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Article ; Online: Designing and developing a digital equity dashboard for the emergency department.

Yi, Sojung / Burke, Caroline / Reilly, Amanda / Straube, Steven / Graterol, Joseph / Peabody, Christopher R

Journal of the American College of Emergency Physicians open

2023 Volume 4, Issue 4, Page(s) e12997

Abstract: Disparities in diagnosis, treatment, and health outcomes of racial minorities are well documented in the emergency department (ED). Although EDs may provide broad departmental feedback on clinical metrics, lack of up-to-date monitoring and data ... ...

Abstract	Disparities in diagnosis, treatment, and health outcomes of racial minorities are well documented in the emergency department (ED). Although EDs may provide broad departmental feedback on clinical metrics, lack of up-to-date monitoring and data availability present significant challenges to identifying and addressing patterns of inequitable care. To address this issue, we developed an online "Equity Dashboard," incorporating data that is updated daily from our electronic medical record to highlight demographic, clinical, and operational variables, stratified by age, race, ethnicity, and language, and sexual orientation, gender identity. Through an iterative design thinking process, we created data visualizations for an interactive interface that tells a story about the ED patient's experience and enables any staff to explore up-to-date trends in patient care. To assess and improve usability of the dashboard, we conducted a survey of end-users using custom questions, as well as the System Usability Scale and Net Promoter Score, both of which are validated health technology use instruments. The Equity Dashboard is of particular use for quality improvement initiatives, as it reflects common departmental challenges including delays in clinician events, inpatient boarding, and throughput metrics. This digital tool further helps demonstrate how these operational factors differentially affect our diverse patient population. The dashboard ultimately enables the ED team to measure current performance, to identify our vulnerabilities, and to design targeted interventions to address disparities in clinical care.
Language	English
Publishing date	2023-06-30
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12997
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Centralization and democratization: Managing crisis communication in health care delivery.

Hayirli, Tuna C / Stark, Nicholas / Hardy, James / Peabody, Christopher R / Kerrissey, Michaela J

Health care management review

2023 Volume 48, Issue 4, Page(s) 292–300

Abstract: Background: Communication is an essential organizational process for responding to adversity. Managers are often advised to communicate frequently and redundantly during crises. Nonetheless, systematic investigation of how information receivers perceive ...

Abstract	Background: Communication is an essential organizational process for responding to adversity. Managers are often advised to communicate frequently and redundantly during crises. Nonetheless, systematic investigation of how information receivers perceive organizational communication amid crises has remained lacking. Purpose: The aim of this study was to characterize features of effective internal crisis communication by examining how information-sharing processes unfolded during the initial stage of the COVID-19 pandemic. Methodology: Between June and August 2020, we conducted 55 semistructured interviews with emergency department workers practicing in a variety of roles. We analyzed interview transcripts following constructivist constant comparative methods. Results: Our findings revealed that at the onset of COVID-19 pandemic response, emergency department workers struggled with immense fear and anxiety amid high uncertainty and equivocality. Frequent and redundant communication, however, resulted in information delivery and uptake problems, worsening anxiety, and interpersonal tension. These problems were ameliorated by the emergence of contextual experts who centralized and democratized communication. Centralization standardized information received across roles, work schedules, and settings while decoupling internal communication from turbulence in the environment. Democratization made information accessible in a way that all could understand. It also ensured information senders' receptiveness to feedback from information receivers. Centralization and democratization together worked to reduce sensed uncertainty and equivocality, which reduced anxiety and interpersonal tension. Conclusion: Establishing frequent and redundant communication strategies does not necessarily address the anxiety and interpersonal tension produced by uncertainty and equivocality in crises. Practice implications: Centralization and democratization of crisis communication can reduce anxiety, improve coordination, and promote a safer workplace and patient care environment.
MeSH term(s)	Humans ; Pandemics ; Communication ; COVID-19 ; Delivery of Health Care ; Information Dissemination
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	430366-0
ISSN	1550-5030 ; 0361-6274
ISSN (online)	1550-5030
ISSN	0361-6274
DOI	10.1097/HMR.0000000000000377
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Article ; Online: Unprecedented Training: Experience of Residents During the COVID-19 Pandemic.

Stark, Nicholas / Hayirli, Tuna / Bhanja, Aditi / Kerrissey, Michaela / Hardy, James / Peabody, Christopher R

Annals of emergency medicine

2022 Volume 79, Issue 5, Page(s) 488–494

MeSH term(s)	COVID-19 ; Humans ; Internship and Residency ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2022-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2022.01.022
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Article ; Online: How psychological safety and feeling heard relate to burnout and adaptation amid uncertainty.

