scholarly journals Canines in the emergency department: a novel approach to stress reduction in emergency medicine providers

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Jacob C. Davis ◽  
Kimberly J. Van Ryzin, MD ◽  
Courtney T. Linville ◽  
Kate L. Pettit, MS ◽  
Jeffrey A. Kline, MD
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Art Therapy ◽  
Stress Reduction ◽  
Emergency Care ◽  
Current Data ◽  
Care Providers ◽  
Therapy Dog ◽  
Validated Questionnaire ◽  
Novel Approach

Background and Hypothesis:  Cognitive stress during shiftwork contributes to burnout in emergency care. We hypothesize that if emergency care providers (physicians and nurses) were to interact with a therapy dog, their stress levels will decrease.  Experimental Design or Project Methods:  Consenting emergency medicine physicians and nurses provided three self-reported assessments of stress as well as saliva samples near the beginning of their shift. During peak hours in the emergency department at Eskenazi Hospital participants are randomized to interact with either a therapy dog or perform a mindfulness exercise via art therapy for five minutes. Self-perceived stress and saliva samples are obtained 30 minutes later and again near the end of shift. To assess potential change in participant behavior, patients of providers in either group receive a validated questionnaire assessing perceived empathy of the provider. Salivary cortisol will be measured at the end of the study by a vendor (Salimetrics). The sample size of 40 per group is predicated on a 25% decrease in self-reported stress in the dog group on the emergency care worker stress scale (ECWSS).  Results:  From June 1 to July 10, 24 participants have been randomized (12 in each group). Seven participants (58%) exposed to dogs had a mean decrease in the ECWSS of -5 (+/-1.8) compared with four participants (33%) who had a mean decrease of -2 (+/-0.8) after art therapy. The mean overall change in ECWSS after dog was -2 (+/-1.5) vs. +3 (+/-1.5) after art therapy.  Current data suggest a greater decrease of self-reported stress after interaction with a therapy dog, compared to art therapy.  Conclusion and Potential Impact:  Interim analysis suggests that exposure to a therapy dog decreases stress in a subset of emergency care workers. This work will help determine if human-animal interaction can modulate stress biology imposed by providing emergency medical care. 

Perceptions of emergency medicine and acute care among a cohort of non-emergency medicine health providers in Myanmar

2019 ◽  
Author(s):  
Corey B. Bills ◽  
Peter Acker ◽  
Tina McGovern ◽  
Rebecca Walker ◽  
Htoo Ohn ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Acute Care ◽  
Emergency Care ◽  
Healthcare Providers ◽  
Unmet Need ◽  
Health Providers ◽  
Care Providers ◽  
Convenience Sample ◽  
Care Services ◽  
Acute Care Services

Abstract Background Currently, Myanmar does not have a nationalized emergency care or emergency medical services (EMS) system. The provision of emergency medicine (EM) education to physicians without such training is essential to address this unmet need for high quality emergency care. We queried a group of healthcare providers in Myanmar about their experience, understanding and perceptions regarding the current and future needs for EM training in their country. Methods A 34-question survey was administered to a convenience sample of healthcare workers from two primary metropolitan areas in Myanmar to assess exposure to and understanding of emergency and pre-hospital care in the country. Results 236 of 290 (81% response rate) individuals attending one of two full-day symposia on emergency medicine completed the survey. The majority of respondents were female (n=138, 59%), physicians (n=171, 74%), and working in private practice (n=148, 64%). A majority of respondents (n=133, 57%) spent some to all of their clinical time providing acute and emergency care however 83.5% (n=192) of all surveyed reported little or no past training in emergency care; and those who have received prior emergency medicine training were more likely to care for emergencies (>2 weeks training; p=.052). 81% (n= 184) thought the development of emergency and acute care services should be a public health priority. Conclusions Although this subset of surveyed health practitioners commonly provides acute care, providers in Myanmar may not have adequate training in emergency medicine. Continued efforts to train Myanmar’s existing healthcare workforce in emergency and acute care should be emphasized.

