. Participatory action research, coordinated and carried out by ED healthcare professionals, which included physicians, nurses and administrative staff who actively engaged in both data collection and analysis. Mixed methodologies were used: documentary analysis of complaints and written claims by patients, 10 individual interviews, and two reflective focus groups of 10 healthcare professionals (who differed in occupation, seniority and experience, including residents in training). The topics that emerged were work factors that lead to errors and threaten patient-centered clinical encounters: work overload and lack of time, the overuse of resources for defensive medicine purposes and technology that replaces physical contact. Healthcare professionals reported episodes of aggression by patients or their families, when long waits and structural insufficiencies (such as lack of beds, saturation of the waiting room, discomfort) threaten patience and tolerance. From these insights, improvements were generated in various areas of the ED. The identification of problems by the ED stakeholders l was a relevant approach that led to a process of collective management change, promoted reflection and raised awareness, allowing the identification of areas for improvement, design strategies and concrete feasible proposals.

Designing a Sensory Kit to Improve the Environment for Children with Autism Spectrum Disorder in the Pediatric Emergency Department.

Children with autism spectrum disorder (ASD) have more frequent use of healthcare services, including visits to the emergency department (ED). Medical care for children with ASD can be adversely affected by the highly stimulating environment of the ED. In this study, we gained insights from stakeholders with lived experience (parents of children with ASD, children with ASD, and ED healthcare providers) to create and implement a sensory equipment kit. The kit was evaluated and iteratively improved based on observations of children using the sensory equipment, satisfaction surveys from their parents, and interviews with healthcare providers in the ED. Findings from this study can be used to guide other EDs in creating their own ASD sensory kit.

Patient and Provider Perspectives on Emergency Department Care Experiences among People with Mental Health Concerns.

Emergency departments (EDs) are an important source of care for people with mental health (MH) concerns. It can be challenging to treat MH in EDs, and there is little research capturing both patient and provider perspectives of these experiences. We sought to summarize the evidence on ED care experiences for people with MH concerns in North America, from both patient and provider perspectives. Medline and EMBASE were searched using PRISMA guidelines to identify primary studies. Two reviewers conducted a qualitative assessment of included papers and inductive thematic analysis to identify common emerging themes from patient and provider perspectives. Seventeen papers were included. Thematic analysis revealed barriers and facilitators to optimal ED care, which were organized into three themes each with sub-themes: (1) interpersonal factors, including communication, patient–staff interactions, and attitudes and behaviours; (2) environmental factors, including accommodations, wait times, and restraint use; and (3) system-level factors, including discharge planning, resources and policies, and knowledge and expertise. People with MH concerns and ED healthcare providers (HCPs) share converging perspectives on improving ED connections with community resources and diverging perspectives on the interplay between system-level and interpersonal factors. Examining both perspectives simultaneously can inform improvements in ED care for people with MH concerns.

Intravenous medication errors in the emergency department, knowledge, tendency to make errors and affecting factors: An observational study

BackgroundIntravenous medication errors are common in hospital settings particularly emergency department. This study aimed to determine intravenous medication preparation and administration errors, contributing factors, tendency towards making errors and knowledge level of emergency department healthcare workers. MethodsA cross-sectional study using a structured, direct observation method was conducted. It was conducted with 23 emergency healthcare workers working in the emergency department of a university hospital in Turkey. Data were collected by questionnaires: Knowledge Test on Intravenous Medication Administration, Intravenous Drug Administration Standard Observation Form, Drug and Transfusion Administration Sub-Dimension scale, Perceived Stress Scale and Pittsburgh Sleep Quality Index. ResultsIt was determined that the knowledge level of the emergency healthcare workers about intravenous medication administration was moderate, and the tendency mistakes regarding drug and transfusion applications was very low. There was no relationship between education level, years of work, years of work in the emergency department, perceived stress level and sleep quality, and the tendency of making mistakes in drug and transfusion applications. ConclusionIt is important for patient safety to prevent medication errors by determining the factors affecting intravenous medication administration, tendency to make mistakes and knowledge levels, which are frequently used in emergency department.