Kerrissey, Michaela J / Hayirli, Tuna C / Bhanja, Aditi / Stark, Nicholas / Hardy, James / Peabody, Christopher R

Health care management review

2022 Volume 47, Issue 4, Page(s) 308–316

Abstract: ... properties and were correlated at r = .54. Levels of feeling heard were lower on average than psychological ...

Abstract	Background: Psychological safety-the belief that it is safe to speak up-is vital amid uncertainty, but its relationship to feeling heard is not well understood. Purpose: The aims of this study were (a) to measure feeling heard and (b) to assess how psychological safety and feeling heard relate to one another as well as to burnout, worsening burnout, and adaptation during uncertainty. Methodology: We conducted a cross-sectional survey of emergency department staff and clinicians (response rate = 52%; analytic N = 241) in July 2020. The survey measured psychological safety, feeling heard, overall burnout, worsening burnout, and perceived process adaptation during the COVID-19 crisis. We assessed descriptive statistics and construct measurement properties, and we assessed relationships among the variables using generalized structural equation modeling. Results: Psychological safety and feeling heard demonstrated acceptable measurement properties and were correlated at r = .54. Levels of feeling heard were lower on average than psychological safety. Psychological safety and feeling heard were both statistically significantly associated with lower burnout and greater process adaptation. Only psychological safety exhibited a statistically significant relationship with less worsening burnout during crisis. We found evidence that feeling heard mediates psychological safety's relationship to burnout and process adaptation. Conclusion: Psychological safety is important but not sufficient for feeling heard. Feeling heard may help mitigate burnout and enable adaptation during uncertainty. Practice implications: For health care leaders, expanding beyond psychological safety to also establish a feeling of being heard may further reduce burnout and improve care processes.
MeSH term(s)	Burnout, Professional/psychology ; COVID-19 ; Cross-Sectional Studies ; Humans ; Surveys and Questionnaires ; Uncertainty
Language	English
Publishing date	2022-02-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	430366-0
ISSN	1550-5030 ; 0361-6274
ISSN (online)	1550-5030
ISSN	0361-6274
DOI	10.1097/HMR.0000000000000338
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Article ; Online: Team and leadership factors and their relationship to burnout in emergency medicine during COVID-19: A 3-wave cross-sectional study.

Bhanja, Aditi / Hayirli, Tuna / Stark, Nicholas / Hardy, James / Peabody, Christopher R / Kerrissey, Michaela

Journal of the American College of Emergency Physicians open

2022 Volume 3, Issue 4, Page(s) e12761

Abstract: Objective: We examined the relationship of team and leadership attributes with clinician feelings of burnout over time during the corona virus disease 2019 (COVID-19) pandemic.: Methods: We surveyed emergency medicine personnel at 2 California ... ...

Abstract	Objective: We examined the relationship of team and leadership attributes with clinician feelings of burnout over time during the corona virus disease 2019 (COVID-19) pandemic. Methods: We surveyed emergency medicine personnel at 2 California hospitals at 3 time points: July 2020, December 2020, and November 2021. We assessed 3 team and leadership attributes using previously validated psychological scales (joint problem-solving, process clarity, and leader inclusiveness) and burnout using a validated scale. Using logistic regression models we determined the associations between team and leadership attributes and burnout, controlling for covariates. Results: We obtained responses from 328, 356, and 260 respondents in waves 1, 2, and 3, respectively (mean response rate = 49.52%). The median response for feelings of burnout increased over time (2.0, interquartile range [IQR] = 2.0-3.0 in wave 1 to 3.0, IQR = 2.0-3.0 in wave 3). At all time points, greater process clarity was associated with lower odds of feeling burnout (odds ratio [OR] [95% confidence interval (CI) = 0.36 [0.19, 0.66] in wave 1 to 0.24 [0.10, 0.61] in wave 3). In waves 2 and 3, greater joint problem-solving was associated with lower odds of feeling burnout (OR [95% CI] = 0.61 [0.42, 0.89], 0.54 [0.33, 0.88]). Leader inclusiveness was also associated with lower odds of feeling burnout (OR [95% CI] = 0.45 [0.27, 0.74] in wave 1 to 0.41 [0.24, 0.69] in wave 3). Conclusions: Process clarity, joint problem-solving, and leader inclusiveness are associated with less clinician burnout during the COVID-19 pandemic, pointing to potential benefits of focusing on team and leadership factors during crisis. Leader inclusiveness may wane over time, requiring effort to sustain.
Language	English
Publishing date	2022-06-30
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12761
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Article ; Online: Designing clinical guidelines that improve access and satisfaction in the emergency department.

