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Scott BK, Singh J, Hravnak M, Everhart SS, Armaignac DL, Davis TM, Goede MR, Haranath SP, Kordik CM, Laudanski K, Pappas PA, Patel S, Rincon TA, Scruth EA, Subramanian S, Villanueva I, Williams LM, Wilson R, Pamplin JC. Best Practices in Telecritical Care: Expert Consensus Recommendations From the Telecritical Care Collaborative Network. Crit Care Med 2024; 52:1750-1767. [PMID: 39417998 DOI: 10.1097/ccm.0000000000006418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
OBJECTIVES Telecritical care (TCC) refers to the delivery of critical care using telehealth technologies. Despite increasing utilization, significant practice variation exists and literature regarding efficacy remains sparse. The Telecritical Care Collaborative Network sought to provide expert, consensus-based best practice recommendations for the design and delivery of TCC. DESIGN We used a modified Delphi methodology. Following literature review, an oversight panel identified core domains and developed declarative statements for review by an expert voting panel. During three voting rounds, voters agreed or disagreed with statements and provided open-ended feedback, which the oversight panel used to revise statements. Statements met criteria for consensus when accepted by greater than or equal to 85% of voters. SETTING/SUBJECTS The oversight panel included 18 multidisciplinary members of the TCC Collaborative Network, and the voting panel included 32 invited experts in TCC, emphasizing diversity of discipline, care delivery models, and geography. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified ten core domains: definitions/terminology; care delivery models; staffing and coverage models; technological considerations; ergonomics and workplace safety; licensing, credentialing, and certification; trust and relationship building; quality, safety, and efficiency, research agenda; and advocacy, leading to 79 practice statements. Of 79 original statements, 67 were accepted in round 1. After revision, nine were accepted in round 2 and two in round 3 (two statements were merged). In total, 78 practice statements achieved expert consensus. CONCLUSIONS These expert consensus recommendations cover a broad range of topics relevant to delivery of TCC. Experts agreed that TCC is most effective when delivered by care teams with specific expertise and by programs with explicit protocols focusing on effective communication, technical reliability, and real-time availability. Interventions should be tailored to local conditions. Although further research is needed to guide future best practice statements, these results provide valuable and actionable recommendations for the delivery of high-quality TCC.
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Affiliation(s)
| | - Jaspal Singh
- Atrium Health, Charlotte, North Carolina & Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | | | - Theresa M Davis
- Inova Health System, High Reliability Center, Falls Church, VA
| | | | | | | | - Krzysztof Laudanski
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN
| | - Peter A Pappas
- University of Central Florida College of Medicine, Orlando, FL
| | | | - Teresa A Rincon
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester MA and Blue Cirrus Consulting, Greenville, SC
| | - Elizabeth A Scruth
- Northern California Kaiser Permanente, Clinical Quality Programs, Data Analytics and Tele Critical Care, Oakland, CA
| | | | | | | | | | - Jeremy C Pamplin
- The Telemedicine and Advanced Technology Research Center, Fort Detrick, MD
- Department of Medicine, The Uniformed Services University, Bethesda, MD
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Gonzalez M, Williams LM, Yanello K, White J, Meyer S, Powell L, Benneche KA, Knoblach C, Jacobs L, Rincon TA. Innovations in Tele-Critical Care Nursing During the COVID-19 Pandemic. AACN Adv Crit Care 2023; 34:324-333. [PMID: 38033216 DOI: 10.4037/aacnacc2023152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
For decades, tele-critical care (TCC) programs have provided expert population surveillance with standardized clinical interventions for critically ill patients. The COVID-19 pandemic created massive strains on critical care resources. For this report, standard questions were used to solicit COVID-19 pandemic workflow and service modifications from a network of TCC leaders to describe the rapid expansion of TCC-supported services during the pandemic. In this article, leaders from 7 TCC programs report on the effective use of services to support changing hospital needs during the pandemic in areas such as clinical education, personal protective equipment stewardship, expansion of virtual care, and creative staffing models, among others.
