Clinician Absences and Contributing Factors During a COVID-19 Surge: Potential Areas for Intervention and Planning.

INTRODUCTION: Our goal was to quantify healthcare clinician (HCC) absenteeism in the emergency department (ED) during the coronavirus disease 2019 (COVID-19) surge and to identify potential interventions that may mitigate the number of absences. METHODS: This was a retrospective, descriptive record review that included 82 resident physicians, physician assistants, and staff physicians who were scheduled to work more than three clinical shifts during March 2020 in an urban, academic ED that received a high number of coronavirus disease 2019 (COVID-19) patients. Exposure was defined as a healthcare clinician who was not wearing appropriate personal protective equipment (PPE) having contact with a confirmed COVID-19 positive patient in the ED. The main outcome was the number of HCC absences secondary to exposure to or symptoms concerning for COVID-19. RESULTS: During March 2020, of 82 ED HCCs, 28 (34%) required an absence from clinical duties, totaling 152 absentee calendar days (N = 13 women [46%]; N = 15 men [54%]). Median HCC age was 32 years (interquartile range 28-39), and median number of days absent was four (interquartile range 3-7). While 16 (57%) of the total absences were secondary to a known exposure, 12 (43%) were symptomatic without a known exposure. A total of 25 (89%) absent HCCs received COVID-19 testing (N = 5 positive [20%]; N = 20 negative [80%]) with test results returning in 1-10 days. Eleven (39%) symptomatic HCCs had traveled domestically or internationally in the prior 30 days. CONCLUSION: Emergency departments should anticipate substantial HCC absences during the initial surge of a pandemic. Possible interventions to mitigate absences include early and broad use of PPE, planning for many asymptomatic HCC absences secondary to exposures, prioritizing HCC virus testing, and mandating early travel restrictions.

Critical Care Delivery Solutions in the Emergency Department: Evolving Models in Caring for ICU Boarders.

The National Academy of Medicine has identified emergency department (ED) crowding as a health care delivery problem. Because the ED is a portal of entry to the hospital, 25% of all ED encounters are related to critical illness. Crowding at both an ED and hospital level can thus lead to boarding of a number of critically ill patients in the ED. EDs are required to not only deliver immediate resuscitative and stabilizing care to critically ill patients on presentation but also provide longitudinal care while boarding for the ICU. Crowding and boarding are multifactorial and complex issues, for which different models for delivery of critical care in the ED have been described. Herein, we provide a narrative review of different models of delivery of critical care reported in the literature and highlight aspects for consideration for successful local implementation.

Radiology report turnaround time: effect on resident education.

RATIONALE AND OBJECTIVES: To compare resident workload from Emergency Department (ED) studies before and after the implementation of a required 1-hour report turnaround time (TAT) and to assess resident and faculty perception of TAT on resident education. MATERIALS AND METHODS: Resident study volume will be compared for 3 years before and 1 year after the implementation of a required 1-hour TAT. Changes to resident workload will be compared among the different radiology divisions (body, muscuolskeletal (MSK), chest, and neuro), as well as during different shifts (daytime and overnight). Residents and faculty at two Midwest institutions, both of which have a required report TAT, will be invited to participate in an online survey to query the perceived effect on resident education by implementation of this requirement. A P < .05 was considered statistically significant. RESULTS: A significant decrease in resident involvement in ED studies was noted in the MSK, chest, and neuro sections with average involvement of the 3 years before the 1-hour TAT of 89%, 88%, and 82%, respectively, which decreased to 66%, 68%, and 51% after the 1-hour TAT requirement (P < .05). The resident involvement in ED studies only mildly decreased in the body section from an average before the 1-hour TAT of 87% to 80% after the 1-hour TAT requirement (P < .1). There was an overall significant decrease in resident ED study involvement during the daytime (P = .01) but not after hours during resident call (P = .1). Seventy percent of residents (43 of 61) and 55% of faculty (63 of 114) responded to our surveys. Overall, residents felt their education from ED studies during the daytime and overnight were good. However, residents who were present both before and after the implementation of a required TAT felt their education had been significantly negatively affected. Faculty surveyed thought that the required TAT negatively affected their ability to teach and decreased the quality of resident education. CONCLUSIONS: Residents are exposed to fewer ED studies after the implementation of a required 1-hour TAT. Overall, the current residents do not feel this decreased exposure to Emergency room studies affects their education. However, residents in training before and after this requirement feel their education has been significantly affected. Faculty perceives that the required TAT negatively affects their ability to teach, as well as the quality of resident education.

An automated dispensing system for improving medication timing in the emergency department.

BACKGROUND: Numerous medical conditions require timely medication administration in the emergency department (ED). Automated dispensing systems (ADSs) store premixed common doses at the point-of-care to minimize time to administration, but the use of such automation to improved time to medication administration has not been studied. Since vancomycin is a commonly used empiric antimicrobial, we sought to quantify the effect of using an ADS on time to drug delivery in patients presenting to the ED. The study aimed to determine the efficacy of utilizing an ADS to improve time to administration of vancomycin and determine any negative effects on dosing appropriateness. METHODS: The institional review board approved the retrospective quality improvement study took place in a single, urban academic tertiary care ED with an annual census of 80 000. Study subjects were all patients receiving vancomycin for the management of sepsis between March 1 to September 30, 2008 and the same time period in 2009. The primary outcome was the proportion of patients who received vancomycin within one hour of bed placement and the secondary outcome was dosing appropriateness. RESULTS: Sixty-three patients had weight and dosing information available (29 before and 34 after intervention) and were included in the study. Before intervention, no patient received vancomycin in less than 60 minutes, while after intervention 14.7% of the patients received it in less than 60 minutes (difference in proportions 14.7%, 95% CI 0.39%-30.0%, P=0.04). A similar proportion of the patients received correct dosing before and after intervention (44.8% vs. 41.2%, difference in proportions 3.7%, 95% CI -20.0%-26.7%, P=0.770). CONCLUSION: The use of an ADS may improve the timing of medication administration in patients presenting to the ED without affecting dosing appropriateness.