Emergency Physician Perceptions Research Articles

Perceptions of gender equity in emergency medicine in Canada.

Women-identifying emergency physicians face gender-based discrimination throughout their careers. The purpose of this study was to explore emergency physician's perceptions and experiences of gender equity in emergency medicine. We conducted a secondary analysis of data from a previously conducted survey of Canadian emergency physicians on barriers to gender equity in emergency medicine. Survey responses were analyzed using logistic regression to determine the impact that gender, practice setting, years since graduation, race, equity-seeking status, and parental status had on agreement about gender equity in emergency medicine and five of the problem statements. A total of 710 participants completed the survey. Most identified as women (58.8%), white (77.4%), graduated between 2010 and 2019 (40%), had CCFP (Emergency Medicine) designation (47.9%), an urban practice (84.4%), were parents (62.4%) and did not identify as equity-seeking (79.9%). Women-identifying physicians were less likely to perceive gender equity in emergency medicine, OR 0.52, CI [0.38, 0.73]. Women-identifying physicians were more likely to agree with statements about microaggressions, OR 4.39, CI [2.66, 7.23]; barriers to leadership, OR 3.51, CI [2.25, 5.50]; gender wage gap, OR 13.46, CI [8.27, 21.91]; lack of support for parental leave, OR 2.85, CI [1.82, 4.44]; and education on allyship, OR 2.23 CI [1.44, 3.45] than men-identifying physicians. In this study, women-identifying physicians were less likely to perceive that there was gender equity in emergency medicine than men-identifying physicians. Women-identifying physicians agreed that there are greater barriers for career advancement including fewer opportunities for leadership, a gender wage gap, a lack of parental leave policies to support a return to work and a lack of education for men to become allies. Men-identifying physicians were less aware of these inequities. Health systems must work to improve gender equity in emergency medicine and this will require education and allyship from men-identifying physicians.

Emergency Physician Perceptions of Electronic Health Record Usability and Safety.

Despite requirements for electronic health record (EHR) vendor usability testing, usability challenges persist, contributing to patient safety concerns. We sought to identify emergency physicians' perceived EHR usability and safety strengths and shortcomings across major EHR vendor products. Fifty-five emergency physicians from 4 different hospitals were interviewed. The interviews were qualitatively analyzed, and physician comments were aligned with a usability taxonomy to identify emerging themes by vendor and hospital. Of the 194 comments about usability, the 3 most commonly discussed usability topics were Workflow Support (33.5% of comments), Visual Display (20.1%), and Data Entry (14.4%). Electronic health record usability strengths were centered on Visual Display, and the most common shortcoming was the lack of Workflow Support. Fourteen cross-hospital/cross-vendor themes, 6 vendor-specific themes, and 4 hospital-specific themes were identified. Usability shortcomings that spanned across hospitals and vendors may suggest a need for more applied research and improved design to resolve these issues. Shortcomings that are localized to a specific product or hospital may be due to customization and may be addressable by learning from other organizations.

Triage and Ongoing Care for Critically Ill Patients in the Emergency Department: Results from a National Survey of Emergency Physicians.

IntroductionWe conducted a cross-sectional study at the Icahn School of Medicine at Mount Sinai to elicit emergency physician (EP) perceptions regarding intensive care unit (ICU) triage decisions and ongoing management for boarding of ICU patients in the emergency department (ED). We assessed factors influencing the disposition decision for critically ill patients in the ED to characterize EPs’ perceptions about ongoing critical care delivery in the ED while awaiting ICU admission.MethodsThrough content expert review and pilot testing, we iteratively developed a 25-item written survey targeted to EPs, eliciting current ICU triage structure, opinions on factors influencing ICU admission decisions, and views on caring for critically ill patients “boarding” in the ED for >4–6 hours.ResultsWe approached 732 EPs at a large, national emergency medicine conference, achieving 93.6% response and completion rate, with 54% academic and 46% community participants. One-fifth reported having formal ICU admission criteria, although only 36.6% reported adherence. Common factors influencing EPs’ ICU triage decisions were illness severity (91.1%), ICU interventions needed (87.6%), and diagnosis (68.2%), while ICU bed availability (13.5%) and presence of other critically ill patients in ED (10.2%) were less or not important. While 72.1% reported frequently caring for ICU boarders, respondents identified high patient volume (61.3%) and inadequate support staffing (48.6%) as the most common challenges in caring for boarding ICU patients.ConclusionPatient factors (eg, diagnosis, illness severity) were seen as more important than system factors (eg, bed availability) in triaging ED patients to the ICU. Boarding ICU patients is a common challenge for more than two-thirds of EPs, exacerbated by ED volume and staffing constraints.