scholarly journals Inter-observer agreement using the Canadian Emergency Department Triage and Acuity Scale

CJEM ◽  
2002 ◽  
Vol 4 (01) ◽  
pp. 16-22 ◽  
Author(s):  
Daria Manos ◽  
David A. Petrie ◽  
Robert C. Beveridge ◽  
Stephen Walter ◽  
James Ducharme
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Life Support ◽  
Vital Signs ◽  
Advanced Life Support ◽  
Emergency Department Patient ◽  
Observer Agreement ◽  
Care Providers ◽  
Emergency Department Triage ◽  
Triage Level

ABSTRACTObjective:To determine the inter-observer agreement on triage assignment by first-time users with diverse training and background using the Canadian Emergency Department Triage and Acuity Scale (CTAS).Methods:Twenty emergency care providers (5 physicians, 5 nurses, 5 Basic Life Support paramedics and 5 Advanced Life Support paramedics) at a large urban teaching hospital participated in the study. Observers used the 5-level CTAS to independently assign triage levels for 42 case scenarios abstracted from actual emergency department patient presentations. Case scenarios consisted of vital signs, mode of arrival, presenting complaint and verbatim triage nursing notes. Participants were not given any specific training on the scale, although a detailed one-page summary was included with each questionnaire. Kappa values with quadratic weights were used to measure agreement for the study group as a whole and for each profession.Results:For the 41 case scenarios analyzed, the overall agreement was significant (quadratic-weighted κ = 0.77, 95% confidence interval, 0.76–0.78). For all observers, modal agreement within one triage level was 94.9%. Exact modal agreement was 63.4%. Agreement varied by triage level and was highest for Level I (most urgent). A reasonably high level of intra- and inter-professional agreement was also seen.Conclusions:Despite minimal experience with the CTAS, inter-observer agreement among emergency care providers with different backgrounds was significant.

scholarly journals P006: Patient passports in the emergency department: a scoping review

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S58-S59
Author(s):  
C. B. Bennett ◽  
J. Curran
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Health Care Providers ◽  
Scoping Review ◽  
Research Question ◽  
Reference List ◽  
Care Providers ◽  
Communication Tool ◽  
Inclusion Criteria ◽  
Emergency Department Setting

Introduction: Discharge communication in the emergency department occurs frequently and has been identified as an important, underestimated problem. Tools, such as patient or caregiver-held passports have been used in other departments to improve communication and facilitate provider and patient decision making. The objective of this review was to identify what modalities, methods and designs have been used and evaluated when implementing a communication tool or passport type document in the emergency department setting. Methods: This review was conducted following Joanna Briggs Institute methodology. Iterative steps included identifying the research question, identifying relevant studies, data extraction and synthesis. Keywords and indexed terms were used to search PubMed, Cinahl, Embase and Web of Science. The reference list of all identified reports and articles from that search were reviewed for additional studies and a hand search of the last 5 years of Annals of Emergency Medicine and the Canadian Journal of Emergency Medicine was completed. Inclusion criteria were set to select studies investigating either patients, caregivers or health care providers use of passports, communication documents or journals with the goal of improving any aspect of communication in the emergency department setting. Results: Of the 81 potential publications screened, only 4 met inclusion criteria for extraction. 1 reviewed a passport that aimed at pediatric pain management in settings that include the emergency department, 2 of the publications reported on the same project which developed a passport for asthma patients and 1 discussed a passport for patients with learning disabilities. All the included publications were published in and discuss passports that were developed for use in the UK. Descriptions of implementation, evaluation and perception of the passports in these publications was limited. Conclusion: This scoping review has revealed a major gap in the current literature on communication tools in the emergency department, a department where communication, especially about discharge is of utmost importance. The included studies focused on very different patient populations and aim to improve different outcomes and therefore dont allow us to make for passports aimed at helping the general emergency department population.

scholarly journals (P2-65) Perception of Emergency Care Providers Toward the Implementation of an Electronic Medical Record System in the Emergency Department of a Level-1 Trauma Center

