Emergency Department Health Care Workers Research Articles

Factors associated with mental health outcomes in emergency department healthcare workers on the frontlines of the COVID-19 pandemic.

Factors associated with mental health outcomes in emergency department healthcare workers on the frontlines of the COVID-19 pandemic.

Variations in Salivary Stress Biomarkers and Their Relationship with Anxiety, Self-Efficacy and Sleeping Quality in Emergency Health Care Professionals.

Hospital healthcare workers of emergency departments (EDs) face a variety of occupational stressors on a daily basis. We have recently published that emergency professionals display increased salivary levels of α-amylase and dehydroepiandrosterone during the working day. The pattern of these markers may suggest a counteracting mechanism of dehydroepiandrosterone against the stress reflected by amylase increases. In order to verify this hypothesis, we have analysed different psychological aspects in the same group of healthcare professionals through different tests related to behaviours resulting from stress. These include the state-trait anxiety inventory, the self-efficacy test and the sleeping quality questionnaire. The tests were provided at the beginning of the working day and collected at the end. STAI scores (trait and state) were indicative of no anxiety. Self-efficacy scores were considered optimal, as well as those from the sleeping quality questionnaire. This is supported by the modest correlation between STAI scores and salivary levels of α-amylase and dehydroepiandrosterone. In conclusion, the emergency professionals of the studied hospitals seem to have adequate work management. Altogether it means that the stress generated during work performance is controlled, allowing a correct adaptation to the demanding situations undergone in emergency departments.

Leadership communication, stress, and burnout among frontline emergency department staff amid the COVID-19 pandemic: A mixed methods approach

BackgroundOrganizations have a key role to play in supporting healthcare workers (HCWs) and mitigating stress during COVID-19. We aimed to understand whether perceptions of support and communication by local leadership were associated with reduced reports of stress and burnout among frontline HCWs. MethodsWe conducted cross-sectional surveys embedded within emergency department (ED) workflow during the first wave of COVID-19 from April 9, 2020 to June 15th, 2020 within three EDs of a multisite health system in the Northeast United States. All ED HCWs were administered electronic surveys during shift via text message. We simultaneously conducted 64 qualitative interviews to better characterize and validate survey responses. Primary survey outcomes were levels of work stress and burnout. ResultsOver 10 week study, 327 of 431 (76%) frontline HCWs responded to at least one round of the survey. More useful communication mediated through higher perception of support was significantly associated with lower work stress (B = −0.33, p < 0.001) and burnout (B = −7.84, p < 0.001). A one-point increase on the communication Likert scale was associated with a 9% reduction in stress and a 19% reduction in burnout. Three themes related to effective crisis communication during COVID-19 emerged in interviews: (1) information consolidation prior to dissemination, (2) consistency of communication, and (3) bi-directional communication. ConclusionThis work suggests that effective local leadership communication, characterized by information consolidation, consistency, and bi-directionality, leads to higher perceptions of support and lower stress and burnout among ED frontline workers. As the pandemic continues, these results present an evidence-based framework for leaders to support frontline HCWs through effective crisis communication.

Risk for short-term undesirable outcomes in older emergency department users: Results of the ER2 observational cohort study.

The "Emergency Room Evaluation and Recommendations" (ER2) is a clinical tool designed to determine prognosis for the short-term Emergency Department (ED) undesirable outcomes including long length of stay (LOS) in ED and in hospital, as well as the likelihood of hospital admission during an index ED visit. It is also designed to guide appropriate and timely tailor-made geriatric interventions. This study aimed to examine whether ER2 assessment part was: 1) usable by ED healthcare workers (e.g. nurses) and 2) scoring system associated with long LOS in ED and in hospital, as well as hospital admission in older ED users on stretchers. Based on an observational, prospective and longitudinal cohort study 1,800 participants visiting the ED of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited between September and December 2017. ER2 assessment determined three risk-levels (i.e., low, medium and high) for short-term ED undesirable outcomes. The rate of ER2 digital form completed, the time to fill ER2 items and obtain ER2 risk-levels, the LOS in ED and in hospital, and hospital admission were used as outcomes. ER2 was usable by ED nurses in charge of older ED users. High-risk group was associated with both increased ED stay (coefficient of regression β = 3.81 with P≤0.001) and hospital stay (coefficient of regression β = 4.60 with P = 0.002) as well as with hospital admission (HR = 1.32 with P≤0.001) when low ER2 risk level was used as referent level. Kaplan-Meier distributions showed that the three risk groups of participants differed significantly (P = 0.001). Those with high-risk level (P≤0.001) were discharged later from hospital to a non-hospital location compared to those with low risk. There was no significant difference between those classified in low-risk and in medium-risk groups (P = 0.985) and those in medium and high-risk groups (P = 0.096). The ER2 assessment part is usable in daily practice of ED care and its risk stratifications may be used to predict adverse outcomes including prolonged LOS in ED and in hospital as well as hospital admission. NCT03964311.

