- Email: [email protected]
8th International Conference on Emergency Medicine, Abstracts 165-171
8th I N T E R N A T I O N A L CONFERENCE ON E M E R G E N C Y MEDICINE ABSTRACTS
65
The 1999 Studyof the Workforce in EmergencyMedicine
Moorhead dO, Gallery M/American College of EmergencyPhysicians, Dallas, TX Study°blective'W°rkf°rceplanningtsanimp°rtantp°hcyissuef°rthespec'ahy of emergency medmme. Current graduate medical education fundmg is determined by national policies. Advocacy for appropriate funding for specialty traimng reqmres a coherent policy based on scientifically derived workforce data. In the United States, a national workforce study undertaken in 1997 by the American College of Emergency Physicians (ACEP) revealed that there were approximately 32,020 physicians hlling 24,548 full-nine equivalent (FTE) clinical positions m hospital emergency departments. A mandate to contain costs is resulting m unprecedented changes m the structure of the US health care delivery system. These budgetary pressures are cornpounded by the increasing number of uninsured patients seeking care in the nation's EDs. The purpose of this study is to determine what effects these changes are having on the total number of physmlans practicing dmical emergency medicine, to describe certain characteristics of those in&viduals, and to determine the change, during the intervening 2 years, in the total number of hospital ED emergency physm~an FTEs, as well as the total number of mdividuals needed to staff those FTEs. Methods: Data were gathered from 2 sources. The first source came from a survey of a random sample of 2,153 hospitals drawn from a population of 5,239 hospitals reported by the American Hospttal Association as having an ED The survey instrumerit addressed the total number of physicians working in the ED during the period June 1, 1999, through June 14, 1999. Demographic data, remuneration, and credenrials of the individuals were also collected. In addition, a survey was sent to a random sample of 6,000 emergency physicians from the databases of ACEP and the Amencan Medical Association lAMA) The survey instrument was developed to collect information on demographic variables, salary mformation, as well as information of in&ridual physicians' future plans for remaming in the specialty. Results: The study is complete. The response rate for both studies exceeded 40% The authors will report the number of FTEs and the number of emergency physicians being used to staff these FTEs in 1999. These data will be reported by hospital control status, teachmg status, and geographic location. Demographic and credennaling characterisrtcs of this population group will be provided. Conclusion: Changes in the emergency medicme workforce between 1997 and 1999 are presented. The value of these data for a national spec~ahy sectary in advocating for appropriate national graduate medical education policy will be described. Most coun-
rues should conduct stm~lar national emergency medicine workforce studies to guide
inn, food/drink services, and a special nurse. Although most of the people in Taiwan are not Christian, they like this form of spiritual comfort and would like to provide
their concern to other patients when possible.
167
Automated External Defihrillator Use and the Effect of Provider Exposure to Cardiac Arrest
O'Connor RE, Megargel RE, dasani NB, Ross RW, Bitner M/Department of Emergency Medicine, Christiana Care Health System, Newark, DE Study objective: Defibrillation vnth automated external defibrillators 4AEDs) results in improved surwval and has become a mainstay in the treatment of out-of-hospital cardiac arrest 4OOHCA). Emergency medical technicians (EMTs) formerly unaccustomed to treating OOHCA are now using AEDs. We conducted this study to analyze the usage pattern of AEDs by EMTs with varying exposure to OOHCA. Methods: Th~s observational study was conducted prospecuvely by 2 county-wide emergency medical services providers. EMTs received equivalent traimng on AED use. Count?, A has a population of 470,000 (1,076/sq mi), and county B has a populaUon of 125,000 (210/sq mi). OOHCA cases where the EMT with the AED was first on the scene were identified Whether the AED was in place on paramedic amval was determined. Statistical analysis used X2 and 95% confidence intervals. Results: County A had 23 AED provider agencms and county B had 18. Each AED pro,nder agency used 10 to 18 AED providers. The annual rate of OOHCA where EMTs with the AED were the first to arrive was 10 per agency m county A, and 2 per agency m county B Of a total of 203 OOHCAs studied in county A, there were 82 440%) opportunities for AED use. The AED was applied in 79 (96%) of these cases. Of a total of 208 OOHCAs studied in county B, there were 80 (38%) opportunities for AED use. The AED was applied in 47 (59%) of these cases. The difference in AED opportumtms was not significant, whereas the difference m application was (P<.00001). Conclusion: AEDs are not universally applied to victims of OOHCA. Providers with little experience treating OOHCA fail to apply the AED in a large proportion of cases. Failure to apply AEDs in OOHCA underscores the need to provide periodic retraining. An important public health inmative would be to track all cases of OOHCA to assess whether an AED is used m all cases where it is indicated t
