Emergency Department Personnel Research Articles

9 Managing Burnout in a Prolonged Crisis: A 2-Wave Cross-Sectional Analysis of Emergency Department Personnel Over 6 Months of the COVID-19 Pandemic

Management research suggests that inclusive leaders, problem-solving teams and clear processes might matter for addressing uncertainty, but how these factors unfold during prolonged crisis and their relationship to burnout is not well understood. The study objective was to examine associations between teamwork and leadership factors and clinician burnout as the care burden increased over 8 months of the COVID-19 pandemic.

Facilitators, barriers and opportunities in workplace wellbeing: A national survey of emergency department staff

IntroductionEmergency department (ED) staff face daily exposure to the illness, injury, intoxication, violence and distress of others. Rates of clinician burnout are high and associated with poor patient outcomes. This study sought to measure the prevalence of burnout in ED personnel as well as determine the important facilitators of and barriers to workplace wellbeing. MethodAn anonymous online survey including six open-ended questions on workplace wellbeing was completed by 1372 volunteer participants employed as nurses, doctors, allied health or nonclinical roles at 22 EDs in Aotearoa, New Zealand in 2020.Responses to the questions were analysed using a general inductive approach. ResultsThe three key themes that characterise what matters most to participants' workplace wellbeing are: (1) Supportive team culture (2) Delivering excellent patient-centred care and (3) Professional development opportunities. Opportunities to improve wellbeing also focused on enhancements in these three areas. ConclusionIn order to optimise workplace wellbeing, emergency departments staff value adequate resourcing for high-quality patient care, supportive and cohesive teams and professional development opportunities. Initiatives in these areas may facilitate staff wellbeing as well as improving safety and quality of patient care.

Decreasing Blood Culture Contamination Rates When Using an Initial Peripheral IV: Implementing the 5 P's and Using a Closed System Device

Blood culture remains the gold standard for the diagnosis and treatment of bacteraemia and is the first-line tool for detecting bloodstream infections [1]. Research shows that the emergency department (ED) is an essential component of the health care system and subject to workflow challenges, which may hinder ED personnel adherence to guideline-based infection prevention practices [2]. This impact has wide-reaching effects. Moreover, a fast-paced ED presents a host of challenges with competing priorities. In addition, EDs are perceived as 24/7 portals where rapid and efficient diagnosis, urgent attention, primary care, and inpatient admission is provided for stabilizing seriously ill and wounded patients [3]. Blood culture contaminants are common, and they have a significant impact on patients and staff, contributing to unnecessary or inappropriate antibiotic treatment, increased length of stay, and costly economic burden [4]. The aim of this study was to evaluate the use of an automated blood culture collection system when drawing blood cultures from a peripheral IV and to evaluate the effectiveness of implementing evidence-based policies, procedures, practice, products, and patient care to reduce blood culture contamination rates.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Teaming and Thinking Outside the Box for Trainee Redeployment During the COVID-19 Pandemic.

