American College of Emergency Physicians

Objectives: Emergency Departments (EDs) across the US vary widely in resources and availability of specialty consultation. Access to neurology expertise during acute stroke care may influence treatment decisions that impact patient outcomes. We investigated whether hospital-level differences in Neurology access during ED stroke codes were associated with hospital performance on 30-day stroke mortality rates. Methods: We used data from EDs participating in the Emergency Quality Network (E-QUAL) Stroke Collaborative between 2022 and 2024, linked to CMS data for 30-day stroke mortality reported as of June 30, 2023. The primary independent variable was Neurology access during ED stroke code activation, categorized as: in-person, telestroke, or phone/no Neurology. We performed descriptive analysis and linear regression to examine the relationship between Neurology access and 30-day stroke mortality, adjusting for ED annual stroke volume, rurality, participation in a stroke registry, and disposition practices for thrombolysis-treated patients. Results: Among the 52 EDs, Neurology was available during a stroke code in person for 48.1% of EDs, by telestroke for 38.4%, and by phone or not at all for 13.5%. Mean 30-day stroke mortality was 13.1% (standard deviation [SD] 1.7%) for EDs with in-person Neurology, 14.0% (SD 1.8%) for telestroke, and 15.2% (SD 1.2%) for phone/no Neurology (Figure). In both unadjusted and adjusted analyses, EDs with phone/no Neurology had higher 30-day stroke mortality compared to in-person access (adjusted: +1.7%, p = 0.02), while 30-day mortality for EDs with telestroke was not significantly different from in-person Neurology (Table). Independent of neurology access, rural EDs had higher stroke mortality compared to non-rural EDs (adjusted: +2.8%, p = 0.006). Stroke volume, participation in a stroke registry, and disposition of thrombolysis-treated patients were not significantly associated with mortality. Conclusion: Limited access to Neurology expertise during ED stroke codes was associated with higher 30-day stroke mortality for community hospitals. However, consistent with prior research, EDs with telestroke demonstrated comparable outcomes to EDs with in-person Neurology. These findings underscore the importance of addressing gaps in access to Neurology expertise in community EDs for ensuring optimal stroke outcomes for all patients and highlight the value of telestroke as a tool to do so.

The American healthcare system is amid a burnout epidemic, worsened by COVID, that must be addressed expeditiously and with high priority. The burden Emergency Physicians encountered before and during the pandemic is well known, with countless healthcare workers exiting the work force. A Chief Wellness Officer (CWO) is a senior leader who works primarily to cultivate organisational wellness and to foster and promote a culture of well-being throughout an institution. Specifically, the CWO assists the health system leadership promote clinician engagement and address clinician burnout. This paper explores the status of existing CWOs, and cites the benefits, impacts, and barriers to implementation of a CWO, with focus on the field of Emergency Medicine (EM). A steering committee of wellness experts was formed from a national EM organisation. A purposive search and literature review using search terms relating to CWOs was completed. Publications were examined for relevance and recency. The committee created an online questionnaire surveying current US CWOs, conducted personal interviews, and met through regular focused meetings. A framework delineating the role of a CWO as an organisation evolves from instituting novice wellness interventions to expert organisational innovations was created. Despite their title, CWOs are not regularly included in c-suite decisions. Barriers to instituting a CWO include perceived financial cost, the medical system itself, and physician resistance. Defining and measuring objective return on investment may be a solution to overcoming barriers. CWOs who create comprehensive institutional wellness innovations bring organisations to the highest proficient and expert levels of wellness practices, positively affecting physician engagement and deflecting burnout. CWOs instituting novice and beginner levels of wellness interventions, especially in EM, only modestly impact individual wellness practices. A CWO and team with an organisational voice and a C-suite stakeholder's seat are essential to centralising and leading effective wellness efforts and innovations in EM and other specialities. This team will improve the work environment and culture and begin to fix our broken healthcare system and providers.

IntroductionTrainees underrepresented in medicine (URiM) face additional challenges seeking community in predominantly white academic spaces, as they juggle the effects of institutional, interpersonal, and internalized racism while undergoing medical training. To offer support and a space to share these unique experiences, mentorship for URiM trainees is essential. However, URiM trainees have limited access to mentorship from URiM faculty. To address this gap, we developed a national virtual mentoring program that paired URiM trainees interested in emergency medicine (EM) with experienced mentors.MethodsWe describe the implementation of a virtual Diversity Mentoring Initiative (DMI) geared toward supporting URiM trainees interested in EM. The program development involved 1) partnering of national EM organizations to obtain funding; (2) identifying a comprehensive platform to facilitate participant communication, artificial intelligence-enabled matching, and ongoing data collection; 3) focusing on targeted recruitment of URiM trainees; and (4) fostering regular leadership meeting cadence to customize the platform and optimize the mentorship experience.ConclusionWe found that by using a virtual platform, the DMI enhanced the efficiency of mentor-mentee pairing, tailored matches based on participants’ interests and the bandwidth of mentors, and successfully established cross-institutional connections to support the mentorship needs of URiM trainees.