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Gettel CJ, Camargo CA, Bennett CL, Courtney DM, Kaji AH, Fermann GJ, Gallahue FE, Nelson LS, Hebbard CF, Rothenberg C, Raja AS, Venkatesh AK. Estimating the size and scope of the academic emergency physician workforce. Acad Emerg Med 2024; 31:732-738. [PMID: 38769602 DOI: 10.1111/acem.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/26/2024] [Accepted: 04/11/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Academic emergency medicine (EM) is foundational to the EM specialty through the development of new knowledge and clinical training of resident physicians. Despite recent increased attention to the future of the EM workforce, no evaluations have specifically characterized the U.S. academic EM workforce. We sought to estimate the national proportion of emergency physicians (EPs) identified as academic and the proportion of emergency department (ED) visits that take place at academic sites. METHODS We performed a cross-sectional analysis of EPs and EDs using data from the American Hospital Association, the Centers for Medicare & Medicaid Services, and Doximity's Residency Navigator. EPs were identified as "academic" if they were affiliated with at least one facility determined to be academic, defined as EDs officially designated by the Accreditation Council for Graduate Medical Education (ACGME) as clinical training sites at accredited EM residency programs. Our primary outcomes were to estimate the national proportion of EPs identified as academic and the proportion of ED visits performed at academic sites. RESULTS Our analytic sample included 26,937 EPs practicing clinically across 4920 EDs and providing care during 130,471,386 ED visits. Among EPs, 11,720 (43.5%) were identified as academic, and among EDs, 635 (12.9%) were identified as academic sites, including 585 adult/general sites, 45 pediatric-specific sites, and 10 sites affiliated with the Department of Veterans Affairs. In 2021, academic EDs provided care for 42,794,106 ED visits or 32.8% of all ED visits nationally. CONCLUSIONS Approximately four in 10 EPs practice in at least one clinical training site affiliated with an ACGME-accredited EM residency program, and approximately one in three ED visits nationally occur in these academic EDs. We encourage further work using alternative definitions of an academic EPs and EDs, along with longitudinal research to identify trends in the workforce's composition.
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Affiliation(s)
- Cameron J Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher L Bennett
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - D Mark Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy H Kaji
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Torrance, California, USA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Fiona E Gallahue
- Department of Emergency Medicine, The University of Washington, Seattle, Washington, USA
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Carleigh F Hebbard
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Craig Rothenberg
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
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Kilaru AS, Scheulen JJ, Harbertson CA, Gonzales R, Mondal A, Agarwal AK. Boarding in US Academic Emergency Departments During the COVID-19 Pandemic. Ann Emerg Med 2023; 82:247-254. [PMID: 36681622 PMCID: PMC9851166 DOI: 10.1016/j.annemergmed.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE The first 2 years of the COVID-19 pandemic brought substantial and dynamic changes to emergency department volumes and throughput. The objective of this study was to describe changes in ED boarding among US academic EDs across the duration of the COVID-19 pandemic. METHODS We conducted a retrospective analysis of monthly data collected from a convenience sample of academic departments of emergency medicine. The study period was from January 2019 to December 2021. The primary outcome was total boarding hours, and secondary outcomes included patient volume stratified by ED disposition. We used multivariable linear panel regression models with fixed effects for individual EDs to estimate adjusted means for 3-month quarters. RESULTS Of the 73 academic departments of emergency medicine contacted, 34 (46.6%) participated, comprising 43 individual EDs in 25 states. The adjusted mean total boarding hours per month significantly decreased during the second quarter of 2020 (4,449 hours; 95% confidence interval [CI] 3,189 to 5,710) compared to the first quarter of 2019 (8,521 hours; 95% CI 7,845 to 9,197). Beginning in the second quarter of 2021, total boarding hours significantly increased beyond pre-pandemic levels, peaking during the fourth quarter of 2021 (12,127 hours; 95% CI 10,925 to 13,328). CONCLUSIONS A sustained and considerable increase in boarding observed in selected US academic EDs during later phases of the COVID-19 pandemic may reflect ongoing stresses to the health care system, with potential consequences for patient outcomes as well as clinician well-being.
