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Background
The COVID-19 pandemic has pushed us to find better ways to accurately diagnose what can be an elusory disease, preferably in a way that limits exposure to others. The potential for home diagnosis and monitoring could reduce infectious risk for other patients and healthcare providers, limit use of finite hospital resources and enable better social distancing/isolation practices.
Case Report
We report a case of an otherwise healthy Emergency Physician diagnosed with COVID-19 at home using portable ultrasound, pulse oximetry and antibody testing. Her clinical picture and typical lung findings of COVID-19 on ultrasound, combined with a normal echo and negative DVT study, helped inform her diagnosis. She then monitored her clinical course using pulse oximetry, was able to self-isolate for four weeks and had an uneventful recovery. Her diagnosis was confirmed with a positive IgG antibody test after three weeks.
Conclusions
Novel times call for novel solutions and our case demonstrates one possible path for home diagnosis and monitoring of COVID-19. The tools used, namely ultrasound and pulse oximetry, should be familiar with most modern emergency physicians. Ultrasound in particular was helpful in eliminating other potential diagnoses, such as pulmonary embolus.
attendings' and residents' perception of the impact of using SRT on overall resident efficiency in an academic ED after an 18-month implementation of the technology. Methods: This is an observational study that aims to examine the perception of SRT use at a community hospital in the southeast, with an annual ED volume of 120,000 patient visits per year. The ED is staffed by 27 EM attendings. The EM residency program is comprised of 6 residents per year, who voluntarily used SRT in the ED. SRT implementation began 18 months before the survey. The attendings and residents completed a 27-and 22-question survey, respectively. It was developed and sent out electronically using Survey Monkey and consisted of Likert scale questions. Data was exported and analyzed in Microsoft Excel. Results: There was a 70% response rate for both the attending and resident survey with a high percentage of interns and PGY 2 responding to the resident survey. The majority of attendings had more than two years of experience. On average, the attendings report that residents use SRT 45% of the time. The majority of residents use SRT for "History of Present Illness" and "re-evaluation" aspects of the EMR and are highly likely to be used in combination with macros and/or dot phrases. Residents preferred SRT over hand typing and inexperience scribes but prefer experience scribes to SRT. Both attendings and residents perceive that SRT use allows residents to make fewer documentation errors and reduces residents' stress during the shift. Both groups feel that residents are more likely to go home on time and improves overall resident efficiency if residents use SRT. The majority of attendings observe that SRT reduces delays to complete documentation, improves overall ED flow of residents, and are more likely to have charts completed by the patient's disposition. Residents believe they are more likely to write notes in a narrative format, to go home on time with completed notes, improves their job satisfaction, and allows them to spend less time on documentation. Residents feel that SRT use also allows for more attending and medical student educational time during the shift and allows them to see more patients. Conclusion: In conclusion, this study found that both attendings and residents perceive that using SRT in the ED improves overall EM resident efficiency, reduces resident's stress during the shift, and reduces documentation errors in general. This study provides a springboard for further implementation of SRT in this academic community ED. EM residencies searching for ways to improve resident efficiency and possibly reduce resident stress may be encouraged by the results of this survey to implement SRTs in their particular ED setting
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