We applaud Meo and colleagues' article, “Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons from the University of Washington,”1 for outlining 10 tenets based on the University of Washington redeployment experience. Furthermore, we suggest that hospital strategic and educational leaders could think outside the box and seek additional workforce reinforcements from trainees outside of Accreditation Council for Graduate Medical Education programs.Per the Interprofessional Education Collaborative Expert Panel,2 clinical practice is shifting toward team-based collaboration to deliver optimal patient-centered care. Yet, clinicians have limited training working within interprofessional teams. The COVID-19-related challenges of increased clinical demands combined with workforce shortages create unique opportunities for novel interprofessional models of redeployment.During the first wave of the pandemic, emergency department (ED) and internal medicine (IM) personnel found they needed more staff to facilitate communication with patients and families, given high caseloads, restricted visitations, and over-extended clinicians. As stated in guiding principle No. 3, program directors are the point persons to determine the scope of training for trainees. With buy-in from dental and oral pathology (D/OP) program directors and residents, we executed a novel redeployment model with D/OP residents at our academic community hospital. D/OP residents were trained as “communication partners” for ED and IM staff in anticipation of a second surge.We trained 9 residents over 3 weeks, with goals to identify appropriate surrogates for patients and to provide brief updates and emotional support. The curriculum highlighted role introduction, advance directives (AD), and empathic communication skills. Each resident practiced the skills with standardized patient actors, with real-time feedback.Educational and clinical leaders from IM and ED collaborated across disciplines with palliative medicine leaders and D/OP program directors to prepare and execute this redeployment plan. D/OP residents would be supervised by palliative care faculty.Per guiding principle No. 8, trainees should have opportunities to provide feedback and program evaluation. Post training, D/OP residents completed anonymous surveys. Their comments reflected both appreciation for the training and reluctance to engage in high-stakes communication with families of severely ill patients. Comments included:Even though the D/OP residents completed communication skills training, the ED and IM teams reported hesitation for using them in the role of “communication partner,” due to uncertainty in D/OP residents' ability to engage in difficult discussions around complex medical issues. Similarly, D/OP residents' confidence level for carrying out this new role varied by individual. Lipworth et al3 reported successful implementation of a communication liaison program to provide support and medical updates to family members of critically ill patients, utilizing subspecialists such as ophthalmologists and pathologists.The COVID-19 pandemic has brought havoc to our health care system, but also has provided opportunities for exploring new roles, more interprofessional “teaming,”4 and innovative thinking outside the box strategies for patient care.

Use of whole-genome sequencing to investigate a cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in emergency department personnel.

Several recent reports have raised concern that infected coworkers may be an important source of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) acquisition by healthcare personnel. In a suspected outbreak among emergency department personnel, sequencing of SARS-CoV-2 confirmed transmission among coworkers. The suspected 6-person outbreak included 2 distinct transmission clusters and 1 unrelated infection.

Mass-Casualty Training Exercise Using High-Fidelity Computerized Simulators and Involving Time and Resource Limitation.

Training emergency department (ED) personnel in the care of victims of mass-casualty incidents (MCIs) is a highly challenging task requiring unique and innovative approaches. The purpose of this study was to retrospectively explore the value of high-fidelity simulators in an exercise that incorporates time and resource limitation as an optimal method of training health care personnel in mass-casualty care. Mass-casualty injury patterns from an explosive blast event were simulated for 12 victims using high-fidelity computerized simulators (HFCS). Programmed outcomes, based on the nature of injuries and conduct of participants, ranged from successful resuscitation and survival to death. The training exercise was conducted five times with different teams of health care personnel (n = 42). The exercise involved limited time and resources such as blood, ventilators, and imaging capability. Medical team performance was observed and recorded. Following the exercise, participants completed a survey regarding their training satisfaction, quality of the exercise, and their prior experiences with MCI simulations. The Likert scale responses from the survey were evaluated using mean with 95% confidence interval, as well as median and inter-quartile range. For the categorical responses, the frequency, proportions, and associated 95% confidence interval were calculated. The mean rating on the quality of experiences related trainee survey questions (n = 42) was between 4.1 and 4.6 on a scale of 5.0. The mean ratings on a scale of 10.0 for quality, usefulness, and pertinence of the program were 9.2, 9.5, and 9.5, respectfully. One hundred percent of respondents believed that this type of exercise should be required for MCI training and would recommend this exercise to colleagues. The five medical team (n = 5) performances resulted in the number of deaths ranging from two (including the expectant victims) to six. Eighty percent of medical teams attempted to resuscitate the "expectant" infant and exhausted the O- blood supply. Sixty percent of medical teams depleted the supply of ventilators. Forty percent of medical teams treated "delayed" victims too early. A training exercise using HFCS for mass casualties and employing limited time and resources is described. This exercise is a preferred method of training among participating health care personnel.

Predicting waiting and treatment times in emergency departments using ordinal logistic regression models.

