ABSTRACT
Study Objectives: Amid the US opioid epidemic, emergency providers and patients are searching for non-opioid or nonpharmacologic pain treatment options. The challenge of managing pain without opioids was escalated by the COVID-19 pandemic with opioid related overdoses and deaths increasing by 20-40%. Most healthcare professionals have limited knowledge, resources or time for pain education, especially in the emergency department (ED). To address these needs a novel pain coaching program was designed including a menu of nonpharmacologic patient discharge toolkit materials. Study objectives were to determine descriptive patient and toolkit utilization data and challenges in the first 4 months of a novel pain program. Methods: Target population consisted of patients ≥14 years of age seen by a new ED Pain Coaching staff from January 4, 2021- April 30, 2021. The two ED sites consisted of an urban, academic center with trauma center, pediatric ED, etc. and an affiliated community ED. Patients were determined by ED rounding, ED census review and consultation by ED staff, physicians, physical therapy, palliative care and pharmacy. Summary statistics for patient demographics, pain type, REALM-SF score, educational topics, toolkit materials, challenges and other data were ed from coaching and patient notes on a daily basis using a REDCap database for analysis. Upon request, there were select inpatient and repeat coaching encounters. Results: During this 4-month pilot, 296 coaching sessions were completed on 276 unique patients;20 screen outs for severe pain, procedures, violent behavior or other obstacles. Average age was 43 with 85% between 20-70 years of age;62% female;60% African American. Pain was 46% acute, 50% acute on chronic and 4% chronic with patients often having multiple pain etiologies: musculoskeletal (74%), inflammatory (71%), post-trauma (15%), headache (14%), post-surgical (4%) and neuropathic (3%). Education topics provided with accompanying toolkit items: hot/cold gel packs (90%), car with 4 flat tires analogy (90%), pain neuroscience education (88%), aromatherapy inhalers (82%), breathing techniques (69%), virtual reality (51%), exercise (38%), stretching (35%), diet (20%), acupressure (11%). The majority of patients were seen in 2 EDs or associated trauma center (87%);however, the coach received referrals for selected inpatients (13%). Seventeen educational brochures were made available to patients with aromatherapy, managing pain, pain and stress, and nonpharmacologic management being most utilized. Challenges to coaching included medical condition (14%), too much pain (11%), time constraints (7%);52% had no challenges. Regarding patient feedback, 61% indicated the session was helpful and 39% were unsure at the time. Conclusion: Results from this novel ED pain coach and discharge toolkit model provide valuable insights for development of a national pain coach model. Coaching scripts, note template, brochures, videos, inventory and other programmatic materials will be published for further implementation. Future plans include longitudinal patient follow-up, staff satisfaction assessment and addition of new modalities.
ABSTRACT
Intro/Background: In 2019, our department created an Assistant Chair for Faculty Development position with the purpose of working with the Chair to establish a culture fully engaging all faculty and their tremendous, diverse talents and to maintain a rewarding and engaging workplace. From this collaboration, a departmental faculty development (FDC) committee was established. Purpose/Objective: The FDC mission is to foster faculty morale and promote professional growth at all career levels through: (1) amplification and recognition of faculty accomplishments by seeking and responding to award opportunities;(2) facilitation of skill building for teaching, mentorship, and leadership development in various niches and divisions;and (3) equipping faculty to publish and disseminate their innovations and scholarly work. Methods: An 8-member committee representing assignments in operations, research and education, at all ranks, and all clinical sites was formed (4 women, 4 men;1 professor, 4 associate professors, 3 assistant professors). The FDC meets monthly to discuss faculty needs previously identified through survey and issues raised ad hoc. The committee serves as a nomination letter-writing bureau for local and national award opportunities. It also identifies diverse candidates for appointments to hospital and university committees. Outcomes (if available): In the first year, we held 10 monthly meetings and produced a departmental website with faculty development resources. Micro-lectures on university-assigned mentorship, promotion and tenure, resident evaluations, and faculty ultrasound skills training were delivered in faculty meetings. We introduced a new annual faculty retreat model. Faculty received twelve international, national and university awards in 2020. The FDC managed submissions for university and hospital-wide committee appointments. A planned 2-day mentoring skills workshop was postponed for COVID-19. Summary: While many institutions focus on faculty development from a global perspective, our program is novel in that it is structured at the department, level addressing the unique challenges and opportunities encountered by Emergency Medicine faculty. A website with resources under the following headings was produced: “Annual evaluation, CV, Promotion,” “Mentorship and Coaching,” “Scholarly Productivity and Publications,” “Required CME,” “Faculty Awards,” and “Time Management Resources.” We coordinate faculty mentorship and coaching with assigned mentors, annual reviews and planned workshops to improve mentor/mentee relationships and skills. We coordinate with departmental research committees to identify and respond to faculty research needs. Utilizing a new faculty retreat model, we transitioned from a traditional business-meeting format to a new FDC-moderated small-group working agenda focusing on important topics in scholarly productivity, onboarding of new faculty, education, clinical practice and operations. Faculty reviewed prompts and met with departmental leadership to brainstorm solutions to departmental challenges. Working points were summarized and action items reviewed with all faculty in the next departmental meeting. These action items outline a departmental faculty development agenda for the year ahead. Informal faculty feedback responses are positive about the new format for faculty retreats, the delivered micro-lectures on faculty development and annual evaluation and mentorship meetings. Future evaluation of the committee could focus on faculty engagement with FDC initiatives and metrics related to scholarly outputs.