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Affiliation(s)
- Austin S Kilaru
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania.
| | - James J Scheulen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cathi A Harbertson
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Gonzales
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angira Mondal
- Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania
| | - Anish K Agarwal
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania
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Huang D, Winter L, Macauley E, Alterman T, Renouard B, Wilson JL, Leon LN. Difficult Intravenous Access Requiring Ultrasound in the Emergency Department: Associations With Delays in Care and Areas for Quality Improvement. Cureus 2023; 15:e44960. [PMID: 37822433 PMCID: PMC10564258 DOI: 10.7759/cureus.44960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
Background Patients with difficult intravenous access (DIVA) requiring ultrasound-guided intravenous (USGIV) access have been associated with delays in treatment, imaging, and disposition in academic emergency department (ED) patient populations. Our objective in this study was to characterize differences in time to intravenous access, imaging, and disposition between patients with DIVA versus those without DIVA requiring USGIV access in a community ED while also assessing for DIVA-associated comorbidities. Methods A cross-sectional, observational analysis was performed on admitted ED patients evaluated from September 2 to September 31, 2022, at a community ED. Patients with DIVA were defined as patients with two failed attempts at traditional intravenous placement. These patients require USGIV placement per institutional protocol. Patients younger than 18 years of age, trauma admissions, repeated visits from the same patient, patients with missing data, and direct hospital admissions were excluded. Continuous variables were recorded with medians and included ED throughput measures of time to vascular access, contrast CT imaging, and disposition. Differences in median times between DIVA patients versus non-DIVA patients were assessed with the Mann-Whitney U-test. Categorical data involving comorbidities were reported as percentages, and differences in proportions between DIVA versus non-DIVA patients were assessed via chi-square tests. Multivariate logistic regression analysis evaluated for correlations between DIVA and times to access, contrast CT imaging, disposition, and significant covariates while adjusting for demographic information. Results A total of 1250 patients were included in this investigation (5.8% associated with DIVA requiring USGIV access). The median age of all subjects was 69 (interquartile range = 58, 79) with no significant difference between the DIVA and non-DIVA groups. Patients with DIVA were more likely to be female in comparison to patients without DIVA (65.3% and 51.2%, respectively, p < 0.05). Patients with a history of end-stage renal disease (ESRD) (p < 0.001), intravenous drug use (IVDU) (p < 0.001), and venous thromboembolism (p < 0.05) had statistically significant associations with DIVA. On regression analysis, patients with DIVA were more likely to have a history of ESRD with an odds ratio (OR) of 3.56 (95% confidence interval (CI): 1.62-7.81) and a history of IVDU with an OR of 14.29 (95% CI: 5.17-39.54). Patients with DIVA were associated with statistically significant greater median times to vascular access, contrast CT imaging, and disposition (p < 0.001 for time to access and disposition and p < 0.01 for time to contrast CT imaging). Conclusion In this study, DIVA cases requiring USGIV access were positively associated with significantly longer times to access, contrast CT imaging, and disposition compared to patients without DIVA at our community ED. Comorbidities such as IVDU and ESRD had statistically significant associations with DIVA requiring USGIV access.
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Affiliation(s)
- Derrick Huang
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Lucas Winter
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Emily Macauley
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Thomas Alterman
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Bryson Renouard
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - James L Wilson
- Emergency Medicine, University of Central Florida, Ocala, USA
| | - Leoh N Leon
- Emergency Medicine, University of Central Florida, Ocala, USA
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Van Heukelom P, Vakkalanka JP, Pedersen R, Nugent AS. Inpatient boarding definitions and mitigation strategies: A cross-sectional survey of academic emergency departments in the United States. Am J Emerg Med 2023; 67:37-40. [PMID: 36796239 PMCID: PMC10121851 DOI: 10.1016/j.ajem.2023.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE Conceptually, inpatient boarding is a result in the delay of admitting patients from the Emergency Department (ED) to inpatient units, but there is no consistent definition across academic EDs. The purpose of this study was to evaluate the definition of boarding across academic EDs, and to identify mitigation strategies used by EDs to alleviate crowd management. METHODS This was a cross-sectional survey of boarding-related questions (i.e., boarding definitions and practices) that were embedded into the annual benchmarking survey conducted by the Academy of Academic Administrators of Emergency Medicine and the Association of Academic Chairs of Emergency Medicine. Results were descriptively assessed and tabulated. RESULTS Of the 130 eligible institutions, 68 participated in the survey. Approximately 70% of institutions reported starting the boarding clock at the time of ED admission, while 19% reported that the clock started with the completion of inpatient orders. Approximately 35% of institutions considered patients boarded within 2 h, while 34% considered patients boarded >4 h after admission decision. In response to ED overcrowding brought on by inpatient boarding, 35% reported using hallway beds for patient care. Surge capacity measures reported included having a high census/surge capacity plan (81%), going on ambulance diversion (54%), and institutional use of a discharge lounge (49%). CONCLUSIONS We found that definitions for boarding varied widely. Inpatient boarding has serious consequences to patient care and well-being, suggesting the need for standardized definitions to describe inpatient boarding.
