Another Look at the Persistent Moral Problem of Emergency Department Crowding

Moskop, John C.; Geiderman, Joel M.; Marshall, Kenneth D.; McGreevy, John; Derse, Arthur R.; Bookman, Kelly; McGrath, Norine A.; Iserson, Kenneth V.

doi:10.1016/j.annemergmed.2018.11.029

Cited by 63 publications

(48 citation statements)

References 61 publications

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“…As a vital health care safety net and a major gateway to the hospital system, the ED and its unpredictable and often chaotic nature pose practice challenges that require unique skill sets. 1 Emergency medicine (EM) physicians work shifts of varying lengths in the ED. The ability to effectively run an ED shift (i.e., manage the various clinical, administrative, and educational responsibilities of the shift) is a defining attribute of any practicing emergency physician and represents a key outcome of EM specialty training.…”

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confidence: 99%

“…The emergency department (ED) is a front‐line clinical microsystem in which immediate medical care and stabilization are provided to the acutely ill and injured. As a vital health care safety net and a major gateway to the hospital system, the ED and its unpredictable and often chaotic nature pose practice challenges that require unique skill sets 1 . Emergency medicine (EM) physicians work shifts of varying lengths in the ED.…”

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confidence: 99%

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The Ottawa Emergency Department Shift Observation Tool (O‐EDShOT): A New Tool for Assessing Resident Competence in the Emergency Department

Cheung

Wood

Gofton

et al. 2019

AEM Education and Training

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Objectives: The outcome of emergency medicine (EM) training is to produce physicians who can competently run an emergency department (ED) shift. However, there are few tools with supporting validity evidence specifically designed to assess multiple key competencies across an entire shift. The investigators developed and gathered validity evidence for a novel entrustment-based tool to assess a resident's ability to safely run an ED shift. Methods: Through a nominal group technique, local and national stakeholders identified dimensions of performance that are reflective of a competent ED physician and are required to safely manage an ED shift. These were included as items in the Ottawa Emergency Department Shift Observation Tool (O-EDShOT), and each item was scored using an entrustment-based rating scale. The tool was implemented in 2018 at the

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confidence: 99%

mentioning

confidence: 99%

The Ottawa Emergency Department Shift Observation Tool (O‐EDShOT): A New Tool for Assessing Resident Competence in the Emergency Department

Cheung

Wood

Gofton

et al. 2019

AEM Education and Training

View full text Add to dashboard Cite

show abstract

“…Ensuring adequate ED resources, call panels, and transfer agreements is also paramount for providers feeling good about the care they can provide. Although boarding is not likely to disappear any time soon, operational improvements that improve flow and reduce crowding almost certainly improve emergency physician satisfaction 30 …”

Section: The Frameworkmentioning

confidence: 99%

Beyond the Maslach burnout inventory: addressing emergency medicine burnout with Maslach's full theory

et al. 2020

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Burnout, a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job, remains a substantial problem for emergency physicians, leading to decreased quality of care and attrition from the workforce. The majority of prior work on burnout in emergency medicine has focused on individualized solutions, which have demonstrated modest efficacy for ameliorating burnout. However, recent studies suggest that burnout in medicine is primarily caused by workplace factors (eg, unmanageable workloads, unreasonable time pressures) and therefore requires solutions at an organizational level. In her decades of research across industries, Christina Maslach identified 6 domains of organizations that can either promote engagement or lead to burnout. In this article, we apply Maslach's 6 domains to emergency medicine to provide a systematic framework for alleviating burnout and promoting engagement among emergency physicians. By considering the domains of workload, reward, control, fairness, community, and value congruence, emergency medicine leaders can develop and deploy more effective interventions aimed at improving the experience and longevity of physicians across our specialty.

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Section: Introductionmentioning

confidence: 99%

“…Utilization of emergency department (ED) services in the United States has sharply increased to a rate faster than that of population growth; at the same time, the total number of EDs in the United States has decreased 3.4% (1,2). This decrease has led to higher patient volumes across EDs, with greater than 90% routinely reporting crowded conditions, impacting capacity to provide quality care (2). In addition to a degraded patient experience, the consequences of ED crowding include poorer patient outcomes; increased medical errors; compromises in patient physical privacy, confidentiality, and communication; and provider moral distress (2).…”

Section: Introductionmentioning

confidence: 99%

Nurse-Led Call Back Program to Improve Patient Follow-Up With Providers After Discharge From the Emergency Department

Luciani-Mcgillivray

Cushing

Klug

et al. 2020

Journal of Patient Experience

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Phone calls to patients after discharge from the emergency department (ED) serve as reminders to schedule medical follow-up, support adherence to discharge instructions, and reduce revisits to already-crowded EDs. An existing, nurse-administered, call-back program contacted randomly selected ED patients 24 to 48 hours following discharge. This program did not improve patient follow-up (48.68%) nor reduce the ED revisit rate (6.7% baseline vs 6.0% postimplementation). Plan-Do-Study-Act methodology tested a modification to the existing program consisting of a second, scripted phone call from a trained volunteer at 72 to 96 hours postdischarge. Volunteers utilized a patient list and script, and nurses provided expertise to eliminate identified barriers to follow-up. Follow-up rate and ED revisit were monitored through the electronic medical record. A total of 894 patients participated between October 2017 and June 2018. Follow-up increased from 48.68% to 65.5% ( P < .0001) and ED revisit decreased significantly (4.5% vs 8.6%, P < .001). This innovative nurse-led, systematic postdischarge call-back program utilizing hospital volunteers increased patient compliance with post-ED medical follow-up while significantly reducing the rate of patient revisit to the ED within 7 days of discharge.

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Another Look at the Persistent Moral Problem of Emergency Department Crowding

Cited by 63 publications

References 61 publications

The Ottawa Emergency Department Shift Observation Tool (O‐EDShOT): A New Tool for Assessing Resident Competence in the Emergency Department

The Ottawa Emergency Department Shift Observation Tool (O‐EDShOT): A New Tool for Assessing Resident Competence in the Emergency Department

Beyond the Maslach burnout inventory: addressing emergency medicine burnout with Maslach's full theory

Nurse-Led Call Back Program to Improve Patient Follow-Up With Providers After Discharge From the Emergency Department

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