Emergency Medicine Physician Work Environments During the COVID-19 Pandemic

C. Christopher Zalesky, MD MSc, Nathan Dreyfus, MD, Joshua Davis, MD, Natalie Kreitzer, MD MS

To appear in: Annals of Emergency Medicine

Received Date: 2 August 2020

Keywords: COVID-19, coronavirus, SARS-CoV-2, physician wellness, physician burnout, pandemic stress, rationing patient care, personal protective equipment

COVID-19 pandemic.1,2 To better understand these conditions and their effects, we surveyed a nationwide cross-section of Emergency Medicine (EM) attending and resident physicians.

We obtained a convenience sample of United States (US) EM physicians via the Emergency Medicine Residents’ Association email distribution list [AQ: How many email addresses are on this list]?. The survey included questions covering four topics: demographics, workplace environment, COVID-19 exposure, and a validated instrument on burnout and professional well­being – the Stanford Professional Fulfilment Index (PFI). Survey data were collected from April 29 to May 13, 2020.3

We analyzed 296 completed surveys, of 443 that were started [you can add the answer to the above AQ here.]. Further demographic information can be found in the appendix. Regarding pandemic work conditions, 39% of respondents were moderately or extremely concerned for their safety in the workplace(Appendix Table 2) . PPE reuse was reported by 93% of respondents. Two thirds (66%) of respondents reported that they had rationed medical resources other than PPE; among this subset, 69% had rationed medications, 39% had rationed non-invasive ventilation, and 21% had rationed ventilators. Of all respondents, 26% reported having had symptoms of COVID-19, 26% had been tested, and 7% had tested positive for COVID-19. Median PFI scores were consistent with work exhaustion and burnout.

We report several key differences in measures for respondents practicing in self-reported COVID-19 “hotspots.” Not surprisingly, a greater proportion of physicians in hotspots had rationed medical resources compared with non-hotspot respondents (82% vs. 56%, Table 1). Of those physicians in hotspots who had rationed resources, 35% had rationed ventilators, compared with 10% of non-hotspot respondents. EM physicians in hotspots also had a higher positive test rate for COVID-19: 40% of those tested in hotspots were positive, while 17% of those tested were positive in non-hotspots.The kind of COVID-19 test used was not specified by respondants.

Our survey suggests that a concerning proportion of emergency physicians have rationed medications, critical interventions, and basic PPE during the pandemic. These findings underscore a fact that is intuitive yet warrants emphasis: when COVID-19 caseloads exceed relative clinical capacities, both the safety of providers and the quality of patient care become compromised. Building rapidly scalable clinical capacity and controlling the rate of pandemic spread are critical to avoid future compromise as additional hotspots emerge.

References

  1. Rodriguez RM, Medak AJ, Baumann BM, et al. Academic Emergency Medicine Physicians’ Anxiety Levels, Stressors, and Potential Stress Mitigation Measures During the Acceleration Phase of the COVID-19 Pandemic. Acad Emerg Med 2020.
  2. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA 2020.
  3. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019;95:103208.COVID-19 pandemic.1,2 To better understand these conditions and their effects, we surveyed a nationwide cross-section of Emergency Medicine (EM) attending and resident physicians.

    We obtained a convenience sample of United States (US) EM physicians via the Emergency Medicine Residents’ Association email distribution list [AQ: How many email addresses are on this list]?. The survey included questions covering four topics: demographics, workplace environment, COVID-19 exposure, and a validated instrument on burnout and professional well­being – the Stanford Professional Fulfilment Index (PFI). Survey data were collected from April 29 to May 13, 2020.3

    We analyzed 296 completed surveys, of 443 that were started [you can add the answer to the above AQ here.]. Further demographic information can be found in the appendix. Regarding pandemic work conditions, 39% of respondents were moderately or extremely concerned for their safety in the workplace(Appendix Table 2) . PPE reuse was reported by 93% of respondents. Two thirds (66%) of respondents reported that they had rationed medical resources other than PPE; among this subset, 69% had rationed medications, 39% had rationed non-invasive ventilation, and 21% had rationed ventilators. Of all respondents, 26% reported having had symptoms of COVID-19, 26% had been tested, and 7% had tested positive for COVID-19. Median PFI scores were consistent with work exhaustion and burnout.

    We report several key differences in measures for respondents practicing in self-reported COVID-19 “hotspots.” Not surprisingly, a greater proportion of physicians in hotspots had rationed medical resources compared with non-hotspot respondents (82% vs. 56%, Table 1). Of those physicians in hotspots who had rationed resources, 35% had rationed ventilators, compared with 10% of non-hotspot respondents. EM physicians in hotspots also had a higher positive test rate for COVID-19: 40% of those tested in hotspots were positive, while 17% of those tested were positive in non-hotspots.The kind of COVID-19 test used was not specified by respondants.

    Our survey suggests that a concerning proportion of emergency physicians have rationed medications, critical interventions, and basic PPE during the pandemic. These findings underscore a fact that is intuitive yet warrants emphasis: when COVID-19 caseloads exceed relative clinical capacities, both the safety of providers and the quality of patient care become compromised. Building rapidly scalable clinical capacity and controlling the rate of pandemic spread are critical to avoid future compromise as additional hotspots emerge.

    References

    1. Rodriguez RM, Medak AJ, Baumann BM, et al. Academic Emergency Medicine Physicians’ Anxiety Levels, Stressors, and Potential Stress Mitigation Measures During the Acceleration Phase of the COVID-19 Pandemic. Acad Emerg Med 2020.
    2. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA 2020.
    3. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019;95:103208.

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