I~O
Two-Thumb Versus Two-Finger Chest Compression in an Infant
| I,H~ Model of ProlongedCardiopulmonan/Resuscitation Dorfsman ML, Menegazzidd, Wadas RJ, Auble T/University of PittsburghAffiliated Residencyin Emergency Medicine, Pittsburgh, PA, Centerfor EmergencyMedicine for Western Pennsylvania,PA
graduate medical eduation pohcy
166
Regular Spiritual Comfort for Emergency Patients
Huang YC, Yang SH/Chiayi Christian Hospital, Departments of Emergency Medicine and Pastoral Care, ChiayiCity, Taiwan Study objective: Pauents vtsitmg emergency departments are under great phystologic and psychological stress. Besides the medical management and reassurance, emotional support and comfort are of great help We include spiritual comfort m our emergency services to provide high-quality human care. Methods: in addition to regular medical reassurance, regular comfort from chaplains is provided to patients m our observation unit. Actiwties include staging of hymns, brief sermons, prayer, listening, shanng, and benediction to the patient Questtonnaims about the activities were collected and analyzed, Results: Thirty quesuonnaires were completed. Fear (19/307 was the most common feeling, followed by anxiety (8/30), uncertainty (7/30), gnef (6/30), relief (6/30), confusmn (5/30), frightened (4/30), astonishment (3/30), shock (.2/30), loneliness (2/307, sadness (1/30), and misery 41/30). Most of the patmnts (25/30) need support. Besides medmal ser,nces, people need sympathy (18/307, food/drink service (9/30), emotional support (9/307, a special person who cares (8/30), someone to listen to the patients (7/30), and assistance m problem solving (7/30) Twenty-seven of the 30 people hked this comfort and thmk it should be provtded to emergency patmnts (15/30 to all patients, 13/30 to part of them). Smging of hymns (22/30) was the most popular measure, followed by prayer (15/30), brief sermon (10/30), benediction (10/30), listening (6/30), and sharing (5/30). Etghteen of the 30 patients would like to provide comfort to other patients. Conclusion: Adequate support is necessary and welcomed by most ED patients. Sympathy, hstening, and emotional support are not less important than problem solv-
$44
Study objective In previous experiments in our swine laboratory, we have shown that2-thumbchestcompressionwtthathoraclcsqueeze4TT) produces htgher blood and perfuslon pressures when compared with the American Heart Association (AHA)-
recommended 2-finger (TF) techmque Previous studies were of short durauon l1 to 2 minutes) We hypothesized that TT would be superior to TF during prolonged car diopulmonary resuscitaUon (CPR) in an infant model. Methods' We performed a prospecnve, randomized crossover-designed experiment tn a laboratory setting. Twenty AHA-certffied rescuers performed basic CPR for two 1D-minute penods, one with TT the other with TF. Trials were separated by 5 to 10 days. and the order was randomly assigned. The experimental circuit consisted of a modified manikin (ResusciBaby, Laerdal Medtcal Corp., Armonk, NY) with a fixedvolume "artenal" system atlached to a Neonatal Monitor (Hewlett Packard) via an arterial pressure transducer (.model PX-1800, Baxter Heahhcare Corp., Irvine. CA). The arterial circuit consisted of a 50-mE bag of normal saline solution (air removed) attached to the manikin chest plate and connected to the transducer with a 2D-gauge intravenous catheter and tubing. Rescuers were hhnded to the arterial pressure tracinc. Systolic blood pressure (SBP), &astolic blood pressure (DBP), and mean arterial pressures (MAPs) were recorded m millimeters of mercury. Data were analyzed w~th 2-way RMANOVA. Sphenctty assumed modeling, with Greenhouse-Geisser and Huynh-Feldt adjustments, was applied. Results Mean MAPs, by techmque and minute, are presented in the Table. Marginal means for TT SBP (68 9) and DBP (17.6) were higher than for TF SBP (44.8) and DBP (12.5). All 3 pressures were sigmficantly different between the 2 techniques (P<.O01). Conclusmn: In this infant CPR model, TT chest compression produced higher MAP, SBP, and DBP when compared with TF chest compression durmg a clinically relevant duration of prolonged CPR.
