BACKGROUND: In March of 2020, the novel coronavirus 2019 (COVID-19) pandemic required healthcare systems to be rapidly responsive to adapt hospital guidelines for the most up-to-date care and safety protocols as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate, and non-COVID-19 patients have now returned to the emergency department for care. This increase in patient volume leads to new challenges and threats to patient and clinician safety as suspected COVID-19 patients need to be quickly detected and isolated amongst other patients with non-COVID-19 related illnesses. In addition, emergency physicians face continued personal safety concerns and increased work burden on the front lines, heightening stress and anxiety. Burnout is a serious concern for emergency physicians due to the cumulative pressures of their daily practice, even under non-pandemic circumstances. Given the prolonged course of the pandemic, burnout may likely present as a longer-term outcome of these acute stressors.
METHODS: A rapidly adaptive simulation-based approach was implemented to understand and improve physician preparedness while decreasing physician stress and anxiety. A randomized control trial was conducted to test the effectiveness of a simulation preparedness intervention on physician physiologic stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory.
OUTCOMES: Front-line EM physicians participated in a simulation-based educational intervention aimed to facilitate the adoption of protocols and treatment algorithms. Four virtual simulation scenarios highlighted the care pathways a practitioner might implement when managing a COVID-19 positive patient. A debriefing session followed each scenario to interactively analyze the learners' management decisions. The discussion focused on the most current hospital protocols so that any gaps in knowledge could be successfully addressed. The scenarios were iteratively updated, and the debriefing emphasis changed to deliver the newest clinical guidance and operational procedures as they evolved while continuing to highlight the aspects of care that remained challenging. Ongoing analysis of the physiological data is still being conducted.
NEXT-STEPS: Mixed model analysis of physiologic and self-report measures of stress and anxiety will be used to determine if this virtual simulation intervention improves adherence to guidelines and protocols in the clinical setting and its impact on physicians while on shift. The next steps include further dissemination and objective feedback from institutions that may adopt this learning intervention.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/45553 |
| Date | 31 January 2023 |
| Creators | Gerwin, Jeffrey |
| Contributors | Evans, Leigh, McKnight, C. James |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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