Introduction/Innovation Concept: Emergency medicine (EM) requires physicians to deal with acutely ill patients in a fast-paced and dynamic environment, which creates a barrier to debriefing after critical events. These unique challenges can negatively impact wellness. We sought to adapt and implement a peer-support wellness program called 'Ice Cream Rounds' in an EM residency setting. Methods: A needs assessment survey was conducted among EM residents at The University of Ottawa to gauge interest and obtain resident input regarding program design. The structure of the sessions was adapted from similar initiatives in Canadian Pediatric Residency programs. Curriculum, Tool or Material: Confidential peer-support sessions were created and piloted. Residents preferred peer facilitators, rather than staff, so two residents obtained training the Faculty of Medicine's Wellness Program to lead sessions. Attendance at rounds was voluntary; however, overall attendance was recorded along with feedback from pilot sessions. Discussion topics included difficult patient encounters, poor patient outcomes, challenges in residency, and ethical issues. Post implementation feedback demonstrated that Ice Cream Rounds was a helpful forum for residents to discuss important issues with colleagues. Conclusions: This is the first Canadian EM training program to adapt, implement, and evaluate peer-support wellness rounds for debriefing, and this initiative can be easily adopted by any EM training program.

Objective: We assessed the impact of the transition from a primarily paper-based electronic health record (EHR) to a comprehensive EHR on emergency physician work tasks and efficiency in an academic emergency department (ED). Methods: We conducted a time motion study of emergency physicians on shift in our ED. Fifteen emergency physicians were directly observed for two 4-hour sessions prior to EHR implementation, during go live, and then during post-implementation. Observers performed continuous observation and measured times for the following tasks: chart review, direct patient care, documentation, physical movement, communication, teaching, handover, and other. We compared time spent on tasks during the 3 phases of transition and analyzed mean times for the tasks per patient and per shift using 2-tailed t test for comparison. Results: Physicians saw fewer patients per shift during go-live (0.51 patient/hour, P < 0.01), patient efficiency increased in post-implementation but did not recover to baseline (−0.31 patient/hour, P = 0.03). From pre-implementation to post-implementation, we observed a trend towards increased physician time spent charting (+54 seconds/patient, P = 0.05) and documenting (+36 seconds/patient, P = 0.36); time spent doing direct patient care trended towards decreasing (−0.43 seconds/patient, P = 0.23). A small percentage of shifts were spent receiving technical support and time spent on teaching activities remained relatively stable during EHR transition. Conclusion: A new EHR impacts emergency physician task allocation and several changes are sustained post-implementation. Physician efficiency decreased and did not recover to baseline. Understanding workflow changes during transition to EHR in the ED is necessary to develop strategies to maintain quality of care.

Introduction: Public health response to the coronavirus 2019 (COVID-19) pandemic has emphasized social distancing and stay-at-home policies. Reports of decreased emergency department (ED) visits in non-epicenters of the outbreak have raised concerns that patients with non-COVID-19 emergencies are delaying or avoiding seeking care. We evaluated the impact of the pandemic on ED visits at an academic tertiary care center. Methods: We conducted an observational health records review between January 1–April 22, 2020, comparing characteristics of all ED visits between pre- and post-pandemic declaration by the World Health Organization. Measures included triage acuity, presenting complaints, final diagnoses, disposition, and mortality. We further examined three time-sensitive final diagnoses: stroke; sepsis; and acute coronary syndrome (ACS). Results: In this analysis, we included 44,497 ED visits. Average daily ED visits declined from 458.1 to 289.0 patients/day (-36.9%). For the highest acuity triaged patients there was a drop of 1.1 patients/day (-24.9%). Daily ED visits related to respiratory complaints increased post-pandemic (+14.1%) while ED visits for many other complaints decreased, with the greatest decline in musculoskeletal (-52.5%) and trauma (-53.6%). On average there was a drop of 1.0 patient/day diagnosed with stroke (-17.6%); a drop of 1.6 patients/day diagnosed with ACS (-49.9%); and no change in patients diagnosed with sepsis (pre = 2.8 patients/day; post = 2.9 patients/day). Conclusion: Significant decline in ED visits was observed immediately following formal declaration of the COVID-19 pandemic, with potential for delayed/missed presentations of time-sensitive emergencies. Future research is needed to better examine long-term clinical outcomes of the decline in ED visits during pandemics.

