The primary objective of this study was to investigate providers’ perceived impact - PowerPoint Presentation

1. The primary objective of this study was to investigate providers’ perceived impact of shift work on quality of care given in emergency departments in both rural and urban settings.The study focuses on the demographic of emergency medicine physicians, physician assistants, and advanced practice registered nurses in two urban and tow rural facilities in Kentucky. PURPOSE OF STUDY•The study sample consisted of emergency medicine providers including physicians, physician assistants, and advanced practice registered nurses  each employed at University of Kentucky Chandler Hospital,  University of Kentucky Good Samaritan Hospital, Clark Regional Medical Center, and Bourbon Community Hospital in Kentucky. The University of Kentucky Institutional Review Board approved the conduction of this research.•The survey was conducted using a Likert scale. The survey had 17 questions that investigated the healthcare providers' perceptions of shift work, job satisfaction, staffing and resources, as well as quality of care.   The survey was designed to be unbiased and to avoid leading participants towards a specific  answer.  Positive or negative language was  avoided when asking questions regarding shift work so that providers would not be inclined to answer a certain way. Anonymous voluntary survey responses were collected via electronic QR codes through the  online database powered by Qualtrics. The data was then exported for analysis into the R software package.•A p-value of less than .05 was  considered statistically significant.METHODSRESULTSBarger LK, Ayas NT, Cade BE, et al. Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. PLoS Med. 2006;3(12):e487. doi:10.1371/journal.pmed.0030487 Brown C, Abdelrahman T, Lewis W, Pollitt J, Egan R; members of the Welsh Surgical Research Initiative. To bed or not to bed: the sleep question?. Postgrad Med J. 2020;96(1139):520-524. doi:10.1136/postgradmedj-2018-135795 Dall'Ora C, Ball J, Recio-Saucedo A, Griffiths P. Characteristics of shift work and their impact on employee performance and wellbeing: A literature review. Int J Nurs Stud. 2016;57:12-27. doi:10.1016/j.ijnurstu.2016.01.007 Ferguson B, Lauriski D, Huecker M, Wichmann M, Shreffler J, Shoff H. Testing Alertness of Emergency Physicians: A Novel Quantitative Measure of Alertness and Implications for Worker and Patient Care. J Emerg Med. 2020;58(3):514-519. doi:10.1016/j.jemermed.2019.10.032Frank, J. and Ovens, H., 2002. Shiftwork and emergency medical practice. CJEM, 4(06), pp.421-428REFERENCESAn Exploratory Study of Perception of Quality of Care among Providers in Rural and Urban Emergency DepartmentsJana Chadwell, Robert Dorris, Caroline Lynch, Kelly McCormick, Caitlin Mott, Ana Stone, Oleva C. Mullins PA-C, MSPASThe only statistically significant finding that the data revealed was there was a difference in the staffing and resources perceived in rural vs urban emergency departments. The rural locations reported a lower average score (3.6) than the urban locations (4.5). There were not significant differences found between rural and urban in regards to questions about the quality of care provided. The study showed that there are many similar struggles faced by both. Both urban and rural locations reported that the care providers give are not perceived to be affected by shift work. This indicates that similar challenges exist in both rural and urban facilities, and may be related more to shift work itself rather than the environment. This research is of utmost importance to the medical literature as it helps to highlight the differences in how providers perceive staffing and resources in urban compared to rural settings.Informing the public of the potential pitfalls of shift work in the Emergency Department may encourage new policies and process improvement (for example, encouraging employers to reach out more to their urban facilities and offer resources), further analysis of the demands placed on providers, and further exploration of possible disparities between rural and urban.DISCUSSIONCONCLUSIONA total of 17 Questionnaires were completed and submitted using the two different QR codes into Qualtrics. 