Since providing timely care is the primary concern of emergency departments (EDs), long waiting times increase patient dissatisfaction and adverse outcomes. Especially in overcrowded ED environments, emergency care quality can be significantly improved by developing predictive models of patients' waiting and treatment times to use in ED operations planning. Retrospective data on 37,711 patients arriving at the ED of a large urban hospital were examined. Ordinal logistic regression models were proposed to identify factors causing increased waiting and treatment times and classify patients with longer waiting and treatment times. According to the proposed ordinal logistic regression model for waiting time prediction, age, arrival mode, and ICD-10 encoded diagnoses are all significant predictors. The model had 52.247% accuracy. The model for treatment time showed that in addition to age, arrival mode, and diagnosis, triage level was also a significant predictor. The model had 66.365% accuracy. The model coefficients had negative signs in the corresponding models, indicating that waiting times are negatively related to treatment times. By predicting patients' waiting and treatment times, ED workloads can be assessed instantly. This enables ED personnel to be scheduled to better manage demand supply deficiencies, increase patient satisfaction by informing patients and relatives about expected waiting times, and evaluate performances to improve ED operations and emergency care quality.

Symptoms of Anxiety, Burnout, and PTSD and the Mitigation Effect of Serologic Testing in Emergency Department Personnel During the COVID-19 Pandemic

Study ObjectiveAmong a comprehensive range of frontline emergency department health care personnel, we assessed symptoms of anxiety and burnout, specific coronavirus disease 2019 (COVID-19) work-related stressors, and risk for post-traumatic stress disorder (PTSD). We also determined whether COVID-19 serologic testing of HCP decreased their self-reported anxiety.MethodsIn a prospective cohort study from May 13, 2020, to July 8, 2020, we used electronic surveys to capture participant self-reported symptoms before and after serologic testing for anti-SARS-CoV-2 immunoglobulin G antibodies. Participants were physicians, nurses, advanced practice providers, and nonclinical ED personnel at 20 geographically diverse United States EDs. We evaluated these domains: 1) the effects of the COVID-19 pandemic on overall stress and anxiety; 2) COVID-19-related work stressors; 3) burnout; and 4) PTSD risk (measured using the Primary Care-PTSD Screen for DSM-5, a 5-item screening instrument in which a score of ≥3 signifies high risk for PTSD). We also assessed perceptions of whether results of COVID-19 antibody testing decreased participants’ self-reported anxiety.ResultsOf 1,606 participants, 100% and 88% responded to the baseline and follow-up surveys, respectively. At baseline, approximately half (46%) reported symptoms of emotional exhaustion and burnout from their work, and 308 (19.2%, 95% confidence interval [CI] 17.3% to 21.1%) respondents screened positive for increased PTSD risk. Female respondents were more likely than males to screen positive (odds ratio [OR] 2.03, 95% CI 1.49 to 2.78). Common concerns included exposing their family and the health of coworkers diagnosed with COVID-19. After receiving antibody test results, 54% (95% CI 51.8 to 56.7) somewhat agreed, agreed, or strongly agreed that knowledge of their immune status had decreased their anxiety. A positive serology result indicating prior SARS-CoV-2 infection was associated with a higher likelihood of reporting decreased anxiety (2.83, 95% CI 1.37 to 5.83).ConclusionSymptoms of anxiety and burnout were prevalent across the spectrum of ED staff during the COVID-19 pandemic. One-fifth of ED personnel appeared to be at risk for PTSD. Increased provision of serologic testing may help to mitigate anxiety.

Prospective Longitudinal Serosurvey of Healthcare Workers in the First Wave of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic in a Quaternary Care Hospital in Munich, Germany.

BackgroundHigh infection rates among health care personnel in an uncontained pandemic can paralyze health systems due to staff shortages. Risk constellations and rates of seroconversion for health care workers during the first wave of the SARS-CoV-2 pandemic are still largely unclear.MethodsHealth care personnel (n=300) on different organizational units in the LMU Munich University Hospital were included and followed in this prospective longitudinal study in the period of March 24 until July 7, 2020. Participants were monitored in intervals of two to six weeks using different antibody assays for serological testing and questionnaires to evaluate risk contacts. In a subgroup of infected participants, we obtained nasopharyngeal swabs to perform whole genome sequencing for outbreak characterization.ResultsHealth care workers involved in patient care on dedicated COVID-19 wards or on regular non-COVID-19 wards showed a higher rate of SARS-CoV-2 seroconversion compared to staff in the emergency department and non-frontline personnel. The landscape of risk contacts in these units was dynamic, with a decrease of unprotected risk contacts in the emergency department and an increase on non-COVID-19 wards. Both, the intensity and number of risk contacts, were associated with higher rates of seroconversion. On regular wards, staff infections tended to occur in clusters, while infections on COVID-19 wards were less frequent and apparently independent of each other.ConclusionThe risk of SARS-CoV-2 infection for front-line health care workers was increased during the first pandemic wave in Southern Germany. Stringent measures for infection control are essential to protect all patient-facing staff during the ongoing pandemic.