2011 ◽  
Vol 26 (S1) ◽  
pp. s156-s157
Author(s):  
S. Chauhan ◽  
S. Bhoi ◽  
D.T. Sinha ◽  
M. Rodha ◽  
G. Adhikari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Emergency Care ◽  
Trauma Center ◽  
Positive Reinforcement ◽  
Care Providers ◽  
Record System ◽  
Level 1 ◽  
Level 1 Trauma Center

BackgroundManual documentation has an inherent problem of improper communication, manipulation, and validity. An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital. EMRs tend to be a part of a local, stand-alone, health information system that allows for storage and retrieval.ObjectivesThe objective of this study was to assess the perception of emergency care providers toward the implementation of an EMR System in the emergency department of a Level-1 Trauma Center.MethodsA qualitative survey was conducted among consenting doctors and nurses in the emergency department of the All India Institute of Medical Sciences February to October 2010. Data were collected from a sample of 22—eight doctors and 14 nurses. The collection tool was a structured, closed-ended questionnaire of 12 questions based on usability, applicability, and security, of EMR. A Likert scale (LS) was used (1 = worst, 4 = best). Surveys were done on Day 20, Day 45, and after nine months of implementation of. Responses of emergency care providers were compiled and analyzed using SPSS version 16.ResultsThree surveys consisted of 22 participants in each survey. The survey domain of usability improved on Survey 3 (LS = 2.57), Survey 2 (LS = 2.46), Survey 1 (LS = 2.24). Application of EMR improved from Survey 1 to Survey 3. The data regarding perception of security concerns such as manipulation of data, transparency, and accountability were comparable among Survey 1, Survey 2, and Survey 3. Initial satisfaction was strongly associated with perception of usefulness of data mining for research purposes.ConclusionsSatisfaction with an EMR system at its implementation generally persisted through the first year of use. Implementation plans must include positive reinforcement regarding EMR among emergency care providers.

scholarly journals How the COVID-19 pandemic has adversely affected the economics of U.S. emergency care

2020 ◽  
Author(s):  
Jesse M. Pines ◽  
Mark S. Zocchi ◽  
Bernard S. Black ◽  
Rebecca Kornas ◽  
Pablo Celedon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Observational Study ◽  
Emergency Care ◽  
Moving Averages ◽  
Ed Visits ◽  
National Emergency

ABSTRACTObjectiveWe describe how the coronavirus (COVID-19) pandemic impacted emergency department (ED) economics, acuity, and staffing.MethodsWe conducted an observational study of visits during January to September 2020 compared to 2019 in 136 EDs staffed by a national emergency medicine group. We created ratios of three-week moving averages for 2020 visits, acuity, costs divided by 2019 moving averages, by age and ED size. We tabulated reductions in clinician hours and FTEs compared to early 2020 staffing.Results2020-2019 ED visit ratios declined in March nadiring mid-April for both adults (to 0.60) and children (to 0.30) and rose thereafter but remained below 2019 levels through September 2020. The ratio of adult RVUs/visit rose to 1.1 for adults and 1.2 for children in the early pandemic, falling to 1.04 and 1.1 through September. The ratio of direct salary expenses in freestanding (FSED) and small EDs declined less dramatically than in medium and large EDs. Clinical revenues in medium and large EDs declined more sharply and recovered slowly but plateaued well below 2019 levels. By September 2020, expenses were still higher than revenues for small EDs, similar for FSEDs, and somewhat higher for medium and large EDs. During the pandemic, physician hours fell 15% and APP hours 27% during COVID-19 translating to 174 lost physician and 193 lost APP FTEs.ConclusionThe COVID-19 pandemic reduced ED visits and increased acuity in the first 7 months of the pandemic, leading to a contraction of the ED workforce, and threatening ED economics, more so in small and FSEDs.

scholarly journals Emergency department crowding in Singapore: Insights from a systems thinking approach

