Telemedicine Certified Recovery Specialists for Patients with Opioid Use Disorders in the Emergency Department in COVID-19

COVID-19 is a staggering tragedy in a number of manners, but the lack of available access points to healthcare services due to federal, state, local and institutional regulations and decisions creates higher levels of patient vulnerability. Patients with opioid use disorders (OUD) are especially vulnerable given high levels of coexistent housing insecurity, food insecurity and lack of primary care at baseline. These patients frequently utilize the emergency department for both medical and non-medical concerns. Existing pathways to assist these patients utilize in person certified (peer) recovery specialists (CRS) who are not employed by the enterprise. Given the need to limit exposure to non-employees, finding a means of connecting patients to CRS became a highly important challenge

Teaching the Emergency Department Patient Experience: Needs Assessment from the CORD-EM Task Force.

INTRODUCTION: Since the creation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction (PS) scores, patient experience (PE) has become a metric that can profoundly affect the fiscal balance of hospital systems, reputation of entire departments and welfare of individual physicians. While government and hospital mandates demonstrate the prominence of PE as a quality measure, no such mandate exists for its education. The objective of this study was to determine the education and evaluation landscape for PE in categorical emergency medicine (EM) residencies. METHODS: This was a prospective survey analysis of the Council of Emergency Medicine Residency Directors (CORD) membership. Program directors (PDs), assistant PDs and core faculty who are part of the CORD listserv were sent an email link to a brief, anonymous electronic survey. Respondents were asked their position in the residency, the name of their department, and questions regarding the presence and types of PS evaluative data and PE education they provide. RESULTS: We obtained 168 responses from 139 individual residencies, representing 72% of all categorical EM residencies. This survey found that only 27% of responding residencies provide PS data to their residents. Of those programs, 61% offer simulation scores, 39% provide third-party attending data on cases with resident participation, 37% provide third-party acquired data specifically about residents and 37% provide internally acquired quantitative data. Only 35% of residencies reported having any organized PE curricula. Of the programs that provide an organized PE curriculum, most offer multiple modalities; 96% provide didactic lectures, 49% small group sessions, 47% simulation sessions and 27% specifically use standardized patient encounters in their simulation sessions. CONCLUSION: The majority of categorical EM residencies do not provide either PS data or any organized PE curriculum. Those that do use a heterogeneous set of data collection modalities and educational techniques. American Osteopathic Association and Accreditation Council for Graduate Medical Education residencies show no significant differences in their resident PS data provision or formal curricula. Further work is needed to improve education given the high stakes of PS scores in the emergency physician\u27s career

Progression of Patient Cohorting in Response to COVID-19 at the Jefferson Methodist Emergency Department

While COVID-19 and it’s various complications are a source of a substantial number of Emergency Department (ED) visits, many patients still arrive to the ED for non-COVID-19 indications. Due to pre-existing construction which was halted by the pandemic, external space for a tent configuration was unavailable. In effort to decrease patient, staff and nurse exposure to COVID, a system of cohorting was created to assure uninterrupted service in a manner as safe as possible for all involved. Given the uncertainty of patient volumes and the potential for a high burden of disease similar to our colleagues in New York and New Jersey, this system was created in stages to dynamically flex to the needs of the department

Academic Primer Series: Five Key Papers for Consulting Clinician Educators.

INTRODUCTION: Clinician educators are often asked to perform consultations for colleagues. Invitations to consult and advise others on local problems can help foster great collaborations between centers, and allows for an exchange of ideas between programs. In this article, the authors identify and summarize several key papers to assist emerging clinician educators with the consultation process. METHODS: A consensus-building process was used to generate a list of key papers that describe the importance and significance of educational consulting, informed by social media sources. A three-round voting methodology, akin to a Delphi study, determined the most impactful papers from the larger list. RESULTS: Summaries of the five most highly rated papers on education consultation are presented in this paper. These papers were determined by a mixed group of junior and senior faculty members, who have summarized these papers with respect to their relevance for their peer groups. CONCLUSION: Five key papers on the educational consultation process are presented in this paper. These papers offer background and perspective to help junior faculty gain a grasp of consultation processes

Prolonged Duration of Viral Shedding of SARS-CoV-2: A Case Report

Introduction: The literature on the clinical course of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) suggests patients continue shedding viral particles typically for an average of 20 days until the body builds immunity against the infection. However, a few cases have shown prolonged duration in viral shedding and highlight the significant increased mortality in these patients. It has also been suggested that multiple strains of SARS-COV-2 exist, keying the possibility to reinfection.Case Report: We present a case of a 57-year-old male who presented twice over 37 days with symptoms related to SARS-COV-2, and only on his second visit was found to be in hypoxemic respiratory failure and cardiogenic shock. He also reportedly had a period of convalescence in between presentations.Discussion: This case highlights the still unclear disease course of SARS-COV-2 and the need for diligence in providing strong follow-up instructions and evaluation for sequelae of the infection

Prolonged Duration of Viral Shedding of SARS-CoV-2: A Case Report

Introduction: The literature on the clinical course of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) suggests patients continue shedding viral particles typically for an average of 20 days until the body builds immunity against the infection. However, a few cases have shown prolonged duration in viral shedding and highlight the significant increased mortality in these patients. It has also been suggested that multiple strains of SARS-COV-2 exist, keying the possibility to reinfection.Case Report: We present a case of a 57-year-old male who presented twice over 37 days with symptoms related to SARS-COV-2, and only on his second visit was found to be in hypoxemic respiratory failure and cardiogenic shock. He also reportedly had a period of convalescence in between presentations.Discussion: This case highlights the still unclear disease course of SARS-COV-2 and the need for diligence in providing strong follow-up instructions and evaluation for sequelae of the infection

A Delphi Method Analysis to Create an Emergency Medicine Educational Patient Satisfaction Survey

Introduction: Feedback on patient satisfaction (PS) as a means to monitor and improve performance in patient communication is lacking in residency training. A physician’s promotion, compensation and job satisfaction may be impacted by his individual PS scores, once he is in practice. Many communication and satisfaction surveys exist but none focus on the emergency department setting for educational purposes. The goal of this project was to create an emergency medicine-based educational PS survey with strong evidence for content validity. Methods: We used the Delphi Method (DM) to obtain expert opinion via an iterative process of surveying. Questions were mined from four PS surveys as well as from group suggestion. The DM analysis determined the structure, content and appropriate use of the tool. The group used four-point Likert-type scales and Lynn’s criteria for content validity to determine relevant questions from the stated goals. Results: Twelve recruited experts participated in a series of seven surveys to achieve consensus. A 10-question, single-page survey with an additional page of qualitative questions and demographic questions was selected. Thirty one questions were judged to be relevant from an original 48-question list. Of these, the final 10 questions were chosen. Response rates for individual survey items was 99.5%. Conclusion: The DM produced a consensus survey with content validity evidence. Future work will be needed to obtain evidence for response process, internal structure and construct validity

Initial Response to the Opioid Crisis: Availability of Buprenorphine and Warm Handoff in the ED

Background: The United States is in the midst of an opioid crisis. The Centers for Disease Control and Prevention has cited Emergency Departments (ED) as important centers for treatment and referral, including medication assisted treatment (MAT), which has been shown to be superior to motivational interviewing and referral alone.1,2 While direct linkage to outpatient programs via the ED may be an opportunity to better serve this population, data on such “warm handoff” interventions are sparse. Objective: We initiated an ED opioid use disorder (OUD) pathway, which aimed to initiate buprenorphine therapy and perform warm handoff directly into the community for treatment.https://jdc.jefferson.edu/patientsafetyposters/1149/thumbnail.jp