Thoughts on Personnel Management of Disease Control Departments after Public Health Emergencies Based on the Perspective of Human Resource Management

In COVID-19 outbreak, such a sudden public health incident, the deficiency of China’s department of CDC exposed, especially the disease control department’s ability to cope with risk is low. For public health emergency department personnel management, it is a wake-up call for disease control. Starting from the current situation of personnel management in the disease control department, from the perspective of human resources management, this paper discusses how to improve the management of personnel to improve the capacity of the disease control department to respond to public health emergencies, and puts forward relevant suggestions and measures.

COVİD-19 ile Mücadele Eden Acil Servis Çalışanlarının Anksiyete Düzeyi ve Etkileyen Faktörler

Aim: We aimed to determine anxiety levels of the emergency department (ED) personnel working in close contact with infected patients and potential risk factors associated with this anxiety. 
 Materials and Methods: This cross-sectional, hospital-based study was conducted among healthcare personnel working at the ED of the tertiary healthcare hospital in question, who are directly involved in the diagnosis and treatment of COVID-19 patients. The participants were administered a questionnaire that included items on sociodemographic characteristics; items on health, social, and demographic factors considered to be related with anxiety; and the 40 items of State-Trait Anxiety Inventory (STAI). 
 Results: The study included 138 healthcare professionals. In total, 29.7% of the participants were female and 70.3% were male. The minimum and maximum ages of the participants were 21 and 52 years, respectively, with a median age of 33 (27–40) years. The mean STAI-S and STAI-T scores of healthcare professionals included in the study were 45.4 ± 10.4 and 41.3 ± 7.3, respectively. The effect of women nurses and having children, on anxiety levels was found to be significantly high. Comparing the groups categorized for their compliance with COVID-19-related measures, the state anxiety scores of the “somewhat compliant” group were found to be higher. Participants with the perception that measures taken and institution’s available capacity were insufficient were found to have statistically significantly higher STAI-S scores than the others (p < 0.001) 
 Conclusion: Maintaining mental health of healthcare personnel during a pandemic is vital to better control contagious diseases. Thus, exclusive effort should be made to maintain mental well-being of healthcare professionals being exposed to COVID-19.

First aid spirit and first aid thinking should be established in saving lives in new epidemic of coronavirus disease 2019

Saving lives is the bounden glorious mission and sacred duty of medical staff. As the front-line and cutting-edge, the emergency department and prehospital first-aid personnel have a deeper understanding and feeling. In the face of all kinds of patients and coming critical patients, as well as potential, suspected and even clearly diagnosed infectious diseases, the first-aid personnel of the emergency department performed their duties without hesitation, saved countless lives, and composed a song of life praise. In order to better carry forward and inherit this kind of boundless love, life-saving professional ethics and revolutionary spirit, this paper proposes to establish and uphold the first aid spirit in the industry and cultivate first aid thinking.

Association between personal protective equipment and SARS-CoV-2 infection risk in emergency department healthcare workers.

