P132: Optimizing a physician surge protocol to address emergency department wait times during times of increased patient demand

Background: Emergency Department overcrowding remains a significant problem. Interventions have often focused on areas external to the ED, with patient flow in the ED receiving less attention. Efforts to address ED flow are complicated by daily fluctuations in patient volume and acuity. Our local protocol brings in additional physicians when internal metrics indicate patient demand can't be met by current physician resources (a ‘surge’ period). However, anecdotal evidence suggests a lack of satisfaction and efficacy. We therefore undertook a project to improve our local management of these surge periods. Aim Statement: To improve the effectiveness of an ED Physician Surge Protocol to allow for a physician scheduling strategy that is reflective of the needs of the ED. Measures & Design: This project consists of 3 phases. Phase 1 was an analysis of current surge metrics (including frequency, temporal patterns and physician response), with concurrent literature search to identify any best practices or easily addressable protocol changes, with first planned PDSA cycle. Phase 2 is a mixed methods survey of local staff to identify barriers and enablers of our current protocol, concurrent with a national survey of current practices. Phase 3 will be the implementation of a revised protocol, followed by a second mixed methods survey and analysis of metrics of interest. Evaluation/Results: Analysis of surge data (Oct 2018-Oct 2019) demonstrated a high volume of surges per month (78.7 +/- 10.9), highest at Foothills Medical Centre (94.3). Across all sites, afternoon periods had highest frequency of surges (absolute peak 1400 - 1500) with a secondary peak 2200–2300, both peaks occurring most frequently on weekends (Fri-Sun) However, physician response to surge calls was < 10% (5.8-9.1%), with no discernable temporal pattern, even accounting for the significant number of automatic surge calls cancelled by clinicians. Analysis of data, in addition to literature review and engagement with senior administration suggested no immediate protocol changes, therefore project moved to 2nd phase. This phase is currently in progress, with planned analysis using Pareto Chart methodology. Discussion/Impact: Our initial data clearly demonstrates that current procedures are inadequate to address this ongoing issue, with no readily apparent solutions. Analysis of local barriers and enablers is currently underway, in addition to a national survey, with the results expected to inform an extensive redesign of current procedures.

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Shared-Task Worklists Improve Clinical Trial Recruitment Workflow in an Academic Emergency Department

Applied Clinical Informatics ◽

10.1055/s-0041-1727153 ◽

2021 ◽

Vol 12 (02) ◽

pp. 293-300

Author(s):

Kevin S. Naceanceno ◽

Stacey L. House ◽

Phillip V. Asaro

Keyword(s):

Clinical Trial ◽

Emergency Department ◽

Clinical Trials ◽

Clinical Research ◽

Substantial Reduction ◽

Text Message ◽

High Volume ◽

Text Messages ◽

Shared Task ◽

Clinical Research Coordinators

Abstract Background Clinical trials performed in our emergency department at Barnes-Jewish Hospital utilize a centralized infrastructure for alerting, screening, and enrollment with rule-based alerts sent to clinical research coordinators. Previously, all alerts were delivered as text messages via dedicated cellular phones. As the number of ongoing clinical trials increased, the volume of alerts grew to an unmanageable level. Therefore, we have changed our primary notification delivery method to study-specific, shared-task worklists integrated with our pre-existing web-based screening documentation system. Objective To evaluate the effects on screening and recruitment workflow of replacing text-message delivery of clinical trial alerts with study-specific shared-task worklists in a high-volume academic emergency department supporting multiple concurrent clinical trials. Methods We analyzed retrospective data on alerting, screening, and enrollment for 10 active clinical trials pre- and postimplementation of shared-task worklists. Results Notifications signaling the presence of potentially eligible subjects for clinical trials were more likely to result in a screen (p < 0.001) with the implementation of shared-task worklists compared with notifications delivered as text messages for 8/10 clinical trials. The change in workflow did not alter the likelihood of a notification resulting in an enrollment (p = 0.473). The Director of Research reported a substantial reduction in the amount of time spent redirecting clinical research coordinator screening activities. Conclusion Shared-task worklists, with the functionalities we have described, offer a viable alternative to delivery of clinical trial alerts via text message directly to clinical research coordinators recruiting for multiple concurrent clinical trials in a high-volume academic emergency department.

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Harnessing Technology for Research During the COVID-19 Pandemic: A Mixed Methods Diary Study Protocol

International Journal of Qualitative Methods ◽

10.1177/1609406920986043 ◽

2021 ◽

Vol 20 ◽

pp. 160940692098604

Author(s):

L. Y. Saltzman ◽

L. D. Terzis ◽

T. C. Hansel ◽

J. M. Blakey ◽

D. Logan ◽

...

Keyword(s):

Social Work ◽

Mixed Methods ◽

Phase 1 ◽

Social Work Students ◽

Diary Study ◽

Cross Sectional ◽

Master Of Social Work ◽

Global Pandemic ◽

Msw Students ◽

Changes Over Time

Project Title: Psychosocial Reactions to a Global Pandemic: A Diary Study During COVID-19. Design: The study uses a mixed methods design that includes both a cross-sectional quantitative survey and qualitative diary entries submitted online eight times by student participants. Context of Study: The study timeline spans the full shutdown, phase 1 reopening, and phase 2 reopening of New Orleans Louisiana. Objectives: The study has three primary objectives: (1) To better understand the experiences of Social Work Students during the COVID-19 pandemic; (2) To explore risk and protective factors that influences Social Work Students’ ability to cope with stressors and changes associated with the COVID-19 pandemic; and (3) to track changes over time in coping among Social Work Students during the COVID-19 pandemic. Study Population: Current Master of Social Work (MSW) Students enrolled at Tulane University during the COVID-19 Pandemic will be invited to participate in this study.

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Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa252 ◽

2020 ◽

Author(s):

Sarah D Fouquet ◽

Laura Fitzmaurice ◽

Y Raymond Chan ◽

Evan M Palmer

Keyword(s):

Emergency Department ◽

Mixed Methods ◽

Medical Record ◽

Electronic Medical Record ◽

Pediatric Emergency ◽

Second Phase ◽

Pediatric Emergency Department ◽

Mixed Methods Approach ◽

Time And Motion ◽

Attending Physician

Abstract Objective The pediatric emergency department is a highly complex and evolving environment. Despite the fact that physicians spend a majority of their time on documentation, little research has examined the role of documentation in provider workflow. The aim of this study is to examine the task of attending physician documentation workflow using a mixed-methods approach including focused ethnography, informatics, and the Systems Engineering Initiative for Patient Safety (SEIPS) model as a theoretical framework. Materials and Methods In a 2-part study, we conducted a hierarchical task analysis of patient flow, followed by a survey of documenting ED providers. The second phase of the study included focused ethnographic observations of ED attendings which included measuring interruptions, time and motion, documentation locations, and qualitative field notes. This was followed by analysis of documentation data from the electronic medical record system. Results Overall attending physicians reported low ratings of documentation satisfaction; satisfaction after each shift was associated with busyness and resident completion. Documentation occurred primarily in the provider workrooms, however strategies such as bedside documentation, dictation, and multitasking with residents were observed. Residents interrupted attendings more often but also completed more documentation actions in the electronic medical record. Discussion Our findings demonstrate that complex work processes such as documentation, cannot be measured with 1 single data point or statistical analysis but rather a combination of data gathered from observations, surveys, comments, and thematic analyses. Conclusion Utilizing a sociotechnical systems framework and a mixed-methods approach, this study provides a holistic picture of documentation workflow. This approach provides a valuable foundation not only for researchers approaching complex healthcare systems but also for hospitals who are considering implementing large health information technology projects.

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