Objectives: Problems with on-call specialist physician coverage have been identified as a significant issue for our nation's health care system. Despite this, little is known about the full extent of these coverage deficiencies in emergency departments (EDs), their effect on emergency care provision, or the subsequent effect on patient flow should specialist-requiring patients need to be transferred to centers of higher-level care. The objective was to report the experiences of a national sample of ED directors regarding the degree of difficulty in providing specialist coverage and the effect of on-call coverage problems on emergency patient care. Methods:The authors conducted a cross-sectional self-administered survey of a national sample of ED directors. How frequently ED directors reported on-call coverage problems, whether they recently lost on-call coverage, whether their current on-call coverage was reliable, and the potential effect on emergency care provision were all assessed.Results: The overall response rate was 62% (442 of 715). Seventy-four percent of respondents reported on-call coverage problems with specialist physicians. Sixty percent reported having lost 24 ⁄ 7 coverage for at least one specialty in the past 4 years. Twenty-six percent reported unreliability in their current on-call coverage. Twenty-three percent noted that their trauma center designation level had been affected by on-call coverage, and 22% noted an increase in patients leaving before being seen by a medically needed specialist.Conclusions: Difficulties in obtaining specialty on-call coverage are a pervasive issue for EDs at the national level. Emergency care provision appears to have been affected, and this issue is further impacted by a perceived unreliability in current on-call coverage provision as well as the attrition of coverage for individual specialties.
The provision of emergency care in the United States, regionalized or not, depends on an adequate workforce. Adequate must be defined both qualitatively and quantitatively. There is currently a shortage of emergency care providers, one that will exist for the foreseeable future. This article discusses what is known about the current emergency medicine (EM) and non-EM workforce, future trends, and research opportunities.ACADEMIC EMERGENCY MEDICINE 2010; 17:1286-1296 ª 2010 by the Society for Academic Emergency Medicine A well-trained, efficiently distributed workforce is critical to provide for the nations' emergency care needs. This includes any regionalized system of emergency care. The cognitive and technical skills of emergency care providers are vital resources in ensuring delivery of timely, high-quality emergency care to all Americans. Currently, 120 million patients go to our nation's emergency departments (EDs) each year. Historic trends have shown that the demand for emergency care continues to rise, 1 even with health care reform and a push toward universal insurance coverage.2 This reflects a growing, aging population with many chronic diseases. This rising demand is likely to increase the need for emergency care providers. There is currently a shortage and mal-distribution of emergency medicine (EM) residency-trained and board-certified physicians (emergency physicians [EPs]). 3-7The 2010 Academic Emergency Medicine consensus conference on regionalization of emergency care focused on getting the right care to the right patient at the right time. We describe the current state of the emergency care workforce, potential solutions, and a vision for the future. Our discussion looks at EPs, non-EM-trained physician providers, and nonphysician providers. We identify gaps in knowledge that form the basis of an emergency care workforce research agenda. Our discussion focuses on the goal of improved access to high-quality emergency care for all acutely ill or injured patients across the entire United States. Under any regionalization plan, an efficiently distributed, qualified workforce will ensure a sufficient number of providers with appropriate training for their practice environments and will be distributed according to patient need throughout the system.
Violence is a major cause of morbidity and mortality among adolescents. We conducted serial focus groups with 30 youth from a violence prevention program to discuss violence in their community. We identified four recurrent themes characterizing participant experiences regarding peer decision-making related to violence: (1) youth pursue respect, among other typical tasks of adolescence; (2) youth pursue respect as a means to achieve personal safety; (3) youth recognize pervasive risks to their safety, frequently focusing on the prevalence of firearms; and (4) as youth balance achieving respect in an unsafe setting with limited opportunities, they express conflict and frustration. Participants recognize that peers achieve peer-group respect through involvement in unsafe or unhealthy behavior including violence; however they perceive limited alternative opportunities to gain respect. These findings suggest that even very high risk youth may elect safe and healthy alternatives to violence if these opportunities are associated with respect and other adolescent tasks of development.
Personality traits are important predictors of health behaviors, healthcare utilization, and health outcomes. However, we know little about the role of personality traits for emergency department outcomes. The present study used data from 200 patients (effective Ns range from 84 to 191), who were being discharged from the emergency department at an urban hospital, to investigate whether the Big Five personality traits were associated with post-discharge outcomes (i.e., filling prescriptions, following up with primary care physician, making an unscheduled return to the emergency department). Using logistic regression, we found few associations among the broad Big Five domains and post-discharge outcomes. However, results showed statistically significant associations between specific Big Five items (e.g., “responsible”) and the three post-discharge outcomes. This study demonstrates the feasibility of assessing personality traits in an emergency medicine setting and highlights the utility of having information about patients’ personality tendencies for predicting post-discharge compliance.
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