Browsing by Author "Haut, Lindsey"

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    Assessment Of Need For Trauma Education For Pediatric Residents In The Emergency Department, And Creation Of A Video Module In Response
    (2020-03-06) Whitehead, Anne; Phillips, Brian; Haut, Lindsey
    Introduction: Over 200 learners rotate through our pediatric emergency department yearly, and roughly 130 of them are residents in a pediatrics (categorical or combined) residency program. For many of these residents, the pediatric emergency medicine rotation is one of the only opportunities for experience with pediatric trauma resuscitation. Consistently, residents have identified pediatric trauma as an area of discomfort within their practice. Trauma resuscitations in the emergency department are relatively infrequent, and high stakes, so are not ideal opportunities for novice learners. Simulation exists as part of the curriculum, but scheduling challenges make increasing this portion of the curriculum impractical. We sought to further explore resident experience with trauma resuscitation education, and to create a new approach to trauma education that would supplement the existing curriculum. Methods: We distributed 2 different surveys to all pediatric residents on their pediatric emergency medicine rotation: one prior to the start of the rotation, and one after completion. Survey data were collected anonymously and voluntarily, over the course of 1 year. Based on preliminary survey data and informal discussions with residents and education leadership, we conceived of the idea of a video as a novel educational tool to supplement our existing pediatric trauma curriculum. This would be viewed online, asynchronously, circumventing many of the practical challenges associated with increasing simulation or patient care time. We developed a script with an emphasis on a practical approach to running a pediatric trauma resuscitation. Results: Our survey data found that residents started their pediatric emergency medicine rotations with low confidence in leading trauma resuscitation, rating their confidence an average of 25.1 on a visual analog scale (VAS) from 1 to 100. There was a modest improvement after the rotation to 43.7. Anxiety about trauma resuscitation, however, remained high with a rating of 63.2 on a VAS of 1 to 100 before the rotation, and 62.5 after. At the end of their rotations, residents reported that patient care and simulation sessions both contributed a moderate amount (63.2 and 56.5 respectively on a VAS from 1 to 100), while self study only contributed a little (33.1). In response to these data, we created a trauma education video for residents rotating through the pediatric emergency department. The video was filmed in one of our own trauma resuscitation rooms in the Riley Pediatric Emergency Department with our own nurses and Emergency Medicine/Pediatrics residents, with technical support from IU Collaboration Technologies and Classroom Support. Conclusions: Our survey data confirmed the need for improvement in education on pediatric trauma resuscitation. Results suggest residents find that more “hands on” opportunities contribute more to their education, but there remain significant challenges to increasing these opportunities. We are hopeful that the practical emphasis of our pediatric trauma education video will improve the effectiveness over other self-study modalities already in existence. In the coming months, we intend to incorporate the video into the online education modules and investigate its impact on resident confidence and comfort with pediatric trauma resuscitation.
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    Establishing a Novel Group-based Litigation Peer Support Program to Promote Wellness for Physicians Involved in Medical Malpractice Lawsuits
    (University of California, 2023) Doehring, Marla C.; Strachan, Christian C.; Haut, Lindsey; Heniff, Melanie; Crevier, Karen; Crittendon, Megan; Nault Connors, Jill; Welch, Julie L.; Emergency Medicine, School of Medicine
    Introduction: Being named as a defendant in a malpractice lawsuit is known to be a particularly high-stress and vulnerable time for a physician. Medical malpractice stress syndrome (MMSS) is a consequence of being named as a physician defendant in a malpractice lawsuit. Symptoms include depression, anxiety, and insomnia, which may lead to burnout, loss of confidence in clinical decision-making, substance abuse, strain on personal and professional relationships, and suicidal ideation. Although the legal process requires strict confidentiality regarding the specific details of the legal case, discussing the emotional impact of the case is not prohibited. Given that physicians often do not choose formalized therapy with a licensed professional, there is a recognized need to provide physicians with options to support their wellness during a lawsuit. Methods: The peer support model is a promising option to address the negative impacts to wellness that physician defendants face during medical malpractice lawsuits. We developed and implemented a peer support program to provide a safe, protected space for discussion of the personal impact of a lawsuit and to normalize this experience among peer physicians. Results: Physicians were receptive to joining a peer support group to discuss the personal impacts of being named in a medical malpractice lawsuit. Participants in this novel group-based program found it helpful and would unanimously recommend it to others who are being sued. Conclusion: To our knowledge, this pilot study is the first to implement and assess a facilitated, group-based peer support model for emergency physicians who are named as defendants in malpractice lawsuits. While group discussions demonstrated that symptoms of acute distress and MMSS were prevalent among physicians who were being sued, in this study physicians were receptive to and felt better after peer support sessions. Despite increasing burnout in the specialty of emergency medicine (EM) during the study time frame, burnout did not worsen in participants. Extrapolating from this pilot program, we hypothesize that formal peer support offered by EM groups can be an effective option to normalize the experience of being sued, promote wellness, and benefit physicians who endure the often long and stressful process of a medical malpractice lawsuit.
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    Identification of Bias in Ordering Further Imaging in Ethnic Groups With Indeterminate Ultrasound for Appendicitis
    (Springer Nature, 2022-08-17) Desai, Puja; Haut, Lindsey; Wagers, Brian; Coffee, R. Lane, Jr.; Kelker, Heather; Wyderko, Michael; Sarmiento, Elisa J.; Kanis, Jessica; Emergency Medicine, School of Medicine
    Background: Recent studies have shown a higher incidence of complications from acute appendicitis in Hispanic populations. Hispanic ethnicity alone has been shown to be a risk factor. In contrast, one study found little evidence of racial disparities in complication rates. The objective of this study was to identify physician bias regarding whether ethnicity drives further testing after initial radiologic imaging has been obtained in the evaluation of appendicitis in our pediatric emergency department (PED). The use of computed tomography (CT) scan in the diagnosis of appendicitis was compared between Hispanic versus non-Hispanic populations when ultrasound (US) was indeterminate. Methodology: This is a retrospective cohort study of Hispanic and non-Hispanic patients aged 2-18 who presented to the PED with right lower quadrant abdominal pain over a one-year period (January 1, 2017 to December 29, 2017). Both groups were subdivided into positive, negative, or indeterminate US findings for appendicitis. Each subgroup was analyzed based on those who had CT imaging done. Results: A total of 471 ultrasounds were performed, 162 Hispanic and 309 non-Hispanic patients. Indeterminate US scans were documented in 90/162 (56%) Hispanic versus 155/309 (50%) non-Hispanic patients. Of those with indeterminate US scans, 30% Hispanic versus 32% non-Hispanic patients received CT scans. Negative US scans were documented in 54/162 (33%) Hispanic versus 102/309 (33%) non-Hispanic patients. Of those with negative US scans, 7% Hispanic versus 5% non-Hispanic patients received CT scans. Chi-square analysis comparing both the proportion of CT scans received for indeterminate US scans (p=0.71) and negative US scans (p=0.52) showed no statistical significance. Conclusions: There was no significant difference in the number of CT scans ordered for indeterminate US scans between Hispanic and non-Hispanic patients. One can infer that there is no inherent bias toward ordering advanced imaging in Hispanic children based on ethnicity alone.