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Affiliation(s)
- Miguel Gonzalez
- Miguel Gonzalez is Nurse Manager, Tele-Critical Care & Virtual Sepsis Unit, Baptist Health South Florida, 6855 Red Road, Coral Gables, FL 33143
| | - Lisa-Mae Williams
- Lisa-Mae Williams is Operations Director, Tele-Critical Care & Virtual Sepsis Unit, Baptist Health South Florida, Coral Gables, Florida
| | - Kim Yanello
- Kim Yanello is Telehealth Product Manager, Ascension Illinois, Boilingbrook, Illinois
| | - Jason White
- Jason White is Clinical Nurse Manager, Tele-ICU, St Louis, Missouri
| | - Shelley Meyer
- Shelley Meyer is Assistant Nurse Manager, Tele-ICU, St Louis, Missouri
| | - Lillian Powell
- Lillian Powell is Administrative Director, Connected Care, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Kara A Benneche
- Kara A. Benneche is Assistant Vice President, Operations, Telehealth Services, Northwell Health, Syosset, New York
| | - Carol Knoblach
- Carol Knoblach is retired from Sutter Health Valley, Sacramento, California
| | - Lynn Jacobs
- Lynn Jacobs is retired from UW Health eICU, University of Wisconsin, Madison, Wisconsin
| | - Teresa A Rincon
- Teresa A. Rincon is Assistant Professor, UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, and Senior Telehealth Consultant, Blue Cirrus Consulting, Greenville, South Carolina
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Armaignac DL, Ramamoorthy V, DuBouchet EM, Williams LM, Kushch NA, Gidel L, Badawi O. Descriptive Comparison of Two Models of Tele-Critical Care Delivery in a Large Multi-Hospital Health Care System. Telemed J E Health 2023; 29:1465-1475. [PMID: 36827094 DOI: 10.1089/tmj.2022.0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Introduction: The Society of Critical Care Medicine Tele-Critical Care (TCC) Committee has identified the need for rigorous comparative research of different TCC delivery models to support the development of best practices for staffing, application, and approaches to workflow. Our objective was to describe and compare outcomes between two TCC delivery models, TCC with 24/7 Bedside Intensivist (BI) compared with TCC with Private Daytime Attending Intensivist (PI) in relation to intensive care unit (ICU) and hospital mortality, ICU and hospital length of stay (LOS), cost, and complications across the spectrum of routine ICU standards of care. Methods: Observational cohort study at large health care system in 12 ICUs and included patients, ≥18, with Acute Physiology and Chronic Health Evaluation (APACHE) IVa scores and predictions (October 2016-June 2019). Results: Of the 19,519 ICU patients, 71.7% (n = 13,993) received TCC with 24/7 BI while 28.3% (n = 5,526) received TCC with PI. ICU and Hospital mortality (4.8% vs. 3.1%, p < 0.0001; 12.6% vs. 8.1%, p < 0.001); and ICU and Hospital LOS (3.2 vs. 2.4 days, p < 0.001; 9.8 vs. 7.2 days, p < 0.001) were significantly higher among 24/7 BI compared with PI. The APACHE observed/expected ratios (odds ratio [OR]; 95% confidence interval [CI]) for ICU mortality (0.62; 0.58-0.67) vs. (0.53; 0.46-0.61) and Hospital mortality (0.95; 0.57-1.48) vs. (0.77; 0.70-0.84) were significantly different for 24/7 BI compared with PI. Multivariate mixed models that adjusted for confounders demonstrated significantly greater odds of (OR; 95% CI) ICU mortality (1.58; 1.28-1.93), Hospital mortality (1.52; 1.33-1.73), complications (1.55; 1.18-2.04), ICU LOS [3.14 vs. 2.59 (1.25; 1.19-1.51)], and Hospital LOS [9.05 vs. 7.31 (1.23; 1.21-1.25)] among 24/7 BI when compared with PI. Sensitivity analyses adjusting for ICU admission within 24 h of hospital admission, receiving active ICU treatments, nighttime admission, sepsis, and highest third acute physiology score indicated significantly higher odds for 24/7 BI compared with PI. Conclusion: Our comparison demonstrated that TCC delivery model with PI provided high-quality care with significant positive effects on outcomes. This suggests that TCC delivery models have broad-ranging applicability and benefits in routine critical care, thus necessitating progressive research in this direction.
