scholarly journals P078: Handover education in Canadian adult and pediatric emergency medicine residencies: a national survey and needs assessment

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S104-S105
Author(s):  
P. Lee ◽  
I. Rigby ◽  
S.J. McPherson
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Patient Care ◽  
Pediatric Emergency ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Risk Period ◽  
Hand Off ◽  
Pediatric Inpatient ◽  
Didactic Lecture

Introduction: Emergency department handover is a high-risk period for patient safety. A recent study showed a decreased rate of preventable adverse events and errors after implementation of a resident hand-off bundle on pediatric inpatient wards. In a 2013 survey by the Canadian Associations of Internes and Residents, only 11% of residents in any discipline stated they received a formal teaching session on handover. Recently, the CanMEDS 2015 Physician Competency Framework has added safe and skillful transfer of patient care as a new proficiency within the collaborator role. We hypothesize that significant variation exists in the current delivery and evaluation of handover education in Canadian EM residencies. Methods: We conducted a descriptive, cross-sectional survey of Canadian residents enrolled in the three main training streams of Emergency Medicine (FRCP CCFP-EM, PEM). The primary outcome was to determine which educational modalities are used to teach and assess handover proficiency. Secondarily, we described current sign-over practices and perceived competency at patient handover. Results: 130 residents completed the survey (73% FRCP, 19% CCFP-EM, 8% PEM). 6% of residents were aware of handover proficiency objectives within their curriculum, while 15% acknowledged formal evaluation in this area. 98% of respondents were taught handover by observation of staff or residents on shift, while 55% had direct teaching on the job. Less than 10% of respondents received formal sessions in didactic lecture, small group or simulation formats. Evaluation of handover skills occurred primarily by on shift observation (100% of respondents), while 3% of residents had received assessment through simulation. Local centre handover practices were variable; less than half of residents used mnemonic tools, written or electronic adjuncts. Conclusion: Canadian EM residents receive variable and sparse formal training and assessment on emergency department handover. The majority of training occurs by on shift observation and few trainees receive instruction on objective tools or explicit patient care standards. There exists potential for further development of standardized objectives, utilization of other educational modalities and formal assessments to better prepare residents to conduct safer patient handoffs.

scholarly journals Patient Reported Experience in a Pediatric Emergency Department

2019 ◽  
Vol 7 (1) ◽  
pp. 116-123
Author(s):  
Chandan Bal ◽  
Mohammad AlNajjar ◽  
Jennifer Thull-Freedman ◽  
Erin Pols ◽  
Ashley McFetridge ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Experience ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Parents And Children ◽  
Children And Parents ◽  
Patient Reported ◽  
Experience Measure

Objectives: To describe patient-reported experience in a pediatric emergency department (ED) and determine: ( 1 ) whether there are differences between the experience children report in comparison to their parents; and ( 2 ) whether factors such as time of visit (day, evening, night) and ED census are associated with patient experience. Methods: We conducted a prospective cross-sectional survey of children ≥8 years of age and the parents/guardians of children 0 to 17 years who visited a pediatric ED using a validated patient experience measure. The proportion of respondents for each question indicating that an aspect of their care could have been improved was calculated as problem scores for each survey item. The primary outcome was the overall problem scores for all respondents combined and for children and parents separately. Results: A total of 237 parents and 109 children completed surveys. The areas with the highest problem scores identified by both parents and children were: having enough to do while waiting to be seen (53.5; 95% confidence interval [CI]: 48.1, 58.8) and when to restart usual activities (34.7; 95% CI: 29.7, 40.0). There were meaningful differences in problem scores between children and parents including: doctors and nurses explaining what they were doing (parents: 19; 95% CI: 14.3, 24.7, child 40.4; 95% CI: 31.2, 50.2) and privacy when examined and treated (parents: 17.3; 95% CI: 12.8, 22.9, child: 36.7; 95% CI: 27.8, 46.5). Conclusion: There are differences in reported experience between children and their parents. This highlights the importance of including children when assessing patient experience in a pediatric setting.

scholarly journals Use of Handheld Versus Standard Ultrasound Devices in Ultrasound Rotation at the Emergency Department

2021 ◽  
Vol 9 (E) ◽  
pp. 29-32
Author(s):  
Kamonwon Ienghong ◽  
Kotchakorn Jumroenketpratheep ◽  
Somsak Tiamkao ◽  
Korakot Apiratwarakul
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Point Of Care ◽  
Learning Experience ◽  
Baseline Survey ◽  
Point Of Care Ultrasound ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Handheld Device ◽  
Handheld Ultrasound

BACKGROUND: Recently, handheld ultrasound equipment has come to replace standard machines in the training of emergency medicine residents. However, there have been few studies examining how this change has affected medical education. AIM: We aimed to compare standard and handheld ultrasound machines as educational tools in the emergency medicine residency program. METHODS: A cross-sectional survey of 17 emergency medicine residents at Srinagarind Hospital emergency department were trained to use point-of-care ultrasound and provided with handheld ultrasound devices during their 2-week ultrasound rotations, which took place between July 2019 and May 2020. Participants were given a 25-question survey comparing their learning experiences with standard versus handheld ultrasound machines. Data were analyzed using an independent sample t-test, and p < 0.05 was considered statistically significant. RESULTS: The response rate was 100%. At the baseline survey, most participants rated their learning experience as greater than 4 out of 5 with both ultrasound devices. They rated the learning experience with the handheld device as being more enjoyable and accessible but not to a statistically significant extent. There were also no significant differences in participants’ ratings of image quality or the ease of obtaining images. However, they rated the handheld device as being more useful and convenient (p < 0.001 and 0.034, respectively). CONCLUSIONS: The handheld ultrasound machine is useful in the training of emergency medicine residents. Further studies should be conducted to evaluate residents’ competency in using these devices.