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Affiliation(s)
- Paul Van Heukelom
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Suite RCP1008, Iowa City, IA 52242, USA.
| | - J Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Suite RCP1008, Iowa City, IA 52242, USA; Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, IA 52242, USA.
| | - Robert Pedersen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Suite RCP1008, Iowa City, IA 52242, USA; Minneapolis VA Health Care System, 1 Veterans Dr, Minneapolis, MN 55417, USA
| | - Andrew S Nugent
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Suite RCP1008, Iowa City, IA 52242, USA.
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Canellas M, Michael S, Kotkowski K, Reznek M. Operations Factors Associated with Emergency Department Length of Stay: Analysis of a National Operations Database. West J Emerg Med 2023; 24:178-184. [PMID: 36976590 PMCID: PMC10047726 DOI: 10.5811/westjem.2022.10.56609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/08/2022] [Indexed: 03/20/2023] Open
Abstract
Introduction: Prolonged emergency department (ED) length of stay (LOS) has been shown to adversely affect patient care. We sought to determine factors associated with ED LOS via analysis of a large, national, ED operations database.
Methods: We performed retrospective, multivariable, linear regression modeling using the 2019 Emergency Department Benchmarking Alliance survey results to identify associated factors of ED LOS for admitted and discharged patients.
Results: A total of 1,052 general and adult-only EDs responded to the survey. Median annual volume was 40,946. The median admit and discharge LOS were 289 minutes and 147 minutes, respectively. R-squared values for the admit and discharge models were 0.63 and 0.56 with out-of-sample R-squared values of 0.54 and 0.59, respectively. Both admit and discharge LOS were associated with academic designation, trauma level designation, annual volume, proportion of ED arrivals occurring via emergency medical services, median boarding, and use of a fast track. Additionally, admit LOS was associated with transfer-out percentage, and discharge LOS was associated with percentage of high Current Procedural Terminology, percentage of patients <18 years old, use of radiographs and computed tomography, and use of an intake physician.
Conclusion: Models derived from a large, nationally representative cohort identified diverse associated factors of ED length of stay, several of which were not previously reported. Dominant within the LOS modeling were patient population characteristics and other factors extrinsic to ED operations, including boarding of admitted patients, which was associated with both admitted and discharged LOS. The results of the modeling have significant implications for ED process improvement and appropriate benchmarking.
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Affiliation(s)
- Maureen Canellas
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Sean Michael
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Kevin Kotkowski
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Martin Reznek
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
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Hobgood CD, Draucker C. Barriers, Challenges, and Solutions: What Can We Learn About Leadership in Academic Medicine From a Qualitative Study of Emergency Medicine Women Chairs? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1656-1664. [PMID: 35703191 DOI: 10.1097/acm.0000000000004772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Women have made significant gains in leadership across all disciplines in academic medicine but have not yet achieved leadership parity as department chairs. The authors investigated the challenges experienced by one cohort of women department chairs in emergency medicine (EM) and the solutions they proposed to address these challenges. METHOD The authors conducted a qualitative descriptive study of 19 of 20 possible current and emeritus emergency medicine women department chairs at academic medical centers between April and December 2020. Participant interviews elicited self-reported demographic characteristics and narrative responses to a semistructured interview template that focused on the role of gender in their leadership and career trajectories. Interviews were transcribed, blinded, and iteratively coded and categorized. RESULTS The analysis demonstrated 4 common challenges and 5 enacted or proposed solutions. The challenges discussed by the participants were: feeling unprepared for the role of department chair, being one of few women in leadership, inheriting unhealthy department cultures, and facing negative faculty reactions. The individual- and institutional-level solutions discussed by the participants were: gaining and maintaining confidence (individual), maintaining accountability and mission alignment (individual), facilitating teamwork (individual), supporting women's leadership (institution), and creating safe leadership cultures (institution). CONCLUSIONS Women department chairs in EM were successful academic leaders despite confronting several challenges to their leadership. Considering the study findings through the lens of the concept of second-generation gender bias further illuminates the influence of gender on leadership in academic medicine. These findings suggest several possible strategies that can combat gender bias, increase gender parity among academic medicine's leadership, and improve the leadership experience for women leaders.