Validation of the short form of the International Crowding Measure in Emergency Departments: an international study

There is little consensus on the best way to measure emergency department (ED) crowding. We have previously developed a consensus-based measure, the International Crowding Measure in Emergency Departments. We aimed to externally validate a short form of the International Crowding Measure in Emergency Department (sICMED) against emergency physician's perceptions of crowding and danger. We performed an observational validation study in seven EDs in five different countries. We recorded sICMED observations and the most senior available emergency physician's perceptions of crowding and danger at the same time. We performed a times series regression model. A total of 397 measurements were analysed. The sICMED showed moderate positive correlations with emergency physician's perceptions of crowding, r = 0.4110, P < 0.05) and safety (r = 0.4566, P < 0.05). There was considerable variation in the performance of the sICMED between different EDs. The sICMED was only slightly better than measuring occupancy or ED boarding time. The sICMED has moderate face validity at predicting clinician's concerns about crowding and safety, but the strength of this validity varies between different EDs and different countries.

VALIDATION OF THE SHORT FORM OF THE INTERNATIONAL CROWDING MEASURE IN EMERGENCY DEPARTMENTS (ICMED): INTERNATIONAL STUDY

Objectives & BackgroundThere is little consensus on the best way to measure emergency department crowding. We have previously developed a consensus based measure, the International Crowding Measure in Emergency Departments...

Emergency physician perceptions of shared decision-making.

Despite the potential benefits of shared decision-making (SDM), its integration into emergency care is challenging. Emergency physician (EP) perceptions about the frequency with which they use SDM, its potential to reduce medically unnecessary diagnostic testing, and the barriers to employing SDM in the emergency department (ED) were investigated. As part of a larger project examining beliefs on overtesting, questions were posed to EPs about SDM. Qualitative analysis of two multispecialty focus groups was done exploring decision-making around resource use to generate survey items. The survey was then pilot-tested and revised to focus on advanced diagnostic imaging and SDM. The final survey was administered to EPs recruited at four emergency medicine (EM) conferences and 15 ED group meetings. This report addresses responses regarding SDM. A purposive sample of 478 EPs from 29 states were approached, of whom 435 (91%) completed the survey. EPs estimated that, on average, multiple reasonable management options exist in over 50% of their patients and reported employing SDM with 58% of such patients. Respondents perceived SDM as a promising solution to reduce overtesting. However, despite existing research to the contrary, respondents also commonly cited beliefs that 1) "many patients prefer that the physician decides," 2) "when offered a choice, many patients opt for more aggressive care than they need," and 3) "it is too complicated for patients to know how to choose." Most surveyed EPs believe SDM is a potential high-yield solution to overtesting, but many perceive patient-related barriers to its successful implementation.

Emergency physician perceptions of medically unnecessary advanced diagnostic imaging.

The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice. As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented. In this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be "extremely" or "very" helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high-yield solutions that must be addressed simultaneously to curb overimaging.

Emergency Physician and Stroke Specialist Beliefs and Expectations Regarding Telestroke

Telestroke has been effective in the management of acute ischemic stroke. This study characterizes and compares stroke specialist (SS) and emergency physician (EP) perceptions of telestroke and identifies barriers preventing increased implementation. A survey was developed and distributed nationwide to 382 SSs through an online survey system and in paper form to 226 EPs attending the 2008 American College of Emergency Physicians national conference. Stroke specialists perceived themselves to be more knowledgeable about telemedicine and telestroke (P<0.001 and P=0.010, respectively). A large majority of physicians in both specialties either strongly agreed or agreed that telestroke will reduce geographical differences in stroke management and that it is superior to telephone consultation. EPs perceived patient preference (P<0.001), recombinant tissue plasminogen activator side effects (P<0.001), level of technology (P=0.005), and recombinant tissue plasminogen activator not the standard of care (P<0.001) to be more significant obstacles to increased implementation of telestroke than SSs. However, SSs found increased personal work to be a greater barrier than EPs (P<0.001). SSs and EPs report positive beliefs regarding telestroke; however, perceived obstacles exist to implementation. Differences between barriers perceived by EPs and SSs need to be addressed to enhance acute ischemic stroke treatment.

