Survey Of Emergency Physicians Research Articles

Navigating trauma airway responsibilities in the Modern Emergency Department: A survey of emergency physicians

Navigating trauma airway responsibilities in the Modern Emergency Department: A survey of emergency physicians

Pathways to cancer care after a suspected cancer diagnosis in the emergency department: a survey of emergency physicians across Ontario.

Little is known about how patients are managed after a suspected cancer diagnosis through the emergency department. The objective of this study was to examine the ED management, specifically referral practices, for ten suspected cancer diagnoses by emergency physicians across Ontario and to explore variability in management by cancer-type and centre. An electronic survey was distributed to emergency physicians across Ontario, asking about referral practices for patients who could be discharged from the ED with one of ten suspected cancer diagnoses. Options for referral included: in-ED consult, outpatient medical or surgical specialists, surgical or medical oncology, and specialized cancer clinics. Data were described using frequencies and proportions. Variance partition coefficients were calculated to determine variation in responses attributed to differences between hospitals, with physicians nested within hospitals. 262 physicians from 54 EDs responded. Across most cancers, emergency physicians would refer to surgical specialists for further work-up; however, this ranged from 30.2% for lung cancer to 69.5% for head and neck cancer. For patients with an unknown primary malignancy, most physicians would refer to internal medicine clinic (34.3%) or obtain an in-ED consult (25.0%). Few physicians would refer directly to surgical or medical oncology from the ED. Comments suggest this may be due to oncologists requiring tissue confirmation of malignancy. Most referrals to specialized clinics were for suspected lung (30.2%) or breast cancer (19.5%); however, these appear to only be available at some centres. Variance in referrals between hospitals was lowest for breast cancer (variance partition coefficient = 8.6%) and highest for unknown primary malignancies (variance partition coefficient = 29.8%). Physician management of new suspected cancer varies between EDs and is specific to cancer type. Strategies to standardize access to cancer care in a timely and equitable way for patients with newly suspected cancer in the ED are needed.

Knowledge and practice of emergency physicians regarding drug therapy for acute myocardial infarction

Objective: This study aimed to assess the knowledge and practice of emergency physicians regarding drug therapy for acute myocardial infarction (AMI). Methods: A cross-sectional survey of emergency physicians aged between 35 and 60 years was carried out. Emergency physicians were surveyed regarding drug therapy interventions in acute myocardial infarction. Results: Around 267 (89.0%) of the 300 emergency physicians who responded were under 40 years. Among emergency physicians, 176 were men (58.0%). Emergency physicians responded to the study they treated 1 to 4 patients with AMI (n = 183, 61.0%) and more than 5 (n = 117, 39.0%). According to the current results, the demographic data of responses to emergency physicians (age and gender) had a significant effect on the knowledge and practice of emergency physicians regarding drug therapy for acute myocardial infarction. Conclusion: This study indicated that emergency physicians were significantly more aware of and skilled in using most short-term pharmacological therapies while treating AMI. The treatment of patients with AMI, based on evidence-based medicine, is one of the most basic examples of the purpose and responsibilities of the emergency physician.

Prehospital postcardiac-arrest-sedation and -care in the Federal Republic of Germany-aweb-based survey of emergency physicians

This study evaluates the implementation of postcardiac-arrest-sedation (PCAS) and -care (PRC) by prehospital emergency physicians in Germany. Analysis of aweb-based survey from October to November2022. Questions were asked about implementation, medications used, complications, motivation for implementing or not implementing PCAS, and measures and target parameters of PRC. Atotal of 500 emergency physicians participated in the survey. In all, 73.4% stated that they regularly performed PCAS (hypnotics: 84.7%; analgesics: 71.1%; relaxants: 29.7%). Indications were pressing against the respirator (88.3%), analgesia (74.1%), synchronization to respirator (59.5%), and change of airway device (52.6%). Reasons for not performing PCAS (26.6%) included unconscious patients (73.7%); concern about hypotension (31.6%), re-arrest (26.3%), and worsening neurological assessment (22.5%). Complications of PCAS were observed by 19.3% of participants (acute hypotension [74.6%]); (re-arrest [32.4%]). In addition to baseline monitoring, PRC included 12-lead-electrocardiogram (96.6%); capnography (91.6%); catecholamine therapy (77.6%); focused echocardiography (20.6%), lung ultrasound (12.0%) and abdominal ultrasound (5.6%); induction of hypothermia (13.6%) and blood gas analysis (7.4%). An etCO2 of 35-45 mm Hg was targeted by 40.6%, while 9.0% of participants targeted an SpO2 of 94-98% and 19.2% of participants targeted asystolic blood pressure of ≥ 100 mm Hg. Prehospital PRC in Germany is heterogeneous and deviations from its target parameters are frequent. PCAS is frequent and associated with relevant complications. The development of preclinical care algorithms for PCAS and PRC within preclinical care seems urgently needed.

