Rethinking Traditional Emergency Department Care Models in a Post-Coronavirus Disease-2019 World.

As the nursing shortage in United States emergency departments has drastically worsened since the coronavirus disease-2019 (COVID-19) pandemic, emergency departments have experienced increased rates of inpatient onboarding, higher rates of patients leaving without being seen, and declining patient satisfaction scores. This paper reviews the impacts of the coronavirus disease-2019 pandemic on the current nursing shortage and considers how various medical personnel (emergency nurse-extenders) can ameliorate operational challenges by redesigning emergency department systems. During the height of the coronavirus disease-2019 pandemic, the psychological effects of increased demand for emergency nurses coupled with the fear of coronavirus infection exacerbated nursing turnover rates. Health care workers who can be trained to augment the existing emergency department workforce include paramedics, Emergency Medical Technicians, emergency department technicians, ancillary staff, scribes, and motivated health sciences students. Utilizing non-nurse providers to fulfill tasks traditionally assigned to emergency nurses can improve emergency department flow and care delivery in a post-coronavirus disease-2019 world.

Hand Sanitizer Intoxication in the Emergency Department.

Hand hygiene has always been an area of emphasis within the hospital setting, never more so than during the coronavirus disease 2019 (COVID-19) pandemic. The consumption of alcohol-containing hand sanitizer products, whether intentional or accidental, often garners attention, particularly since these products may contain methanol. This report describes a case of surreptitious theft and intentional ingestion of the emergency department's (ED) ethanol-based hand sanitizer by a patient who presented to the ED clinically intoxicated with a high ethanol level. When the patient remained clinically intoxicated for more than 18 hours and had a rising serum ethanol level in the ED, clinicians searched his belongings and found several purloined bottles of the ED's hand sanitizer. When confronted, the patient admitted to ingesting hand sanitizer during his ED stay. This case highlights the need for clinicians to be suspicious of intentional ingestion of ethanol-containing products for at-risk patients. Additionally, it demonstrates that measures and protocols should be put in place that minimize the ability for the inappropriate use of these widely accessible products within the hospital.

Lack of Telemedicine Training in Academic Medicine: Are We Preparing the Next Generation?

Background: Telemedicine focuses on providing medical care to patients in remote locations using telecommunication technologies. It has been shown to be cost-effective, improve health outcomes, and enhance patient satisfaction. This study examines the extent to which medical students and resident physicians are exposed to telemedicine during training. Materials and Methods: The authors accessed the American College of Graduate Medical Education (ACGME) Residency Milestones from specialties and subspecialties mentioned in the 2018 Milestones National Report and searched for key terms, including "Technology," "Telemedicine," "Telehealth," "EMR," "Electronic Medical Record," "EHR," "Electronic Health Record," "Electronics," and "Social Media." The authors also accessed the 2018 American Association of Medical Colleges (AAMC) "Curriculum Inventory and Reports" to retrieve data from surveys of medical schools that included telemedicine in required courses and electives for medical students from 2013 to 2018. Results: From the 104 ACGME specialty milestones, only one specialty (Child and Adolescent Psychiatry) mentioned telehealth in its ACGME Milestone document. According to the AAMC data the number of medical schools surveyed increased every academic year from 140 in 2013/2014 to 147 in 2017/2018, telemedicine education in medical school increased significantly from 41% in 2013/2014 to 60% in 2017/2018 (p = 0.0006). However, the growth in telemedicine education plateaued from 56% in 2015/2016 to 60% in 2017/2018 (p = 0.47). Conclusion: Familiarizing medical students with telemedicine is essential; the next generation of health care providers should be equipped with knowledge of telemedicine as a valuable skill to serve populations that do not have direct access to quality medical care. Methods of implementing telemedicine education into more medical schools and residency programs merits further study.

Shifting attention to an undervalued asset; the emergency department technician.

US emergency departments are facing a number of operational challenges related to chronic shortages of registered nurses. Many of the tasks done by registered nurses can be safely and successfully delegated to the emergency department technician (EDT), particularly if a hospital's nursing and administrative leadership are affirmatively engaged in a process to professionalize and train their EDT workforce. This paper examines the state, Joint Commission on Accreditation of Healthcare Organizations, and Centers for Medicare & Medicaid Services regulatory landscape for the EDT, reviews the literature on how hospital's utilize EDT's, discusses approaches to skills training, and examines the need for profession standardization that enables job role expansion.