38 Posttraumatic Stress in Emergency Department Health Care Workers During the COVID-19 Outbreak in Brooklyn, New York

Emergency department (ED) health care workers (HCW) have experienced extensive mental health burden in the fight against COVID-19. This study measured symptoms of post-traumatic stress disorder (PTSD) in ED HCW in Brooklyn, New York, experienced during the peak of the COVID-19 pandemic.

Mental Health of Emergency Department Healthcare Workers During COVID-19 in Brooklyn, New York, United States

Background: Mental health symptoms in Emergency Department healthcare workers were measured in Brooklyn, New York, a COVID-19 epicenter.Methods: An email-distributed survey of Emergency Department healthcare workers was conducted September–December, 2020. Primary outcomes included symptoms of depression, psychological distress, perceived stress, and post-traumatic stress disorder (PTSD). Primary predictors included gender, age, race, healthcare worker status, SARS-CoV-2 testing, number of people to talk to, COVID-19-related home problems, mental health care interruption during COVID-19, loneliness, and survey date. Multivariable-adjusted linear regression analyses predicted continuous scores (b-coefficient, p-value). Multivariable-adjusted logistic regression analyses modelled likelihoods of clinically-relevant symptom burdens (Odds Ratio (OR) 95%Confidence Interval (95%CI)).Findings: Of 774 healthcare workers, 247 (31.9%) responded (mean age, 38.2±10.8 years; 59.4% White; 52.5% men; 80.1% clinical; 61.6% SARS-CoV-2 tested). Clinically-relevant symptom burdens were observed for psychological distress (35.8% clinical vs 13.8% non-clinical healthcare workers (p=0.019); and suggested for depression (53.9% clinical vs 35.7% non-clinical, p=0.072); perceived stress (63.6% clinical vs 44.8% non-clinical, p=0.053); and PTSD (18.2% clinical vs 3.6% non-clinical, p=0.064). Higher odds of clinically-relevant depression, perceived stress, and PTSD symptoms were observed for clinical vs non-clinical healthcare workers (ORs>1.0, 95%CI>1.00 lower limit). Increasing age, number of COVID-19-related home problems and people to talk to, loneliness and mental health care interruption were adversely associated with mental health (pInterpretation: COVID-19-related mental health burden was amplified among Emergency Department healthcare workers in Brooklyn.Funding: Maimonides Research Foundation; the NIH/National Heart, Lung and Blood Institute/National Institute on Aging, 3U01 HL146202 02S2.Declaration of Interest: None to declare. Ethical Approval: This protocol was approved by the Maimonides Medical Center institutional review board, and deemed exempt because the survey was anonymous and did not contain personal identifiers.

Prevalence, risk factors and sources of anxiety among Emergency Department healthcare workers in Pakistan during COVID-19 pandemic: A single center survey

Summary COVID-19 has challenged the mental health of healthcare workers confronting it world-wide. Our study identifies the prevalence and risk of anxiety among emergency healthcare workers confronting COVID-19 in Pakistan. We conducted a cross-sectional survey in an Emergency Department using the Generalized Anxiety Scale (GAD-7), and questions about sources of anxiety. Of 107 participants, 61.7% were frontline workers. The prevalence of anxiety was 50.5%. Nonparametric tests determined that nurses, younger and inexperienced staff, developed significant anxiety. Multivariate ordinal regression determined independent risk factors for developing anxiety were younger age (OR 2.11, 95% CI 0.89–4.99) and frontline placement (OR 1.34, 95% CI 0.33–1.66). Significant sources of stress were fear of infecting family (P = 0.003), lack of social support when the health care providers were themselves unwell (P = 0.02) and feelings of inadequate work performance (P = 0.05). Our study finds that HCWs’ anxiety is considerable. Appropriate measures for its alleviation and prevention are required.

