A Life-Threatening Emergency Exacerbated by Untreated Mental Illness in a Low-Barrier Health Center

Introduction: We report on a patient with untreated severe mental illness who presented with a life-threatening emergency: retained products of conception and hemorrhage. Clinical Findings: A female patient experiencing homelessness developed life-threatening hemorrhage. Her mental illness impaired effective communication and treatment. Clinical Course: The patient presented with fatigue, vaginal bleeding, and known retained products of conception. Her active mental illness complicated the situation as it limited effective communication and treatment due to delusions. She requested only treatment for an infectious cause of her symptoms. She refused most interventions and had a self-directed discharge from the hospital. Throughout this process, we assessed that she understood the implications of declining care, despite her mental illness. After extensive patient-centered and trauma-informed discussions, she accepted medical treatment. Conclusions: This case highlights the importance of patient-centered communication and team-based care during emergencies and refusal of care. Shared decision-making and trauma-informed care are appropriate methods for assessing the capacity of patients with severe mental illness in acute and life-threatening conditions

Obstetric Outcomes Assessment for New Mainers

Introduction • 13% of Portland’s population in 2019 was recent immigrants • Numbers have increased, with \u3e350 asylum-seeking families (1500 individuals) in 2022 in Portland alone • Maine Medical Center (MMC) provides obstetrical care for more newly arrived, non-English speaking patients • Total deliveries in 2020, 2021 (6192) broke records at MMC • New Mainers at Increased risk for health disparities due to: language barriers, low socioeconomic status and stressors from a history of traumahttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1025/thumbnail.jp

How to address health misinformation? Using focus groups to understand the experience and needs of Interprofessional undergraduate health professionals

The Problem of Health Misinformation Students from six different health professions share ideashttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1020/thumbnail.jp

Equipping Health Professions Educators to Better Address Medical Misinformation

As part of a cooperative agreement with the US Centers for Disease Control and Prevention (Federal Award Identification Number [FAIN]: NU50CK000586), the Association of American Medical Colleges (AAMC) began a strategic initiative in 2022 both to increase confidence in COVID-19 vaccines and to address medical misinformation and mistrust through education in health professions contexts. Specifically, the AAMC solicited proposals for integrating competency-based, interprofessional strategies to mitigate health misinformation into new or existing curricula. Five Health Professions Education Curricular Innovations subgrantees received support from the AAMC in 2022 and reflected on the implementation of their ideas in a series of meetings over several months. Subgrantees included the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Florida International University Herbert Wertheim College of Medicine, the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, the Maine Medical Center/Tufts University School of Medicine, and the University of Chicago Pritzker School of Medicine. This paper comprises insights from each of the teams and overarching observations regarding the challenges and opportunities involved with leveraging health professions education to address medical misinformation and improve patient health

Hand-Based Activity for Navigating Discomfort with extragenital STD testing using a Brief, Unconventional, Transportable Training (HAND-BUTT)

Gonorrhea and Chlamydia are the two most common STDs that can spread widely among populations, are highly transmissible, and rates of both have increased nationally in recent years. It is important to identify and treat gonorrhea and chlamydia infections as early as possible in at-risk populations, as they are often asymptomatic. Healthcare providers have been traditionally taught that genitalia are the site of infection, but inoculation and infection can also involve anal and oral sites. Screening with genital-only testing misses more than half of gonorrhea and chlamydia infections among men who have sex with men, and significant proportions in heterosexual female patients. A recent study found only 50% of primary care and OB/Gyn clinicians nationally were aware of extragenital testing. The HAND-BUTT Simulation is very brief (2-3 minutes) intervention to train interprofessional learners on rectal STD screening, while simultaneously increasing their knowledge of extragenital screening modalities. Few resources are needed; two sets of hands to simulate buttocks, a cotton-tipped swab, and a student “tester”

Assessment of Obstetric Outcomes Graphs and Figures for New Mainers

Introduction • 4% of Maine’s population in 2018 was recent immigrants • Maine Medical Center provides obstetrical care for more newly arrived, non- English speaking patients • Increased risk for health disparities due to: language barriers, low socioeconomic status and stressors from a history of trauma.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2022/1010/thumbnail.jp

Accuracy Screening for ST Elevation Myocardial Infarction in a Task-switching Simulation