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Affiliation(s)
- Cherri D Hobgood
- C.D. Hobgood is professor of emergency medicine, Indiana University School of Medicine, Indianapolis, Indiana; ORCID: http://orcid.org/0000-0003-4860-1385
| | - Claire Draucker
- C. Draucker is the Angela Barron McBride Professor of Psychiatric Nursing, Indiana University School of Nursing, Indianapolis, Indiana; ORCID: http://orcid.org/0000-0001-9844-351X
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Sakamoto JT, Lee J, Lu DW, Sundaram V, Bird SB, Blomkalns AL, Alvarez A. Factors driving burnout and professional fulfillment among emergency medicine residents: A national wellness survey by the Society for Academic Emergency Medicine. AEM EDUCATION AND TRAINING 2022; 6:S5-S12. [PMID: 35783080 PMCID: PMC9222870 DOI: 10.1002/aet2.10746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 06/15/2023]
Abstract
Objectives This study aimed to identify rates of and contributors to burnout and professional fulfillment among emergency medicine (EM) resident physicians. Methods This was a cross-sectional, national survey of resident members of the Society for Academic Emergency Medicine (SAEM). Primary outcomes were burnout and professional fulfillment measured using a previously validated instrument with additional domains pertaining to the academic environment. The survey included question domains examining organizational factors (e.g., academic work environment, satisfaction with training, electronic health records, values alignment, and control over schedule) and individual factors (e.g., self-compassion, meaningfulness of clinical work, impact of work on health and personal relationships, perceived appreciation, thoughts of attrition, and expectations of the field of EM). Logistic regression was performed to determine the relationships between the primary outcomes and each domain. Results The survey was sent electronically to 2641 SAEM resident members. A total of 275 residents completed the survey with a response rate of 10.4%. A total of 151 (55%) respondents were male, and 210 (76%) were White. A total of 132 (48%) residents reported burnout, and 75 (28%) reported professional fulfillment. All organizational and individual factors were significantly associated with both primary outcomes. EM residents reported that meaningfulness of clinical work had the most significant positive association with professional fulfillment (adjusted odds ratio [OR] 2.2 [95% confidence interval {CI} 1.8-2.7]) and negative association with burnout (adjusted OR 0.46 [95% CI 0.37-0.56]). Thoughts of attrition from academics and accurate expectations of EM were also associated with both primary outcomes, with adjusted ORs (95% CIs) of 0.40 (0.21-0.72) and 5.6 (1.9-23.8) for professional fulfillment and 4.1 (2.5-7.1) and 0.19 (0.08-0.40) for burnout, respectively. Conclusions This study found a high prevalence of burnout and a low prevalence of professional fulfillment among EM residents. Multiple factors were significantly associated with each occupational phenomenon, with meaningfulness of clinical work demonstrating the strongest relationships with burnout and professional fulfillment.