Background and importanceHealthcare personnel working in the emergency department (ED) is at risk of acquiring severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2). So far, it is unknown if the reported variety in infection rates among healthcare personnel is related to the use of personal protective equipment (PPE) or other factors.ObjectiveThe aim of this study was to investigate the association between PPE use and SARS-CoV-2 infections among ED personnel in the Netherlands.Design, setting and participantsA nationwide survey, consisting of 42 questions about PPE-usage, ED layout - and workflow and SARS-CoV-2 infection rates of permanent ED staff, was sent to members of the Dutch Society of Emergency Physicians. Members were asked to fill out one survey on behalf of the ED of their hospital. The association between PPE use and the infection rate was investigated using univariable and multivariable regression analyses, adjusting for potential confounders.Outcome measuresPrimary outcome was the incidence of confirmed SARS-CoV-2 infections among permanent ED staff between 1 March and 15 May 2020.ResultsSurveys were sent to 64 EDs of which 45 responded (70.3%). In total, 164 ED staff workers [5.1 (3.2–7.0)%] tested positive for COVID-19 during the study period compared to 0.087% of the general population. There was significant clustering of infected ED staff in some hospitals (range: 0–23 infection). In 13 hospitals, an FFP2 (filtering facepiece particles >94% aerosol filtration) mask or equivalent and eye protection was worn for all contacts with patients with suspected or confirmed SARS-CoV-2 during the whole study period. The unadjusted staff infection rate was higher in these hospitals [7.3 (3.4–11.1) vs. 4.0 (1.9–6.1)%, absolute difference + 3.3%]. Hospital staff testing policy was identified as a potential confounder of the relation between PPE use and confirmed SARS-CoV-2 infections (collinearity statistic 0.95). After adjusting for hospital testing policy, type of PPE was not associated with incidence of COVID 19 infections among ED staff (P = 0.40).ConclusionIn this cross-sectional study, the use of high-level PPE (FFP2 or equivalent and eye protection) by ED personnel during all contacts with patients with suspected or confirmed SARS-CoV-2 does not seem to be associated with a lower infection rate of ED staff compared to lower level PPE use. Attention should be paid to ED layout and social distancing to prevent cross-contamination of ED personnel.

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Use of complementary and alternative medicine (CAM) among emergency department (ED) patients in Sweden

BackgroundIt has been suggested that the combination of complementary and alternative medicine (CAM) with conventional medicine carries a risk of adverse effects. The prevalence of CAM usage among patients in the Swedish emergency department (ED) is unknown. Hence, the aim of this study was to investigate CAM use among visiting patients at a Swedish ED.MethodA cross-sectional descriptive study was performed between August and October 2016 at an ED in Sweden. The questionnaire included 16 items regarding CAM use, factors associated with CAM use and patient healthcare communication and was distributed to 1600 patients.ResultsA total of 1029 questionnaires was returned (RR 64.3%). Current CAM use was reported by 7.9%, during the last year by 38.0%, and within lifetime by 72.9%. Factors associated with CAM use were: being a woman, middle-aged, in full-time employment, with secondary education level, higher use of non-prescription drugs and lower use of prescription drugs. Patient healthcare personnel communication about CAM was found to be approximately 5%.ConclusionCAM usage exists among patients visiting Swedish EDs and almost one in ten uses CAM on the same day as the ED visit. CAM usage is associated with demographic factors. However, communication about CAM usage with ED personnel is poor.

Initial assessment and management of respiratory infections in persons with spinal cord injuries and disorders in the COVID-19 era.

As the COVID‐19 pandemic unfolds, emergency department (ED) personnel will face a higher caseload, including those with special medical needs such as persons living with spinal cord injuries and disorders (SCI/D). Individuals with SCI/D who develop COVID‐19 are at higher risk for rapid decompensation and development of acute respiratory failure during respiratory infections due to the combination of chronic respiratory muscle paralysis and autonomic dysregulation causing neurogenic restrictive/obstructive lung disease and chronic immune dysfunction. Often, acute respiratory infections will lead to significant mucus production in individuals with SCI/D, and aggressive secretion management is an important component of successful medical treatment. Secretion management techniques include nebulized bronchodilators, chest percussion/drainage techniques, manually assisted coughing techniques, nasotracheal suctioning, and mechanical insufflation–exsufflation. ED professionals, including respiratory therapists, should be familiar with the significant comorbidities associated with SCI/D and the customized secretion management procedures and techniques required for optimal medical management and prevention of respiratory failure. Importantly, protocols should also be implemented to minimize potential COVID‐19 spread during aerosol‐generating procedures.

