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Life on the ground floor : letters from the edge of emergency medicine
\"A celebrated humanitarian doctor's unique perspective on sickness, health and what it is to be alive. In this deeply personal book, humanitarian doctor and activist James Maskalyk, author of the highly acclaimed Six Months in Sudan, draws upon his experience treating patients in the world's emergency rooms. From Toronto to Addis Ababa, Cambodia to Bolivia, he discovers that although the cultures, resources and medical challenges of each hospital may differ, they are linked indelibly by the ground floor: the location of their emergency rooms. Here, on the ground floor, is where Dr. Maskalyk witnesses the story of \"human aliveness\"--Our mourning and laughter, tragedies and hopes, the frailty of being and the resilience of the human spirit. And it's here too that he is swept into the story, confronting his fears and doubts and questioning what it is to be a doctor. Masterfully written and artfully structured, Life on the Ground Floor is more than just an emergency doctor's memoir or travelogue--it's a meditation on health, sickness and the wonder of human life.\"--Provided by publisher.
Book
Impacts and challenges of the COVID-19 pandemic on emergency medicine physicians in the United States
Emergency medicine (EM) physicians have been on the front line of the COVID-19 pandemic. This study aims to determine the impact of COVID-19 pandemic and other related factors such as resource availability and institutional support on well-being, burnout and job-satisfaction of EM physicians in the United States.
A cross-sectional survey study of EM physicians was conducted through the Emergency Medicine Practice Research Network of the ACEP. The survey focused on resource adequacy, institutional support, well-being, and burnout. A total of 890 EM physicians were invited to participate. Both descriptive and risk adjusted, and multivariate regressions were performed with a statistical significance defined as p < 0.05.
EM physicians' response rate was 18.7% (166) from 39 states. Burnout was reported by 74.7% (124) since the start of the pandemic. Factors contributing included work-related emotional strain and anxiety, isolation from family and friends, and increased workload. Those reporting inadequate resources felt ignored by their institutions (p < 0.0001). Physicians who felt there was inadequate institutional support, were also dissatisfied with patient care resources (p = 0.001). Physicians expressing job dissatisfaction were more likely to report feelings of burnout (p = 0.001).
EM physicians face greater burnout in the COVID-19 pandemic. This may be compounded by resource scarcity, psychological stress, isolation, and job dissatisfaction. Many of the survey respondents reported inadequate mental health services and resources. The findings of this study may help identify solutions to mitigate these issues.
Journal Article
Something for the pain : compassion and burnout in the ER
In this riveting memoir, an ER doctor reveals how his high-stress career of helping others led to a struggle to save himself.
Book
COVID–19 driven decline in emergency visits: Has it continued, is it permanent, and what does it mean for emergency physicians?
Hospital-based emergency departments have been a sustained source of overall hospital utilization in the United States. In 2019, an estimated 150 million hospital-based emergency department (ED) visits occurred in the United States, up from 90 million in 1993, 108 million in 2000 and 137 million in 2015. This study analyzes hospital ED visit registration data pre and post to the COVID-19 pandemic describe the impact of on hospital ED utilization and to assess long-term implications of COVID and other factors on the utilization of hospital-based emergency services.
We analyze real-time hospital ED visit registration data from a large sample of US hospitals to document changes in ED visits from January 2020 through March 2022 relative to 2019 (pre-COVID baseline) to describe the impact of the COVID-19 pandemic on EDs and assess long-term implications.
Our data show an initial steep reduction in ED visits during the first half of 2020 (compared to 2019 levels) with rebounding occurring in 2021, but never reaching pre-pandemic levels. Overall, ED visit volumes across the study states declined in each year since 2019: 2020 declined by −18%, 2021 by −10% and the first quarter of 2022 is −12% below 2019 levels.
There is a wide range of potential long-term implications of the observed reduction in the demand for hospital-based emergency services not only for emergency physicians, but for hospitals, health plans and consumers.
Journal Article
Living and dying in Brick City : stories from the front lines of an inner-city E.R.
Dr. Davis looks at the healthcare crisis in the inner city from the perspective of a doctor who works on the front line of emergency medical care in the community where he grew up, and as a member of that community who has faced the same challenges as the people he treats every day.
Book
A mixed methods pilot study of an internal coaching program within an academic emergency department
Background
Over 60% of emergency medicine physicians experience burnout. Professional coaching of physicians may reduce emotional exhaustion and burnout, while improving quality of life and resilience; however, few studies have specifically investigated coaching’s impact on job satisfaction and burnout of emergency physicians. This study assesses the effects of a novel coaching program, which utilized internal professional coaches, on burnout and job satisfaction among emergency physicians in an academic emergency department.
Methods
In January 2022, an internal coaching program commenced for upper-level residents, fellows, and new faculty physicians. Participants engaged in individual coaching sessions, and group coaching sessions (
n
= 4) were offered to the entire department on a variety of topics (e.g., Leadership, Bedside Teaching). Quantitative data were collected to measure baseline and follow-up burnout and job satisfaction scores via the 2-Question Summative Score of Maslach Burnout Inventory [MBI] and Global Job Satisfaction [GJS] scales, respectively. Qualitative data gathered through surveys were inductively coded, leading to the identification of experiential themes.