Introduction: Interruptions in the emergency department (ED) are associated with clinical errors, yet are important when providing care to multiple patients. Screening triage electrocardiograms (ECG) for ST-segment elevation myocardial infarction (STEMI) represent a critical interrupting task that emergency physicians (EP) frequently encounter. To address interruptions such as ECG interpretation, many EPs engage in task switching, pausing their primary task to address an interrupting task. The impact of task switching on clinical errors in interpreting screening ECGs for STEMI remains unknown. Methods: Resident and attending EPs were invited to participate in a crossover simulation trial. Physicians first completed a task-switching simulation in which they viewed patient presentations interrupted by clinical tasks, including screening ECGs requiring immediate interpretation before resuming the patient presentation. Participants then completed an uninterrupted simulation in which patient presentations and clinical tasks were completed sequentially without interruption. The primary outcome was accuracy of ECG interpretation for STEMI during task switching and uninterrupted simulations. Results: Thirty-five participants completed the study. We found no significant difference in accuracy of ECG interpretation for STEMI (task switching 0.89, uninterrupted 0.91, paired t-test p=0.21). Attending physician status (odds ratio [OR] [2.56], confidence interval [CI] [1.66-3.94], p\u3c0.01) and inferior STEMI (OR [0.08], CI [0.04-0.14], p\u3c0.01) were associated with increased and decreased odds of correct interpretation, respectively. Low self-reported confidence in interpretation was associated with decreased odds of correct interpretation in the task-switching simulation, but not in the uninterrupted simulation (interaction p=0.02). Conclusion: In our simulation, task switching was not associated with overall accuracy of ECG interpretation for STEMI. However, odds of correct interpretation decreased with inferior STEMI ECGs and when participants self-reported low confidence when interrupted. Our study highlights opportunities to improve through focused ECG training, as well as self-identification of high-risk screening ECGs prone to error during interrupted clinical workflow

Accuracy Screening for ST Elevation Myocardial Infarction in a Task-switching Simulation

Introduction: Interruptions in the emergency department (ED) are associated with clinical errors, yet are important when providing care to multiple patients. Screening triage electrocardiograms (ECG) for ST-segment elevation myocardial infarction (STEMI) represent a critical interrupting task that emergency physicians (EP) frequently encounter. To address interruptions such as ECG interpretation, many EPs engage in task switching, pausing their primary task to address an interrupting task. The impact of task switching on clinical errors in interpreting screening ECGs for STEMI remains unknown.Methods: Resident and attending EPs were invited to participate in a crossover simulation trial. Physicians first completed a task-switching simulation in which they viewed patient presentations interrupted by clinical tasks, including screening ECGs requiring immediate interpretation before resuming the patient presentation. Participants then completed an uninterrupted simulation in which patient presentations and clinical tasks were completed sequentially without interruption. The primary outcome was accuracy of ECG interpretation for STEMI during task switching and uninterrupted simulations. Results: Thirty-five participants completed the study. We found no significant difference in accuracy of ECG interpretation for STEMI (task switching 0.89, uninterrupted 0.91, paired t-test p=0.21). Attending physician status (odds ratio [OR] [2.56], confidence interval [CI] [1.66-3.94], p<0.01) and inferior STEMI (OR [0.08], CI [0.04-0.14], p<0.01) were associated with increased and decreased odds of correct interpretation, respectively. Low self-reported confidence in interpretation was associated with decreased odds of correct interpretation in the task-switching simulation, but not in the uninterrupted simulation (interaction p=0.02). Conclusion: In our simulation, task switching was not associated with overall accuracy of ECG interpretation for STEMI. However, odds of correct interpretation decreased with inferior STEMI ECGs and when participants self-reported low confidence when interrupted. Our study highlights opportunities to improve through focused ECG training, as well as self-identification of “high-risk” screening ECGs prone to error during interrupted clinical workflow

Accuracy Screening for ST Elevation Myocardial Infarction in a Task-switching Simulation

Introduction: Interruptions in the emergency department (ED) are associated with clinical errors, yet are important when providing care to multiple patients. Screening triage electrocardiograms (ECG) for ST-segment elevation myocardial infarction (STEMI) represent a critical interrupting task that emergency physicians (EP) frequently encounter. To address interruptions such as ECG interpretation, many EPs engage in task switching, pausing their primary task to address an interrupting task. The impact of task switching on clinical errors in interpreting screening ECGs for STEMI remains unknown.Methods: Resident and attending EPs were invited to participate in a crossover simulation trial. Physicians first completed a task-switching simulation in which they viewed patient presentations interrupted by clinical tasks, including screening ECGs requiring immediate interpretation before resuming the patient presentation. Participants then completed an uninterrupted simulation in which patient presentations and clinical tasks were completed sequentially without interruption. The primary outcome was accuracy of ECG interpretation for STEMI during task switching and uninterrupted simulations. Results: Thirty-five participants completed the study. We found no significant difference in accuracy of ECG interpretation for STEMI (task switching 0.89, uninterrupted 0.91, paired t-test p=0.21). Attending physician status (odds ratio [OR] [2.56], confidence interval [CI] [1.66-3.94], p<0.01) and inferior STEMI (OR [0.08], CI [0.04-0.14], p<0.01) were associated with increased and decreased odds of correct interpretation, respectively. Low self-reported confidence in interpretation was associated with decreased odds of correct interpretation in the task-switching simulation, but not in the uninterrupted simulation (interaction p=0.02). Conclusion: In our simulation, task switching was not associated with overall accuracy of ECG interpretation for STEMI. However, odds of correct interpretation decreased with inferior STEMI ECGs and when participants self-reported low confidence when interrupted. Our study highlights opportunities to improve through focused ECG training, as well as self-identification of “high-risk” screening ECGs prone to error during interrupted clinical workflow