Self-rated health and its related influencing factors among emergency department physicians: a national cross-sectional study.

Protecting and improving the personal health of healthcare workers is critical to improving the efficiency and quality of care. To effectively meet the needs of the emergency service system, emergency physicians need to be in a good state of health. However, due to the special characteristics of work in the emergency department, emergency physicians have to face various psychosocial pressures, which may bring them physical and mental distress. Therefore, this study aims to explore the emergency physicians' self-rated health status and its related factors, to provide an empirical study for the improvement of emergency physicians' self-rated health status. A cross-sectional survey of emergency physicians was conducted in China between July and August 2018. The questionnaires contained items on demographic characteristics, behavioral lifestyle and job-related factors, as well as self-rated health. The generalized ordinal logistic model was used to identify related factors of emergency physicians' self-rated health status. Only 14.4% of Chinese emergency physicians considered themselves in good health status. Results showed that emergency physicians who never exercised (β = 0.76, p < 0.001) and exercised <2 times per week (β = 0.34, p < 0.001) were more likely to report poor health status. In addition, emergency physicians with good sleep quality (β = -3.84, p < 0.001), fewer night work shifts (β = -0.47, p < 0.001), less frequency of visiting patients (β = -0.33, p < 0.001), never suffered the workplace violence (β = -0.47, p < 0.001) and never perceived effort-reward imbalance (β = -0.68, p < 0.001) were more likely to report good self-rated health. Chinese emergency physicians' self-rated health status was not optimistic. Self-rated health is associated with multiple domains of work-related factors and personal lifestyle. Feasible measures should be taken to improve the working environment of emergency physicians, develop acceptable shift schedules for employees, monitor and maintain the health status of emergency department physicians.

Barriers to Palliative Care in the Emergency Department (ED)—Results from a National Survey of Emergency Physicians (Sch413)

Barriers to Palliative Care in the Emergency Department (ED)—Results from a National Survey of Emergency Physicians (Sch413)

Effect of an artificial-intelligent chest radiographs reporting system in an emergency department

Though chest radiography is a first-line diagnostic tool in the emergency department (ED), interpretation has a high error rate. We aimed to evaluate the usability and acceptability of deep learning-based computer-aided detection for chest radiography (DeepCADCR) in an ED environment. We conducted a single-institution survey of emergency physicians (EPs) who had used DeepCADCR (Lunit INSIGHT Chest Xray (CXR), version 3.1.4.1) as part of their ED workflow for at least three months. We developed 22 questions that assessed the subscales of effectiveness, efficiency, safety, satisfaction, and reliability. A seven-point Likert agreement scale was used to rate the responses. A total of 23 EPs who completed the survey was enrolled in the study. When averaged by subscale, satisfaction scores were highest (mean 4.71, standard deviation (SD) 1.43), and safety scores were lowest (mean 4.3, SD 0.72). When scores were converted to acceptability, the total average acceptance of DeepCADCR was 86.0%, with higher scores in ED residents than ED specialists for all subscales. Use of DeepCADCR in the ED workflow was well accepted by EPs.

98 Developing a Protocol for Medication Abortion in the Emergency Department: A Cross-sectional Survey of Emergency Physicians Regarding Providing Abortion Care

98 Developing a Protocol for Medication Abortion in the Emergency Department: A Cross-sectional Survey of Emergency Physicians Regarding Providing Abortion Care

The Number of Monthly Night Shift Days and Depression Were Associated with an Increased Risk of Excessive Daytime Sleepiness in Emergency Physicians in South Korea.