Workplace violence among health-care workers in emergency departments of public hospitals in Dammam, Saudi Arabia.

Workplace violence is a serious occupational health problem. Emergency health-care workers have a high risk of exposure to violence with negative personal consequences. To estimate the prevalence and possible associated factors of workplace violence among health-care workers in emergency departments of public hospitals in Dammam, Saudi Arabia. A cross-sectional study was conducted during August to October 2018 at 4 emergency departments of public hospitals belonging to the Saudi Ministry of Health. Data were collected using a self-administered questionnaire. Of 380 questionnaires distributed, 324 were returned (85% response rate). Almost two thirds of the participants were women (66.4%) and more than half (54%) were nurses. A total of 155 health-care workers (47.8%) had experienced at least 1 type of violent incident in the preceding 12 months. Of the total violence incidents, 52% were verbal abuse, 19% were physical violence, and sexual harassment (3%) was the least common. Lack of encouragement to report incidents and Saudi nationality were the only significant variables associated with workplace violence. Workplace violence was prevalent, and verbal abuse was the commonest type among health-care workers in emergency departments of Saudi hospitals. Encouragement to report violent incidents and raising awareness among health-care workers about violence reporting systems are important strategies to improve workplace safety.

SARS-CoV-2 infection among asymptomatic healthcare workers of the emergency department in a tertiary care facility.

Healthcare workers (HCWs) represent a high-risk category during the coronavirus disease 2019 (COVID-19) pandemic crisis, with frontline HCWs at emergency departments (EDs) may be at an even higher risk. Determining the spread of infection among HCWs may have implications for infection control policies in hospitals. This study aimed to detect severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection among asymptomatic HCWs of the ED of a large tertiary center in Cairo, Egypt. The study was conducted from June 1st to June 14th, 2020. All the recommended national and international indications on infection control measures were followed. Two hundred and three HCWs were included in the study and tested by nasopharyngeal swab (NPS) and rapid serological test (RST). Descriptive statistical analyses were used to summarize the data. Of the 203 HCWs, 29 (14.3 %) tested positive by real-time reverse transcription polymerase chain reaction (RT-PCR). Thirty-seven (18.2 %) HCWs tested positive with RST: 20 with both IgM and IgG; 14 with IgM only, and 3 with IgG only. Age, gender, and/or occupation were not risk factors for SARS-CoV-2 infection. Point prevalence of COVID-19 in asymptomatic HCWs in ED of tertiary care facility is 14.3 % by RT-PCR. This illustrates the importance of screening all HCWs regardless of symptoms, and the need for strict measures in securing HCWs to reduce transmission from healthcare facilities to the community during the current pandemic.

Prevalence and Determinants of Workplace Violence among Physicians and Nurses at Emergency Department in Ministry of Health Hospitals, Jeddah 2019

Background: Emergency healthcare workers (HCWs) have a high risk of exposure to violence with negative personal consequences. Violence is an occupational hazard in hospitals. Occupational researches have gradually shifted focus from traditional, visible environmental risk factors, such as physical, chemical, biological exposure or ergonomic problems, to the invisible, psychological harm that maybe present in the workplace. For example, violence in the workplace is a possible cause of stress, and can contribute to a greater morbidity of asthma. In addition, it can lead to a shortage of health care workers and undermine the quality of health services; study in Riyadh showed that the prevalence of violence among HCWs was 47.8%, which was considerably lower than 89.3% in nurses in the EDs in 3 public hospitals in Saudi Arabia. Because of the increased risk factors associated with violence, the US Department of Labor Occupational Safety and Health Administration (OSHA) has made an effort to establish guidelines for the prevention of workplace violence. Aim of the study: To explore the prevalence of physical and verbal workplace violence among physicians and nurses in emergency department at Ministry of Health Hospitals, Jeddah 2019. Method: Cross-sectional analytical study has been conducted at emergency departments (EDs), Ministry of health hospitals in Jeddah city, during data collection period 2019, the total sample has been (175) physicians and nurses. Results: age the highest age was (42.0%) were (30-35) years and the data ranged from (23-50) by mean ±SD (32.55±5.331), (61.1%) were females (38.9%)while males. (63.4%) Saudi, the majority of participated nursing were(70.3%). Regarding age, marital status, place of work, Years of experience in ER department results show a significant relation between Physical or Verbal violence and age, marital status, place of work, Years of experience in ER department. Conclusion: Workplace violence was prevalent, and verbal abuse was the commonest type among HCWs in emergency departments of hospitals. Workplace violence, a possible cause of job stress, has recently become an important concern in occupational health. Almost half of the ED physicians and nurses experienced one or more WPV incident. Encouragement to report violent incidents and raising awareness among HCWs about violence reporting systems are important strategies to improve workplace safety.