Results
Thirty-two participants enrolled in individual coaching. Eighty-nine individual coaching sessions were delivered, totaling 69.34 h. Participants received a median of 2 (range:1–6) sessions. Department-wide baseline and follow-up survey response rates were 33.7% and 32.7%, respectively. Among all respondents, burnout symptoms did not change significantly (MBI: t(55) = 2.00,
p
= 0.15), but job satisfaction declined significantly, with mean GJS scores decreasing from 3.73 (SD = 0.70, 95% CI: 3.49–3.98) to 3.15 (SD = 0.91, 95% CI: 2.82–3.47). When analyzed by coaching participation, no significant differences were found in MBI (t(12) = 2.18,
p
= 0.71) or GJS (t(10) = 2.23,
p
= 0.75) scores between participants and non-participants. Thematic analysis highlighted benefits and challenges of the internal coaching program. Identified themes reinforced coaching best practices (e.g., solutions-focused sessions), provided context for future efforts (e.g., maintaining diverse perspectives), and highlighted advantages and disadvantages of internal coaches (e.g., familiarity versus privacy).
Conclusion
Our pilot study did not demonstrate a reduction in burnout or an increase in job satisfaction. However, internal coaching offers valuable opportunities for academic emergency departments, including unique benefits and challenges. Future research should explore system-level impacts on burnout and job satisfaction during coaching program implementation as well as cost-effectiveness.
Journal Article
Turning point : a novel
\"Bill Browning heads the trauma unit at San Francisco's busiest emergency room, SF General. With his ex-wife and daughters in London, he immerses himself in his work and lives for rare visits with his children. A rising star at her teaching hospital, UCSF at Mission Bay, Stephanie Lawrence has two young sons, a frustrated stay-at-home husband, and not enough time for any of them. Harvard-educated Wendy Jones is a dedicated trauma doctor at Stanford, trapped in a dead-end relationship with a married cardiac surgeon. And Tom Wylie's popularity with women rivals the superb medical skills he employs at his Oakland medical center, but he refuses to let anyone get too close, determined to remain unattached forever. These exceptional doctors are chosen for an honor and a unique project: to work with their counterparts in Paris in a mass-casualty training program. As professionals, they will gain invaluable knowledge from the program. When an unspeakable act of mass violence galvanizes them into action, their temporary life in Paris becomes a stark turning point: a time to face harder choices than they have ever made before - with consequences that will last a lifetime\" -- Front jacket flap.
Book
Evaluating Clinical Decision Tools for Intensive Care Unit Admission Prediction in Patients With Coronavirus Disease 2019
During the coronavirus disease 2019 pandemic, several clinical decision rules were promulgated to support triage and optimize resource allocation, particularly regarding intensive care unit admissions. This retrospective cohort study aimed to validate and compare the predictive performance of 3 such systems: the National Early Warning Score 2, the Pandemic Respiratory Infection Emergency System Triage score, and the American College of Emergency Physicians coronavirus disease 2019 severity classification. The primary outcome was intensive care unit admission within 24 hours after ED presentation.
Data were collected from unvaccinated patients with coronavirus disease 2019 presenting to the emergency department of Antwerp University Hospital between March 1, 2020 and June 27, 2021. The National Early Warning Score 2 was calculated during routine care, and the Pandemic Respiratory Infection Emergency System Triage and American College of Emergency Physicians coronavirus disease 2019 severity classification scores were calculated retrospectively. Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC), positive likelihood ratio, and negative likelihood ratio.
Among 490 patients, optimal cutoff values were National Early Warning Score 2 of ≥3, Pandemic Respiratory Infection Emergency System Triage score of ≥8, and American College of Emergency Physicians coronavirus disease 2019 severity classification of moderate severity. All scores demonstrated good discrimination: areas under the receiver operating characteristic curve were 0.885 (National Early Warning Score 2), 0.851 (Pandemic Respiratory Infection Emergency System Triage), and 0.892 (American College of Emergency Physicians coronavirus disease 2019 severity classification), with no significant differences. The American College of Emergency Physicians coronavirus disease 2019 severity classification had the highest positive likelihood ratio (3.79), significantly higher than the National Early Warning Score 2 (2.48; P<.001). The National Early Warning Score 2 had the lowest negative likelihood ratio (0.04), although differences were not statistically significant.
Although the American College of Emergency Physicians coronavirus disease 2019 severity classification demonstrated superior rule-in characteristics, the National Early Warning Score 2 offered the best rule-out characteristics. Given its simplicity, widespread use, and rule-out potential, the National Early Warning Score 2 may offer the greatest practical value to predict intensive care unit admission 24 hours after ED presentation of unvaccinated patients with coronavirus disease 2019, particularly in a pandemic context.
Journal Article
Emergency physician’s dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard
Background
Some emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care “in the field”, with the second tier being an Emergency Physician (EP).
In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient’s condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS.
Methods
This prospective observational study included all emergency calls received in Geneva’s dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient’s condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales.
Results
97′861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90–13.32], and second line was 2.94, 95% CI [2.84–3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15–21.67], sensitivity was 36.2, 95% CI [35.5–36.9] and specificity 93.2 95% CI [93–93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734–0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98–3.20], sensitivity was 64.4, 95% CI [62.7–66.1] and specificity 88.5, 95% CI [88.3–88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623–0.82950].
Conclusion
The assessment by Geneva’s EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP’s dispatching performance.
Journal Article