10 were from urban hospitals and 7 from rural hospitals. The following survey table shows the mean data of urban vs. Rural responses as well as the total.The term “shift work” refers to a work schedule that falls outside of the hours of 7 am and 6 pm. Shift work is essential for facilities to be operating 24 hours a day, 7 days a week. Shift work in a healthcare setting allows for the transition of care and information to  be passed along between providers. Providers in the emergency department have particularly unpredictable schedules when it comes to consistent days, times, and lengths of shifts. Shift work has been correlated with sleep deficits, family life, patient safety, and increase in errors.1,2,3,4 This research is crucial in understanding how different work schedules for providers, and subsequently their awareness of their fatigue, mental exhaustion, and burnout, can affect the quality of care that patients receive in the emergency room.INTRODUCTIONItemMean RuralMean UrbanMean TotalQ1 – Overall I am satisfied with my career in Emergency Medicine.4.34.64.5Q2 – Shift work is the best schedule for my career choice.4.44.04.2Q3 – There are adequate staffing and resources during my shift in order to provide quality patient care3.64.54.1Q4 - Shift work negatively influences my job satisfaction1.83.72.2Q5 – Shift work impacts my provider/patient relationship in a negative way1.71.71.7Q6 - I have difficulty maintaining a normal sleep schedule when I am not working.2.63.83.3Q7 - Appropriate use of aids (antidepressants, sleep-aids, anxietymedication) is helpful for sleep/stress due to shift work.1.03.22.8Q8 - Shift work negatively influences my mental health. (i.e. stress, depression, problems with emotions)2.62.62.6Q9 - I receive an adequate number of mental breaks during my shift2.42.92.7Q10- I provide the same level of empathy at the beginning and end of my shift2.93.23.1Q11– I provide the same quality of care at the beginning and end of my shift.4.43.84.1Q12 – I am able to give adequate care to each patient throughout the shift.4.34.34.3Q13 –Shift work has a higher risk of errors as compared to consistent/regular working time2.12.12.1Q14 – Overall, shift work interferes with my ability to physically and mentally care for my patients adequately.1.71.51.6Q15 – Having breaks between my shifts gives me adequate time to recover.3.94.03.9Q16 –Upon completion of a shift, I feel satisfied with the quality of care I provided to my patients4.74.34.5Chi-Square TestsValuedfAsymptotic Significance (2-sided)Pearson Chi-Square6.826a2.033Likelihood Ratio8.9752.011Number of Valid Cases17a. 6 cells (100.0%) have expected count less than 5. The minimum expected count is 1.65.Symmetric MeasuresValueApproximate SignificanceNominal by NominalPhi.634.033Cramer's V.634.033Number of Valid Cases17The results were statistically significant in showing that those working in the ED in rural settings felt that they had less adequate staff and resources than their urban counterparts with a p value of < 0.033, a likelihood ratio of 8.975, and a Cramer’s V value of 0.634. This value indicates a strong association. As far as the other survey questions, the results did not show statistically significant differences between rural and urban settings.SUMMARY OF RESULTSEmergency MedicineThis study set out to investigate providers’ perceived impact of shift work on quality of care given in emergency departments in both rural and urban settings. The study found one statistically significant finding: those working in the ED in rural settings felt that they had less adequate staff and resources that their urban counterparts, as outlined above. There were no significant differences found between rural and urban provider's perceived quality of care. s have the support they need to give the highest quality of care possible  in these areas. This research encourages employers of all facilities, regardless of geographic location, to consider how their shift scheduling will affect  providers and, ultimately, patients. Finally, this research is intended to simply inform providers, students who are soon to become providers, employers, and patients of the potential impact that shift work has on perception of quality of care. Our data revealed there was little difference between rural and urban hospital responses. The mean data correlation between question 3, 11, 12, and 14 showed the relationship between provider and patient was rarely impacted by shift work in a negative way. For question 1, all but one responded with overall satisfaction with their career choice in emergency medicine. The outlier clarified by stating they felt shift work negatively impacted long term to professional burnout and fatigue. Question 3 revealed a disconnection between rural and urban hospitals in the mean data. Rural responses were not as positive as urban responses about adequate staffing.