ANNALS OF EMERdENCY MEDICINE 35.5 MAY 2000
8th I N T E R N A T I O N A L CONFERENCE ON E M E R G E N C Y MEDICINE ABSTRACTS
Table, abstract 168. Mean arterial pressures for TT versus TF chest compression,
MAP TT TF
1
2
3
4
5
6
7
8
9
10
36.4 26.6
35.6 25.0
36.2 23.9
36.8 23.2
36.3 22.7
35.4 22.5
34.6 22.3
34.0 22.3
34.2 22.2
33.7 22.4
69 Disaster
Medicine Education in Medical School Curricula
Results Surveys were solicited from 478 (42.1%) of 1,139 patients and 59 (77.6%) of 76 ED staff (nurses, residents, physicians). Statistically significant differences existed between ED staffs estimates of patient satisfaction and actual patient satisfaction across 19 of the 22 indicators (P<.005). Across each of these 19 indicators, staff consistently estimated average satisfaction scores to be lower than what patients actually reported Staff did not overestimate scores on any items The 19 items were spread across multiple domains. Additionally, staff overestimated average patient length of stay by more than 2 hours (P< 001). Conclusion: In contrast to the hypothesized self-serving bias, ED staff consistently estimated patients to be less satisfied than they actually were This trend held true across multiple domains, mcluding satisfaction with registration, nursing, and physician staff, and waiting times. Moreover, ED staff estimated average length of stay to be more than 2 hours longer than it actually was (5.7 hours versus 3 5 hours). Such
Colombo JB, PetersonW, Thackerayd, Tompkins M, Burkholder-Allen, Budd C, Bega P/Medmal College of Ohio, Toledo, OH; Toledo Hospital, Department of Emergency Medicine and Trauma Services, Toledo, OH
biases may act as a self-fulfilhng prophecy, negatively affecting both patient satlsfaction and employee morale Future research should focus on assessing provider estt-
Study objecUve. Quality disaster medicine education is lacking among various medical specialtms, desplte increasmg susceptibifity to major dzsasters Theobjectlve of this study was to determine to what extent medical school curricula include ele-
171 SlressorsExperiencedby EmergencyMedieine Residents
ments of disaster medicine Methods: We conducted a prospective analysis of 124 accredited US medical schools. A written survey, distributed to administrators initially by electronic mall and subsequently by telephone, assessed level and type of disaster medicine training given to medical students. If disaster medicme training was absent, information regarding reasons for its omission and perceived need for undergraduate disaster medicme training was collected, Results. The response rate was 75% (n=93). Only 10 (11%) schools offered trainmg in disaster medicine. Of 83 (89%) mschools that did not offer disaster medicine training, 6 t % provided reasons for its absence from the curriculum which included" it had not been considered, no available time in the curriculum, lack of qualified instructors, and lack of funding for new electives, 21% of respondents provided multiple reasons. Of those providing no disaster medicme training in the curriculum, 57% agreed that disaster medicine training was needed, and 35% remained undectded Correlation to existence of emergency medicine residency programs was also examined, Conclusion: For several reasons, most US medical schools do not prmqde disaster medicine education to their students.