226Gilles de la Tourette's syndrome (TS) is a neuropsychiatric disorder characterized by recurrent motor and vocal tics for at least one year 1 . Tourette's syndrome has a prevalence of 0·4% to 3·8% in children aged 5 to 18 years 2 , with peak severity between the ages of 8 to 12 3 . Common co-morbidities include attention deficit hyperactivity disorder (ADHD) 4 , learning disabilities 5 , and obsessive compulsive disorder (OCD) 6 . The etiology of TS is unknown, and as such, its symptoms are often misdiagnosed and misunderstood by the lay public 7 .This lack of understanding may be why peers rate individuals with tics lower in social acceptability 8 . Stokes and colleagues found that school-aged children with TS are rated significantly lower in popularity than their peers and are viewed as more aggressive and withdrawn 9 . Nearly half of TS patients suffer ABSTRACT: Objective: To determine the representation of Tourette Syndrome (TS) in fictional movies and television programs by investigating recurrent themes and depictions. Background: Television and film can be a source of information and misinformation about medical disorders. Tourette Syndrome has received attention in the popular media, but no studies have been done on the accuracy of the depiction of the disorder. Methods: International internet movie databases were searched using the terms "Tourette's", "Tourette's Syndrome", and "tics" to generate all movies, shorts, and television programs featuring a character or scene with TS or a person imitating TS. Using a grounded theory approach, we identified the types of characters, tics, and co-morbidities depicted as well as the overall representation of TS. Results: Thirty-seven television programs and films were reviewed dating from 1976 to 2010. Fictional movies and television shows gave overall misrepresentations of TS. Coprolalia was overrepresented as a tic manifestation, characters were depicted having autism spectrum disorder symptoms rather than TS, and physicians were portrayed as unsympathetic and only focusing on medical therapies. School and family relationships were frequently depicted as being negatively impacted by TS, leading to poor quality of life. Conclusions: Film and television are easily accessible resources for patients and the public that may influence their beliefs about TS. Physicians should be aware that TS is often inaccurately represented in television programs and film and acknowledge misrepresentations in order to counsel patients accordingly. Despite TS having received popular media attention there has yet to be a study investigating the portrayal of TS in film and television. The aim of the study was to investigate recurrent depictions of TS to indentify major themes of its portrayal in fictional television programs and films. METHODS Search StrategyInternational internet movie databases were searched using the key words "Tourette's", "Tourette's Syndrome," and "Tics". All movies, shorts, and television programs featuring characters or scenes with TS or a person imitating ...

include: trauma team activation, waiting room anxiety, and referral delays from the ED). Working with designers and stakeholders (including patient representatives), learners would map the experience of a particular project. Strengths and opportunities for improvements would be identified at each step of the project. The team would then prototype solutions which will be presented to site chiefs for implementation and evaluation. Conclusion: Working with designers offers a practical and powerful approach to undertaking QI projects in the ED. We hope that this process allows residents to undertake projects that they are personally invested in and helps build longitudinal relationships beyond direct clinical work with the local ED they are working in Keywords: quality improvement, operations, curriculum LO42 Ice Cream Rounds: the adaptation and implementation of a peer-support wellness rounds in an emergency medicine residency training program

Introduction. Many Emergency Departments (ED) publish wait times; however, the patient perspective in what information is requested and the quantity of information to post is limited. Methods. We conducted a mixed-methods study at a tertiary care academic center. First, we conducted focus groups of 7 patients. We then generated themes following content analysis to create a patient survey. We administered in-person surveys to patients in ED waiting rooms at sites randomized for survey administration. We used preassigned shifts utilized for even patient perspective representation of the 24 hours-a-day/7 days-a-week service. We included waiting room patients over 18 years of age and excluded patients directly referred to a specialty service or who did not speak French or English. We analyzed survey data using descriptive statistics. Results. We identified nine dominant focus group themes: wait time definition, wait time notification, communication, education, patient expectations, utilization of the ED, patient behaviour, physical comfort, and patient empowerment. Of the 240 patient questionnaires administered, 81.3% of respondents wanted to know ED wait times before hospital arrival hospital and 90.8% wanted ED wait times posted in the waiting room. Website (46.7%) was the most popular choice for publishing wait times outside the ED. Within the ED, patients had no preference regarding display modality, if times were displayed (39.6%). Overall, 76.7% stated that their satisfaction with the ED would be improved if wait times were posted. Conclusion. ED patients strongly supported having access to wait time information. Patients believed having wait time information will have a positive impact on their overall ED satisfaction.

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Wellness programs exist for medical students but the opportunity to debrief challenging experiences is lacking. We piloted Ice Cream Rounds (ICRs) for University of Ottawa clerkship students during the 2018-2019 academic year to provide students a safe environment to discuss challenges. Students reported a decrease in stress, anxiety and burnout, and an improvement in collegiality as a result of ICRs. ICRs could benefit medical students at other universities. To successfully implement ICRs at your institution, we recommend obtaining funding for ice cream, having peer facilitators, and creating a safe and confidential environment where students feel comfortable to debrief challenging experiences.