Tracking Staff Mood and Concerns in a Pediatric Emergency Department During the COVID-19 Pandemic

INTRODUCTION

Few studies have monitored health care worker mood and job satisfaction changes longitudinally throughout an epidemic. The objective of this study was to track staff mood, job satisfaction, questions, and suggestions in a pediatric emergency department over 1 year during the coronavirus disease 2019 pandemic. We hypothesized that staff would experience heightened negative emotions earlier in the pandemic due to uncertainty around hospital protocols and the coronavirus disease 2019 disease process.

METHODS

A voluntary, cross sectional descriptive study using an anonymous electronic survey assessed job satisfaction and mood over 4 domains (sad-happy, angry-peaceful, exhausted-energized, fearful-confident) in pediatric emergency department staff members. Responses were reported with Likert scales and free-text fields.

RESULTS

Of 272 survey responses, most were from nurses and clinical technicians (N = 173, 63.6%), followed by physicians and physician assistants (N = 55, 20.2%) and nonmedical staff (N = 44, 16.2%). Department-wide values for the fearful-confident and angry-peaceful domains increased over time (P = .001 and P = .01, respectively), indicating an overall more confident and peaceful mood in department staff. Job satisfaction did not change over time or by staff role. Nurses and clinical technicians reported the most exhaustion (P = .002), and physicians and physician assistants reported the most fear (P = .03). We received a total of 71 comments, which we grouped into 4 themes: protocols and procedures, personnel, infection risk, and miscellaneous. Comments submitted early in the pandemic centered around intradepartmental protocols and procedures, with a peak in staffing comments 5 months into the pandemic.

DISCUSSION

An electronic survey monitoring mood, job satisfaction, and concerns in a pediatric emergency department identified mood changes in staff over the course of the coronavirus disease 2019 pandemic.

Changes in training patterns and confidence to return to sport in United States collegiate athletes during the COVID-19 pandemic

OBJECTIVE

To describe the training patterns, return to sport (RTS) confidence, and perceived fitness during the COVID-19 pandemic summer 2020 and to compare training patterns and RTS readiness during COVID-19 versus during the 2019 summer in a cohort of Division III collegiate athletes.

METHODS

An electronic survey of varsity athletes ≥18 years at three United States Division III colleges querying athlete demographics, Modified Athletic Identity Scale (mAIMS), changes in training regimen summer 2020 vs. 2019, RTS confidence, and perceived physical fitness.

RESULTS

One hundred and ninety-two surveys were completed (19% response). Total reported summer 2020 training decreased by 4 hours/week, with increased aerobic (56% vs. 53%, p = 0.03) and decreased sport-specific training (48% vs 70%, p < 0.001). Median RTS confidence score for formal training and competition was 3 ('neither more or less confident') in men's versus 2 ('less confident') in women's athletes. Median fitness self-assessment for men's athletes was 3 ('neither more nor less physically fit') compared to previous season versus median score of 2 ('less physically fit) among women's athletes (p = 0.004). For each mAIMS unit, training increased by 11 minutes/week (95% CI: 2-19 minutes; p = 0.01) and sport-specific training increased by 1.3% (95% CI: 0.5-2.2%; p = 0.003), controlling for age, sport, grade, and school. mAIMS was not associated with confidence or fitness rating.

CONCLUSION

Collegiate athletes decreased overall training hours, particularly sport-specific training time during the COVID-19 summer compared to the prior summer. Athletic identity was related to overall and sport-specific training hours but not confidence to RTS or fitness.

Factors Associated With Repeat Emergency Department Visits in a State-wide Cohort of Pediatric Patients With Mild Traumatic Brain Injury

OBJECTIVE

To describe demographic, injury, and clinical characteristics of pediatric patients treated in the ED for mild traumatic brain injury (mTBI), and to evaluate characteristics associated with mTBI-related return emergency department (ED) visit within 1 month of initial presentation.