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Affiliation(s)
- Donna Lee Armaignac
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
| | | | - Eduardo Martinez DuBouchet
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
- Wertheim School of Medicine, Florida International University, Miami, Florida, USA
| | - Lisa-Mae Williams
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
- Wertheim School of Medicine, Florida International University, Miami, Florida, USA
| | | | - Louis Gidel
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
| | - Omar Badawi
- School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
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Xyrichis A, Iliopoulou K. Telehealth in the intensive care unit: Current insights and future directions. Intensive Crit Care Nurs 2023:103412. [PMID: 36813610 DOI: 10.1016/j.iccn.2023.103412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Laudanski K, Huffenberger AM, Scott MJ, Williams M, Wain J, Jablonski J, Hanson CW. Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers. Front Med (Lausanne) 2022; 9:883126. [PMID: 35991667 PMCID: PMC9388902 DOI: 10.3389/fmed.2022.883126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Our study addresses the gaps in knowledge of the characterizations of operations by remote tele-critical care medicine (tele-CCM) service providers interacting with the bedside team. The duration of engagements, the evolution of the tele-CCM service over time, and the distress during interactions with the bedside team have not been characterized systematically. These characteristics are critical for planning the deployment of teleICU services and preventing burnout among remote teleICU providers. Methods REDCap self-reported activity logs collected engagement duration, triggers (emergency button, tele-CCM software platform, autonomous algorithm, asymmetrical communication platform, phone), expediency, nature (proactive rounding, predetermined task, response to medical needs), communication modes, and acceptance. Seven hospitals with 16 ICUs were overseen between 9/2020 and 9/2021 by teams consisting of telemedicine medical doctors (eMD), telemedicine registered nurses (eRN), and telemedicine respiratory therapists (eRT). Results 39,915 total engagements were registered. eMDs had a significantly higher percentage of emergent and urgent engagements (31.9%) vs. eRN (9.8%) or eRT (1.7%). The average tele-CCM intervention took 16.1 ± 10.39 min for eMD, 18.1 ± 16.23 for eRN, and 8.2 ± 4.98 min for eRT, significantly varied between engagement, and expediency, hospitals, and ICUs types. During the observation period, there was a shift in intervention triggers with an increase in autonomous algorithmic ARDS detection concomitant with predominant utilization of asynchronous communication, phone engagements, and the tele-CCM module of electronic medical records at the expense of the share of proactive rounding. eRT communicated more frequently with bedside staff (% MD = 37.8%; % RN = 36.8, % RT = 49.0%) but mostly with other eRTs. In contrast, the eMD communicated with all ICU stakeholders while the eRN communicated chiefly with other RN and house staff at the patient's bedside. The rate of distress reported by tele-CCM staff was 2% among all interactions, with the entity hospital being the dominant factor. Conclusions Delivery of tele-CCM services has to be tailored to the specific beneficiary of tele-CCM services to optimize care delivery and minimize distress. In addition, the duration of the average intervention must be considered while creating an efficient workflow.
