The Not So Obvious Impact of COVID 19: The Hidden “Curriculum”

The last two years of the Covid 19 pandemic has certainly brought on and inculcated a variety of changes, new practices, innovative approaches and altered mindsets. Some of these were intended, planned and incorporated into pathways and practices. There were many lessons and new experiences. Without our complete realization, there were also many less obvious lessons: the hidden curriculum. This refers to the unwritten, unspoken, unplanned and less obvious values, behaviour and norms practised or experienced during the pandemic. The hidden curriculum is conveyed and communicated without our direct awareness and intent. The hidden curriculum will certainly contribute towards healthcare staff resilience, handling of stressors, decisions on utilization of resources and patient care. Not to be forgotten, it will also impact how they develop friendships, partnerships, collaborations, negotiate their self-development and strengthen their sense of purpose and challenge assumptions. In this paper, the author, who worked at the frontline during the pandemic shares some of her views on the new healthcare landscape, mindset changes, technology adoption, psychological safety and the meaning of ‘staying home’. They represent her views, coloured by her experiences as an emergency physician, a medical educator, academic medicine practitioner and researcher.

Point-of-Care Ultrasound Training and Credentialing for mid-late Career Emergency Physicians: Is it worth it?

Point-of-care ultrasound (POCUS) is becoming more prevalent in community emergency medicine (EM) practice with the current American College of Emergency Physician guidelines recommending POCUS training for all graduates from United States based residency programs as well as support for POCUS privileging by the American Medical Association. However, in a recent survey of nonacademic EDs, it was found that most providers lack US training, credentialing, and quality assurance (QA) assessments of their POCUS studies. In 2017, our healthcare system embarked on a system-wide credentialing process for POCUS to credential community physicians with little to no POCUS training.

Q-DEPICT: Qatar Determining Emergency Physician Incidence of COVID-Positive Testing

Despite protective measures such as personal protective equipment (PPE) and a COVID airway management program (CAMP), some emergency physicians will inevitably test positive for COVID. We aim to develop a model predicting weekly numbers of emergency physician COVID converters to aid operations planning. The data were obtained from the electronic medical record (EMR) used throughout the national healthcare system. Hamad Medical Corporation's internal emergency medicine workforce data were used as a source of information on emergency physician COVID conversion and numbers of emergency physicians completing CAMP training. The study period included the spring and summer months of 2020 and started on March 7 and ran for 21 whole weeks through July 31. Data were extracted from the system's EMR database into a spreadsheet (Excel, Microsoft, Redmond, USA). The statistical software used for all analyses and plots was Stata (version 16.1 MP, StataCorp, College Station, USA). All data definitions were made a priori. A total of 35 of 250 emergency physicians (14.0%, 95% CI 9.9%–19.9%) converted to a positive real-time reverse transcriptase-polymerase chain reaction (PCR) during the study's 21-week period. Of these. only two were hospitalized for having respiratory-only disease, and none required respiratory support. Both were discharged within a week of admission. The weekly number of newly COVID-positive emergency physicians was zero and was seen in eight of 21 (38.1%) weeks. The peak weekly counts of six emergency physicians with new COVID-positive were seen in week 14. The mean weekly number of newly COVID-positive emergency physicians was 1.7 ± 1.9, and the median was 1 (IQR, 0 to 3). This study demonstrates that in the State of Qatar's Emergency Department (ED) system, knowing only four parameters allows the reliable prediction of the number of emergency physicians likely to convert COVID PCR tests within the next week. The results also suggest that attention to the details of minimizing endotracheal intubation (ETI) risk can eliminate the expected finding of the association between ETI numbers and emergency physician COVID numbers.

Impact of emergency physician-staffed ambulances on preoperative time course and survival among injured patients requiring emergency surgery or transarterial embolization: A retrospective cohort study at a community emergency department in Japan

Injured patients requiring definitive intervention, such as surgery or transarterial embolization (TAE), are an extremely time-sensitive population. The effect of an emergency physician (EP) patient care delivery system in this important trauma subset remains unclear. We aimed to clarify whether the preoperative time course and mortality among injured patients differ between ambulances staffed by EPs and those staffed by emergency life-saving technicians (ELST). This was a retrospective cohort study at a community emergency department (ED) in Japan. We included all injured patients requiring emergency surgery or TAE who were transported directly from the ED to the operating room from January 2002 to December 2019. The primary exposure was dispatch of an EP-staffed ambulance to the prehospital scene. The primary outcome measures were preoperative time course including prehospital length of stay (LOS), ED LOS, and total time to definitive intervention. The other outcome of interest was in-hospital mortality. One-to-one propensity score matching was performed to compare these outcomes between the groups. Of the 1,020 eligible patients, 353 (34.6%) were transported to the ED by an EP-staffed ambulance. In the propensity score-matched analysis with 295 pairs, the EP group showed a significant increase in median prehospital LOS (71.0 min vs. 41.0 min, P < 0.001) and total time to definitive intervention (189.0 min vs. 177.0 min, P = 0.002) in comparison with the ELST group. Conversely, ED LOS was significantly shorter in the EP group than in the ELST group (120.0 min vs. 131.0 min, P = 0.043). There was no significant difference in mortality between the two groups (8.8% vs.9.8%, P = 0.671). At a community hospital in Japan, EP-staffed ambulances were found to be associated with prolonged prehospital time, delay in definitive treatment, and did not improve survival among injured patients needing definitive hemostatic procedures compared with ELST-staffed ambulances.

This Article Corrects: “The Effects of Implementing a “Waterfall” Emergency Physician Attending Schedule”

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