Logistics and administration-related stressors among young physicians working in the emergency medicine (EM) department and their perceived job satisfaction in EM department across hospitals of India: a nationwide multicentric digital survey.

OBJECTIVE: Emergency medicine (EM) is a growing specialty in India with the board approving training programme commencing only since 2009. This study aimed to identify the challenges faced by EM department personnel in the country and to obtain valuable insight into the concerns and problems experienced by them. METHODS: This study was a cross-sectional digital survey conducted among EM department personnel in teaching institutions across India. The study involved 170 respondents, who completed an online questionnaire that covered various aspects of their work and identified the challenges they faced. It also captured potential solutions as perceived by the respondents. RESULTS: A total of n=170 participants completed the survey of which N=164 fulfilled the eligibility criteria. The study revealed significant challenges faced by EM personnel in India. Administrative and clerical work consumed a considerable amount of respondents' time. Understaffing (n=144/164; 87.8%), followed by complains about delay due to hospital administrative processes and policies (n=141/164; 85.9%), and delay in interhospital transfers (n=139/164; 84.8%) were the primary concerns spelt out by the respondents. Additionally, respondents experienced interpersonal conflicts, and verbal/physical abuse and inappropriate behaviour from patients and their family members. Potential key solutions suggested were to improve resources including manpower and take steps to prevent violence against EM staff. CONCLUSION: The study's results call for policy-makers and hospital administrators to address the issues faced by EM department staff. Improving EM department operations can improve patient care and staff well-being. Future research should examine challenges in non-teaching institutions and potential solutions.

Prevalence and Predictors of Stress, anxiety, and Depression among Healthcare Workers Managing COVID-19 Pandemic in India: A Nationwide Observational Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has caused great financial and psychological havoc. Healthcare professionals (HCPs) are among the many groups of people who are in the frontline and facing a risk of direct exposure to the virus. This study aimed to assess the prevalence and predictors of stress, depressive, and anxiety symptoms among HCPs of India. METHODS: It was a cross-sectional, online survey conducted in April 2020 among HCPs who are directly involved in the triage, screening, diagnosing, and treatment of COVID-19 patients and suspects. Stress was estimated using Cohen's perceived stress scale. Depression and anxiety were assessed using the tools Public Health Questionnaire-9 and Generalized Anxiety Disorder-7. Predictors were analyzed using univariate and multivariate binary logistic regression. RESULTS: A total of 433 online responses were obtained, and N = 350 were finally included. The prevalence (95% CI) of HCPs with high-level stress was 3.7% (2.2, 6.2), while the prevalence rates of HCPs with depressive symptoms requiring treatment and anxiety symptoms requiring further evaluation were 11.4% (8.3, 15.2) and 17.7% (13.9, 22.1), respectively. Women had approximately two times the increased odds of developing moderate- or high-level stress, depressive symptoms requiring treatment, and anxiety symptoms requiring further evaluation. Similarly, women staying in a hostel/temporary accommodation had two times the increased odds of developing depression or anxiety symptoms. CONCLUSION: The prevalence of stress, depressive, and anxiety symptoms among HCPs in India during the pandemic is comparable with other countries.

Quantifying Burnout among Emergency Medicine Professionals.

BACKGROUND: Burnout is a syndrome explained as serious emotional depletion with poor adaptation at work due to prolonged occupational stress. It has three principal components namely emotional exhaustion(EE), depersonalization(DP) and diminished feelings of personal accomplishment(PA). Thus, we aimed at measuring the degree of burnout in doctors and nurses working in emergency medicine department (EMD) of 4 select tertiary care teaching hospitals in South India. METHODS: A cross sectional survey was conducted among EMD professionals using a 30-item standardized pilot tested questionnaire as well as the Maslach burnout inventory. Univariate and Multivariate analyses were conducted using binary logistic regression models to identify predictors of burnout. RESULTS: Total number of professionals interviewed were 105 of which 71.5% were women and 51.4% were doctors. Majority (78.1%) belonged to the age group 20-30 years. Prevalence of moderate to severe burnout in the 3 principal components EE, DP and PA were 64.8%, 71.4% and 73.3% respectively. After multivariate analysis, the risk factors [adjusted odds ratio (95% confidence intervals) for DP included facing more criticism [3.57(1.25,10.19)], disturbed sleep [6.44(1.45,28.49)] and being short tempered [3.14(1.09,9.09)]. While there were no statistically significant risk factors for EE, being affected by mortality [2.35(1.12,3.94)] and fear of medication errors [3.61(1.26, 10.37)] appeared to be significant predictors of PA. CONCLUSION: Degree of burn out among doctors and nurses is moderately high in all of the three principal components and some of the predictors identified were criticism, disturbed sleep, short tempered nature, fear of committing errors and witnessing death in EMD.

A descriptive study of hand injuries presenting to the adult emergency department of a tertiary care center in urban India.

BACKGROUND: Despite having a dedicated Plastic Surgery Unit, emergency physicians (EPs) manage many of the acute, traumatic hand injuries. Further very minimal information exists about the extent to which tetanus recommendations as per Advisory Committee on Immunization Practices are followed in emergency departments (EDs). Furthermore, the management of pain is often neglected. OBJECTIVES: To provide a clinical description of hand injuries with etiology and mechanism; and describe the trends of ED management, including analgesia and tetanus prophylaxis. METHODOLOGY: Records of eighty patients with hand injuries were reviewed. SPSS version 18 was used for statistical analysis. Wilcoxon signed rank test, and Pearson Chi-square test were used to compare left with right-hand injuries and validate associations, respectively. RESULTS: The mean age of the patients was 27.41 years and median delay in presentation was 2 h. Occupational injury was the predominant mode of injury (74%) most patients (59 of the 86) received intravenous analgesia; while very few (6) received local anesthesia and (24) received no analgesia at all. A majority of patients (56) received tetanus toxoid prophylaxis, while only four patients (4.6%) also received tetanus immunoglobulin intramuscular. Most patients (71%) were admitted, while only a small number of patients (14%) were discharged from the ED. CONCLUSION: Proper training and sensitization towards the need and technique of anesthesia (particularly local anesthesia) would improve the quality of patient care. Printed guidelines and periodic review of the charts would help to overcome poor adherence to tetanus prophylaxis. Hand injuries could be managed better by the EP, with training through rotations to the Plastic Surgery Unit.