Implementing At-the-Elbow Training in the Emergency Department: Feasibility, Outcomes, and Lessons

Introduction: Individuals who die by suicide often make ED contact the year prior to death. In accordance with Joint Commission recommendations, universal suicide screening has been implemented across UMass Memorial Health Care EDs, in an effort to improve quality of care for patients with suicide risk. We developed clinician decision aids, clinical workflows, and electronic health record (EHR) items, and introduced them using an \u27at-the-elbow\u27 training model in the ED. Methods: We programmed a data visualization application (Tableau), which pulls data directly from the EHR, to measure suicide-positive detection rates and physician secondary screener completion. Training logs were completed following every shift, and were used to identify barriers to training and lessons learned. Results: Over an average of 3.4 weeks per site, 207 ED clinicians (79 physicians, 32 residents, and approximately 96 nurses) were trained across all five EDs; encounters usually took 5-10 minutes. Trainers successfully reached 79 of 104 attending physicians (76%) across all sites. Suicide-detection rates increased post-training for three units, and secondary screening rates increased for four units. Three common barriers included understanding the definition of a suicide-positive screen; importance of physician secondary screening and how to use the tool for decision-making; and issues with nurse-physician communication of suicide risk. Discussion: The \u27at-the-elbow\u27 approach was an efficient way of reaching the majority of ED clinicians and facilitated rapid-cycle improvement in response to emerging barriers. However, this approach was resource-intensive for project staff and not sustainable long term. Integration into onboarding and a \u27train-the-trainer\u27 model could improve sustainability

Perspectives on barriers and facilitators to mental health support after a traumatic birth among a sample of primarily White and privately insured patients

OBJECTIVE: To elicit the perspectives of individuals with a traumatic birth experience on barriers and facilitators to receiving mental health support in the postpartum period. METHODS: Individuals who experienced a traumatic birth within the last three years (n = 32) completed semi-structured phone interviews about their birth and postpartum experience. The Post-traumatic Stress Disorder Checklist for DSM-V (PCL-5), Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder scale (GAD-7) were administered. Qualitative data was analyzed using a modified grounded theory by three independent coders. RESULTS: Among participants, 34.4% screened positive for PTSD, 18.8% for depression, and 34.4% for anxiety. Participants described multi-level barriers that prevented clinicians from recognizing and supporting patients\u27 postpartum mental health needs; those involved lack of communication, education, and resources. Recommendations from participants included that 1) obstetric professionals should acknowledge birth-related trauma experienced by any individual, 2) providers of multiple disciplines need to be integrated into postpartum care, and 3) mental health support may be needed before the ambulatory postpartum visit. CONCLUSIONS: There are multi-level barriers towards detecting and responding to individuals\u27 mental health needs after a traumatic birth. Obstetric professionals need to use a trauma-informed approach and proactively assess mental health throughout the postpartum period

Aging and COVID-19 in Minority Populations: a Perfect Storm

Purpose of Review: COVID-19 is a major concern for the health and wellbeing of individuals worldwide. As COVID-19 cases and deaths continue to increase in the USA, aging Black and Hispanic populations have emerged as especially at-risk for increased exposure to COVID-19 and susceptibility to severe health outcomes. The current review discusses the weathering hypothesis and the influence of social inequality on the identified health disparities. Recent Findings: Aging minoritized populations have endured structural and social inequality over the lifecourse. Consequently, these populations experience weathering, a process that results in physiological dysregulation due to stress associated with persistent disadvantage. Through weathering and continued inequity, aging minoritized populations have an increased risk of exposure and poor health outcomes from COVID-19. Summary: Current literature and available data suggests that aging minoritized persons experience high rates of COVID-19 morbidity and mortality. The current review hypothesizes and supports that observed disparities are the result of inequalities that especially affect Black and Hispanic populations over the lifecourse. Future efforts to address these disparities should emphasize research that supports governments in identifying at-risk groups, providing accessible COVID-19-related information to those groups, and implementing policy that addresses the structural and social inequities that perpetuate current COVID-19 disparities