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Introduction: Emergency clinicians on the frontline of the coronavirus pandemic experience a range of emotions including anxiety, fear, and grief. Debriefing can help clinicians process these emotions, but the coronavirus pandemic makes it difficult to create a physically and psychologically safe space in the emergency department (ED) to perform this intervention. In response, we piloted a video-based debriefing program to support emergency clinician well-being. We report the details of our program and results of our evaluation of its acceptability and perceived value to emergency clinicians during the pandemic. Methods: ED attending physicians, resident physicians, and non-physician practitioners (NPP) at our quaternary-care academic medical center were invited to participate in role-based, weekly one-hour facilitated debriefings using Zoom. ED attendings with experience in debriefing led each session and used an explorative approach that focused on empathy and normalizing reactions. At the end of the pilot, we distributed to participants an anonymous 10-point survey that included multiple-answer questions and visual analogue scales. Results: We completed 18 debriefings with 68 unique participants (29 attending physicians, 6 resident physicians, and 33 NPPs. A total of 76% of participants responded to our survey and 77% of respondents participated in at least two debriefings. Emergency clinicians reported that the most common reasons to participate in the debriefings were “to enhance my sense of community and connection” (81%) followed by “to support colleagues” (75%). Debriefing with members of the same role group (92%) and the Zoom platform (81%) were considered to be helpful aspects of the debriefing structure. Although emergency clinicians found these sessions to be useful (78.8 +/− 17.6) interquartile range: 73–89), NPPs were less comfortable speaking up (58.5 +/− 23.6) than attending physicians (77.8 +/− 25.0) (p = < 0.008). Conclusion: Emergency clinicians participating in a video-based debriefing program during the coronavirus pandemic found it to be an acceptable and useful approach to support emotional well-being. Our program provided participants with a platform to support each other and maintain a sense of community and connection. Other EDs should consider implementing a debriefing program to safeguard the emotional well-being of their emergency clinician workforce.

Introduction: The objective of this study was to investigate the factors associated with first-pass success in pediatric intubation in the emergency department (ED). Methods: We analyzed the data from two multicenter prospective studies of ED intubation in 17 EDs between April 2010 and September 2014. The studies prospectively measured patient’s age, sex, principal indication for intubation, methods (e.g., rapid sequence intubation [RSI]), devices, and intubator’s level of training and specialty. To evaluate independent predictors of first-pass success, we fit logistic regression model with generalized estimating equations. In the sensitivity analysis, we repeated the analysis in children

Introduction: While emergency department (ED) crowding has myriad causes and negative downstream effects, applying systems engineering science and targeting throughput remains a potential solution to increase functional capacity. However, the most effective techniques for broad application in the ED remain unclear. We examined the hypothesis that Lean-based reorganization of Fast Track process flow would improve length of stay (LOS), percent of patients discharged within one hour, and room use, without added expense. Methods: This study was a prospective, controlled, before-and-after analysis of Fast Track process improvements in a Level 1 tertiary care academic medical center with >95,000 annual patient visits. We included all adult patients seen during the study periods of 6/2010-10/2010 and 6/2011-10/2011, and data were collected from an electronic tracking system. We used concurrent patients seen in another care area used as a control group. The intervention consisted of a simple reorganization of patient flow through existing rooms, based in systems engineering science and modeling, including queuing theory, demand-capacity matching, and Lean methodologies. No modifications to staffing or physical space were made. Primary outcomes included LOS of discharged patients, percent of patients discharged within one hour, and time in exam room. We compared LOS and exam room time using Wilcoxon rank sum tests, and chi-square tests for percent of patients discharged within one hour. Results: Following the intervention, median LOS among discharged patients was reduced by 15 minutes (158 to 143 min, 95%CI 12 to 19 min, p

Introduction: The American College of Emergency Physicians (ACEP) Task Force on Boardingdescribed high-impact initiatives to decrease crowding. Furthermore, some emergencydepartments (EDs) have implemented a novel initiative we term “vertical patient flow,” i.e.segmenting patients who can be safely evaluated, managed, admitted or discharged withoutoccupying a traditional ED room. We sought to determine the degree that ACEP-identified highimpactinitiatives for ED crowding and vertical patient flow have been implemented in academicEDs in the United States (U.S.).Methods: We surveyed the physician leadership of all U.S. academic EDs from March toMay 2010 using a 2-minute online survey. Academic ED was defined by the primary site of anemergency residency program.Results: We had a response rate of 73% (106/145) and a completion rate of 71% (103/145).The most prevalent hospital-based initiative was inpatient discharge coordination (46% [47/103]of respondents) while the least fully initiated was surgical schedule smoothing (11% [11/103]).The most prevalent ED-based initiative was fast track (79% [81/103]) while the least initiated wasphysician triage (12% [12/103]). Vertical patient flow had been implemented in 29% (30/103) ofresponding EDs while an additional 41% (42/103) reported partial/in progress implementation.Conclusion: We found great variability in the extent academic EDs have implemented ACEP’sestablished high-impact ED crowding initiatives, yet most (70%) have adopted to some extentthe novel initiative vertical patient flow. Future studies should examine barriers to implementingthese crowding initiatives and how they affect outcomes such as patient safety, ED throughput andpatient/provider satisfaction.