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.

Use of World Health Organization Guidelines to Improve Hand Washing Efficacy.

Hand washing continues to be the number one most effective way to prevent the spread of germs. This quality improvement project examines whether a hands-on soap and water hand washing tutorial increases the quality of hand washing technique. The Glow Team developed and presented an evidence-based hands-on teaching tutorial demonstrating proper hand washing technique as recommended by the World Health Organization to 100 emergency department health care workers. The efficacy of the technique was evaluated by applying black light-sensitive lotion. Participants washed their hands before and after the education session. Participants completed a posttest to evaluate their gained knowledge of hand washing. Hand washing efficacy improved from 60% preeducation to 82% posteducation. Each individual step noted improvement posteducation. Of 100 participants, 98 reported this education was helpful and suggested yearly competencies, posted fliers, and repeated demonstrations to improve compliance among self and peers. [J Contin Educ Nurs. 2020;51(10):453-456.].

Universal screening for SARS-CoV-2 infection: a rapid review.

Universal screening for SARS-CoV-2 infection: a rapid review.

Prevalence of methicillin-resistant Staphylococcus aureus colonization in the emergency department health care workers

Introduction: AThe aim of this study was to evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in the health care workers of emergency department of Imam Reza hospital, Tabriz, Iran Methods: In a total of 63 physicians and nurses in the emergency department of Imam Reza hospital, after obtaining written consent and completing a checklist, a sample of nasal mucosa was collected for microbiological examination and isolation of Staphylococcus aureus (SA) strain. Determination of resistance patterns (by diffusion method) was performed according to the standard methods of methicillin. Results: Out of 63 participants, 8 subjects (12.7%) had colonization of S. aureus; 4 of them were physicians (17.3% of the participated physicians) and 4 were nurses (10% of the participated nurses). Out of 8 isolated SA, 2 cases (25%) and overall 3.1% were methicillin-resistant. In our study, there was a significant relationship between co-employment in other hospitals and patient care at home with SA colonization, but there was not a significant relationship with specialty, work experience, sinusitis, history of antibiotic use, history of skin disease, hand washing habits and use of personal protective equipment. Conclusion: Prevalence of MRSA was not high among health workers of emergency department.

Creating Successful Emergency Department and Intensive Care Unit Team Dynamics

Hospital emergency departments (EDs) and intensive care units (ICUs) are part of the frontline response to the coronavirus disease 2019 (COVID-19) pandemic, caring for both infected and uninfected critically ill patients. To maintain effective sustainable multidisciplinary teams of health care workers, team dynamics and institutional support structures must be strong. During this pandemic, health care workers in EDs and ICUs have been susceptible to unique influences and fears.1,2 Mayo Clinic responded to concerns of their health care workers by rapidly implementing changes in communication approaches throughout the institution, which EDs and ICUs used to meet the needs of staff in these strategic areas.