Boudreaux ED, Ary B/Louisiana State University, School of Medicine, Emergency Medicine
4 "1 I ~ Emergency Department Staff Estimates of Patient Satisfaction: ! I U The Squeaky Wheel Gels the Grease BoudreauxED, Ary R, Mandry C/LouisianaState University, School of Medicine, Baton Rouge,LA Study objecuve: Theories outlining determinants of patient satisfaction point out that the health care providers' own behefs and attitudes Influence their beha,nor toward the patient and, therefore, indirectly influence patient satisfaction. Hence, emergency medicine staffs expectations regarding patient satisfaction may actually influence patient satisfaction through its effect on staff behavior For example, if a provider overestimates his or her patient's satisEactlon, he or she may miss important but subtle cues of dissatisfaction, causing him of her to miss an opportunity to rectify the situation before the patient leaves the ED. Our study mvestigated the accuracy of ED staffs estimates of their patients' satisfaction with services. We hypothesized that ED staff would exhibit a self-serving bias (ie, they would estimate patient satisfaction as higher than it actually is). Methods' The study was conducted through a municipal ED with approximately 89,000 visits per year. Actual pauent sausfaction was assessed using a telephone interview with 2 indicators across several domains, including registration, nursing staff, physician staff, wait times, discharge, instructions, and other miscellaneous areas. Shortly after the assessment was complete, but before the results of the survey were disseminated, ED staff were asked to "predict" the results by estimating the average rating they believed patients gave for each of the 22 indicators. Staff members were also asked to estimate the patients' average length of stay To further reduce bias, ED staff were not informed that the patient satisfaction survey was being conducted, Independent samples t tests were used to compare averages for each item obtained through staff ratings versus averages denved from actual patient satisfaction,
MAY 2000
35 5 ANNALS OF EMERGENCYMEDICINE
mates of patient satisfaction m "real time" (versus asking for estimates of averages).
Residency Program, Baton Rouge, LA Study objectives: Considerable research has focused on the stress of medical residency. However, most of these studies have invesugated internal medicine or family practice residents Because emergency medicine is a young field, relatively little has been published on the stressors experienced by emergency medicine residents. The current study used 2 well-validated instruments to explore the level and types of stressors experienced by a sample of emergency medicine residents. Methods: A cross-secuonal design was used. All emergency medlcme residents attending 2 programs located in the southern United States were ehgible to participate (N=83). Subjects were specifically instructed to omit any identifying or demographic information to guarantee anonymity and to encourage honest responses. Residents completed the questionnaires before a weekly didactic session We used the Health Professions Stress Inventory (HPSI), which is a measure assessing stressors specific to health care providers, and the Occupational Roles Questionnaire (ORQ), which is a measure assessing general job-related stressors. The ORQ has 6 subscales: Role Overload, Role Insufficiency, Role Ambiguity, Role Boundary, Responsibility, and Physical Emqronment. These instruments ha . . . . tensi. . . . search supporting their reliability and validity. Results: Complete surveys were collected on 52 (62.7%) residents. The mean score on the HPSI placed them in the high-average range (based on physician normative data); 13 5% of the sample scored greater than or equal to 2 SDs above the mean. On the ORQ, mean scores on the Physical Environment subscale fell in the clinically elevated range (T score >70); 53.8% of the sample scored greater than or equal to 2 SDs above the mean. Mean scores on the other subscales of the ORQ were within normal limits. Stressor profiles differed significantly between the 2 programs on Role Overload (T score 56 versus 44; P<.00I) and Responsibility (T score 64 versus 49, P<.001). Conclusion: Emergency medicine residents' scores on the HPSI imply that the frequency/intensity of patient care-related stressors were within the normal range for most residents. However, approximately 13.5% of the emergency medicine residents scored in the worrisome range (le, _>2 SDs above the mean). The ORQ revealed only 1 of the 6 subscales to be signthcantly elevated the Physical Environment subscale This subscale assesses job characteristics such as erratic work schedules and exposure to noxious/dangerous environmental stimuli, Although both programs yielded elevated scores on the Physical Environment subscale, the stressor profiles obtained on 2 of the other ORQ subscales (Role Overload, Responsibihty) differed significantly between the 2 programs. This highlights an important point: conclusions regarding the stressors emergency medicine residents face during their training should be made cautiously because these stressors may be program-specific Larger studies should be designed to investigate the relation between program characteristms, specific stressors, and outcome measures (le, psy chological distress, performance evaluations).
