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Over the past two decades, there have been increasing calls for physicians to develop the capabilities to lead health care transformation. Many experts and authors have suggested that leadership education should begin during medical school; however, little information exists regarding the presence or nature of undergraduate medical education leadership curricula in the USA. This study sought to determine the prevalence of formal leadership education in US undergraduate medical schools, as well as the delivery methods and degree of student participation. A web-based survey of medical education deans from US allopathic medical schools (N = 144) was administered from November 2014 to February 2015. The survey included questions on the presence of leadership curricula, delivery format, student participation rates, and forms of recognition. Eighty-eight surveys were completed; the majority (85%) of respondents were associate or assistant deans for medical education. Approximately half (54.5%) of respondents reported leadership curricula within their medical schools. Of those, 34.8% (16/46) were required; 32.6% (15/46) were elective; and 32.6% (15/46) indicated both required and elective components. Of schools with formal leadership curricula ​(n = 48), the common forms of content delivery were: mentoring programs (65.1%); dual degree programs (54.5%); workshops (48.8%); seminar/lecture series (41.9%); courses (41.9%); or single seminars (18.6%). Nineteen percent of institutions offer longitudinal leadership education throughout medical school. Common forms of recognition for leadership education were: course credit (48.8%); dual degrees (37.2%); certificates of completion (18.6%); and transcript notations (7.0%). This study indicates that formal leadership education exists in more than half of US allopathic medical schools, suggesting it is an educational priority. Program format, student participation, delivery methods, and recognition varied considerably. Further study is needed to identify the optimal content, competencies, and pedagogy for leadership education. Identifying best practices may help guide standards for leadership curricula across UME and fill this educational need.​

ObjectivesThe COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic.Design, setting and participantsThis was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021.Outcomes and analysisWe identified 42 potential pandemic-related strategies and obtained week-to-week data about their use. We calculated descriptive statistics for use of each strategy and plotted percent uptake and weeks used. We assessed the relationship between strategy use and hospital type, geographic region and phase of the pandemic using generalised estimating equations (GEEs), adjusting for weekly county case counts.ResultsWe found heterogeneity in strategy uptake over time, some of which was associated with geographic region and phase of pandemic. We identified a body of strategies that were both commonly used and sustained over time, for example, limiting staff in COVID-19 rooms and increasing telehealth capacity, as well as those that were rarely used and/or not sustained, for example, increasing hospital bed capacity.ConclusionsHospital strategies during the COVID-19 pandemic varied in resource intensity, uptake and duration of use. Such information may be valuable to health systems during the ongoing pandemic and future ones.

Introduction The application of implementation science (IS) frameworks to evaluate quality process improvement initiatives in an academic emergency department (ED) setting offers a promising approach for learning health systems (LHS). This report describes the University of Colorado Department of Emergency Medicine's LHS partnership among clinical operations, data analytics, and IS experts to evaluate a novel shared note workflow. Methods The University of Colorado Health (UCH) ED, staffed with scribes, advanced practice providers, and physicians, implemented a shared note workflow in summer 2022. This workflow involved all parties in a clinical encounter using a single note template, unlike previous separate notes. An IS expert guided the evaluation using the implementation of change model and the theoretical domains framework, with surveys and Epic electronic health record (EHR) encounter data. Analysis included descriptive statistics and regression analysis, comparing note completion rates pre (summer 2021) and post (summer 2022 and 2023) shared notes. Results Among 146 survey respondents, knowledge [M (SD) = 6.0 (0.9)] and confidence [5.5 (1.3)] following the new workflow were high (1–7 scale). Acceptability [M (SD) = 4.42 (0.80)], appropriateness [4.48 (0.70)], and feasibility [4.5 (0.61)] were also high (1–5 scale). EHR data showed note completion during the shift increased to 48.3% in 2022 from 32.2% in 2021, a 50% improvement (OR (95% CI) = 2.34 (2.28–2.40), p < 0.0001). By summer 2023, note completion attenuated to 41.3%, still significantly higher than pre‐shared note workflow (OR (95% CI) = 1.96 (1.90–2.01), p < 0.0001). Conclusion This IS‐enhanced LHS evaluation of a shared note workflow in an academic ED demonstrated high satisfaction and a positive impact on note completion during shifts. Timely note completion is crucial for reducing clinician burnout and providing high‐quality care. IS methods provided data‐driven insights to justify the sustainment of the shared note workflow to organizational leaders.