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Affiliation(s)
| | - Justin Lee
- Stanford University School of MedicineStanfordCaliforniaUSA
| | - Dave W. Lu
- University of Washington School of MedicineSeattleWashingtonUSA
| | | | - Steven B. Bird
- UMassMemorial Healthcare and University of Massachusetts Medical School WorcesterWorcesterMassachusettsUSA
| | | | - Al'ai Alvarez
- Stanford University School of MedicineStanfordCaliforniaUSA
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Carpenter CR, Abrams S, Courtney DM, Dorner SC, Dyne P, Elia T, Jourdan DN, Kaji AH, Martin IBK, Mills AM, Nagasawa K, Pillow M, Reznek M, Starnes A, Temin E, Wolfe R, Chekijian S. Advanced practice providers in academic emergency medicine: A national survey of chairs and program directors. Acad Emerg Med 2022; 29:184-192. [PMID: 34860436 DOI: 10.1111/acem.14424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Society for Academic Emergency Medicine Board of Directors convened a task force to elucidate the current state of workforce, operational, and educational issues being faced by academic medical centers related to advanced practice providers (APPs). The task force surveyed academic emergency department (ED) chairs and residency program directors (PDs). METHODS The survey was distributed to the Association of Academic Chairs of Emergency Medicine (AACEM)-member chairs and their respective residency PDs in 2021. We surveyed 125 chairs with their self-identified PDs. The survey sampled hiring, state-independent practice laws, scope of practice, teaching and supervision, training opportunities, delegation of procedures between physician learners and APPs, and perceptions of the impact on resident and medical student education. RESULTS Of the AACEM-member chairs identified, 73% responded and 47% of PDs responded. Most (98%) employ either physician assistants or nurse practitioners. Among responding departments, 86% report APPs working in fast-track settings, 80% work in the main ED, and 54% work in the waiting room. In 44% of departments, APPs and residents evaluate patients concurrently, and 2% of respondents reported that APPs manage high-acuity patients without attending involvement. Two-thirds of chairs believe that APPs contribute positively to the quality of patient care, while 44% believe that APPs contribute to the academic environment. One-third of PDs believe that the presence of APPs interferes with resident education. Although 75% of PDs believe that residents require training to work effectively with APPs in the ED, almost half (49%) report zero hours of training around APP supervision or collaborative skills. CONCLUSIONS APPs are ubiquitous across academic EDs. Future research is required for academic ED leaders to balance physician and APP deployment across the academic ED within the context of patient care, resident education, institutional resources, professional development opportunities for APP staff, and standardization of APP EM training.
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Affiliation(s)
- Christopher R. Carpenter
- Department of Emergency Medicine Washington University in St. Louis School of Medicine Emergency Care Research Core St. Louis Missouri USA
| | - Stacy Abrams
- Department of Emergency Medicine Columbia University College of Physicians and Surgeons New York New York USA
| | - D. Mark Courtney
- Department of Emergency Medicine UT Southwestern Medical Center Dallas Dallas Texas USA
| | - Stephen C. Dorner
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Pamela Dyne
- Department of Emergency Medicine UCLA David Geffen School of Medicine Olive View‐UCLA Medical Center Sylmar California USA
| | - Tala Elia
- Department of Emergency Medicine University of Massachusetts Medical School‐Baystate Springfield Massachusetts USA
| | - Daniel N. Jourdan
- Department of Emergency Medicine Henry Ford Hospital–Detroit Detroit Michigan USA
| | - Amy H. Kaji
- Department of Emergency Medicine Harbor‐UCLA Medical Center David Geffen School of Medicine at UCLA Torrance California USA
| | - Ian B. K. Martin
- Department of Emergency Medicine Department of Medicine Medical College of Wisconsin Medical School Milwaukee Wisconsin USA
| | - Angela M. Mills
- Department of Emergency Medicine Columbia University College of Physicians and Surgeons New York New York USA
| | - Kat Nagasawa
- Society for Academic Emergency Medicine Des Plaines Illinois USA
| | - Malford Pillow
- Department of Emergency Medicine Faculty, Department of Education, Innovation & Technology Baylor College of Medicine Houston Texas USA
| | - Martin Reznek
- Department of Emergency Medicine University of Massachusetts Medical School Worcester Massachusetts USA
| | - Andrew Starnes
- Wake Forest University School of Medicine Winston‐Salem North Carolina USA
| | - Elizabeth Temin
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Richard Wolfe
- Department of Emergency Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA
| | - Sharon Chekijian
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
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Rathlev NK, Holt NM, Harbertson CA, Hettler J, Reznek MA, Tsai SL, Lopiano KK, Bohrmann T, Scheulen JJ. 2017 AAAEM Benchmarking Survey: Comparing Pediatric and Adult Academic Emergency Departments. Pediatr Emerg Care 2021; 37:e1278-e1284. [PMID: 31977768 DOI: 10.1097/pec.0000000000002002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Academy of Administrators in Academic Emergency Medicine Benchmark Survey of academic emergency departments (EDs) was conducted in 2017. We compared operational measures between pediatric and adult (defined as fewer than 5% pediatric visits) EDs based on survey data. Emergency departments in dedicated pediatric hospitals were not represented. METHODS Measures included: (1) patient volumes, length of stay, and acuity; and 2) faculty staffing, productivity, and percent effort in academics. t Tests were used to compare continuous measures and inferences for categorical variables were made using Pearson χ2 test. RESULTS The analysis included 17 pediatric and 52 adult EDs. We found a difference in the number of annual visits between adult (median, 66,275; interquartile range [IQR], 56,184-77,702) and pediatric EDs (median, 25,416; IQR, 19,840-29,349) (P < 0.0001). Mean "arrivals per faculty clinical hour" and "total arrivals per treatment space" showed no differences. The proportion of visits (1) arriving by emergency medical services and (2) for behavioral health were significantly higher in adult EDs (both P < 0.0001). The mean length of stay in hours for "all" patients was significantly longer in adult (5.4; IQR, 5.0-6.6) than in pediatric EDs (3.5; IQR, 2.9-4.3; P = 0.017). A similar difference was found for "discharged" patients (P = 0.004). Emergency severity indices, professional evaluation and management codes, and hospitalization rates all suggest higher acuity in adult EDs (all P < 0.0001). There were no differences in mean work relative value units per patient or in the distribution of full time equivalent effort dedicated to academics. CONCLUSIONS In this cohort, significant differences in operational measures exist between academic adult and pediatric EDs. No differences were found when considering per unit measures, such as arrivals per faculty clinical hour or per treatment space.