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Healthcare Economics, Philadelphia, PA, United States
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Krzysztof Laudanski
| | - Ann Marie Huffenberger
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Michael J. Scott
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Maria Williams
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Justin Wain
- Campbell University School of Osteopathic Medicine, Lillington, NC, United States
| | - Juliane Jablonski
- University of Pennsylvania Health System, Philadelphia, PA, United States
| | - C. William Hanson
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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Laudanski K, Huffenberger AM, Scott MJ, Wain J, Ghani D, Hanson CW. Pilot of rapid implementation of the advanced practice provider in the workflow of an existing tele-critical care program. BMC Health Serv Res 2022; 22:855. [PMID: 35780144 PMCID: PMC9250728 DOI: 10.1186/s12913-022-08251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Abstract
Incorporating the advanced practice provider (APP) in the delivery of tele critical care medicine (teleCCM) addresses the critical care provider shortage. However, the current literature lacks details of potential workflows, deployment difficulties and implementation outcomes while suggesting that expanding teleCCM service may be difficult. Here, we demonstrate the implementation of a telemedicine APP (eAPP) pilot service within an existing teleCCM program with the objective of determining the feasibility and ease of deployment. The goal is to augment an existing tele-ICU system with a balanced APP service to assess the feasibility and potential impact on the ICU performance in several hospitals affiliated within a large academic center. A REDCap survey was used to assess eAPP workflows, expediency of interventions, duration of tasks, and types of assignments within different service locations. Between 02/01/2021 and 08/31/2021, 204 interventions (across 133 12-h shift) were recorded by eAPP (nroutine = 109 (53.4%); nurgent = 82 (40.2%); nemergent = 13 (6.4%). The average task duration was 10.9 ± 6.22 min, but there was a significant difference based on the expediency of the task (F [2; 202] = 3.89; p < 0.022) and type of tasks (F [7; 220] = 6.69; p < 0.001). Furthermore, the eAPP task type and expediency varied depending upon the unit engaged and timeframe since implementation. The eAPP interventions were effectively communicated with bedside staff with only 0.5% of suggestions rejected. Only in 2% cases did the eAPP report distress. In summary, the eAPP can be rapidly deployed in existing teleCCM settings, providing adaptable and valuable care that addresses the specific needs of different ICUs while simultaneously enhancing the delivery of ICU care. Further studies are needed to quantify the input more robustly.
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Leonard Davis Institute for Health Economics, Philadelphia, PA, 19104, USA. .,Department of Anesthesiology and Critical Care, Leonard Davis Institute for Health Economic, JMB 127; 3620 Hamilton Walk, Philadelphia, PA, 19146, USA.
| | | | - Michael J Scott
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Justin Wain
- School of Osteopathic Medicine, Campbell University, Buies Creek, NC, 27506, USA.,Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Danyal Ghani
- College of Art & Sciences, Drexel University, Philadelphia, PA, 19104, USA
| | - C William Hanson
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Laudanski K, Scott M, Huffenberger AM, Wain J, Hanson CW. Deployment of Tele-ICU Respiratory Therapy and the Creation of an eRT Service Line. NEJM CATALYST 2022. [PMCID: PMC9580011 DOI: 10.1056/cat.21.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Penn Medicine launched a 24-7 telemedicine respiratory therapist (eRT) service as part of its tele–critical care medicine (tele-CCM) service serving seven hospitals and more than 320 critical care beds. Service line interventions were focused on protocolized evidence-based practices, safety, documentation compliance, and urgent emergent ad hoc clinical needs. Concomitantly, the eRTs were available to respond to urgent and emergent interventions on the basis of the clinical bedside situation. Their activity was triggered by Penn E-lert staff (serving the tele-ICUs), bedside staff, algorithmic trigger software, or the eRT’s own review of a patient’s clinical condition. A standardized data collection was deployed to gather information about the interventions. The value of the eRT service was defined in terms of estimated lives saved by implementing the standards of care earlier than the bedside staff would or acute respiratory distress syndrome (ARDS) algorithmic trigger and by intervening during emergent and urgent clinical request, improving care delivery, and complying with best clinical practices, and by the time freed for onsite staff to perform other duties. Between May 2020 and August 2021, eRTs registered 31,609 activities; 97.8% of interventions were related to the routine established workflows, while 1.9% were urgent and 0.3% emergent. In 51.2% of all eRT accomplished activities, no communication with other staff