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Introduction: Hospitals have implemented various wellness interventions to offset the negative effects of coronavirus disease 2019 (COVID-19) on emergency physician morale and burnout. There is limited high quality evidence regarding effectiveness of hospital-directed wellness interventions, leaving hospitals without guidance on best practices. We sought to determine intervention effectiveness and frequency of use in the spring/summer 2020. The goal was to facilitate evidence-based guidance for hospital wellness program planning. Methods:This cross-sectional observational study we used a novel survey tool piloted at a single hospital and then distributed throughout the United States via major emergency medicine (EM) society listservs and closed social media groups. Subjects reported their morale levels using a slider scale from 1 (lowest) to 10 (highest) at the time of the survey and, retrospectively, at their respective COVID-19 peak in 2020. Subjects also rated effectiveness of wellness interventions using a Likert scale from 1 (not at all effective) to 5 (very effective). Subjects indicated their hospital's usage frequency of common wellness interventions. We analyzed results using descriptive statistics and t-tests.Results: Of 76,100 EM society and closed social media group members, 522 (0.69%) subjects were enrolled. Study population demographics were similar to the national emergency physician population. Morale at the time of the survey was worse (mean [M] 4.36, SD 2.29) than the spring/summer 2020 peak (M 4.57, SD 2.13) [t(458)=-2.27, P=0.024]. The most effective interventions were hazard pay (M 3.59, SD 1.12), staff debriefing groups (M 3.51, SD 1.16), and free food (M 3.34, SD 1.14). The most frequently used interventions were free food (350/522, 67.1%), support sign display (300/522, 57.5%), and daily email updates (266/522, 51.0%). Infrequently used were hazard pay (53/522, 10.2%) and staff debriefing groups (127/522, 24.3%). Conclusion:There is discordance between the most effective and most frequently used hospital-directed wellness interventions. Only free food was both highly effective and frequently used. Hazard pay and staff debriefing groups were the two most effective interventions but were infrequently used. Daily email updates and support sign display were the most frequently used interventions but were not as effective. Hospitals should focus effort and resources on the most effective wellness interventions. [West J Emerg Med. 2023;24(3)597-604.] How does this improve population health? This study provides guidance for hospitals to refocus their wellness planning efforts to use the most effective interventions.

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Since early 2020, the world has been living through coronavirus disease 2019 (COVID-19). Westchester County, New York, was one of the hardest and earliest hit places in the United States. Working within a community emergency department amid the rise of a highly infectious disease such as COVID-19 presented many challenges, including appropriate isolation, adequate testing, personnel shortages, supply shortfalls, facility changes, and resource allocation. Here we discuss our process in navigating these complexities, including the practice changes implemented within our institution to counter these unprecedented issues. These adjustments included establishing three outdoor tents to serve as triage areas; creating overflow intensive care units through conversion of areas that had previously served as the ambulatory surgery unit, post-anesthesia care unit, and endoscopy suite; increasing critical care staff to meet unprecedented need; anticipating and adapting to medical supply shortages; and adjusting resident physician roles to meet workflow requirements. By analyzing and improving upon the processes delineated below, our healthcare system should be better prepared for future pandemics.

Introduction Previous studies have shown that risk attitudes and tolerance for uncertainty are significant factors in clinical decision-making, particularly in the practice of defensive medicine. These attributes have also been linked with rates of physician burnout. To date, the risk profile of emergency medicine (EM) physicians has not yet been described. Our goal was to examine the risk profile of EM residents using a widely available risk tolerance and attitude assessment tool. Methods First-, second-, and third-year residents of Thomas Jefferson University Hospital’s EM residency program completed the commercially available, unmodified Risk Type Compass, a validated instrument offered by Multi-Health Systems (MHS Inc, New York, USA). Scored reports included information on residents’ risk type (one of eight personality types that reflect their temperament and disposition); risk attitudes (domains where residents are more likely to engage in risky behaviors); and an overall risk tolerance indicator (RTi) (a numerical estimate of risk tolerance). RTi scores are reported as means with 95% confidence intervals (CIs). Results There was no significant change in RTi scores in residents across different years of their post-graduate year (PGY) training. PGY-one residents trended towards risk aversion; PGY-two residents were more risk-taking; and PGY-three residents scored in the middle. Conclusion Our pilot assessment of risk types in EM residents highlighted shifts across the years of training. Variations between members of each PGY cohort outweighed any outright differences between classes with regards to absolute risk tolerance. There was an increase in the frequency of health and safety risk-taking attitude with higher PGY class, and this was also the risk attitude that was the prominent domain for resident risk tolerance. The study was limited by sample size and single cross-sectional evaluation.