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Affiliation(s)
- Niels K Rathlev
- From the University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Nate M Holt
- Roundtable Analytics, Inc., Research Triangle Park, NC
| | | | - Joeli Hettler
- From the University of Massachusetts Medical School-Baystate, Springfield, MA
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Abo AM, Nordberg A, Pearman R, Gaspari RJ. The Society for Clinical Ultrasound Fellowships 2018 benchmark survey: Summary of salary and administrative data. Am J Emerg Med 2021; 56:275-279. [PMID: 34393030 DOI: 10.1016/j.ajem.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alyssa M Abo
- Children's National Hospital, Washington, DC, United States of America.
| | - Alexandra Nordberg
- University of Massachusetts Medical Center, Worcester, MA, United States of America.
| | - Ryan Pearman
- Children's National Hospital, Washington, DC, United States of America
| | - Romolo J Gaspari
- University of Massachusetts Medical Center, Worcester, MA, United States of America.
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Reznek MA, Larkin CM, Scheulen JJ, Harbertson CA, Michael SS. Operational factors associated with emergency department patient satisfaction: Analysis of the Academy of Administrators of Emergency Medicine/Association of Academic Chairs of Emergency Medicine national survey. Acad Emerg Med 2021; 28:753-760. [PMID: 33977605 DOI: 10.1111/acem.14278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patient satisfaction is a focus for emergency department (ED) and hospital administrators. ED patient satisfaction studies have tended to be single site and focused on patient and clinician factors. Inclusion of satisfaction scores in a large, national operations database provided an opportunity to conduct an investigation that included diverse operational factors. METHODS We performed a retrospective analysis of the 2019 Academy of Administrators in Academic Emergency Medicine/Association of Academic Chairs of Emergency Medicine (AAAEM/AACEM) benchmarking survey to identify associations between operational factors and patient satisfaction. We identified 59 database variables as potential predictors of Press Ganey likelihood-to-recommend and physician overall scores. Using random forest modeling, we identified the top eight predictors in the models and described their associations. RESULTS Forty-three (57.3%) academic departments responding to the AAAEM/AACEM survey reported patient satisfaction scores for 78 EDs. Likelihood to recommend ranged from 30.0 to 93.0 (median = 74.8) and was associated with ED length of stay, boarding, use of hallway spaces, hospital annual admissions, faculty base clinical hours, proportion of patients leaving before treatment complete (LBTC), and provider in triage hours per day. Physician overall score ranged from 53.3 to 93.4 (median = 81.9) and was associated with faculty base clinical hours, x-ray utilization, annual ED arrivals, LBTC, use of hallway spaces, arrivals per attending hour, and CT utilization. CONCLUSIONS ED patient satisfaction was associated with intrinsic and extrinsic factors, some being potentially manageable within the ED but others being relatively fixed or outside the control of ED operations. For likelihood to recommend, patient flow was dominant, with erosion of satisfaction observed with increased boarding and longer LOS. Factors associated with physician overall score were more varied. The use of hallway spaces and base clinical hours greater than 1,500 per year were associated with both lower likelihood-to-recommend and lower physician overall scores.