METHODS

Retrospective cohort study from April 1, 2012, to September 30, 2017, of children 19 years or younger presenting to any Maryland ED for mTBI identified in the Maryland Health Services Cost Review Commission database using ICD-9/10 codes. Demographic, injury, and clinical characteristics of individuals were collected. The primary outcome was mTBI-related return ED visit within 4 weeks. Multiple logistic regression tested the associated of individual demographic, injury, and clinical characteristics with mTBI-related return ED visit.

RESULTS

There were 25,582 individuals who had an ED visit for mTBI, of which 717 (2.8%) returned to the ED within 4 weeks and 468 (1.8%) within 1 week with a mTBI-related diagnosis. In multivariable logistic regression analyses, public insurance (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.21-1.72) and female sex (aOR, 1.34; 95% CI, 1.15-1.56) were associated with increased odds of return to the ED within 4 weeks. Age younger than 2 years (aOR, 0.39; 95% CI, 0.21-0.72) was associated with decreased odds of return visit. There was a trend toward decreased odds of return patients receiving computed tomography head imaging (aOR, 0.86; 95% CI, 0.74-1.01).

CONCLUSIONS

Although return to the ED for mTBI-related complaints is uncommon, girls, older children, and publicly insured individuals may be at increased risk. Future targeted study may identify areas to improve access to appropriate longitudinal care and justify ED programs to better coordinate follow-up for mTBI.

Implementation of LURIES: A New Handoff Tool for Pediatric Residents

Introduction

At our institution, inpatient pediatric residents spend about 50 hours each month on 52 total handoff encounters. We created a modifiable electronic handoff tool (LURIES) and measured its impact on resident perception of self-efficacy. We also elicited feedback and identified topics omitted in the handoffs following its adoption on general medicine, intensive care, and sub-specialty wards. Our objective was to standardize the handoff tool used by residents and to measure the impact of the new tool on resident perception of self-efficacy.

Methods

Residents were trained to use LURIES and completed a voluntary online survey during the first and second year of implementation. Senior residents reflected on experiences prior to and after implementation of LURIES. Night team residents reported key items omitted from the handoff.

Results

65/96 (68%) residents responded in year one and 45/97 (46%) in year two of implementation. The majority of residents perceived that LURIES improved handoff efficiency, promoted active listening, and reduced the number of missed tasks overnight. There was a statistically significant increase in self-efficacy for all queried overnight tasks. Omitted information was most commonly identified on complex subspecialty services and pertained to communication with parents, late admissions, and discharges.

Conclusion

LURIES increased resident self-efficacy with patient management. There was no difference in findings when controlled for previous medical school handoff training or type of handoff tool used in medical school clerkships. More data are needed to establish the significance of this trend in relation to handoffs beyond residency, patient safety, and patient satisfaction scores.

F2L, a peptide derived from heme-binding protein, chemoattracts mouse neutrophils by specifically activating Fpr2, the low-affinity N-formylpeptide receptor

F2L (formylpeptide receptor (FPR)-like (FPRL)-2 ligand), a highly conserved acetylated peptide derived from the amino-terminal cleavage of heme-binding protein, is a potent chemoattractant for human monocytes and dendritic cells, and inhibits LPS-induced human dendritic cell maturation. We recently reported that F2L is able to activate the human receptors FPRL-1 and FPRL2, two members of the FPR family, with highest selectivity and affinity for FPRL2. To facilitate delineation of mechanisms of F2L action in vivo, we have now attempted to define its mouse receptors. This is complicated by the nonequivalence of the human and mouse FPR gene families (three vs at least eight members, respectively). When cell lines were transfected with plasmids encoding the eight mouse receptors, only the one expressing the receptor Fpr2 responded to F2L (EC(50) approximately 400 nM for both human and mouse F2L in both calcium flux and cAMP inhibition assays). This value is similar to F2L potency at human FPRL1. Consistent with this, mouse neutrophils, which like macrophages and dendritic cells express Fpr2, responded to human and mouse F2L in both calcium flux and chemotaxis assays with EC(50) values similar to those found for Fpr2-expressing cell lines ( approximately 500 nM). Moreover, neutrophils from mice genetically deficient in Fpr2 failed to respond to F2L. Thus, Fpr2 is a mouse receptor for F2L, and can be targeted for the study of F2L action in mouse models.