Brigitte M. Baumann

Objectives: The objective was to provide a longitudinal assessment of anxiety levels and work and home concerns of U.S. emergency physicians during the COVID‐19 pandemic.Methods: We performed a longitudinal, cross‐sectional email survey of clinically active emergency physicians (attending, fellow, and resident) at seven academic emergency departments. Follow‐up surveys were sent 4 to 6 weeks after the initial survey and assessed the following: COVID‐19 patient exposure, availability of COVID‐19 testing, levels of home and workplace anxiety/stress, changes in behaviors, and performance on a primary care posttraumatic stress disorder screen (PC‐PTSD‐5). Logistic regression explored factors associated with a high PC‐PTSD‐5 scale score (≥3), indicating increased risk for PTSD.Results: Of the 426 surveyed initial respondents, 262 (61.5%) completed the follow‐up survey. While 97.3% (255/262) reported treating suspected COVID‐19 patients, most physicians (162/262, 61.8%) had not received testing themselves. In follow‐up, respondents were most concerned about the relaxing of social distancing leading to a second wave (median score = 6, IQR = 4–7). Physicians reported a consistently high ability to order COVID‐19 tests for patients (median score = 6, IQR = 5–7) and access to personal protective equipment (median score = 6, IQR = 5–6). Women physicians were more likely to score ≥ 3 than men on the PC‐PTSD‐5 screener on the initial survey (43.3% vs. 22.5%; Δ 20.8%, 95% confidence interval [CI] = 9.3% to 31.5%), and despite decreases in overall proportions, this discrepancy remained in follow‐up (34.7% vs. 16.8%; Δ 17.9%, 95% CI = 7.1% to 28.1%). In examining the relationship between demographics, living situations, and institution location on having a PC‐PTSD‐5 score ≥ 3, only female sex was associated with a PC‐PTSD‐5 score ≥ 3 (adjusted odds ratio = 2.48, 95% CI = 1.28 to 4.79).Conclusions: While exposure to suspected COVID‐19 patients was nearly universal, stress levels in emergency physicians decreased with time. At both initial and follow‐up assessments, women were more likely to test positive on the PC‐PTSD‐5 screener compared to men.

Introduction: Our aim was to examine potential risk factors and modifiable behaviors that could lead to pediatric poisonings. Our secondary objectives were to explore socioeconomic factors associated with caregiver (parent/guardian) safe medication storage and knowledge of poison control contact information. Methods: We conducted a prospective, cross-sectional survey of caregivers of patients 2-10 years old presenting to an inner city pediatric emergency department. Caregiver and patient demographic data, prescription and nonprescription medication type, storage and when and where taken, were recorded. We used multivariable regression to explore factors associated with secure prescription medication storage and knowledge of poison control center contact information.Results: Of 1457 caregivers, 29% took daily prescription and 17% took daily non-prescription medications. Only 25% of caregivers stored their prescription medications in a secure place, and <3% stored medications in a locked drawer or safe. Of demographic and socioeconomic factors, only income ≥$80,000 was associated with storage of prescription medication in a secure place (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.27-4.81). When asked how they would access poison control in case of an ingestion, the majority, 86%, had an appropriate plan. In multivariable regression, the only factor associated with knowledge of poison control center contact information was college education in the caregiver (OR 1.6; 95% CI, 1.10-2.32). Conclusion: A minority of caregivers store medications in a safe place and even fewer keep prescription medications under lock and key. The majority, however, were aware of how to contact a poison control center in case of ingestion.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Computer technologies hold promise for implementing tobacco screening, brief intervention, and referral to treatment (SBIRT). This study aims to evaluate a computerized tobacco SBIRT system called the Health Evaluation and Referral Assistant (HERA). Smokers (n = 421) presenting to an emergency department were randomly assigned to the HERA or a minimal-treatment Control and were followed for 3 months. Analyses compared smoking cessation treatment provider contact, treatment initiation, treatment completion, and smoking behavior across condition using univariable comparisons, generalized estimating equations (GEE), and post hoc Chi square analyses. HERA participants were more likely to initiate contact with a treatment provider but did not differ on treatment initiation, quit attempts, or sustained abstinence. Subanalyses revealed HERA participants who accepted a faxed referral were more likely to initiate treatment but were not more likely to stop smoking. The HERA promoted initial contact with a smoking cessation provider and the faxed referral further promoted treatment initiation, but it did not lead to improved abstinence. Trial registration: ClinicalTrials.gov number NCT01153373

Uncontrolled hypertension is associated with significant patient morbidity and health care costs. Many patients evaluated in the emergency department (ED) do not regularly consult health care providers and have socioeconomic barriers to receiving primary care. Hypertension screening and counseling has been advocated as a routine part of ED care. Previous work has shown poor referral rates and education for ED patients presenting with elevated blood pressure (BP). We sought to determine whether implementation of an electronic medical record (EMR) would improve these rates. We performed a retrospective study conducted in 2 urban academic EDs, comparing pre-EMR (handwritten discharge) to post-EMR discharge instructions for patient referral for BP management and education on lifestyle modification. Medical records of patients aged ≥ 18 years with a systolic BP rate ≥ 140 or diastolic BP rate ≥ 90 mm Hg were included. Patient data included demographics, BP rate, presenting symptoms, and administration of antihypertensive medication while in the ED. Discharge instructions were reviewed for a directed referral for outpatient BP management, prescriptions for antihypertensive medication, and lifestyle modifications. Of the 1000 medical records reviewed, 500 were pre- and 500 were post-EMR, including a total of 389 patients who had persistently elevated BP on reassessment. At discharge, acknowledgment of elevated BP occurred in 45% of patients in the pre-EMR phase and only 26% in the post-EMR phase (P < 0.0001). Provision of all 5 lifestyle modifications occurred in none of the pre-EMR patients and in 15% of the post-EMR patients (P < 0.0001). Factors associated with a directed referral for the patient included increasing BP rate, pharmacologic treatment of hypertension in the ED, or provision of a prescription for an antihypertensive medication at discharge. The post-EMR phase was negatively associated with a directed referral for outpatient BP management. Overall, the initiation of EMR led to a decrease in outpatient referrals and acknowledgment of elevated BP rates in discharge instructions. The provision of more complete lifestyle modifications improved in the post-EMR phase.