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Rixon A, Elder E, Bull C, Crilly Oam J, Østervan C, Frieslich H, Robertson S, Pink E, Wilson S. Leadership conceptions of nurses and physicians in emergency care: A scoping review. Int Emerg Nurs 2024; 74:101454. [PMID: 38677058 DOI: 10.1016/j.ienj.2024.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The Emergency Department (ED) is a setting where teamwork and leadership is imperative, however, the literature to date is mostly discipline (nursing or medical) specific. This scoping review aimed to map what is known about nurses' and physicians' conceptions of leadership in the ED to understand similarities, differences, and opportunities for leadership development and research. METHOD Guided by the Joanna Briggs Institute approach, and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines, a systematic search of three electronic databases was performed. The Mixed Methods Assessment Tool was used for quality appraisal of included articles. RESULTS In total, 37 articles were included. Four key findings emerged: 1) leadership was rarely explicitly defined; 2) nurse leaders tended to be characterised as agents of continuity whilst physician leaders tended to be characterised as agents of change and continuity; 3) the clarification of expectations from nurse leaders was more evident than expectations from physician leaders; and 4) leadership discourse tended to be traditional rather than contemporary. CONCLUSION Despite the proliferation of studies into ED nurse, physician and interprofessional leadership, opportunities exist to integrate learnings from other sectors to strengthen the development of current and next generation of ED leaders.
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Affiliation(s)
- Andrew Rixon
- Department of Business Strategy and Innovation - Griffith Business School, Griffith University, Gold Coast, Queensland, Australia; Centre for Work, Organisation and Wellbeing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Elizabeth Elder
- Centre for Work, Organisation and Wellbeing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Claudia Bull
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Julia Crilly Oam
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Christina Østervan
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Hayley Frieslich
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Shaun Robertson
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Ed Pink
- QEII Hospital, Brisbane, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Samuel Wilson
- Department of Management and Marketing, Swinburne Business School, Swinburne University of Technology, Melbourne, Australia
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Sera T, Otani N, Bannai H, Hasegawa T, Umemura T, Honda H, Kimura A. The current status of emergency departments in secondary emergency medical institutions in Japan: a questionnaire survey. Int J Emerg Med 2023; 16:40. [PMID: 37353768 DOI: 10.1186/s12245-023-00513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND While emergency medicine (ER)-based emergency care is prevalent in many countries, in Japan, the "department-specific emergency care model" and the "emergency center model" are mainstream. We hypothesized that many secondary emergency medical institutions in Japan have inadequate systems. Using a questionnaire, we investigated the status of and problems in the emergency medical services system in secondary emergency medical institutions in Japan. Until date, there has not been an exhaustive survey of emergency facilities on a countrywide scale. The main objective of this study was to investigate problems in the Japanese emergency medical services system and thereby improve optimal care for emergency patients. RESULTS A nationwide questionnaire survey involving 4063 facilities (all government-approved emergency medical facilities certified by prefectural governors) in Japan was conducted. Of the facilities that responded, all secondary emergency facilities were included in the analysis. Responses from 1289 facilities without a tertiary emergency medical care center were analyzed. Among them, 61% (792/1289) had ≤ 199 beds, and 8% were emergency department specialty training program core facilities. Moreover, 42% had an annual patient acceptance number of ≤ 500, 19% did not calculate the number of acceptances, 29% had an acceptance rate of ≥ 81%, and 25% had an acceptance rate of 61-80%. Pregnant women (63%) and children (56%) were the major types of patients that affected the acceptance rate. Factors affecting facilities with a response rate of 81% or higher were "hospitals designated for residency training" and "facilities making some efforts to improve the quality of emergency care and the emergency medical system" (logistic analysis, P < .001). CONCLUSION Relevant authorities and core regional facilities should consider and implement specific measures for regions and hospitals with a shortage of emergency medicine specialists and physicians (e.g., development of ER-based emergency medicine and provision of education). This study may lead to further improvement in the optimal care of emergency patients through the nationwide establishment of the proposed measures as well as through grouping and integrating the structures and systems in emergency and other medical facilities.