S45
65
The 1999 Studyof the Workforce in EmergencyMedicine
Moorhead dO, Gallery M/American College of EmergencyPhysicians, Dallas, TX Study°blective'W°rkf°rceplanningtsanimp°rtantp°hcyissuef°rthespec'ahy of emergency medmme. Current graduate medical education fundmg is determined by national policies. Advocacy for appropriate funding for specialty traimng reqmres a coherent policy based on scientifically derived workforce data. In the United States, a national workforce study undertaken in 1997 by the American College of Emergency Physicians (ACEP) revealed that there were approximately 32,020 physicians hlling 24,548 full-nine equivalent (FTE) clinical positions m hospital emergency departments. A mandate to contain costs is resulting m unprecedented changes m the structure of the US health care delivery system. These budgetary pressures are cornpounded by the increasing number of uninsured patients seeking care in the nation's EDs. The purpose of this study is to determine what effects these changes are having on the total number of physmlans practicing dmical emergency medicine, to describe certain characteristics of those in&viduals, and to determine the change, during the intervening 2 years, in the total number of hospital ED emergency physm~an FTEs, as well as the total number of mdividuals needed to staff those FTEs. Methods: Data were gathered from 2 sources. The first source came from a survey of a random sample of 2,153 hospitals drawn from a population of 5,239 hospitals reported by the American Hospttal Association as having an ED The survey instrumerit addressed the total number of physicians working in the ED during the period June 1, 1999, through June 14, 1999. Demographic data, remuneration, and credenrials of the individuals were also collected. In addition, a survey was sent to a random sample of 6,000 emergency physicians from the databases of ACEP and the Amencan Medical Association lAMA) The survey instrument was developed to collect information on demographic variables, salary mformation, as well as information of in&ridual physicians' future plans for remaming in the specialty. Results: The study is complete. The response rate for both studies exceeded 40% The authors will report the number of FTEs and the number of emergency physicians being used to staff these FTEs in 1999. These data will be reported by hospital control status, teachmg status, and geographic location. Demographic and credennaling characterisrtcs of this population group will be provided. Conclusion: Changes in the emergency medicme workforce between 1997 and 1999 are presented. The value of these data for a national spec~ahy sectary in advocating for appropriate national graduate medical education policy will be described. Most coun-
rues should conduct stm~lar national emergency medicine workforce studies to guide
inn, food/drink services, and a special nurse. Although most of the people in Taiwan are not Christian, they like this form of spiritual comfort and would like to provide
their concern to other patients when possible.
167
Automated External Defihrillator Use and the Effect of Provider Exposure to Cardiac Arrest
O'Connor RE, Megargel RE, dasani NB, Ross RW, Bitner M/Department of Emergency Medicine, Christiana Care Health System, Newark, DE Study objective: Defibrillation vnth automated external defibrillators 4AEDs) results in improved surwval and has become a mainstay in the treatment of out-of-hospital cardiac arrest 4OOHCA). Emergency medical technicians (EMTs) formerly unaccustomed to treating OOHCA are now using AEDs. We conducted this study to analyze the usage pattern of AEDs by EMTs with varying exposure to OOHCA. Methods: Th~s observational study was conducted prospecuvely by 2 county-wide emergency medical services providers. EMTs received equivalent traimng on AED use. Count?, A has a population of 470,000 (1,076/sq mi), and county B has a populaUon of 125,000 (210/sq mi). OOHCA cases where the EMT with the AED was first on the scene were identified Whether the AED was in place on paramedic amval was determined. Statistical analysis used X2 and 95% confidence intervals. Results: County A had 23 AED provider agencms and county B had 18. Each AED pro,nder agency used 10 to 18 AED providers. The annual rate of OOHCA where EMTs with the AED were the first to arrive was 10 per agency m county A, and 2 per agency m county B Of a total of 203 OOHCAs studied in county A, there were 82 440%) opportunities for AED use. The AED was applied in 79 (96%) of these cases. Of a total of 208 OOHCAs studied in county B, there were 80 (38%) opportunities for AED use. The AED was applied in 47 (59%) of these cases. The difference in AED opportumtms was not significant, whereas the difference m application was (P<.00001). Conclusion: AEDs are not universally applied to victims of OOHCA. Providers with little experience treating OOHCA fail to apply the AED in a large proportion of cases. Failure to apply AEDs in OOHCA underscores the need to provide periodic retraining. An important public health inmative would be to track all cases of OOHCA to assess whether an AED is used m all cases where it is indicated t
