Impact of COVID-19 Pandemic on Food Insecurity in an Urban Emergency Department Patient Population.

INTRODUCTION: Food insecurity (FI) has been associated with adverse health outcomes and increased healthcare expenditures. Many families experienced reduced access to food during the coronavirus disease 2019 (COVID-19) pandemic. A 2019 study revealed that the pre-pandemic prevalence of FI at an urban, tertiary care hospital's emergency department (ED) was 35.3%. We sought to evaluate whether the prevalence of FI in the same ED patient population increased during the COVID-19 pandemic. METHODS: We performed a single-center, observational, survey-based study. Surveys assessing for FI were administered to clinically stable patients presenting to the ED over 25 consecutive weekdays from November-December 2020. RESULTS: Of 777 eligible patients, 379 (48.8%) were enrolled; 158 (41.7%) screened positive for FI. During the pandemic, there was a 18.1% relative increase (or 6.4% absolute increase) in the prevalence of FI in this population (P=0.040; OR=1.309, 95% CI 1.012-1.693). The majority (52.9%) of food-insecure subjects reported reduced access to food due to the pandemic. The most common perceived barriers to access to food were reduced food availability at grocery stores (31%), social distancing guidelines (26.5%), and reduced income (19.6%). CONCLUSION: Our findings suggest that nearly half of the clinically stable patients who presented to our urban ED during the pandemic experienced food insecurity. The prevalence of FI in our hospital's ED patient population increased by 6.4% during the pandemic. Emergency physicians should be aware of rising FI in their patient population so that they may better support patients who must choose between purchasing food and purchasing prescribed medications.

Validation of a Simulation-Based Resuscitation Curriculum for Maternal Cardiac Arrest.

OBJECTIVE: To assess the knowledge, skills, and self-efficacy of health care participants completing a simulation-based blended learning training curriculum on managing maternal medical emergencies and maternal cardiac arrest (Obstetric Life Support). METHODS: A formative assessment of the Obstetric Life Support curriculum was performed with a prehospital cohort comprising emergency medical services professionals and a hospital-based cohort comprising health care professionals who work primarily in hospital or urgent care settings and respond to maternal medical emergencies. The training consisted of self-guided precourse work and an instructor-led simulation course using a customized low-fidelity simulator. Baseline and postcourse assessments included multiple-choice cognitive test, self-efficacy questionnaire, and graded Megacode assessment of the team leader. Megacode scores and pass rates were analyzed descriptively. Pre- and post-self-confidence assessments were compared with an exact binomial test, and cognitive scores were compared with generalized linear mixed models. RESULTS: The training was offered to 88 participants between December 2019 and November 2021. Eighty-five participants consented to participation; 77 participants completed the training over eight sessions. At baseline, fewer than half of participants were able to achieve a passing score on the cognitive assessment as determined by the expert panel. After the course, mean cognitive assessment scores improved by 13 points, from 69.4% at baseline to 82.4% after the course (95% CI 10.9-15.1, P <.001). Megacode scores averaged 90.7±6.4%. The Megacode pass rate was 96.1%. There were significant improvements in participant self-efficacy, and the majority of participants (92.6%) agreed or strongly agreed that the course met its educational objectives. CONCLUSION: After completing a simulation-based blended learning program focused on managing maternal cardiac arrest using a customized low-fidelity simulator, most participants achieved a defensible passing Megacode score and significantly improved their knowledge, skills, and self-efficacy.

An assessment blueprint for the Advanced Medical Life Support two-day prehospital emergency medical services training program in the United States.

PURPOSE: Traditional approaches to blueprint creation may focus on fine-grained detail at the expense of important foundational concepts. The purpose of this study was to develop a method for constructing an assessment blueprint to guide the creation of a new post-test for a two-day prehospital emergency medical services training program. METHODS: In order to create the blueprint, we first determined the proportions of the total classroom and home-study minutes associated with the lower- and higher-order cognitive objectives of each chapter of the textbook and the two-day classroom activities during training courses conducted from January to April 2015. These proportions were then applied to a 50-question test structure in order to calculate the number of desired questions by chapter and content type. RESULTS: Our blueprint called for the test to contain an almost even split of lower- and higher-order cognitive questions. One-best-answer multiple choice items and extended matching-type items were written to assess lower- and higher-order cognitive content, respectively. CONCLUSION: We report the first known application of an assessment blueprint to a prehospital professional development education program. Our approach to blueprint creation is computationally straightforward and could be easily adopted by a group of instructors with a basic understanding of lower- and higher-order cognitive constructs. By blueprinting at the chapter level, as we have done, item-writers should be more inclined to construct questions that focus on important central themes or procedures.