Mass vaccination campaigns have been used effectively to limit the impact of communicable disease on public health. However, the scale of the coronavirus disease (COVID-19) vaccination campaign is unprecedented. Mass vaccination sites consolidate resources and experience into a single entity and are essential to achieving community (“herd”) immunity rapidly, efficiently, and equitably. Health care systems, local and regional public health entities, emergency medical services, and private organizations can rapidly come together to solve problems and achieve success. As medical directors at several mass vaccination sites across the United States, we describe key mass vaccination site concepts, including site selection, operational models, patient flow, inventory management, staffing, technology, reporting, medical oversight, communication, and equity. Lessons learned from experience operating a diverse group of mass vaccination sites will help inform not only sites operating during the current pandemic, but also may serve as a blueprint for future outbreaks of highly infectious communicable disease.

Drive-through clinics have previously been utilized in vaccination efforts and are now being more widely adopted for COVID-19 vaccination in different parts of the world by offering many advantages including utilizing existing infrastructure, large daily throughput and enforcing social distancing by default. Successful, effective, and efficient drive-through facilities require a suitable site and keen focus on layout and process design. To demonstrate the role that high fidelity computer simulation can play in planning and design of drive-through mass vaccination clinics, we used multiple integrated discrete event simulation (DES) and agent-based modelling methods. This method using AnyLogic simulation software to aid in planning, design, and implementation of one of the largest and most successful early COVID-19 mass vaccination clinics operated by UCHealth in Denver, Colorado. Simulations proved to be helpful in aiding the optimization of UCHealth drive through mass vaccination clinic design and operations by exposing potential bottlenecks, overflows, and queueing, and clarifying the necessary number of supporting staff. Simulation results informed the target number of vaccinations and necessary processing times for different drive through station set ups and clinic formats. We found that modern simulation tools with advanced visual and analytical capabilities to be very useful for effective planning, design, and operations management of mass vaccination facilities.

Among critically ill patients undergoing orotracheal intubation in the emergency department (ED) or intensive care unit (ICU), failure to visualise the vocal cords and intubate the trachea on the first attempt is associated with an increased risk of complications. Two types of laryngoscopes are commonly available: direct laryngoscopes and video laryngoscopes. For critically ill adults undergoing emergency tracheal intubation, it remains uncertain whether the use of a video laryngoscope increases the incidence of successful intubation on the first attempt compared with the use of a direct laryngoscope. The ir ct versus deo Laryngos op (DEVICE) trial is a prospective, multicentre, non-blinded, randomised trial being conducted in 7 EDs and 10 ICUs in the USA. The trial plans to enrol up to 2000 critically ill adults undergoing orotracheal intubation with a laryngoscope. Eligible patients are randomised 1:1 to the use of a video laryngoscope or a direct laryngoscope for the first intubation attempt. The primary outcome is successful intubation on the first attempt. The secondary outcome is the incidence of severe complications between induction and 2 min after intubation, defined as the occurrence of one or more of the following: severe hypoxaemia (lowest oxygen saturation <80%); severe hypotension (systolic blood pressure <65 mm Hg or new or increased vasopressor administration); cardiac arrest or death. Enrolment began on 19 March 2022 and is expected to be completed in 2023. The trial protocol was approved with waiver of informed consent by the single institutional review board at Vanderbilt University Medical Center and the Human Research Protection Office of the Department of Defense. The results will be presented at scientific conferences and submitted for publication in a peer-reviewed journal. ClinicalTrials.gov Registry (NCT05239195).

Among critically ill adults undergoing tracheal intubation, hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain. In a multicenter, randomized trial conducted at 24 emergency departments and intensive care units in the United States, we randomly assigned critically ill adults (age, ≥18 years) undergoing tracheal intubation to receive preoxygenation with either noninvasive ventilation or an oxygen mask. The primary outcome was hypoxemia during intubation, defined by an oxygen saturation of less than 85% during the interval between induction of anesthesia and 2 minutes after tracheal intubation. Among the 1301 patients enrolled, hypoxemia occurred in 57 of 624 patients (9.1%) in the noninvasive-ventilation group and in 118 of 637 patients (18.5%) in the oxygen-mask group (difference, -9.4 percentage points; 95% confidence interval [CI], -13.2 to -5.6; P<0.001). Cardiac arrest occurred in 1 patient (0.2%) in the noninvasive-ventilation group and in 7 patients (1.1%) in the oxygen-mask group (difference, -0.9 percentage points; 95% CI, -1.8 to -0.1). Aspiration occurred in 6 patients (0.9%) in the noninvasive-ventilation group and in 9 patients (1.4%) in the oxygen-mask group (difference, -0.4 percentage points; 95% CI, -1.6 to 0.7). Among critically ill adults undergoing tracheal intubation, preoxygenation with noninvasive ventilation resulted in a lower incidence of hypoxemia during intubation than preoxygenation with an oxygen mask. (Funded by the U.S. Department of Defense; PREOXI ClinicalTrials.gov number, NCT05267652.).

Democratic members of Congress from California seized on the oil spill off the state's coast to promote federal legislation to ban all offshore oil drilling, as investigators search for what caused the pipeline to burst.