Rapid responses in the emergency department of Linkou Chang Gung Memorial Hospital, Taiwan effectively prevent spread of COVID-19 among healthcare workers of emergency department during outbreak: Lessons learnt from SARS

sLinkou Chang Gung Memorial Hospital, Taiwan has been on the forefront of efforts to manage and mitigate the Coronavirus Disease 2019 (COVID-19) pandemic since 20th January 2020. Despite having one of the largest and busiest emergency departments (EDs) in the world, we have managed to maintain a “zero-infection” rate among our ED healthcare workers through various systematic approaches. The measures implemented include establishing a clear flowchart with route planning, strict infection control policies and regulation of medical equipment, and team-based segregation in the workplace. These strategies, borne of our experience during the severe acute respiratory syndrome (SARS) outbreak, can complement a network of well-trained personnel to enable EDs around the world in successfully mounting an effective defense against new airborne illness while minimizing healthcare personnel casualties.

Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other personal protective equipment

The COVID-19 pandemic is highly challenging for the operating room staff and healthcare workers in emergency departments. SARS-CoV-2 is a positive-sense single-stranded RNA beta-coronavirus that primarily targets the human respiratory system, with fever, cough, myalgia, and pneumonia as the most common manifestations. However, since SARS-CoV-2 RNA was detected in stool specimens much more attention has been paid to gastrointestinal symptoms such as loss of appetite, nausea, and diarrhea. Furthermore, the expression of ACE-2 receptors in absorptive enterocytes from ileum and colon suggests that these organs should also be considered as a potential high risk for SARS-CoV-2 infection. During aerosol-generating medical procedures (AGMP; e.g. intubating and extubating patients or any surgical procedures), the production of both airborne particles and droplets may increase the risk of infection. In this situation, the surgical staff is strongly recommended to wear personal protective equipment (PPE). A transparent plastic cube, the so-called “Aerosol Box” (AB), has been recently designed to lend further protection against droplets and aerosol exposure during the AGMP.

Non-COVID and COVID emergency department healthcare workers’ perception of COVID-19 at Patan Hospital, Nepal

Introduction: Patan Hospital (PH), Patan Academy of Health Sciences (PAHS) has separated non COVID and COVID emergencies for the safety of health care workers (HCWs). This study was conducted to assess the safety perception of healthcare workers working in emergency departments during the outbreak of COVID-19.&#x0D; Method: A cross sectional descriptive study was conducted among HCWs in non COVID and COVID emergency departments at PH, PAHS, Nepal, in April 2020 during COVID-19 outbreak. Questionnaires containing open and closed questions were used. Ethical approval was obtained.&#x0D; Result: Out of 72 HCWs, 58 (80.5%) responded, 47 (81%) felt need to have separate non COVID and COVID emergencies, 27 (46.6%) answered they were not comfortable working with the partial PPE (masks, gloves), 29 (50%) felt the need of having primary and secondary triaging.&#x0D; Conclusion: Emergency staff expressed need of having separate non COVID and COVID emergencies, and importance of primary and secondary triage.

Real-time display of laboratory testing status improves satisfaction levels in an emergency department: A pilot study.

BackgroundClinicians need to know timelines of requested laboratory tests to provide effective patient management. We developed a real‐time laboratory progress checking system and measured its effectiveness using appropriate indicators in an emergency room setting.MethodsIn our original in‐house health information system display, blank spaces, which were generated for test results when tests were ordered, remained empty until the final results reported. We upgraded the laboratory reporting system to show real‐time testing information. The stages included requests for test, label printing, sampling, laboratory receipts, performance of tests, verification of results, and interpretation of results and final report by laboratory physician. To assess the usefulness of the function, we measured the emergency department healthcare workers' satisfaction and compared the number of phone calls about test status before and after implementation.ResultsAfter the system upgrade, the healthcare workers' understanding of the testing process increased significantly as follows. More clinicians could estimate the time of final test results through the real‐time testing status information (61.9% and 85.7%, P = .002), and respondents reported that the upgraded system was more convenient than the original system (41.3% and 22.2%, respectively, P = .022). The number of phone calls about the test status decreased after implementation of the upgrade; however, the difference was not statistically significant (before, 0.13% [63 calls/48 637 tests] and after, 0.09% [42/46 666]; P = .066).ConclusionsThe real‐time display of laboratory testing status increased understanding of testing process among healthcare workers in emergency room, which ultimately may increase the usefulness and efficiency of the laboratory service use.

Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study

Objective and settingPrimary prevention, comprising patient-oriented and environmental interventions, is considered to be one of the best ways to reduce violence in the emergency department (ED). We assessed the impact...