key: cord-326421-ng1uhwgs
authors: Zalesky, C. Christopher; Dreyfus, Nathan; Davis, Joshua; Kreitzer, Natalie
title: Emergency Medicine Physician Work Environments During the COVID-19 Pandemic
date: 2020-09-07
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2020.09.007
sha: 
doc_id: 326421
cord_uid: ng1uhwgs

nan

Due to the combined stressors of critically ill patients, limited resources, and increased personal risk, the well-being of frontline healthcare workers has emerged as an issue of critical importance in the COVID-19 pandemic. 1, 2 To better understand these conditions and their effects, we surveyed a nationwide cross-section of Emergency Medicine (EM) attending and resident physicians.

We obtained a convenience sample of United States (US) EM physicians via the Emergency Medicine Residents' Association email distribution list [AQ: How many email addresses are on this list]?. The survey included questions covering four topics: demographics, workplace environment, COVID-19 exposure, and a validated instrument on burnout and professional wellbeing -the Stanford Professional Fulfilment Index (PFI). Survey data were collected from April 29 to May 13, 2020. 3 We analyzed 296 completed surveys, of 443 that were started [you can add the answer to the above AQ here.]. Further demographic information can be found in the appendix. Regarding pandemic work conditions, 39% of respondents were moderately or extremely concerned for their safety in the workplace(Appendix Table 2 ) . PPE reuse was reported by 93% of respondents. Two thirds (66%) of respondents reported that they had rationed medical resources other than PPE; among this subset, 69% had rationed medications, 39% had rationed non-invasive ventilation, and 21% had rationed ventilators. Of all respondents, 26% reported having had symptoms of COVID-19, 26% had been tested, and 7% had tested positive for COVID-19. Median PFI scores were consistent with work exhaustion and burnout.

We report several key differences in measures for respondents practicing in self-reported COVID-19 "hotspots." Not surprisingly, a greater proportion of physicians in hotspots had rationed medical resources compared with non-hotspot respondents (82% vs. 56%, Table 1 ). Of those physicians in hotspots who had rationed resources, 35% had rationed ventilators, compared with 10% of non-hotspot respondents. EM physicians in hotspots also had a higher J o u r n a l P r e -p r o o f positive test rate for COVID-19: 40% of those tested in hotspots were positive, while 17% of those tested were positive in non-hotspots.The kind of COVID-19 test used was not specified by respondants.

Our survey suggests that a concerning proportion of emergency physicians have rationed medications, critical interventions, and basic PPE during the pandemic. These findings underscore a fact that is intuitive yet warrants emphasis: when COVID-19 caseloads exceed relative clinical capacities, both the safety of providers and the quality of patient care become compromised. Building rapidly scalable clinical capacity and controlling the rate of pandemic spread are critical to avoid future compromise as additional hotspots emerge. (62) 17(77) 15.4(-11.8-42.5) ** Denotes questions that were not presented to all participants but only to select participants based on answers to previous answers. Percents for these columns represent the % of the sample that is was in the hotspot or was not in the hotspot. *Totals greater than 100% because more than one answer permitted # question presented to all participants but not all responded, if greater than or equal to 5 participants did not respond revised n = Hotspot and n = Not Hotspot are noted 

This data is the result of a cross-sectional survey of emergency medicine physicians using the Emergency Medicine Resident's Association (EMRA) email distribution list. An email with a link to the survey was sent by EMRA to all medical students, residents, fellows, and attendings(EMRA alumni) associated with the organization. After the initial email distribution and an internal messaging application was used to remind members about the survey an additional two times. The survey was administered via the REDCap electronic data capture tool. Data was collected for fourteen days from April 29, 2020 to May 13, 2020. This study was granted an exemption from informed consent by the Institutional Review Board of the University of Cincinnati and a study information sheet was distributed with the survey.

The survey was developed by two emergency medicine residents and a medical student. The survey. included 7 demographic questions, 29 workplace environment questions, 7 questions on COVID-19 exposure, and a 19-item validated instrument on burnout and professional well-being -the Stanford Professional Fulfillment Index. This index is validated and has normative data for both Attendings and Residents. 2 Two open response questions were asked as the final questions of the survey to allow participants to elaborate on how COVID-19 had affected their well-being and education.

The survey was reviewed by two attending physician experts: one in medical education and one in wellness. It was then pilot tested with 10 emergency medicine residents for face validity, length, and clarity. Participation in the survey was voluntary and no incentives were offered for completion. Participants were asked if they had previously completed the survey to prevent multiple entries.

Data was analyzed using RStudio Version 1.2.5042 and R version 4.0.0. Responses are presented as proportions and 95% confidence intervals were computed using the Sison and Glaz method for multinomial proportions and binomial proportions with the Agresti-Coull.

Academic Emergency Medicine Physicians' Anxiety Levels, Stressors, and Potential Stress Mitigation Measures During the Acceleration Phase of the COVID-19 Pandemic

Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic

The REDCap consortium: Building an international community of software platform partners

The authors would like to thank the EMRA Board of Directors for their support of the study, and EMRA staff members Mr. Todd Downing and Ms. Cathey Wise, who facilitated survey distribution. We also thank the residents and faculty of University of Cincinnati and Penn State at Hershey Medical Center for their input with survey design and content. Cincinnati Center for Clinical and Translational Science and Training grant support (1UL1TR001425-01) allowed access to REDCap.

J o u r n a l P r e -p r o o f (55.7-81.9) ** Denotes questions that were not presented to all participants but only to select participants based on answers to previous answers. Percents for these columns represent the % of the sample that is was in the hotspot or was not in the hotspot. *Totals greater than 100% because more than one answer permitted