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The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has resulted in rapid surges of critically ill patients infected with coronavirus disease 2019 (COVID‐19) pneumonia presenting to the emergency department (ED) and requiring ICU admission nationwide. Despite adaptations in critical care personnel staffing, bed availability and supply provision, many inpatient ICUs have become acutely crowded, leading to boarding of critically ill patients with COVID‐19 and other diseases in the ED. To address this scenario at our urban, safety net, tertiary care institution in the spring of 2020, we designed and implemented a temporary “emergency department‐intensive care unit” (ED‐ICU) patient care service. Critical care‐trained emergency physicians took call and came into the hospital overnight/on weekends to provide bedside treatment to admitted ICU patients boarding for prolonged periods in our ED. In this manuscript, we describe the creation and execution of the ED‐ICU service and the characteristics and management of the patients who received care under this model.

Background. Google Flu Trends (GFT) is a novel Internet-based influenza surveillance system that uses search engine query data to estimate influenza activity and is available in near real time. This study assesses the temporal correlation of city GFT data to cases of influenza and standard crowding indices from an inner-city emergency department (ED). Methods. This study was performed during a 21-month period (from January 2009 through October 2010) at an urban academic hospital with physically and administratively separate adult and pediatric EDs. We collected weekly data from GFT for Baltimore, Maryland; ED Centers for Disease Control and Prevention‐reported standardized influenzalike illness (ILI) data; laboratory-confirmed influenza data; and ED crowding indices (patient volume, number of patients who left without being seen, waiting room time, and length of stay for admitted and discharged patients). Pediatric and adult data were analyzed separately using cross-correlation with GFT. Results. GFT correlated with both number of positive influenza test results (adult ED, r 5 0.876; pediatric ED, r 5 0.718) and number of ED patients presenting with ILI (adult ED, r 5 0.885; pediatric ED, r 5 0.652). Pediatric but not adult crowding measures, such as total ED volume (r 5 0.649) and leaving without being seen (r 5 0.641), also had good correlation with GFT. Adult crowding measures for low-acuity patients, such as waiting room time (r 5 0.421) and length of stay for discharged patients (r 5 0.548), had moderate correlation with GFT. Conclusions. City-level GFT shows strong correlation with influenza cases and ED ILI visits, validating its use as an ED surveillance tool. GFT correlated with several pediatric ED crowding measures and those for low-acuity adult patients.

In the event of a catastrophic disaster, healthcare resources may be completely overwhelmed. To address this, the federal Agency for Healthcare Research and Quality has recommended using “crisis standards of care” during such an event.These standards would recommend allocating scarce medical resources to do the greatest good for the greatest number of patients.In a dire catastrophic event, such standards may include the allocation of intensive care unit (ICU) resources to maximize patient survival.Triage protocols that seek to efficiently allocate ICU resources during a disaster have been reviewed by the Institute of Medicine. Such protocols suggest the exclusion of patients with high mortality or high resource requirements from ICU care to do the most good for the greatest number of patients. In extreme circumstances, these protocols recommend withdrawing ICU resources from sicker patients in favor of more salvageable patients.However, if providers were to follow the earlier protocols in a disaster and withdraw and reallocate ICU care, criminal or civil liability could result. Two legal solutions to avoid this potential for liability have been suggested in this article.

The Patient Safety and Quality Improvement Act 1 (PSQIA or Act) was signed into law on July 29, 2005. This Act represents the first federal legislative attempt to directly and systematically addres...

The Belmont Report established beneficence, justice, and autonomy as the basic principles of informed consent. 1 These ideals of principlism have been applied to varied scenarios within medicine. O...

On 11 June 2009 the World Health Organization raised the pandemic alert level to Phase 6 and declared that a global pandemic was underway. The causative pathogen, an H1N1 influenza A virus, was a triplereassortant combination of swine, avian and human influenza that initially appeared in Mexico earlier that year (Cao et al, 2009). In April 2009, the first US cases of H1N1 were confirmed by the Centers for Disease Control and Prevention (CDC) (Jain et al, 2009). Since then, many more clinical cases have been reported to the CDC and to public health authorities.

The author evaluates current concerns over medical professionalism in residency training. The recent professionalism requirements for residents promulgated by the Accreditation Council for Graduate Medical Education (ACGME) are discussed in relation to the atmosphere of current training. The author first reviews a recent study showing that unprofessional behavior may significantly correlate with burnout, as evaluated by the Maslach Burnout Inventory. Among the elements of that inventory, depersonalization is shown to significantly correspond to unprofessional actions and behavior. Several surveys and studies evaluating residency treatment and stress are reviewed and three sources of training stress are identified: (1) abusive treatment of residents, (2) financial pressures, and (3) pessimism and uncertainty in the medical field. The extent and effects of these stressors are discussed and evaluated in relation to depersonalization, depression, and unprofessional behavior. Each of these pressures is found to correlate with negative effects on residents, such as depersonalization, decreased satisfaction, depression, and burnout. In turn, such effects are found to potentially cause unprofessional behavior among residents. In light of these findings, the author suggests several modifications to the current graduate medical training environment to mitigate such stressors, promote professionalism, and increase morale. Prevention of abusive treatment of residents, alleviation of financial pressure, increased educational opportunities, and role modeling are suggested as beneficial interventions that may foster professionalism and prevent inappropriate behavior. The author indicates that such environmental changes would likely foster professionalism in young physicians more effectively than would ethics seminars or in-class training. Accordingly, the author suggests environmental changes to decrease residency stress as the most effective means of promoting the new ACGME requirements and the ideals of professionalism.