Pondicherry, Neha / Schwartz, Hope / Stark, Nicholas / Dhanoa, Jaskirat / Emanuels, David / Singh, Malini / Peabody, Christopher R

Journal of the American College of Emergency Physicians open

2023 Volume 4, Issue 2, Page(s) e12919

Abstract: Clinical guidelines are evidence-based clinician decision-support tools that improve health outcomes, reduce patient harm, and decrease healthcare costs, but are often underused in emergency departments (EDs). This article describes a replicable, ... ...

Abstract	Clinical guidelines are evidence-based clinician decision-support tools that improve health outcomes, reduce patient harm, and decrease healthcare costs, but are often underused in emergency departments (EDs). This article describes a replicable, evidence-based design-thinking approach to developing best practices for guideline design that improves clinical satisfaction and usage. We used a 5-step process to enhance guideline usability in our ED. First, we conducted end-user interviews to identify barriers to guideline usage. Second, we reviewed the literature to identify key principles in guideline design. Third, we applied our findings to create a standardized guideline format, incorporating rapid cycle learning and iterative improvements. Fourth, we ensured the clinical validity of our updated guidelines by using a rigorous process for peer review. Lastly, we evaluated the impact of our guideline conversion process by tracking clinical guidelines access per day from October 2020 to January 2022. Our end-user interviews and review of the design literature revealed several barriers to guideline use, including lack of readability, design inconsistencies, and guideline complexity. Although our previous clinical guideline system averaged 0.13 users per day, >43 users per day accessed the clinical guidelines on our new digital platform in January 2022, representing an increase in access and use exceeding 33,000%. Our replicable process using open-access resources increased clinician access to and satisfaction with clinical guidelines in our ED. Design-thinking and use of low-cost technology can significantly improve clinical guideline visibility and has the potential to increase guideline use.
Language	English
Publishing date	2023-03-07
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12919
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Building Back Better: Applying Lessons from the COVID-19 Pandemic to Expand Critical Information Access.

Schwartz, Hope E M / Stark, Nicholas R / Sowa, Cathleen S / Singh, Malini K / Peabody, Christopher R

The Journal of emergency medicine

2021 Volume 61, Issue 5, Page(s) 607–614

Abstract: Background: The Coronavirus disease 2019 (COVID-19) pandemic generated an unprecedented volume of evolving clinical guidelines that strained existing clinical information systems and necessitated rapid innovation in emergency departments (EDs).: ... ...

Abstract	Background: The Coronavirus disease 2019 (COVID-19) pandemic generated an unprecedented volume of evolving clinical guidelines that strained existing clinical information systems and necessitated rapid innovation in emergency departments (EDs). Objectives: Our team aimed to harness new COVID-19-related reliance on digital clinical support tools to re-envision how all clinical guidelines are stored and accessed in our ED. Methods: We used a design-thinking approach including empathizing, defining the problem, ideating, prototyping, and testing to develop a low-cost, homegrown clinical information hub: EDrive. To measure impact, we compared web traffic on EDrive to our legacy cloud-based folder system and conducted a survey of end-users using a validated health technology utilization instrument. Results: Our final product, EDrive, is a centralized clinical information hub storing everything from clinical guidelines to discharge resources. Clinical guidelines are standardized and housed within the high-traffic EDrive platform to increase accessibility. Since launch, EDrive has averaged 84 unique weekly users, compared with less than one weekly user on the legacy system. We surveyed 52 clinicians for a total response rate of 47%. Prior to the EDrive rollout, 12.5% of ED clinicians felt confident accessing clinical information on the legacy system, whereas 76.6% of ED clinicians felt they could more easily access clinical information using EDrive. Conclusion:* The COVID pandemic revealed vulnerabilities within our information dissemination system and presented an opportunity to improve clinical information delivery. Centralized web-based clinical information hubs designed around the clinician end-user experience can increase clinical guideline access in the ED.
MeSH term(s)	COVID-19 ; Emergency Service, Hospital ; Humans ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2021-03-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	605559-x
ISSN	0736-4679
ISSN	0736-4679
DOI	10.1016/j.jemermed.2021.03.014
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Article ; Online: Masked and distanced: a qualitative study of how personal protective equipment and distancing affect teamwork in emergency care.

Hayirli, Tuna C / Stark, Nicholas / Bhanja, Aditi / Hardy, James / Peabody, Christopher R / Kerrissey, Michaela J

International journal for quality in health care : journal of the International Society for Quality in Health Care

2021 Volume 33, Issue 2

Abstract: Background: Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines.: Objective: We conducted a qualitative study to categorize and ... ...