Emergency Physician Perceptions of Patient Safety Risks

Although national standards to address patient safety exist, their relevance to emergency department (ED) patient safety is unclear. We survey practicing emergency physicians to assess their perceptions of the relative importance of patient safety concerns and how these varied by urban/rural location and practice characteristics. We developed and analyzed electronically collected survey data that assessed emergency physician perceptions of patient safety risks. American College of Emergency Physicians (ACEP) members rated 16 patient safety concerns with a 5-point Likert scale. Of 2,507 emergency physician respondents, 1,114 (44%) practiced in urban, 1,056 (42%) in suburban, and 337 (13%) in rural settings. Crowding from inpatient boarding (mean Likert scale score 4.3), availability of specialty consultation (mean 4.1), and nursing shortages (mean 3.9) were the greatest concerns. Rural respondents ranked consultant availability (mean 4.3), lack of follow-up after ED care (mean 3.8), and nurse shortages (mean 3.8) as top concerns. Crowding was the greatest concern for suburban (mean 4.3) and urban emergency physicians (mean 4.5) but was ranked seventh by rural emergency physicians (mean 3.5). Crowding was perceived as a greater problem as hospital size, ED volume, and the percentage of patients who left without being seen increased, regardless of practice location. In this sample of practicing emergency physicians, rural emergency physicians' patient safety concerns differ from those of their urban/suburban counterparts. For urban/suburban emergency physicians, crowding is the greatest safety concern; for rural emergency physicians, consultant availability was the greatest concern. Emergency physicians' greatest concerns are not routinely measured and reported as part of national patient safety benchmarking programs.

99: Emergency Physician Perceptions of Patient Safety Risks

Patient safety in the emergency department (ED) is of great concern to all emergency physicians (EP), however, which factors are most concerning to EPs may vary by practice characteristics. We were interested in EP perceptions of patient safety priorities and how they varied across ED characteristics. We were also interested whether national safety concerns mirrored those of EPs. We hypothesized that EP patient safety concerns would differ by ED characteristics.

Emergency physician perceptions of radiology before and after the installation of an electronic work-queue display

Study objectives: Radiology tests are a key component of emergency care. Retrieval of radiology results by emergency physicians may require significant effort and can be complicated by futile retrieval attempts when results are not complete, especially in the use of digital radiology. In our emergency department (ED), an electronic test queue, similar to an airport arrival display, is available for laboratory studies, although final laboratory results are obtained by the emergency physician from a separate information system. Previous studies have shown that implementing a laboratory queue display improves emergency physician work, communication, and perceptions. Before the study, radiology did not display the testing queue of studies, and it was difficult to obtain confirmation of study scheduling, expected study performance time, study completion, and preliminary interpretations. After programming developments, radiology produced a display similar to that of the laboratory, although not functionally identical. The purpose of this study is to compare emergency physician perceptions of radiology services before and after the radiology testing queue was displayed and to determine whether testing queue information alone is sufficient to change emergency physician perceptions of radiology. We hypothesize that emergency physician perceptions and satisfaction will improve when the radiology testing queue is displayed. Methods: The study was conducted in a university Level I trauma center with 90,000 annual visits and a 3-year emergency medicine residency with 30 residents. Radiology ED services are completely digital, with the exception of ultrasonography. Emergency physicians were surveyed for perceptions and overall satisfaction with radiology services (Likert scale 1 to 7, 7=best). Emergency physicians were initially surveyed before the installation of a radiology queue display (September 2003). A follow-up survey of the same emergency physicians took place (April 2004) after the radiology queue display had been functioning for 2 months. All emergency medicine residents and faculty working were eligible for the initial survey. Data were analyzed using dependent t tests. Results: Initial surveys were returned by 43 (64.2%) of 67 emergency physicians. Follow-up surveys were returned by 25 (81%) of 35 available emergency physicians. Data analysis showed that there was no significant interval change in emergency physician awareness of radiology tests being processed (4.88 versus 5.04, 95% confidence interval [CI] –1.09 to 0.77), awareness of tests completed (3.44 versus 3.96, 95% CI –1.26 to 0.22), or awareness of results available (3.12 versus 3.12, 95% CI –0.77 to 0.77). Furthermore, there was no measurable difference in perceived quality of communication of results (3.34 versus 3.58, 95% CI –1.04 to 0.56), perceived turnaround time (2.59 versus 3.16, 95% CI –1.26 to 0.12), reliability of results, (4.00 versus 4.44, 95% CI –1.24 to 0.36), or overall service to the ED (3.56 versus 3.88, 95% CI –1.04 to 0.38). Conclusion: Displaying the work queue electronically for radiology studies does not appreciably improve physician awareness of test status, nor does it improve physician perceptions of reliability or overall quality of radiology service to the ED. Although providing information about test queues has been shown with laboratory status to change emergency physician work and perceptions, a similar process for radiology is not sufficient to improve emergency physician perceptions.