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Affiliation(s)
- Martin A. Reznek
- Department of Emergency Medicine University of Massachusetts Medical School Worcester Massachusetts USA
| | - Celine M. Larkin
- Department of Emergency Medicine University of Massachusetts Medical School Worcester Massachusetts USA
| | - James J. Scheulen
- Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Cathi A. Harbertson
- Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Sean S. Michael
- Department of Emergency Medicine University of Colorado School of Medicine Aurora Colorado USA
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12
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Canellas MM, Kotkowski KA, Michael SS, Reznek MA. Financial Implications of Boarding: A Call for Research. West J Emerg Med 2021; 22:736-738. [PMID: 34125054 PMCID: PMC8203028 DOI: 10.5811/westjem.2021.1.49527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/23/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Maureen M Canellas
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Kevin A Kotkowski
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Sean S Michael
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Martin A Reznek
- University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts
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13
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Abstract
Academic emergency departments (EDs) play a vital role in provision of emergency care and contribute to training of resident physicians. Academic EDs also generate innovations and discoveries through clinical research within academic medical centers. However, academic EDs face challenges when initiating operational process improvement efforts because of the medical complexity of patients, academic culture within academic medical centers, and variability in productivity and specialty training of trainees. To optimize operations within academic EDs, it is critical to understand characteristics shared by academic EDs, how to implement process improvement initiatives, trainee impact on ED operations, and how to promote operational research.
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Affiliation(s)
- Deborah Vinton
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908-0699, USA.
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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14
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Archual GM, Panchal AR, Angelos MG, Way DP. The Impact of Selecting Specific Cohorts for Benchmarking and Interpretation of Emergency Department Patient Satisfaction Scores. Acad Emerg Med 2020; 27:388-393. [PMID: 31778272 DOI: 10.1111/acem.13895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Emergency departments (EDs) patient satisfaction metrics are highly valued by hospitals, health systems, and payers, yet these metrics are challenging to analyze and interpret. Accurate interpretation involves selection of the most appropriate peer group for benchmark comparisons. We hypothesized that the selection of different benchmark peer groups would yield different interpretations of Press Ganey (PG) patient satisfaction scores. METHODS Emergency department PG summary ratings of "doctors section" and "likelihood-to-recommend" raw scores and corresponding percentiles were derived for three benchmark peer groups from three academic years (2016, 2017, and 2018). The three benchmarks are: 1) the PG Large database; 2) the PG University HealthSystem Consortium (UHC) database; and 3) the Academy of Administrators in Academic Emergency Medicine (AAAEM) database, which is composed only of EDs from academic health centers with emergency medicine residency training programs. Raw scores were converted to percentile ranks for each distribution and then compared using Welch's ANOVA and Games-Howell pairwise comparisons. RESULTS For both patient satisfaction raw scores evaluated, the AAAEM database was noted to have significantly higher percentile ranks when compared to the PG Large and PG UHC databases. These results were consistent for all three time frames assessed. CONCLUSIONS Benchmarking with different peer groups provides different results, with similar patient satisfaction raw scores resulting in higher percentile ranks using the AAAEM database compared to the two PG databases. The AAAEM database should be considered the most appropriate peer group for benchmarking academic EDs.
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Affiliation(s)
- Gregory M. Archual
- From the Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Ashish R. Panchal
- From the Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Mark G. Angelos
- From the Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - David P. Way
- From the Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus OH
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Reznek MA, Michael SS, Harbertson CA, Scheulen JJ, Augustine JJ. Clinical operations of academic versus non-academic emergency departments: a descriptive comparison of two large emergency department operations surveys. BMC Emerg Med 2019; 19:72. [PMID: 31752708 PMCID: PMC6868754 DOI: 10.1186/s12873-019-0285-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 10/25/2019] [Indexed: 11/14/2022] Open
Abstract
Background Academic and non-academic emergency departments (EDs) are regularly compared in clinical operations benchmarking despite suggestion that the two groups may differ in their clinical operations characteristics. and outcomes. We sought to describe and compare clinical operations characteristics of academic versus non-academic EDs. Methods We performed a descriptive, comparative analysis of academic and non-academic adult and general EDs with 40,000+ annual encounters, using the Academy of Academic Administrators of Emergency Medicine (AAAEM)/Association of Academic Chairs of Emergency Medicine (AACEM) and Emergency Department Benchmarking Alliance (EDBA) survey results. We defined academic EDs as primary teaching sites for emergency medicine (EM) residencies and non-academic EDs as sites with minimal resident involvement. We constructed the academic and non-academic cohorts from the AAAEM/AACEM and EDBA surveys, respectively, and analyzed metrics common to both surveys. Results Eighty and 454 EDs met inclusion criteria for academic and non-academic EDs, respectively. Academic EDs had more median annual patient encounters (73,001 vs 54,393), lower median proportion of pediatric patients (6.3% vs 14.5%), higher median proportion of EMS patients (27% vs 19%), and were more commonly designated as Level I or II Trauma Centers (94% vs 24%). Median patient arrival-to-provider times did not differ (26 vs 25 min). Median length-of-stay was longer (277 vs 190 min) for academic EDs, and left-before-treatment-complete was higher (5.7% vs 2.9%). MRI utilization was higher for academic EDs (2.2% patients with at least one MRI vs 1.0 MRIs performed per 100 patients). Patients-per-hour of provider coverage was lower for academic EDs with and without consideration for advanced practice providers and residents. Conclusions Demographic and operational performance measures differ between academic and non-academic EDs, suggesting that the two groups may be inappropriate operational performance comparators. Causes for the differences remain unclear but the differences appear not to be attributed solely to the academic mission.