was needed. When communication did take place, eRTs connected with the bedside respiratory therapist in 36.7% of interactions, followed by house staff (7.2%), advanced practice providers (5.2%), and registered nurses (1.6%). The eRTs communicated via phone (81.4%), asynchronous text platform (16%), or tele-CCM software (1.4%). While prompted by staffing, safety, and logistics challenges during a Covid-19 surge, the resulting eRT service line has been well received and has become a part of the standard of care. Overall efficiency of respiratory care service delivery was increased as Penn retained staff and increased the flexibility of bedside therapists. Furthermore, the eRT service detected unfavorable practice patterns in ARDS treatment and intervened before the ARDS algorithmic trigger was activated or acted upon. Some of the tasks can be accomplished by the eRT in a shorter amount of time than it would take bedside staff. In addition, the remote staffing reduced personal protective equipment utilization. All of these gains translated into postpandemic time savings. Penn’s experience shows that the eRT care model can be transformed into a system-valued proposition and retained with sustained benefit beyond the pandemic surge.
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Affiliation(s)
- Krzysztof Laudanski
- Assistant Professor, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Senior Fellow, Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Assistant Professor, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Scott
- Division Chief, Critical Care Medicine, Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Medical Director, Penn E-lert Tele-Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Professor, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Marie Huffenberger
- Director, Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin Wain
- Medical Student, Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina, USA
| | - C. William Hanson
- Chief Medical Information Officer and Vice President, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Professor of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Deutsch AJ, Sangha H, Spadaro A, Goldenring J, Mamtani M, Scott KR, Conlon LW, Agarwal AK. Defining well-being: A case-study among emergency medicine residents at an academic center: A qualitative study. AEM EDUCATION AND TRAINING 2021; 5:e10712. [PMID: 34966881 PMCID: PMC8675814 DOI: 10.1002/aet2.10712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Healthcare-associated burnout is linked to reduced quality of care, decreased patient experience, and higher cost. The National Academy of Medicine has emphasized the importance of supporting clinician well-being across healthcare; however, well-being is poorly defined, especially early in emergency medicine training. OBJECTIVES The primary objective of this study was to explore and understand the attitudes, beliefs, and perspectives of emergency medicine (EM) resident physicians surrounding well-being. A secondary objective was to identify priority areas of focus to promote a culture of well-being for EM trainees. APPROACH We conducted semi-structured focus groups of EM resident physicians at an urban, academic institution with a 4-year training curriculum. Focus group interviews were transcribed and constructivist aggregated themes were identified using content analysis with a constant comparative coding approach. RESULTS Seventeen EM residents participated in semi-structured qualitative focus groups (PGY1 = 6, PGY2 = 6, PGY3 = 2, PGY4 = 3). Six key themes related to well-being emerged spanning clinical and nonclinical areas: (1) a focus on basic needs being met, (2) on-shift operational structure, (3) individual feedback, (4) feeling valued for clinical contributions, (5) a sense of community within the clinical environment, and (6) a sense of personal ownership over time. CONCLUSIONS Shifting the focus for medical trainees away from mitigating burnout and toward proactively promoting well-being is important. Understanding the perspectives and key themes in how EM residents define well-being can help support trainees early in their careers. Using qualitative methods, this study identified six key themes that can guide trainees, educational leaders, and academic hospital systems as they work toward building a culture of well-being early in graduate medical education.
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Affiliation(s)
- Amanda J. Deutsch
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Hareena Sangha
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Anthony Spadaro
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jacob Goldenring
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Mira Mamtani
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kevin R. Scott
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Lauren W. Conlon
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Anish K. Agarwal
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Penn Medicine Center for Digital HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Penn Medicine Center for Healthcare InnovationUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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