This study aimed to report the prevalence and identify the factors associated with excessive daytime sleepiness (EDS) among emergency physicians in South Korea. We analyzed the Korean Emergency Physicians Survey data from 15 January to 26 February 2021. EDS was evaluated using the Epworth sleepiness scale, and a score of 11 or more indicated the presence of EDS. We conducted univariable and multivariable logistic regression analyses to verify the associated factors. A total of 1307 participants responded to the survey, and the response rate was 61.3%. Nine hundred fifty-four participants were included in the study. Two hundred ninety-three participants were classified as the EDS group, and six hundred sixty-one were classified as the non-EDS group. The prevalence of EDS was 30.7% (95% confidence interval (CI), 27.8–33.6%). Monthly night-shift days (odds ratio (OR) 1.106, 95% CI 1.028–1.191) and depression (OR 2.635, 95% CI 1.799–3.861) were significantly associated with an increased risk of EDS, and fair sleep quality (OR 0.560, 95% CI 0.318–0.985) was associated with a decreased risk of EDS. Almost one in three emergency physicians in South Korea suffer from daytime sleepiness. The number of monthly night-shift days and depression were associated with an increased risk of EDS.

Effect of hand versus electronic signatures on response rates in postal surveys: a randomised controlled trial among emergency physicians in Canada

ObjectivesHand signatures offer a more authentic personalisation, which carries over to a sense of trust, although are costly and time-consuming when considering large postal surveys. The objective of this study...

Attitudes and acceptability of organ and tissue donation registration in the emergency department: a national survey of emergency physicians.

PurposeThere is a worldwide shortage of organs for transplantation. One method to increase the number of organs available for transplant is to increase the number of registered organ donors. The emergency department (ED) may be a suitable venue to disseminate knowledge to patients about organ donation, and to offer an immediate or future opportunity to register as an organ donor. This study aimed to assess emergency physicians’ attitudes and acceptability of an ED-based organ donation registration initiative.MethodsWe developed and distributed a national postal survey using a modified Dillman’s tailored design technique to a random sample of emergency physicians selected from the Canadian Medical Directory.ResultsFrom a total of 474 delivered surveys, we received 228 responses (48.1%). 98.5% of emergency physicians support the concept of deceased organ donation. 85.1% felt that the emergency department is an appropriate setting to disseminate information regarding organ donation and 77.6% felt that it is an appropriate location to offer an immediate opportunity to register as an organ donor. 74.1% of physicians who responded report to be personally registered as an organ donor.ConclusionMost emergency physicians are supportive of organ donation promotion in the ED, including offering an immediate opportunity to register.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-022-00262-8.

CAEP 2021 Academic Symposium: recommendations for addressing racism and colonialism in emergency medicine.

PurposeRacism and colonialism impact health, physician advancement, professional development and medical education in Canada. The Canadian Association of Emergency Physicians (CAEP) has committed to addressing inequities in health in their recent statement on racism. The objective of this project was to develop recommendations for addressing racism and colonialism in emergency medicine.MethodsThe authors, in collaboration with a 40 member working group, conducted a literature search, held a community consultation, solicited input from expert medical, academic and community advisors, conducted a national survey of emergency physicians, and presented draft recommendations at the 2021 CAEP Academic Symposium on Equity, Diversity and Inclusion for a live facilitated discussion with a post-session survey.ResultsSixteen recommendations were generated in the areas of patient care, hospital and departmental commitment to Equity, Diversity, and Inclusion, physician advancement, and professional development and medical education.ConclusionEmergency physicians are uniquely positioned to promote equity at each encounter with patients, peers and learners. The 16 recommendations presented here are practical steps to countering racism and colonialism everyday in emergency medicine.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-021-00244-2.

Are emergency physicians satisfied? An analysis of operational/organization factors.

ObjectiveProfessional satisfaction is associated with career longevity, individual well‐being, and patient care and safety. Lack of physician engagement promotes the opposite. This study sought to identify important facets contributing to decreased career satisfaction using a large national data set of practicing emergency physicians.MethodsWe performed a secondary analysis of the national Longitudinal Study of Emergency Physicians survey conducted by the American Board of Emergency Medicine. The survey was composed of 57 variables including career satisfaction as well as occupational and psychological variables potentially associated with career satisfaction. Factor analysis was used to determine the important latent variables. Ordinal logistic regression was performed to determine statistical significance among the latent variables with overall career satisfaction.ResultsA total of 863 participants were recorded. The overall mean career satisfaction rate was 3.9 on a 5‐point Likert scale with 1 and 5 indicating “least satisfied” and “most satisfied,” respectively. Our analysis revealed 9 factors related to job satisfaction. Two latent factors, exhaustion/stress and administration/respect, were statistically significant. When comparing satisfaction scores between sex, there was a statistically significant difference with men reporting a higher satisfaction rate (P = 0.0092). Age was also statistically significant with overall satisfaction lower for younger physicians than older physicians.ConclusionOur study found that emergency physicians are overall satisfied with emergency medicine, although with variability depending on sex and age. In addition, we characterized job satisfaction into 9 factors that significantly contribute to job satisfaction. Future work exploring these factors may help elucidate the development of targeted interventions to improve professional well‐being in the emergency medicine workforce.

