The Chief Wellness Officer: A long overdue catalyst for systemic change in Emergency Medicine.

GOALS: The American healthcare system is amid a burnout epidemic, worsened by COVID, that must be addressed expeditiously and with high priority. The burden Emergency Physicians encountered before and during the pandemic is well known, with countless healthcare workers exiting the work force. A Chief Wellness Officer (CWO) is a senior leader who works primarily to cultivate organisational wellness and to foster and promote a culture of well-being throughout an institution. Specifically, the CWO assists the health system leadership promote clinician engagement and address clinician burnout. This paper explores the status of existing CWOs, and cites the benefits, impacts, and barriers to implementation of a CWO, with focus on the field of Emergency Medicine (EM). METHODS: A steering committee of wellness experts was formed from a national EM organisation. A purposive search and literature review using search terms relating to CWOs was completed. Publications were examined for relevance and recency. The committee created an online questionnaire surveying current US CWOs, conducted personal interviews, and met through regular focused meetings. A framework delineating the role of a CWO as an organisation evolves from instituting novice wellness interventions to expert organisational innovations was created. PRINCIPLE FINDINGS: Despite their title, CWOs are not regularly included in c-suite decisions. Barriers to instituting a CWO include perceived financial cost, the medical system itself, and physician resistance. Defining and measuring objective return on investment may be a solution to overcoming barriers. CWOs who create comprehensive institutional wellness innovations bring organisations to the highest proficient and expert levels of wellness practices, positively affecting physician engagement and deflecting burnout. CWOs instituting novice and beginner levels of wellness interventions, especially in EM, only modestly impact individual wellness practices. PRACTICAL APPLICATIONS: A CWO and team with an organisational voice and a C-suite stakeholder's seat are essential to centralising and leading effective wellness efforts and innovations in EM and other specialities. This team will improve the work environment and culture and begin to fix our broken healthcare system and providers.

Does academic practice protect emergency physicians against burnout?

Burnout is a complex syndrome thought to result from long-term exposure to career-related stressors. Physicians are at higher risk for burnout than the general United States (US) working population, and emergency medicine has some of the highest burnout rates of any medical specialty. Burnout impacts physicians' quality of life, but it can also increase medical errors and negatively affect patient safety. Several studies have reported lower burnout rates and higher job satisfaction in academic medicine as compared with private practice. However, researchers have only begun to explore the factors that underlie this protective effect. This paper aims to review existing literature to identify specific aspects of academic practice in emergency medicine that may be associated with lower physician burnout rates and greater career satisfaction. Broadly, it appears that spending time in the area of emergency medicine one finds most meaningful has been associated with reduced physician burnout. Certain non-clinical academic work, including involvement in research, leadership, teaching, and mentorship, have been identified as specific activities that may protect against burnout and contribute to higher job satisfaction. Given the epidemic of physician burnout, hospitals and practice groups have a responsibility to address burnout, both by prevention and by early recognition and support. We discuss methods by which organizations can actively foster physician well-being and provide examples of 2 leading academic institutions that have developed comprehensive programs to promote physician wellness and prevent burnout.

How fast is the focused assessment with sonography for trauma examination learning curve?

OBJECTIVE: Although accuracy for focused assessment with sonography for trauma (FAST) examination interpretation has been widely reported, the learning curve for FAST interpretation by emergency medicine (EM) residents who are novice to ultrasound has not been well described. The present study's objective was to analyse EM resident FAST interpretation accuracy over 18 months. METHODS: Prospective comparison of EM resident FAST interpretation accuracy for a class of nine EM residents at baseline after initial training, and then every 6 months over 18 months. Accuracy was scored after viewing the same 20 video clip images of the four anatomic views for five FAST examination cases. Three video clips had large anechoic stripe (AS) (>6 mm), four had moderate AS (6 mm > or = AS > or = 3 mm), two had small AS (<3 mm), and eleven had no AS (AS = 0 mm). A surgeon with 20 years of ultrasound experience confirmed the video clip interpretations. Data analysis used descriptive statistics with 95% confidence intervals. RESULTS: For no AS views, EM resident accuracy was 79.8% (70.3-86.9%) baseline, 91.9% (84.2-96.2%) at 12 months, and 92.9% (85.5-96.9%) at 18 months. For small AS views, resident accuracy was 27.8% (10.7-53.6%) baseline, 66.7% (41.2-85.7%) at 12 months, and 72.2% (46.4-89.3%) at 18 months. For large AS views, resident accuracy was 77.8% (57.3-90.6%) baseline, 86.1% (69.7-94.8%) at 12 months, and 100.0% (84.5-100%) at 18 months. CONCLUSION: Over 18 months, EM resident FAST interpretation accuracy steadily increased. By 12 months (or 35 examinations), the accuracy of EM residents novice to ultrasound approximated previously reported accuracy rates.

Ultrasound applications in mass casualties and extreme environments.

A mass-casualty incident is one in which the number of patients with injuries exceeds the available medical resources to care for them in a timely manner. In such a situation, the numerous advantages of ultrasonography make it an ideal triage tool for helping clinicians rapidly screen patients. Experiences during the 1988 Armenian earthquake and the 1999 Turkish earthquake demonstrated the proficiency of ultrasound in providing rapid clinical data to the physicians caring for the mass-casualty patients. Wireless and satellite transmission of ultrasound images also has been shown to be feasible and may be applied to mass-casualty situations. In addition, ultrasound applications have been demonstrated to aid in the diagnosis of various conditions, including pneumothorax, in the International Space Station. Ultrasound's portability, reproducibility, accuracy, and ease of use will make it an important diagnostic instrument for future space missions.