UMEM Educational Pearls - By Mercedes Torres

Do microaggressions and discrimination impact the patient experience in your ED?  How can we address this?

This article is one of few studies to address this topic specifically in the ED. Authors used quantitative (discrimination scale) and qualitative (follow-up interviews) methods to answer this question in two urban academic EDs.  

Common themes from patient responses provide food for thought and action in this regard:

• Clinician behaviors: Positive behaviors included frequent communication, reassurance, privacy, respect, and validation of concerns. Empathy and eye contact were also mentioned.
• Healthcare team actions: Positive interactions with clinicians reassured confidence in the emergency care visit and willingness to return for future health care.
• Environmental pressures in the ED: Participants often noted long wait times and busy staff when describing negative ED experiences.
• Hesitancy to Complain: Patients were hesitant to identify staff members, did not feel that the complaint would be acted on, and worried that their medical care would suffer if they brought up their concerns.

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A recently published study of ED APPs, residents, attendings, and nurses attempted to assess clinician's perspectives on how ED boarding impacts ED staff and patients.  Authors performed a survey followed by focus group sessions to obtain qualitative insignts from participants. 

All respondents associated boarding with feelings of burnout and self-reported poor satisfaction with communication and the process of boarding care.

Several key themes emerged which are outlined below:

1. Clinicians perceived that boarding leads to increased patient safety events.
2. Clinicians desired standardization for the boarding care process.
3. Clinicians felt they had a lack of knowledge, resources, and training to care for boarding patients.
4. Clinicians desired proactive bed and resource planning for boarding patients.
5. Clinicians advocated for improved communication among the team and to patients.
6. Clinicians identified a need for culture change regarding boarding care.

This publication highlights the negative workforce and patient safety effects of ED boarding.  It amplifies the voices of our colleagues who work towards change to improve both the health of our wrokforce as well as that of our patients and the communities that we serve.

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Physician Workforce Diversity in EM

Health inequities along racial, ethnic, and socioeconomic lines are a brutal reality of the current state of health care in the US.  One way to attempt to address these inequities is to make a concerted effort to diversify our physician workforce.  As authors have noted, “Having physicians from diverse backgrounds as colleagues and role models can promote understanding and tolerance in nonminority physicians, ultimately improving medical care for patients who are part of these racial and ethnic groups. Increasing the population of underrepresented minority (URM) physicians in the workforce also directly improves health care for medically underserved populations from all racial and ethnic backgrounds, as studies have shown that physicians from URM backgrounds are more likely to work with these patients.”

Administrators are often tasked with the difficult job of creating a cohesive group of emergency physicians to meet the needs of the community they serve.  Strategies to diversify that workforce would benefit from a multi-level approach, including the following:

• Focus on the high school and college pipeline to increase the number of URM entering the field of medicine and emergency medicine more specifically.
• Make a conscious effort to recruit and interview URM candidates for open positions.
• In meetings, ask specific questions from individuals whose voices are often marginalized.
• In group settings, pay attention to your physical position; if you are a White male, let your URM colleagues position themselves at the head of the table.

 Small steps can create big changes.

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In a recent study of emergency physicians (EPs) who left the workforce between 2013 and 2020, authors sought to investigate their age and number of years since residency graduation for males and females.

A total of 25,839 (70.2%) male and 10,954 (29.8%) female EPs were included.

Female gender (adjusted odds ratio 2.30) was significantly associated with attrition from the workforce.

Of those who left the workforce, the median number of years after residency that males left was 17.5, as compared with only 10.5 years for females.

Furthermore, among those who exhibited attrition, one in 13 males and one in 10 females exited clinical practice within 5 years of residency graduation.

As authors emphasize, these data identify widespread gender-based disparities regarding EM workforce attrition that are critical to address to ensure stability, longevity, and diversity in the EP workforce.

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Clinician Well-Being and the Patient Experience

Did you know that most patient experience responses are overwhelmingly positive?  Rather than focusing all our attention on the bad, let’s focus on the good to promote clinician well-being.  See below for a few key points from a recent study on this:

• Physicians worry that the people who respond to patient experience surveys are more likely to be critical of their care.  The opposite is actually true.
• The authors found a 4:1 positive-to-negative ratio among 2.2 million patient experience responses collected by these authors.
• Physicians and everyone else in health care are deeply motivated by the experience of giving good, patient-centered care.

Consider emphasizing positive patient experiences when providing feedback to emergency physicians.  It will promote clinician well-being and help improve performance in your practice.

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