Abstract	Background: Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines. Objective: We conducted a qualitative study to categorize and describe barriers to teamwork posed by PPE and distancing in the emergency setting. Methods: We conducted 55 semi-structured interviews between June 2020 and August 2020 with personnel from two emergency departments serving in a variety of roles. We then performed a thematic analysis to identify and construct patterns of teamwork challenges into themes. Results: We discovered two types of challenges to teamwork: material barriers related to wearing masks, gowns and powered air-purifying respirators, and spatial barriers implemented to conserve PPE and limit coronavirus exposure. Both material and spatial barriers resulted in disrupted communication, roles and interpersonal relationships, but they did so in unique ways. Material barriers muffled information flow, impeded team member recognition and role/task division, and reduced belonging and cohesion while increasing interpersonal strain. Spatial barriers resulted in mediated communication and added physical and emotional distance between teammates and patients. Conclusion: Our findings identify specific aspects of how intensified PPE use disrupts teamwork and can inform efforts to ensure care quality and safety in emergency settings as PPE use continues during and, potentially beyond, the coronavirus disease-2019 pandemic.
MeSH term(s)	Communication Barriers ; Emergency Service, Hospital ; Health Personnel/psychology ; Humans ; Interpersonal Relations ; Patient Care Team/standards ; Personal Protective Equipment ; Physical Distancing ; Qualitative Research ; Quality of Health Care ; Role ; San Francisco/epidemiology
Language	English
Publishing date	2021-04-14
Publishing country	England
Document type	Journal Article
ZDB-ID	1194150-9
ISSN	1464-3677 ; 1353-4505
ISSN (online)	1464-3677
ISSN	1353-4505
DOI	10.1093/intqhc/mzab069
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Article ; Online: A Toddler with Spontaneous Pneumomediastinum.

Chow, Jessica L / Green-Hopkins, Israel / Peabody, Christopher R

Clinical practice and cases in emergency medicine

2017 Volume 1, Issue 4, Page(s) 411–412

Language	English
Publishing date	2017-10-03
Publishing country	United States
Document type	Case Reports
ISSN	2474-252X
ISSN (online)	2474-252X
DOI	10.5811/cpcem.2017.5.33987
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Article ; Online: Radical prostatectomy for patients with high-risk, very-high risk, or radiographic suspicion for metastatic prostate cancer: Perioperative and early oncologic results from the MUSIC statewide collaborative.

Mora, Silvia / Qi, Ji / Morgan, Todd M / Brede, Christopher M / Peabody, James / George, Arvin / Lane, Brian R

Urologic oncology

2022 Volume 40, Issue 8, Page(s) 380.e1–380.e9

Abstract: Objective: High-risk (HR) prostate cancer (CaP) patients are at greatest risk for occult metastases and disease progression. Radical prostatectomy (RP) provides benefit, but remains of unknown oncologic value compared with other options. We investigated ...

Abstract	Objective: High-risk (HR) prostate cancer (CaP) patients are at greatest risk for occult metastases and disease progression. Radical prostatectomy (RP) provides benefit, but remains of unknown oncologic value compared with other options. We investigated outcomes of RP for HR, very-high-risk (VHR), or metastatic CaP. Methods: Included are 1,635 patients undergoing RP between January 2012 and December 2018 (prior to widespread availability of CaP-specific PET imaging). VHR CaP was defined as having ≥2HR features, >4cores of biopsy Gleason ≥4+4, or primary Gleason pattern 5. Metastatic CaP was defined by radiographic evidence of N1 and/or M1 CaP and grouped as cN1M Results: Length of stay >2days and readmission following RP was 10.8% and 5.5% for patients with HR or higher CaP. Median time to progression was 3.9 months (IQR:1.6-13.9), and 2-year progression-free probability was 67% for HR, 53% for VHR, 51% for cN1M Conclusions: Most patients with HR or higher CaP remain progression-free 2 years after RP, with acceptable perioperative outcomes. Progression-free survival was similar in cN1 and VHR patients, better with non-metastatic HR CaP, and between these for cN0M1 patients indicating the imprecise clinical staging occurring with conventional imaging modalities alone.
MeSH term(s)	Humans ; Male ; Music ; Neoplasm Grading ; Prostate/pathology ; Prostate-Specific Antigen ; Prostatectomy/methods ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/surgery ; Retrospective Studies
Chemical Substances	Prostate-Specific Antigen (EC 3.4.21.77)
Language	English
Publishing date	2022-06-29
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1336505-8
ISSN	1873-2496 ; 1078-1439
ISSN (online)	1873-2496
ISSN	1078-1439
DOI	10.1016/j.urolonc.2022.05.029
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