Simulating approaches to emergency department pandemic physician staffing during COVID-19

Objective: During pandemics, emergency departments (EDs) are challenged by the need to replace quarantined ED staff and avoid staffing EDs with nonemergency medicine (EM) trained physicians. We sought to design and examine three feasible ED staffing models intended to safely schedule EM physicians to staff three EDs within a health system during a prolonged infectious disease outbreak.Methods: We conducted simulation analyses examining the strengths and limitations of three ED clinician staffing models: two-team and three-team fixed cohort, and three-team unfixed cohort. Each model was assessed with and without immunity, and by varying infection rates. We assumed a 12-week pandemic disaster requiring a 2-week quarantine.Main outcome: The outcome, time to staffing shortage, was defined as depletion of available physicians in both 8- and 12-hour shift duration scenarios. Results: All staffing models initially showed linear physician attrition with higher infection rates resulting in faster staffing shortages. The three-team fixed cohort model without immunity was not viable beyond 11 weeks. The three-team unfixed cohort model without immunity avoided staffing shortage for the duration of the pandemic up to an infection rate of 50 percent. The two-team model without immunity also avoided staffing shortage up to 30 percent infection rate. When accounting for immunity, all models behaved similarly initially but returned to adequate staffing during week 5 of the pandemic. Conclusions: Simulation analyses reveal fundamental tradeoffs that are critical to designing feasible pandemic disaster staffing models. Emergency physicians should test similar models based on local assumptions and capacity to ensure adequate staffing preparedness for prolonged pandemics.

Burnout Among Physicians and Medical Interns: Comparing Time-periods of Coronavirus Disease Outbreak in Shiraz

Background: Physician burnout is a serious issue associated with physician attrition, mental and physical problems, and medical errors. This study aimed to investigate prevalence of overall burnout among Interns-Residents and general physician (GPs)-Specialist during the COVID-19 pandemic in Iran.Methods: This cross-sectional study was conducted among 220 Interns-Residents and 212 GPs-Specialists in university affiliated hospitals and clinics in Shiraz, Iran. A random sampling method used to recruit the samples and the data gathered using a valid questionnaire. We used covariance analysis and multiple logistic regression to analyze the data.Results: Multiple logistic regression for GPs-Specialists showed that working in COVID-19 wards during June-July (OR = 13.93) was associated with increasing odds of overall burnout. However, older age was associated with decrease odds overall burnout (OR = 0.94). Multiple logistic regression for Interns-Residents revealed that age (OR = 1.24) and being single (OR = 1.66) were positively associated with overall burnout.Conclusions: The present finding could remind policy makers the importance of burnout issue among physicians during the pandemics and could persuade them for taking appropriate action in order to prevent this phenomenon. It is suggested that focusing on strategies such as improving organizational resilience, improvement of healthcare working environment, and development of coping skills among physicians could be helpful in this regard.

Clinical Research in the ICU

In times of shrinking departmental budgets, physician attrition, restricted house staff work hours, and reductions in grant funding, there has been a trend towards migration of physicians away from academic medicine. Creative solutions to maintain clinical research programs are frequently necessary. At the University of California Irvine Medical Center, a clinical research program has been created that has allowed research to both survive and thrive in challenging times. The MICU Research Associates Program (MICU-RAP) provides a longitudinal experience for select undergraduate students to facilitate research as part of the MICU team while receiving academic credit and valuable experience. The MICU-RAP student coordinator and faculty advisor work together to recruit research associates, organize weekly meetings, create and implement research protocols, and mentor students and future physician-scientists. Student research associates are trained to develop and maintain a secure database, assist in the authorship of IRB protocols, aid in statistical analyses, and co-author abstracts, posters, and papers. In addition to the research, the MICU-RAP students are exposed to experiences meant to educate and prepare them for a career in health care. A coordinated group of student researchers can provide a significant piece of the infrastructure that physicians wishing to build or sustain a research career need to carry out clinical research when resources are scarce.