Survey of ultrasound-guided peripheral intravenous practices: a report of supply usage and variability between clinical roles and departments.

The purpose of this study was to investigate ultrasound-guided peripheral intravenous (UGPIV) supply usage practices by clinicians working in vascular access, in emergency departments (EDs), or in other roles. In 2019, a voluntary cross-sectional descriptive survey was conducted via SurveyMonkey. Data collected included demographics, practice-oriented information, procedural activities, and supplies used for UGPIV insertions. Frequency distributions and results of Fisher's exact test and one-way analysis of variance were reported using R v.3.5.2. A total of 26,649 surveys were distributed with a response rate of 5.5% (n = 1475). Forty-eight percent of respondents (n = 709) indicated that they worked in a vascular access role, 310 (21%) worked in an ED, and 455 (31%) categorized their role as other. Clinically meaningful differences existed in all variables for UGPIV procedures and supplies between departments (P < 0.0001) and in all care settings. Using an investigatorconstructed overall metric of supplies used, important differences were demonstrated between personnel supply use in vascular access roles and other roles (P < 0.0001) and personnel in EDs and other roles (P < 0.0001). Use of supplies for UGPIV insertions varies by department. The variability in supply usage for UGPIV insertions revealed by this survey suggests a need for clinical education on guideline application and evaluation of compliance with policies to promote standardization of supplies for UGPIV insertion.

S2981 Emphysematous Gastritis: An Uncommon Cause of Acute Abdomen

INTRODUCTION: Emphysematous gastritis (EG) is defined as air within the gastric wall leading to inflammation and systemic compromise. It is often caused by gas-forming microorganisms. Malignancy, bowel obstruction, excessive steroid use, chemotherapy, nonsteroidal anti-inflammatory drugs, and perforated ulcers can all lead to EG. We report the case of a male who presented with peritonitis and septic shock in the setting of intramural air in the stomach. CASE DESCRIPTION/METHODS: An 83-year-old male with history of congestive heart failure, diabetes mellitus, hypertension, and hyperlipidemia presented with diffuse abdominal pain for 2 days. On presentation, the patient was tachycardic, tachypneic, and hypotensive. Initial Laboratory values are shown in table 1. Examination revealed a rigid abdomen with guarding and rebound tenderness. He was started on IV norepinephrine to maintain blood pressure. NG tube was placed which produced 1.5 L of dark fluid. CT angiogram of abdomen illustrated intraperitoneal free air and evidence of pneumatosis within the fundus and posterior wall of the body of the stomach (figure 1a, 1b, 1c). An emergent exploratory laparotomy was performed with wedge resection of the fundus. During the procedure, copious amounts of purulent material was noted which was cultured, revealing Candida glabrata. Postoperatively, the patient was transferred to the intensive care unit for further management. He remained hypotensive despite fluid resuscitation requiring vasopressors. Patient was started on fluconazole and piperacillin-tazobactam as antimicrobial therapy. His condition improved and was successfully extubated, and transferred to the surgical floors. He was later discharged to a nursing facility in stable condition. DISCUSSION: EG often presents with systemic compromise. The diagnosis requires a CT scan. Although a serious illness, conservative management is usually first attempted before considering surgical intervention. Vasopressors and fluid resuscitation are sometimes required to stabilize the patient hemodynamically. Appropriate antimicrobial therapy should be initiated with coverage of anaerobic organisms, gram negative organisms as well as candida species. If patients develop complications, such as peritonitis or fail conservative management, surgical intervention is warranted. Although rare, ED personnel should consider this condition in differentials of acute abdomen as prompt diagnosis and management can be lifesaving.Table 1.: Illustrating laboratory values on presentationFigure 1.: Figure 1a (coronal), 1b (sagittal) and 1c (axial): abdominal CT scan illustrating pneumatosis seen within the fundal portions and posterior wall of the body of the stomach (red arrows) with gastric distention.

Delirium prevention and treatment in the emergency department (ED): a systematic review protocol

IntroductionDelirium is a dangerous syndrome of acute brain dysfunction that is common in the emergency department (ED), especially among the geriatric population. Most systematic reviews of interventions for delirium prevention...