I~O
Two-Thumb Versus Two-Finger Chest Compression in an Infant
| I,H~ Model of ProlongedCardiopulmonan/Resuscitation Dorfsman ML, Menegazzidd, Wadas RJ, Auble T/University of PittsburghAffiliated Residencyin Emergency Medicine, Pittsburgh, PA, Centerfor EmergencyMedicine for Western Pennsylvania,PA
graduate medical eduation pohcy
166
Regular Spiritual Comfort for Emergency Patients
Huang YC, Yang SH/Chiayi Christian Hospital, Departments of Emergency Medicine and Pastoral Care, ChiayiCity, Taiwan Study objective: Pauents vtsitmg emergency departments are under great phystologic and psychological stress. Besides the medical management and reassurance, emotional support and comfort are of great help We include spiritual comfort m our emergency services to provide high-quality human care. Methods: in addition to regular medical reassurance, regular comfort from chaplains is provided to patients m our observation unit. Actiwties include staging of hymns, brief sermons, prayer, listening, shanng, and benediction to the patient Questtonnaims about the activities were collected and analyzed, Results: Thirty quesuonnaires were completed. Fear (19/307 was the most common feeling, followed by anxiety (8/30), uncertainty (7/30), gnef (6/30), relief (6/30), confusmn (5/30), frightened (4/30), astonishment (3/30), shock (.2/30), loneliness (2/307, sadness (1/30), and misery 41/30). Most of the patmnts (25/30) need support. Besides medmal ser,nces, people need sympathy (18/307, food/drink service (9/30), emotional support (9/307, a special person who cares (8/30), someone to listen to the patients (7/30), and assistance m problem solving (7/30) Twenty-seven of the 30 people hked this comfort and thmk it should be provtded to emergency patmnts (15/30 to all patients, 13/30 to part of them). Smging of hymns (22/30) was the most popular measure, followed by prayer (15/30), brief sermon (10/30), benediction (10/30), listening (6/30), and sharing (5/30). Etghteen of the 30 patients would like to provide comfort to other patients. Conclusion: Adequate support is necessary and welcomed by most ED patients. Sympathy, hstening, and emotional support are not less important than problem solv-
$44
Study objective In previous experiments in our swine laboratory, we have shown that2-thumbchestcompressionwtthathoraclcsqueeze4TT) produces htgher blood and perfuslon pressures when compared with the American Heart Association (AHA)-
recommended 2-finger (TF) techmque Previous studies were of short durauon l1 to 2 minutes) We hypothesized that TT would be superior to TF during prolonged car diopulmonary resuscitaUon (CPR) in an infant model. Methods' We performed a prospecnve, randomized crossover-designed experiment tn a laboratory setting. Twenty AHA-certffied rescuers performed basic CPR for two 1D-minute penods, one with TT the other with TF. Trials were separated by 5 to 10 days. and the order was randomly assigned. The experimental circuit consisted of a modified manikin (ResusciBaby, Laerdal Medtcal Corp., Armonk, NY) with a fixedvolume "artenal" system atlached to a Neonatal Monitor (Hewlett Packard) via an arterial pressure transducer (.model PX-1800, Baxter Heahhcare Corp., Irvine. CA). The arterial circuit consisted of a 50-mE bag of normal saline solution (air removed) attached to the manikin chest plate and connected to the transducer with a 2D-gauge intravenous catheter and tubing. Rescuers were hhnded to the arterial pressure tracinc. Systolic blood pressure (SBP), &astolic blood pressure (DBP), and mean arterial pressures (MAPs) were recorded m millimeters of mercury. Data were analyzed w~th 2-way RMANOVA. Sphenctty assumed modeling, with Greenhouse-Geisser and Huynh-Feldt adjustments, was applied. Results Mean MAPs, by techmque and minute, are presented in the Table. Marginal means for TT SBP (68 9) and DBP (17.6) were higher than for TF SBP (44.8) and DBP (12.5). All 3 pressures were sigmficantly different between the 2 techniques (P<.O01). Conclusmn: In this infant CPR model, TT chest compression produced higher MAP, SBP, and DBP when compared with TF chest compression durmg a clinically relevant duration of prolonged CPR.