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

2020 ◽  
Vol 51 (4) ◽  
pp. 550-570
Author(s):  
Cindy Luu ◽  
Thomas B. Talbot ◽  
Cha Chi Fung ◽  
Eyal Ben-Isaac ◽  
Juan Espinoza ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Patient Care ◽  
Skill Acquisition ◽  
Video Game ◽  
Rank Correlation ◽  
Fixed Time ◽  
Serious Game ◽  
Cross Sectional ◽  
Number Of Patients

Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.

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

2021 ◽  
Vol 2 ◽  
Author(s):  
N. Haroon ◽  
S. S. Owais ◽  
A. S. Khan ◽  
J. Amin
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Health Care Providers ◽  
Healthcare Workers ◽  
Work Performance ◽  
Nonparametric Tests ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Frontline Workers

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.

scholarly journals The Comparison of Role Conflict Among Registered Nurses and Registered Practical Nurses Working in Acute Care Hospitals in Ontario Canada

2021 ◽  
pp. 084456212110144
Author(s):  
Behdin Nowrouzi-Kia ◽  
Mary T. Fox ◽  
Souraya Sidani ◽  
Sherry Dahlke ◽  
Deborah Tregunno
Keyword(s):  
Emergency Department ◽  
Role Conflict ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Cross Sectional Survey ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Medical Unit ◽  
Scale Scores ◽  
Surgical Unit

Objectives The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit). Methods This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale. Results A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department. Conclusions The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

Current Models for Inpatient and Emergency Room Ophthalmology Consultation in U.S. Residency Programs

2020 ◽  
Vol 12 (02) ◽  
pp. e171-e174
Author(s):  
Donna H. Kim ◽  
Dongseok Choi ◽  
Thomas S. Hwang
Keyword(s):  
Emergency Department ◽  
Medical Education ◽  
Emergency Room ◽  
Program Directors ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Direct Supervision ◽  
Residency Programs ◽  
Residency Program Directors ◽  
Competency Assessments

Abstract Objective This article examines models of patient care and supervision for hospital-based ophthalmology consultation in teaching institutions. Design This is a cross-sectional survey. Methods An anonymous survey was distributed to residency program directors at 119 Accreditation Council for Graduated Medical Education accredited U.S. ophthalmology programs in the spring of 2018. Survey questions covered consult volume, rotational schedules of staffing providers, methods of supervision (direct vs. indirect), and utilization of consult-dedicated didactics and resident competency assessments. Results Of the 119 program directors, 48 (41%) completed the survey. Programs most frequently reported receiving 4 to 6 consults per day from the emergency department (27, 55.1%) and 4 to 6 consults per day from inpatient services (26, 53.1%). Forty-seven percent of programs reported that postgraduate year one (PGY-1) or PGY-2 residents on a dedicated consult rotation initially evaluate patients. Supervising faculty backgrounds included neuro-ophthalmology, cornea, comprehensive, or a designated chief of service. Staffing responsibility is typically shared by multiple faculty on a daily or weekly rotation. Direct supervision was provided for fewer of emergency room consults (1–30%) than for inpatient consults (71–99%). The majority of programs reported no dedicated didactics for consultation activities (27, 55.1%) or formal assessment for proficiency (33, 67.4%) prior to the initiation of call-related activities without direct supervision. Billing submission for consults was inconsistent and many consults may go financially uncompensated (18, 36.7%). Conclusion The majority of hospital-based ophthalmic consultation at academic centers is provided by a rotating pool of physicians supervising a lower level resident. Few programs validate increased levels of graduated independence using specific assessments.

scholarly journals P033: Procedural skills training in emergency medicine physicians within the Edmonton zone: a needs assessment

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S76-S76
Author(s):  
R. Schonnop ◽  
B. Stauffer ◽  
A. Gauri ◽  
D. Ha
Keyword(s):  
Emergency Medicine ◽  
Emergency Departments ◽  
Continuing Professional Development ◽  
Skills Training ◽  
Procedural Skill ◽  
Cross Sectional Survey ◽  
Procedural Skills ◽  
Cross Sectional ◽  
Health Region ◽  
Perceived Importance

Introduction: Procedural skills are a key component of an emergency physician's practice. The Edmonton Zone is a health region that comprises twelve tertiary, urban community and rural community emergency departments (EDs) and represents over three hundred emergency physicians. This study describes the current attitudes toward procedural skill competency, current procedural skill practices, and the role for educational skills training sessions among emergency medicine physicians within a geographical health region. Methods: Multicenter descriptive cross-sectional survey of all emergency medicine physicians working at 12 emergency departments within the Edmonton Zone in 2019 (n = 274). The survey underwent several phases of systematic review; including item generation and reduction, pilot testing, and clinical sensibility testing. Survey items addressed current procedural skill performance frequency, perceived importance and confidence, current methods to maintain competence, barriers and facilitating factors to participation in a curriculum, preferred teaching methods, and desired frequency of practice for each procedural skill. Results: Survey response rate was 53.6%. Variability in frequency of performed procedures was apparent across the type of hospital sites. For majority of skills, there was a significantly positive correlation between the frequency at which a skill was performed and the perceived confidence performing said skill. There was inconsistency and no significant correlation with perceived importance, perceived confidence, or frequency performing a given skill and the desired frequency of training for that skill. Course availability (76.2%) and time (72.8%) are the most common identified barriers to participation in procedural skills training. Conclusion: This study summarized the current emergency department procedural skill practices and attitudes toward procedural skill competency and an educational curriculum among emergency medicine physicians in Edmonton. This represents a step towards targeted continuing professional development in the growing realm of competency-based medical education.

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