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Affiliation(s)
- Martin A Reznek
- Department of Emergency Medicine, University of Massachusetts Medical School Worcester Massachusetts 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Sean S Michael
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cathi A Harbertson
- Department of Emergency Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James J Scheulen
- Department of Emergency Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James J Augustine
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicin Dayton Ohio USA and US Acute Care Solutions, Canton, OH, USA
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Peterson SM, Harbertson CA, Scheulen JJ, Kelen GD. Trends and Characterization of Academic Emergency Department Patient Visits: A Five-year Review. Acad Emerg Med 2019; 26:410-419. [PMID: 30102817 DOI: 10.1111/acem.13550] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/24/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To meet the unique comparative data needs of academic emergency departments (EDs), we describe the recent 5-year national and regional trends for adult emergency patients' characteristics and operational parameters at academic emergency medical centers. METHODS Data collected from the recent 5-year period academic year (AY) 2012 through AY 2016 of the Academy of Administrators in Academic Emergency Medicine (AAAEM) and the Association of Academic Chairs of Emergency Medicine (AACEM) Academic Emergency Medicine Benchmarking Survey were analyzed for trends in 1) ED volumes and modes of arrival, 2) triage acuity level, 3) trends in ED professional fee billing, and 4) disposition patterns of ED patients including admission rates and walkouts. The AY spanned the 12-month period of July 1 through June 30. Only primary academic or academic affiliate hospitals data were included. Community and freestanding affiliated EDs were excluded. Institutional-specific data were stratified into four cohorts based on the following annual ED visit volumes: under 40,000, 40,000 to 60,000, 60,000 to 80,000, and over 80,000. Triage acuity levels were based on the Emergency Severity Index (ESI). Professional fee billing was analyzed specifically for CPT codes 99284, 99285, and 99291 (critical care). Left without being seen (LWBS), defined as leaving before a screening examine by a licensed medical provider, and screened and left (SAL), i.e., patients who were screened by a provider, but left before definitive evaluation and management, were similarly evaluated. Total walkouts were defined as the sum of LWBS and SAL. RESULTS Forty-four primary academic and academic affiliate sites completed the survey for all 5 years. The mean annual patient census increased 13.4% over the study period, with the majority (80%) of sites experiencing volume growth. Acuity/illness severity, measured as ESI 1 and 2, and CPT codes 99284, 99295, and 99291 increased an aggregate 18.2 and 8.4%, respectively. Large-volume hospitals (>60,000-80,000, >80,000) admissions increased by 15 and 21.6%, respectively, primarily due to surge in 2016. Overall emergency medical services (EMS) arrivals increased 7.3% although admissions from EMS remained relatively stable. LWBS rates decreased 19.5%, but total walkouts did not appear to change. CONCLUSION With a focus on larger academic institutions, differences were noted in the overall increases in volume and acuity. In this survey, participating institutions experienced increased volumes of patients with seemingly higher illness severity. While inroads have been made in LWBS rates, there has not been an overall decrease in total walkouts. The data reported here differed in many aspects compared to other benchmark surveys.
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Affiliation(s)
- Susan M. Peterson
- Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Cathi A. Harbertson
- Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - James J. Scheulen
- Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Gabor D. Kelen
- Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore MD
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