ANNALS OF EMERdENCY MEDICINE 35.5 MAY 2000
8th I N T E R N A T I O N A L CONFERENCE ON E M E R G E N C Y MEDICINE ABSTRACTS
Table, abstract 168. Mean arterial pressures for TT versus TF chest compression,
MAP TT TF
1
2
3
4
5
6
7
8
9
10
36.4 26.6
35.6 25.0
36.2 23.9
36.8 23.2
36.3 22.7
35.4 22.5
34.6 22.3
34.0 22.3
34.2 22.2
33.7 22.4
69 Disaster
Medicine Education in Medical School Curricula
Results Surveys were solicited from 478 (42.1%) of 1,139 patients and 59 (77.6%) of 76 ED staff (nurses, residents, physicians). Statistically significant differences existed between ED staffs estimates of patient satisfaction and actual patient satisfaction across 19 of the 22 indicators (P<.005). Across each of these 19 indicators, staff consistently estimated average satisfaction scores to be lower than what patients actually reported Staff did not overestimate scores on any items The 19 items were spread across multiple domains. Additionally, staff overestimated average patient length of stay by more than 2 hours (P< 001). Conclusion: In contrast to the hypothesized self-serving bias, ED staff consistently estimated patients to be less satisfied than they actually were This trend held true across multiple domains, mcluding satisfaction with registration, nursing, and physician staff, and waiting times. Moreover, ED staff estimated average length of stay to be more than 2 hours longer than it actually was (5.7 hours versus 3 5 hours). Such
Colombo JB, PetersonW, Thackerayd, Tompkins M, Burkholder-Allen, Budd C, Bega P/Medmal College of Ohio, Toledo, OH; Toledo Hospital, Department of Emergency Medicine and Trauma Services, Toledo, OH
biases may act as a self-fulfilhng prophecy, negatively affecting both patient satlsfaction and employee morale Future research should focus on assessing provider estt-
Study objecUve. Quality disaster medicine education is lacking among various medical specialtms, desplte increasmg susceptibifity to major dzsasters Theobjectlve of this study was to determine to what extent medical school curricula include ele-
171 SlressorsExperiencedby EmergencyMedieine Residents
ments of disaster medicine Methods: We conducted a prospective analysis of 124 accredited US medical schools. A written survey, distributed to administrators initially by electronic mall and subsequently by telephone, assessed level and type of disaster medicine training given to medical students. If disaster medicme training was absent, information regarding reasons for its omission and perceived need for undergraduate disaster medicme training was collected, Results. The response rate was 75% (n=93). Only 10 (11%) schools offered trainmg in disaster medicine. Of 83 (89%) mschools that did not offer disaster medicine training, 6 t % provided reasons for its absence from the curriculum which included" it had not been considered, no available time in the curriculum, lack of qualified instructors, and lack of funding for new electives, 21% of respondents provided multiple reasons. Of those providing no disaster medicme training in the curriculum, 57% agreed that disaster medicine training was needed, and 35% remained undectded Correlation to existence of emergency medicine residency programs was also examined, Conclusion: For several reasons, most US medical schools do not prmqde disaster medicine education to their students.
