Background: Emergency department (ED) workplace violence is increasingly recognized as an important issue for ED providers. Most studies have occurred in developed countries with established laws and repercussions for violence against healthcare providers. There is a paucity of data on workplace violence against ED providers in less developed countries. The aim of this study was to learn more about workplace violence among healthcare providers in EDs in India. Results: Semi-structured interviews were conducted in-person with physicians, nurses, and paramedics in Indian EDs. Interviews were coded independently using the NVivo qualitative research software. A hybrid thematic analysis approach was used to determine dominant themes. Sixty-three interviews were conducted at 7 sites across India. Interview participants include attending physicians (11), resident physicians (36), nurses (10), and paramedics (5). Events were most often described as involving accompanying persons to the patient, not the patient themselves. Most events involved verbal abuse, although a significant percentage of responses described some kind of physical violence. ED factors such as busy times with high patient volumes or periods of waiting are associated with increased violence, as well as incidents with unanticipated outcomes such as patients with severe illness or death. Decreased levels of health literacy among patients often contribute as the financial stressors of paying for medical care. Providers reported negative consequences of workplace violence on quality of care for patients and their own motivation to work in the ED. Communication strategies were frequently proposed as interventions to mitigate violence in the future including both provider communication as well as public awareness campaigns. Conclusion: Workplace violence is a frequent reality for this sample of Indian ED healthcare providers. Alarming levels of verbal and physical abuse and their impact on patient care are described. This qualitative study identified unique challenges to Indian ED providers that differ from those in more developed settings, including financial stressors, inadequate enforcement of rules governing behavior in the hospital, and an overwhelming frequency of violence emanating from patient family members and attendants rather than the patients themselves. Further investigation into preventive strategies is needed.

and hypertension, stony Brook children's hospital, stony Brook, NY, Usa Background: Hyperglycemia and acute kidney injury (AKI) are common in critically ill children and have been associated with higher morbidity and mortality. The incidence of AKI in children is difficult to estimate because of the lack of a standard definition for AKI. The pediatric RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria can be used to define AKI in children. Various biomarkers in urine and blood have been studied to detect AKI in critically ill children. However, it is not clear whether hyperglycemia is associated with AKI. Our objective was to evaluate the effect of hyperglycemia on kidney function and its effect on neutrophil gelatinase-associated lipocalin (NGAL) in children. Methods: We studied retrospective and prospective cohorts of pediatric critically ill subjects admitted to the pediatric intensive care unit (PICU). We analyzed data from admission that included estimated glomerular filtration rate, plasma and urine NGAL, serum glucose and peak glycemia (highest glycemia during PICU admission), and length of hospital and PICU stay from two different institutions. Results: We found that the prevalence of hyperglycemia was 89% in the retrospective cohort and 86% in the prospective cohort, P=0.99. AKI was associated with peak glycemia, P=0.03. There was a statistically significant correlation between peak glycemia and hospital and PICU stays, P=<0.001 and P<0.001, respectively. Urine NGAL and plasma NGAL were not statistically different in subjects with and without hyperglycemia, P=0.99 and P=0.85, respectively. Subjects on vasopressors had lower estimated glomerular filtration rate and higher glycemia, P=0.01 and P=0.04, respectively. Conclusion: We conclude that in critically ill children, hyperglycemia is associated with AKI and longer PICU stays.

BACKGROUND: Although pharyngitis is common, group A Streptococcus is an uncommon etiology, and sequelae are rare in patients ,3 years old. Inappropriate testing leads to increased cost of health care and unnecessary exposure to antibiotics. Rapid streptococcal tests (RSTs) for group A Streptococcus pharyngitis are not routinely indicated in this age group. At our urban, tertiary pediatric emergency department (ED), on average, 20 RSTs were performed each month for patients ,3 years of age. Our objective was to reduce RSTs in the ED in patients aged ,3 years by 50% in 18 months. METHODS:We initiated this project in October 2016 at an urban, tertiary pediatric ED. We surveyed pertinent multidisciplinary stakeholders to identify factors leading to RSTs in children ,3 years of age. We conducted multiple interventions and collected weekly data on the number of RSTs in children aged ,3 years (outcome measure) and the number of family complaints and return visits for complications of pharyngitis (balancing measure). We used statistical process control for analysis. RESULTS:The mean number of RSTs ordered per month in patients aged ,3 years declined by 52% in 10 months. The majority of tests during the study phase were ordered by nurse practitioners (62%) for patients aged 25 to 36 months (66%). There has been 1 family grievance and no patient complications attributable to the project.CONCLUSIONS: Our interventions led to a successful and sustained reduction of RSTs in patients aged ,3 years. A local clinical practice guideline was developed, and the project was expanded to other acute care settings.

Purpose Travel restrictions during the pandemic created a barrier to the traditional in‐person, observed assessment final examination of our emergency medicine (EM) training programs in India. We conducted remote practical boards and telesimulation bringing examiners and learners from different geographical locations together using an online video conferencing platform. The goal of this paper is to describe the process of implementing a large‐scale, international remote practical boards and telesimulation event. We aim to describe the evaluations of the feasibility and effectiveness of remote practical boards and telesimulation in an examination scenario and the feedback regarding the perception of fairness and attitudes from both examiners and examinees. Methods A total of 104 residents from 14 separate hospitals in eight cities across India were evaluated individually for practical board cases and in pairs for telesimulation. For practical boards, each examinee was evaluated twice, by two independent examiners. For telesimulation, each pair was evaluated by a local facilitator and a remote examiner via an online platform. There were 27 practical examiners and 14 local facilitators and 10 remote examiners for telesimulation. We obtained feedback in the form of a survey from local and remote examiners and examinees. Results We implemented a large‐scale, international remote practical boards and telesimulation event, connecting examinees and local examiners in eight cities in India with examiners in the United States and United Kingdom. Feedback was obtained from 24 examiners and 103 examinees. A total of 96.7% examiners and 96.9% of examinees felt that this examination was fair. All respondents agreed that this format saved time and costs. Conclusion This remote practical boards and telesimulation experience was a feasible and effective way to evaluate EM examinees medical knowledge, communication, and procedural skills. Technology issues was a limitation of our telesimulation experience. Future studies on telesimulation use in global EM training would be useful.

the most experienced nurses, our results suggest that patient safety education should be incorporated in both nursing training as well as continuing education for established nurses. Future steps include repeating such scenarios with interdisciplinary teams to generate a culture of shared responsibility and improved communication.