285 National Survey of Emergency Physicians: Motivations, Barriers, and Capabilities for Telehealth Delivery of Emergency Care Services

The COVID-19 pandemic imposed both constraints and opportunities for innovation in emergency care delivery. Visits to the emergency department (ED) plunged by as much as 42% in the US, resulting in excess morbidity and mortality due to patients deferring or avoiding emergency care. With the declaration of a public health emergency, payors such as Medicare authorized emergency physicians (EPs) to bill for evaluation and management services delivered through telehealth—potentially allowing EPs to project emergency care beyond the four walls of the physical ED.

Effect of prenotification on the response rate of a postal survey of emergency physicians: a randomised, controlled, assessor-blind trial

ObjectivesResponse rates to physician surveys are typically low. The objective of this study was to determine the effect of a prenotification letter on the response rate of a postal survey...

Electrocardiogram in Pediatric Syncope: Practice Variation Among Pediatric Emergency Physicians.

We intended to assess emergency department physician's practice pattern and their motivations for obtaining electrocardiograms (ECGs) in pediatric vasovagal syncope presentations. We also explored if borderline ECG findings alters emergency department physicians' management in this population. We conducted a cross-sectional survey of emergency physicians enrolled in the Pediatric Emergency Research Canada network. The survey questionnaire introduced 2 clinical vignettes presenting a typical vasovagal syncope and a presentation suggestive of a cardiac etiology. Outcome measures included frequency investigations, specialist consultation, and disposition stratified by type of syncope presentation. We also evaluated which specific ECG findings were likely to change physicians' management and explored factors influencing the decision to perform or not perform the ECG. The analyzable response rate was 47% (105/225). In the low-risk scenario, 51% of respondents requested an ECG, and none consulted the cardiology service, given that all requested investigations are normal. Forty-five percent of physicians modified their management if an ECG was reported as anything but totally normal. In the high-risk scenario, all respondents requested either a 12-lead ECG or a high-lead ECG, and 94% consulted the cardiology service. Physicians also identified clear differences in the motivations behind their decision to perform an ECG in typical vasovagal syncope. This study highlights the significant practice variation in the evaluation and management of typical vasovagal syncope among physicians, which is informed by complex interactions of patient, provider, and institutional factors and the perceived clinical significance of borderline ECG findings.

Barriers to point-of-care ultrasound utilization during cardiac arrest in the emergency department: a regional survey of emergency physicians.

Though point-of-care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic intervention during cardiac arrest (CA), critics advise caution. The purpose of this survey study was to determine the barriers to POCUS during CA in the Emergency Department (ED). Two survey instruments were distributed to emergency medicine (EM) attending and resident physicians at three academic centers in the South Florida. The surveys assessed demographics, experience, proficiency, attitudes and barriers. Descriptive and inferential statistics along with Item Response Theory Logistic Model and the Friedman Test with Wilcoxon Signed Rank tests were used to profile responses and rank barriers. 206 EM physicians were invited to participate in the survey, and 187 (91%) responded. 59% of attending physicians and 47% of resident physicians reported that POCUS is performed in all their cases of CA. 5% of attending physicians and 0% of resident physicians reported never performing POCUS during CA. The top-ranked departmental barrier for attending physicians was "No structured curriculum to educate physicians on POCUS." The top-ranked personal barriers were "I do not feel comfortable with my POCUS skills" and "I do not have sufficient time to dedicate to learning POCUS." The top-ranked barriers for resident physicians were "Time to retrieve and operate the machine" and "Chaotic milieu." While our study demonstrates that most attending and resident physicians utilize POCUS in CA, barriers to high-quality implementation exist. Top attending physician barriers relate to POCUS education, while the top resident physician barriers relate to logistics and the machines. Interventions to overcome these barriers might lead to optimization of POCUS performance during CA in the ED.

Post-traumatic stress and stress disorders during the COVID-19 pandemic: Survey of emergency physicians.