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Affiliation(s)
- Toshiki Sera
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Hideo Bannai
- Division of Data Science Algorithm Design and Analysis M&D Data Science Center, Tokyo Medical and Dental University, 2-3-10 Kandasurugadai, Chiyoda-Ku, Tokyo, 101-0062, Japan
| | - Takanori Hasegawa
- Department of Integrated Analytics M&D Data Science Center, Tokyo Medical and Dental University, 2-3-10 Kandasurugadai, Chiyoda-Ku, Tokyo, 101-0062, Japan
| | - Takehiro Umemura
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-Cho, Okina, 903-0215, Japan
| | - Hideki Honda
- Department of Emergency and Critical Care Medicine, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka-City, Kanagawa, 238-0018, Japan
| | - Akio Kimura
- Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
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Torres Perez-Iglesias C, Hill SK, Jhunjhunwala R, A-Baki I, Uribe-Leitz T, Park KB, Ruales J, Borrero Vega A. Strengthening surgical, obstetric, and anesthesia care in the Americas: a call to action. LANCET REGIONAL HEALTH. AMERICAS 2023; 22:100499. [PMID: 37214771 PMCID: PMC10193224 DOI: 10.1016/j.lana.2023.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023]
Affiliation(s)
| | - Sarah K. Hill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Rashi Jhunjhunwala
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Ivonne A-Baki
- Embassy of Ecuador to the United States of America, Washington, USA
| | - Tarsicio Uribe-Leitz
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Kee B. Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Jose Ruales
- Ministry of Health of Ecuador, Quito, Ecuador
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Haidar DA, Peterson WJ, Minges PG, Carnell J, Nomura JT, Bailitz J, Boyd JS, Leo MM, Liu EL, Duanmu Y, Acuña J, Kessler R, Elegante MF, Nelson M, Liu RB, Lewiss RE, Nagdev A, Huang RD. A consensus list of ultrasound competencies for graduating emergency medicine residents. AEM EDUCATION AND TRAINING 2022; 6:e10817. [PMID: 36425790 PMCID: PMC9677397 DOI: 10.1002/aet2.10817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Emergency ultrasound (EUS) is a critical component of emergency medicine (EM) resident education. Currently, there is no consensus list of competencies for EUS training, and graduating residents have varying levels of skill and comfort. The objective of this study was to define a widely accepted comprehensive list of EUS competencies for graduating EM residents through a modified Delphi method. METHODS We developed a list of EUS applications through a comprehensive literature search, the American College of Emergency Physicians list of core EUS benchmarks, and the Council of Emergency Medicine Residency-Academy of Emergency Ultrasound consensus document. We assembled a multi-institutional expert panel including 15 faculty members from diverse practice environments and geographical regions. The panel voted on the list of competencies through two rounds of a modified Delphi process using a modified Likert scale (1 = not at all important, 5 = very important) to determine levels of agreement for each application-with revisions occurring between the two rounds. High agreement for consensus was set at >80%. RESULTS Fifteen of 15 panelists completed the first-round survey (100%) that included 359 topics related to EUS. After the first round, 195 applications achieved high agreement, four applications achieved medium agreement, and 164 applications achieved low agreement. After the discussion, we removed three questions and added 13 questions. Fifteen of 15 panelists completed the second round of the survey (100%) with 209 of the 369 applications achieving consensus. CONCLUSION Our final list represents expert opinion on EUS competencies for graduating EM residents. We hope to use this consensus list to implement a more consistent EUS curriculum for graduating EM residents and to standardize EUS training across EM residency programs.
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Affiliation(s)
- David A. Haidar
- Department of Emergency MedicineMichigan MedicineAnn ArborMichiganUSA
| | | | - Patrick G. Minges
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Jennifer Carnell
- Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Jason T. Nomura
- Department of Emergency Medicine, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - John Bailitz
- Department of Emergency Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Jeremy S. Boyd
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Megan M. Leo
- Department of Emergency MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - E. Liang Liu
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Youyou Duanmu
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Josie Acuña
- Department of Emergency MedicineUniversity of ArizonaTucsonArizonaUSA
| | - Ross Kessler
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Marco F. Elegante
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Mathew Nelson
- Department of Emergency MedicineZucker Northwell School of Medicine, Northwell HealthManhassetNew YorkUSA
| | - Rachel B. Liu
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Resa E. Lewiss
- Department of Emergency Medicine, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Arun Nagdev
- Department of Emergency MedicineHighland Hospital, Alameda Health SystemOaklandCaliforniaUSA
| | - Rob D. Huang
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Maldonado A, Patiño AM, Kearney AS, Tipán D, Chavez-Flores V, Banks M, Boggs KM, Camargo CA. Emergency Department Characteristics and Capabilities in Quito, Ecuador. Ann Glob Health 2021; 87:37. [PMID: 33868969 PMCID: PMC8034401 DOI: 10.5334/aogh.3129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Emergency care is an essential part of a health system. Ecuador has recognized emergency medicine as a specialty and has two emergency medicine residency training programs. However, little has been published about emergency department characteristics and capabilities in Ecuador. Objective We described the characteristics and capabilities of emergency departments (EDs) in Quito, Ecuador, in 2017, using the National Emergency Department Inventory (NEDI) survey. Methods The 23-item survey included questions pertaining to ED characteristics, including: visit volume, physical and administrative structure, clinical capabilities, technological resources, and consult personnel availability. This study included all EDs in Quito operating 24 hours/day, 7 days/week, and serving all patients seeking care. One representative from each ED was asked to complete the survey based on calendar year 2017. Findings Thirty EDs met the inclusion criteria, and 26 completed the survey (87% response). The median number of ED beds was 17 (range 2-61). Median annual visit volume was 22,580 (range 1,680 to 129,676). All but two EDs provided care for both children and adults. Cardiac monitors were available in 88% of EDs, CT scanners in 68%, and rooms for respiratory isolation in 31%. Most EDs could manage patients with general medicine (92%), general surgery (92%), and gynecology (88%) emergencies 24/7. Fewer were able to provide hand surgery (45%) and dental (28%) care 24/7. Typical length of stay was 1-6 hours in 65% and >6 hours in 31% of EDs. Half of EDs reported operating at full capacity and 27% reported operating over their capacity. When compared to private EDs, government EDs (public and social security) had a higher mean number of visits per year (50,090 government vs. 13,968 private, p < 0.001), higher mean number of ED beds (36 government vs. 9 private, p = 0.002), and higher length of stay (58% of patient stays > 6 hours in government EDs vs. 86% of patient stays 1-6 hours in private EDs, p = 0.009). Conclusions EDs in Quito varied widely with respect to annual visit volume, ability to treat different pathologies 24/7, and resources. Most EDs are functioning at or over capacity, and a substantial number have long lengths of stay. Further research and investment in emergency care could help increase the capacity and efficiency of EDs in Ecuador.
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Affiliation(s)
- Augusto Maldonado
- Department of Emergency Medicine, Hospital General Docente Calderón, Universidad San Francisco de Quito, Quito, Ecuador
| | - Andrés M. Patiño
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - Alexis S. Kearney
- Department of Emergency Medicine, Brown University, Providence, RI, US
| | - Diana Tipán
- Hospital General IESS Quito Sur, Quito, Ecuador
| | | | - Michaela Banks
- Louisiana State University School of Medicine, New Orleans, LA, US
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