Boudreaux ED, Ary B/Louisiana State University, School of Medicine, Emergency Medicine
4 "1 I ~ Emergency Department Staff Estimates of Patient Satisfaction: ! I U The Squeaky Wheel Gels the Grease BoudreauxED, Ary R, Mandry C/LouisianaState University, School of Medicine, Baton Rouge,LA Study objecuve: Theories outlining determinants of patient satisfaction point out that the health care providers' own behefs and attitudes Influence their beha,nor toward the patient and, therefore, indirectly influence patient satisfaction. Hence, emergency medicine staffs expectations regarding patient satisfaction may actually influence patient satisfaction through its effect on staff behavior For example, if a provider overestimates his or her patient's satisEactlon, he or she may miss important but subtle cues of dissatisfaction, causing him of her to miss an opportunity to rectify the situation before the patient leaves the ED. Our study mvestigated the accuracy of ED staffs estimates of their patients' satisfaction with services. We hypothesized that ED staff would exhibit a self-serving bias (ie, they would estimate patient satisfaction as higher than it actually is). Methods' The study was conducted through a municipal ED with approximately 89,000 visits per year. Actual pauent sausfaction was assessed using a telephone interview with 2 indicators across several domains, including registration, nursing staff, physician staff, wait times, discharge, instructions, and other miscellaneous areas. Shortly after the assessment was complete, but before the results of the survey were disseminated, ED staff were asked to "predict" the results by estimating the average rating they believed patients gave for each of the 22 indicators. Staff members were also asked to estimate the patients' average length of stay To further reduce bias, ED staff were not informed that the patient satisfaction survey was being conducted, Independent samples t tests were used to compare averages for each item obtained through staff ratings versus averages denved from actual patient satisfaction,
MAY 2000
35 5 ANNALS OF EMERGENCYMEDICINE
mates of patient satisfaction m "real time" (versus asking for estimates of averages).
Residency Program, Baton Rouge, LA Study objectives: Considerable research has focused on the stress of medical residency. However, most of these studies have invesugated internal medicine or family practice residents Because emergency medicine is a young field, relatively little has been published on the stressors experienced by emergency medicine residents. The current study used 2 well-validated instruments to explore the level and types of stressors experienced by a sample of emergency medicine residents. Methods: A cross-secuonal design was used. All emergency medlcme residents attending 2 programs located in the southern United States were ehgible to participate (N=83). Subjects were specifically instructed to omit any identifying or demographic information to guarantee anonymity and to encourage honest responses. Residents completed the questionnaires before a weekly didactic session We used the Health Professions Stress Inventory (HPSI), which is a measure assessing stressors specific to health care providers, and the Occupational Roles Questionnaire (ORQ), which is a measure assessing general job-related stressors. The ORQ has 6 subscales: Role Overload, Role Insufficiency, Role Ambiguity, Role Boundary, Responsibility, and Physical Emqronment. These instruments ha . . . . tensi. . . . search supporting their reliability and validity. Results: Complete surveys were collected on 52 (62.7%) residents. The mean score on the HPSI placed them in the high-average range (based on physician normative data); 13 5% of the sample scored greater than or equal to 2 SDs above the mean. On the ORQ, mean scores on the Physical Environment subscale fell in the clinically elevated range (T score >70); 53.8% of the sample scored greater than or equal to 2 SDs above the mean. Mean scores on the other subscales of the ORQ were within normal limits. Stressor profiles differed significantly between the 2 programs on Role Overload (T score 56 versus 44; P<.00I) and Responsibility (T score 64 versus 49, P<.001). Conclusion: Emergency medicine residents' scores on the HPSI imply that the frequency/intensity of patient care-related stressors were within the normal range for most residents. However, approximately 13.5% of the emergency medicine residents scored in the worrisome range (le, _>2 SDs above the mean). The ORQ revealed only 1 of the 6 subscales to be signthcantly elevated the Physical Environment subscale This subscale assesses job characteristics such as erratic work schedules and exposure to noxious/dangerous environmental stimuli, Although both programs yielded elevated scores on the Physical Environment subscale, the stressor profiles obtained on 2 of the other ORQ subscales (Role Overload, Responsibihty) differed significantly between the 2 programs. This highlights an important point: conclusions regarding the stressors emergency medicine residents face during their training should be made cautiously because these stressors may be program-specific Larger studies should be designed to investigate the relation between program characteristms, specific stressors, and outcome measures (le, psy chological distress, performance evaluations).
S45