Managing healthcare worker well-being in an Australian emergency department during the COVID-19 pandemic.

Emergency Medicine staff in Australia and New Zealand are at the forefront of the healthcare response to COVID-19. This article describes a well-being plan for ED staff that has been devised to mitigate against the negative psychological impact of the COVID-19 pandemic.

Association between Inpatient Delirium and Hospital Readmission in Patients ≥ 65 Years of Age: A Retrospective Cohort Study.

BACKGROUND: Delirium affects more than seven million hospitalized adults in the United States annually. However, its impact on postdischarge healthcare utilization remains unclear. OBJECTIVE: To determine the association between delirium and 30-day hospital readmission. DESIGN: A retrospective cohort study. SETTING: A general community medical and surgical hospital. PATIENTS: All adults who were at least 65 years old, without a history of delirium or alcohol-related delirium, and were hospitalized from September 2010 to March 2015. MEASUREMENTS: The patients deemed at risk for or displaying symptoms of delirium were screened by nurses using the Confusion Assessment Method with a followup by a staff psychiatrist for a subset of screen-positive patients. Patients with delirium confirmed by a staff psychiatrist were compared with those without delirium. The primary outcome was the 30-day readmission rate. The secondary outcomes included emergency department (ED) visits 30 days postdischarge, mortality during hospitalization and 30 days postdischarge, and discharge location. RESULTS: The cohort included 718 delirious patients and 7,927 nondelirious patients. Using an unweighted multivariable logistic regression, delirium was determined to be significantly associated with the increased odds of readmission within 30 days of discharge (odds ratio (OR): 2.60; 95% CI, 1.96-3.44; P < .0001). Delirium was also significantly (P < .0001) associated with ED visits within 30 days postdischarge (OR: 2.18; 95% CI: 1.77-2.69) and discharge to a facility (OR: 2.52; 95% CI: 2.09-3.01). CONCLUSIONS: Delirium is a significant predictor of hospital readmission, ED visits, and discharge to a location other than home. Delirious patients should be targeted to reduce postdischarge healthcare utilization.

Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units.

CONTEXT: Delirium is common among inpatients aged 65 years and older and is associated with multiple adverse consequences, including increased length of stay (LOS). However, delirium is frequently unrecognized and poorly understood. At one hospital, baseline management of delirium on medical-surgical units varied greatly, and psychiatric consultations focused exclusively on crisis management. OBJECTIVE: To implement a multidisciplinary program for rapid identification and proactive management of patients with delirium on medical-surgical units. DESIGN: A pilot from September 2010 to July 2012 included 920 unique patients, of whom 470 were seen by the delirium management team. A delirium management team included a redesigned role for consulting psychiatrists and a new clinical nurse specialist role; the team provided assistance with diagnosis and recommendations for nonpharmacologic and pharmacologic management of delirium. Multidisciplinary education focused on delirium identification and management and nurses' use of appropriate assessment tools. Electronic health record functions supported accurate problem list coding, referrals to the team, and standardized documentation. MAIN OUTCOME MEASURE: Length of stay. RESULTS: During the study period, average LOS in the target population decreased from 8.5 days to 6.5 days (p = 0.001); average LOS for the Medical Center remained stable. Compared with patients whose delirium was diagnosed during the baseline period, patients who received a delirium diagnosis during the pilot period had a higher illness burden and were likelier to have a history of delirium and diagnosed dementia. CONCLUSION: Program implementation was associated with reduced LOS among older inpatients with delirium. The delirium team is an effective model that can be quickly implemented with few additional resources.

Recommendations for training psychiatry residents in psychosomatic medicine.

BACKGROUND: The Accreditation Council of Graduate Medical Education (ACGME) mandates that residents in psychiatry training programs learn to provide psychiatric consultation to other medical and surgical services. The ACGME, however, offers little information to instruct academic faculty and institutions to what constitutes a quality educational experience in psychosomatic medicine/consultation-liaison psychiatry for the resident trainee. METHODS: These recommendations were developed through a collaborative process between educators in C-L psychiatry and members of the Academy of Psychosomatic Medicine's Residency Education Subcommittee. RESULTS: This manuscript provides a broad framework for what constitutes a well-rounded clinical and academic resident rotation on psychiatric consultation-liaison services. A rotation that is viewed positively by residents is important as it likely provides a foundation for a growing interest in Psychosomatic Medicine and the development of future fellows and subspecialty trained physicians.

Feasibility, safety and accuracy of regadenoson-atropine (REGAT) stress echocardiography for the diagnosis of coronary artery disease: an angiographic correlative study.

Regadenoson (REG), a selective A2A receptor vasodilator, has not been widely evaluated in stress echocardiography (SE). We report results of 45 patients participating in REG + atropine (REGAT) SE protocol conducted in a single-center prospective trial. The REGAT study enrolled subjects before a clinically indicated cardiac catheterization for suspected coronary artery disease (CAD). After rest imaging, a 2 mg Atropine (AT) bolus followed by 400 mcg of REG was given. Standard stress imaging views were obtained and interpreted in blinded fashion. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated using cardiac catheterization >70 % stenosis as gold standard. Additional endpoints included major adverse cardiac events (MACE) and patient questionnaire responses. The mean duration of REGAT was 18 ± 7.2 min. There were no MACE, with only transient side-effects of dry mouth, shortness of breath, and headache. The incidence of significant CAD was 51.1 %. The sensitivity and specificity for significant stenosis was 60.9 and 86.4 %, with a PPV and NPV of 82.4 and 67.9 %. By coronary territories, the sensitivity, specificity, PPV, and NPV were: left anterior descending artery 58.8, 92.9, 83.3, and 78.8 %; left circumflex artery 6.7, 93.3, 33.3, and 67.7 %; and right coronary artery 16.7, 93.9, 50, and 75.6 %. Over 90 % of subjects reported feeling comfortable, with 83 % preferring REGAT as a future stress modality. The REGAT protocol is fast, safe, and well-tolerated with good specificity for CAD detection, but its low sensitivity and NPV precludes it from being an imaging modality for routine use.

Coping with a patient's suicide: a curriculum for psychiatry residency training programs.

OBJECTIVE: The suicide of a patient is often experienced as a traumatic event by the clinician involved. Many articles have identified the need for education to guide clinicians through the aftermath of patient suicide; however, little has been published on development of such a curriculum, particularly for residents. This article describes one residency training program's development of an organized curriculum on coping with patient suicide and evaluates the impact of a core aspect of the training on clinicians' knowledge about and confidence with coping with patient suicide. METHODS: The training includes a biennial half-day workshop for all trainees plus an "as-needed curriculum" used after a completed suicide. A total of 42 clinicians (39 psychiatry residents and 3 psychiatry faculty) participated in a workshop on coping with patient suicide. Their attitudes and knowledge about the topic were assessed before and after the training. RESULTS: Participation in the workshop was associated with large and statistically significant increases in knowledge and self-perceptions of competence in coping with patient suicide. CONCLUSIONS: The addition of a curriculum on coping with patient suicide has the potential to significantly enhance psychiatric residency training.