Factors that influence interprofessional implementation of trauma-informed care in the emergency department.

Background: To describe factors that influence interprofessional staff decisions and ability to implement trauma-informed care (TIC) in a level-one emergency department (ED) trauma center. Methods: This qualitative research study consisted of semi-structured interviews and quantitative surveys that were conducted between March and December 2020 at an urban trauma center. Eligible participants were staff working in the ED. Interview questions were developed using the Theoretical Domains Framework (TDF), which is designed to identify influences on health professional behavior related to implementation of evidence-based recommendations. Interview responses were transcribed, coded using Atlas software, and analyzed using thematic analysis. Results: Key themes identified included awareness of TIC principles, impact of TIC on staff and patients, and experiences of bias. Participants identified opportunities to improve care for patients with a trauma history, including staff training, more time with patients, and efforts to decrease bias toward patients. Most participants (85.7%) felt that a TIC plan, tiered trauma inquiry, and warm handovers would be easy or very easy to implement. Conclusion: We identified key interprofessional staff beliefs and attitudes that influence implementation of TIC in the ED. These factors represent potential individual, team-based, and organizational targets for behavior change interventions to improve staff response to patient trauma and to address secondary trauma experienced by ED staff.

Gender Differences in Physician Burnout: Driving Factors and Potential Solutions.

Introduction Burnout among physicians has reached an epidemic level, with substantially higher rates among women. In this brief report, the authors evaluate recent literature to identify major factors leading to gender differences in physician burnout. Methods The authors review data on gender within each of the key drivers of burnout, including workload and job demands, efficiency and resources, control and flexibility, organizational culture and values, social support and community at work, work-life integration, and meaning at work. Results Women physicians face a higher workload, spending more time in electronic health records, and more time per patient. Women physicians also receive fewer resources and report less control over their workload and schedules. Organizational culture factors, such as a lack of women in leadership roles, compensation disparities, lower rates of career advancement and academic promotion, as well as gender bias, microaggressions, and harassment, also play a key role in gender disparities in burnout. Disproportionate responsibilities outside of work, including childcare and elder care, contribute to less satisfaction with work-life integration. Additionally, women physicians report lower self-compassion and perceived appreciation. These factors ultimately lead to decreased professional fulfillment and higher burnout rates among women physicians. Finally, the authors present proposals to address each of these factors at an organizational level, to effectively address the high burnout rate among women physicians. Conclusion Burnout among women physicians is substantially higher compared to men and stems from multiple factors. It is crucial for organizations to evaluate the gender differences within each burnout driver and develop sustainable strategies to reduce disparities.

Trauma-informed Care Interventions in Emergency Medicine: A Systematic Review.

INTRODUCTION: Trauma exposure is a highly prevalent experience for patients and clinicians in emergency medicine (EM). Trauma-informed care (TIC) is an effective framework to mitigate the negative health impacts of trauma. This systematic review synthesizes the range of TIC interventions in EM, with a focus on patient and clinician outcomes, and identifies gaps in the current research on implementing TIC. METHODS: The study was registered with PROSPERO (CRD42020205182). We systematically searched peer-reviewed journals and abstracts in the PubMed, EMBASE (Elsevier), PsycINFO (EBSCO), Social Services Abstract (ProQuest), and CINAHL (EBSCO) databases from 1990 onward on August 12, 2020. We analyzed studies describing explicit TIC interventions in the ED setting using inductive qualitative content analysis to identify recurrent themes and identify unique trauma-informed interventions in each study. Studies not explicitly citing TIC were excluded. Studies were assessed for bias using the Newcastle-Ottawa criteria and Critical Appraisal Skills Programme (CASP) Checklist. RESULTS: We identified a total of 1,372 studies and abstracts, with 10 meeting inclusion criteria for final analysis. Themes within TIC interventions that emerged included educational interventions, collaborations with allied health professionals and community organizations, and patient and clinician safety interventions. Educational interventions included lectures, online modules, and standardized patient exercises. Collaborations with community organizations focused on addressing social determinants of health. All interventions suggested a positive impact from TIC on either clinicians or patients, but outcomes data remain limited. CONCLUSION: Trauma-informed care is a nascent field in EM with limited operationalization of TIC approaches. Future studies with patient and clinician outcomes analyzing universal TIC precautions and systems-level interventions are needed.

Primary Care Physician Gender and Electronic Health Record Workload.

BACKGROUND: Prior research indicates that female physicians spend more time working in the electronic health record (EHR) than do male physicians. OBJECTIVE: To examine gender differences in EHR usage among primary care physicians and identify potential causes for those differences. DESIGN: Retrospective study of EHR usage by primary care physicians (PCPs) in an academic hospital system. PARTICIPANTS: One hundred twenty-five primary care physicians INTERVENTIONS: N/A MAIN MEASURES: EHR usage including time spent working and volume of staff messages and patient messages. KEY RESULTS: After adjusting for panel size and appointment volume, female PCPs spend 20% more time (1.9 h/month) in the EHR inbasket and 22% more time (3.7 h/month) on notes than do their male colleagues (p values 0.02 and 0.04, respectively). Female PCPs receive 24% more staff messages (9.6 messages/month), and 26% more patient messages (51.5 messages/month) (p values 0.03 and 0.004, respectively). The differences in EHR time are not explained by the percentage of female patients in a PCP's panel. CONCLUSIONS: Female physicians spend more time working in their EHR inbaskets because both staff and patients make more requests of female PCPs. These differential EHR burdens may contribute to higher burnout rates in female PCPs.

To Treat My Patient, I Had To Understand Her Trauma.

A patient who is a survivor of abuse benefits from a health care approach that acknowledges her past trauma.

The state of the science on trauma inquiry.

Within the context of longitudinal medical care for adults, health care providers have a unique opportunity to inquire and respond to the traumatic life experiences affecting the health of their patients, as well as a responsibility to minimize retraumatizing these patients during medical encounters. While there is literature on screening women for intimate partner violence, and there is emerging data on pediatric screening for adverse life experiences, there is sparse literature on inquiry of broader trauma histories in adult medical settings. This lack of research on trauma inquiry results in an absence of guidelines for best practices, in turn making it challenging for policy makers, health care providers, and researchers to mitigate the adverse health outcomes caused by traumatic experiences and to provide equitable care to populations that experience a disproportionate burden of trauma. This state of the science summarizes current inquiry practices for patients who have experienced trauma, violence, and abuse. It places trauma inquiry within an anchoring framework of trauma-informed care principles, and emphasizes a focus on resilience. It then proposes best practices for trauma inquiry, which include tiered screening starting with broad trauma inquiry, proceeding to risk and safety assessment as indicated, and ending with connection to interventions.

Promoting Health Equity Through Trauma-Informed Care: Critical Role for Physicians in Policy and Program Development.

Trauma-informed care has emerged as an important model to address the pervasiveness of traumatic experiences across the life cycle and their association with significant adverse medical and psychiatric consequences. To achieve health equity, in which all people have the opportunity for health, it is crucial for physicians to become comfortable with a neurobiopsychosocial understanding of trauma and how to provide optimal trauma-informed care. Given the pervasiveness of trauma exposure, and its impact on individual and community health, this paradigm shift in adult health care delivery systems requires physician engagement at every stage of development and implementation.