2016 ◽  
Vol 4 ◽  
pp. 205031211667195 ◽  
Author(s):  
Lukas K Schoenenberger ◽  
Steffen Bayer ◽  
John P Ansah ◽  
David B Matchar ◽  
Rajagopal L Mohanavalli ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Path Analysis ◽  
Systems Thinking ◽  
International Health ◽  
Emergency Department Crowding ◽  
Causal Loop ◽  
Novel Approach ◽  
Geriatric Emergency Medicine

Objectives: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care. Methods: The construction of the qualitative causal loop diagram is based on consultations with Emergency Department experts, direct observation, and a thorough literature review. For the purpose of policy analysis, a novel approach, the path analysis, is applied. Results: The path analysis revealed that both the introduction of geriatric emergency medicine and the expansion of emergency medicine training may be associated with undesirable consequences contributing to Emergency Department crowding. In contrast, enhancing primary care was found to be germane in reducing Emergency Department crowding; in addition, it has apparently no negative side effects, considering the boundary of the model created. Conclusion: Causal loop diagramming was a powerful tool for eliciting the systemic structure of Emergency Department crowding in Singapore. Additionally, the developed model was valuable in testing different policy options.

Prototype Curriculum for a Fellowship in Emergency Medical Services

1994 ◽  
Vol 9 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Jon R. Krohmer ◽  
Robert A. Swor ◽  
Nicholas Benson ◽  
Steven A. Meador ◽  
Steven J. Davidson
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Emergency Medical Services ◽  
Emergency Care ◽  
Medical Services ◽  
Emergency Department Care ◽  
Emergency Medical

The developments of emergency medicine and emergency medical services (EMS) have occurred simultaneously although at times on parallel paths. The recognition of EMS providers as physician surrogates and emergency care resources as an extension of emergency department care has mandated close physician involvement. This intimate physician involvement in EMS activities is now well accepted. It has, however, pointed out the need for in-depth training of physicians in the subspecialty of EMS.

scholarly journals Examination of EMS Decision Making in Determining Suitability of Patient Diversion to Urgent Care Centers

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 24 ◽  
Author(s):  
Gerard Carroll ◽  
Katelyn Levy ◽  
Richard Pescatore ◽  
Rick Hong
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Emergency Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Urgent Care ◽  
Viable Option ◽  
Large Numbers ◽  
Urgent Care Centers

Widespread use of Emergency Medicine Services (EMS) for non-emergency care has increased recently, causing overcrowding of the Emergency Department (ED). The increased availability of urgent care centers (UCCs), with their ability to see large numbers of unscheduled patients with more acute presentations, may offer a viable option for many EMS systems to divert non-emergent cases. Using a survey-based study combined with retrospective chart review, EMS provider ability to determine patient suitability for diversion to UCCs was assessed. Results indicated a rate of inappropriate diversion of 11.6%. UCCs may be an alternative option for EMS transport, however strict protocols with medical direction are needed.

scholarly journals Geriatric Emergency Care in Canada: Present and Future

2021 ◽  
Author(s):  
Nancy Shi ◽  
Anamika Mishra
Keyword(s):  
Elderly Patient ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Emergency Care ◽  
Geriatric Patients ◽  
The Elderly ◽  
Resident Training ◽  
Current State ◽  
Efficient Resource ◽  
Senior Population

With the growing senior population in Canada, geriatric emergency care becomes an emerging field of importance in medicine. This article will provide an overview to the current state of geriatric care in the emergency department (ED) in Canada by reviewing recent peer-reviewed literature. Although emergency medicine (EM) physicians have a series of sophisticated triage tools and algorithms, Canadian EM residents report feelings of ill-preparedness to treat geriatric patients in ED. High levels of burnout and frustration have been reported by EM staff including physicians and nurses regarding their attitudes towards elderly patients in the ED. The article concludes with several areas to focus on in order to improve geriatric EM in Canada, such as more efficient resource allocation, geriatric exposure in EM resident training, and room for respectful mutual decision-making between EM physicians and the elderly patient and their families.

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