ObjectiveEmergency physicians routinely encounter stressful clinical situations, including treating victims of crime, violence, and trauma; facing the deaths of patients; and delivering bad news. During a pandemic, stress may be increased for healthcare workers. This study was undertaken to identify symptoms of post‐traumatic stress disorder (PTSD) among emergency physicians during the coronavirus disease 2019 (COVID‐19) pandemic.MethodsThis cross‐sectional survey was developed using the Life Events Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM‐5 (DSM‐5) and the PTSD Checklist for DSM‐5 (PCL‐5). The survey was distributed to members of the American College of Emergency Physicians from May 21, 2020, through June 22, 2020.ResultsAmong 1300 emergency physicians, a significant number of participants (22.3%; 95% confidence interval, 20.3–24.3%) reported symptoms of stress consistent with PTSD (PCL score ≥ 33). Higher PCL‐5 scores were associated with age younger than 50 years (P < 0.05) and <10 years in practice (P < 0.05). The major sources of stress identified by participants included disinformation about COVID‐19, computer work/electronic medical record, personal protective equipment concerns, and workload. The most common consequences of workplace stress were feeling distant or cut off from other people and sleep disturbance, such as trouble falling or staying asleep.ConclusionsA significant number of emergency physicians reported symptoms of stress consistent with PTSD. Higher PCL‐5 scores were associated with age younger than 50 years and <10 years in practice.

Prehospital Use of Ketamine in Mountain Rescue: A Survey of Emergency Physicians of a Single-Center Alpine Helicopter-Based Emergency Service

Although ketamine use in emergency medicine is widespread, studies investigating prehospital use are scarce. Our goal was to assess the self-reported modalities of ketamine use, knowledge of contraindications, and occurrence of adverse events associated with its use by physicians through a prospective online survey. The survey was administered to physicians working for Air-Glaciers, a Swiss alpine helicopter-based emergency service, and was available between September 24 and November 23, 2018. We enrolled 39 participants (participation rate of 87%) in our study and collected data regarding their characteristics, methods of ketamine use, knowledge of contraindications, and encountered side effects linked to the administration of ketamine. We also included a clinical scenario to investigate an analgesic strategy. Ketamine was considered safe and judged irreplaceable by most physicians. The main reason for ketamine use was acute analgesia during painful procedures, such as manipulation of femur fractures. The doses of ketamine administered with or without fentanyl ranged from 0.2 to 0.7 mg·kg-1 intravenously. Most physicians reported using fentanyl and midazolam along with ketamine. The median dose of midazolam was 2 (interquartile range 1-2) mg for a 70-kg adult. Monitoring and oxygen administration were used infrequently. Hallucinations were the most common adverse events. Knowledge of ketamine contraindications was poor. Ketamine use was reported by mountain rescue physicians to be safe and useful for acute analgesia. Most physicians use fentanyl and midazolam along with ketamine. Adverse neuropsychiatric events were rare. Knowledge regarding contraindications to the administration of ketamine should be improved.

Intention to Leave Emergency Medicine: Mid-career Women Are at Increased Risk.

IntroductionBurnout is prevalent among emergency physicians and may cause physicians to consider leaving the practice of emergency medicine (EM). This study sought to determine whether there is a gender difference in reporting burnout and seriously considering leaving the specialty of EM, and secondarily to explore the factors reported as contributing to burnout.MethodsThis was a secondary analysis of the 2014 American Board of Emergency Medicine Longitudinal Survey of Emergency Physicians. We used multiple logistic regression to determine which factors were associated with reporting serious consideration of leaving EM, when stratified by years in practice and adjusting for individual, departmental, and institutional factors.ResultsThe response rate was 82%, (n = 868); 22.6% (194) were female and 77.4% (664) were males; and 83.9% (733) White. The mean age of men responding was significantly higher than women (52.7±11.9 vs. 44.9±10.4, p<0.001). Overall, there were no significant gender differences in reporting having had serious thoughts of leaving EM in either unmatched or age-matched analyses. More women reported that burnout was a significant problem, while men more often were equivocal as to whether it was a problem. When stratified by years in practice, mid-career women had a seven-fold increase in the odds ratio (OR) of seriously considered leaving EM, compared to men of similar years in practice (OR 7.07, 95% confidence interval, 2.45–20.39). Autonomy at work, control over working conditions, fair compensation, personal reward, and a sense of ownership were factors associated with a lower rate of reporting considering leaving EM.ConclusionOur findings suggest that the intention to leave EM is not more prevalent in women. However, mid-career women more often reported seriously considering leaving the specialty than mid-career men. Further research on the factors behind this finding in mid-career women in EM is needed.