Faculty Bibliography

Little research has examined the health-related social needs of emergency department (ED) patients who have HIV. We surveyed a random sample of public hospital ED patients and compared the social needs of patients with and without HIV. Social needs were high among all ED patients, but patients with HIV reported significantly higher levels of food insecurity (65.0% vs. 50.3%, p = 0.01) and homelessness or living doubled up (33.8% vs. 21.0%, p < 0.01) than other patients. Our findings suggest the importance of assessing social needs in ED-based interventions for patients with HIV.

STUDY OBJECTIVE/OBJECTIVE:Housing instability is prevalent among emergency department (ED) patients and is known to adversely affect health. We aim to determine the incidence and timing of homeless shelter entry after an ED visit among patients who are not currently homeless. METHODS:We conducted a random-sample survey of ED patients at an urban public hospital from November 2016 to September 2017. Patients provided identifying information and gave informed consent for us to link their survey data with the New York City Department of Homeless Services shelter database. Shelter use was followed prospectively for 12 months after the baseline ED visit. We examined timing of shelter entry in the 12 months after the ED visit, excluding patients who were homeless at baseline. RESULTS:Of 1,929 unique study participants who were not currently homeless, 96 (5.0%) entered a shelter within 12 months of their baseline ED visit. Much of the shelter entry occurred in the first month after the ED visit, with continued yet slower rates of entry in subsequent months. Patients in our sample who entered a shelter were predominantly men and non-Hispanic black, and commonly had past shelter and frequent ED use. CONCLUSION/CONCLUSIONS:In this single-center study, 5.0% of urban ED patients who were not currently homeless entered a homeless shelter within the year after their ED visit. Particularly if replicated elsewhere, this finding suggests that ED patients may benefit from efforts to identify housing instability and direct them to homelessness prevention programs.

INTRODUCTION/BACKGROUND:It is difficult to determine illness severity for coronavirus disease 2019 (COVID-19) patients, especially among stable-appearing emergency department (ED) patients. We evaluated patient outcomes among ED patients with a documented ambulatory oxygen saturation measurement. METHODS:This was a retrospective chart review of ED patients seen at New York University Langone Health during the peak of the COVID-19 pandemic in New York City. We identified ED patients who had a documented ambulatory oxygen saturation. We studied the outcomes of high oxygen requirement (defined as >4 liters per minute) and mechanical ventilation among admitted patients and bounceback admissions among discharged patients. We also performed logistic regression and compared the performance of different ambulatory oxygen saturation cutoffs in predicting these outcomes. RESULTS:Between March 15-April 14, 2020, 6194 patients presented with fever, cough, or shortness of breath at our EDs. Of these patients, 648 (11%) had a documented ambulatory oxygen saturation, of which 165 (24%) were admitted. Notably, admitted and discharged patients had similar initial vital signs. However, the average ambulatory oxygen saturation among admitted patients was significantly lower at 89% compared to 96% among discharged patients (p<0.01). Among admitted patients with an ambulatory oxygen saturation, 30% had high oxygen requirements and 8% required mechanical ventilation. These rates were predicted by low ambulatory oxygen saturation (p<0.01). Among discharged patients, 50 (10%) had a subsequent ED visit resulting in admission. Although bounceback admissions were predicted by ambulatory oxygen saturation at the first ED visit (p<0.01), our analysis of cutoffs suggested that this association may not be clinically useful. CONCLUSION/CONCLUSIONS:Measuring ambulatory oxygen saturation can help ED clinicians identify patients who may require high levels of oxygen or mechanical ventilation during admission. However, it is less useful for identifying which patients may deteriorate clinically in the days after ED discharge and require subsequent hospitalization.

New York City (NYC) has emerged as the global epicenter for the COVID-19 pandemic. The NYC Public Health System (NYC Health +Hospitals, NYC H + H) was key to the city's response because its vulnerable patient population was disproportionately affected by the disease. As cases rose in the city, NYC H+H carried out plans to greatly expand critical care capacity. Primary ICU spaces were identified and upgraded as needed, while new ICU spaces were created in emergency departments (EDs), procedural areas, and other inpatient units. Patients were transferred between hospitals in order to reduce strain. Critical care staffing was supplemented by temporary recruits, volunteers, and military deployments. Supplies to deliver critical care were monitored closely and obtained as needed to prevent interruptions. An ED action team was formed to ensure that the experience of frontline providers was informing network level decisions. The steps taken by NYC H+H greatly expanded its capacity to provide critical care during an unprecedented surge of COVID-19 cases in NYC. These steps, along with lessons learned, could inform preparations for other health systems during a primary or secondary surge of cases. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].

BACKGROUND:While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally ac-cepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospital received multiple injured patients within minutes; lessons learned included the need for a formal-ized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS:After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for multiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS:In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in orga-nizing diagnostic and therapeutic triage. CONCLUSIONS:During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.

BACKGROUND:While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally accepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospi-tal received multiple injured patients within minutes; lessons learned included the need for a formalized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS:After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for hmultiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS:In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in organizing diagnostic and therapeutic triage. CONCLUSIONS:During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.

Background: The work of ED physicians is complex, with increasing patient volumes, rapidly changing EHRs, and growing documentation regulations. Medical scribes aim to address these problems, workflow efficiency, job satisfaction, and increase reimbursements. Despite the advantages, facilities remain resistant to adopting a scribe program for several reasons, including cost, addition of ED personnel, and incorporation new roles within an established workflow. Looking to minimize challenges, we propose modified telescribes utilizing a pre-established, qualified volunteer program. Workflow consists of providers connecting to telescribes via audio/video from secure mobile devices. Proper consent is obtained and telescribes document patient interactions in real time. Providers reap benefits of note drafting and volunteers gain valuable education only obtainable through collaboration with ED providers. Objectives: Assess physician, hospital volunteer, and patient receptiveness to scribes and telescribes. Methods: A survey was sent to 88 attendings (RR=29%) and 59 residents (RR=39%) employing yes/ no, multiple choice, and Likert scale questions to assess receptivity to scribes and telescribes; no supplemental information. A second survey evaluated hospital volunteers' desire to participate (n=50; RR=44%). A third survey (n=12) gauged patient responses to both scribes and telescribes services using a likert scale after a brief explanation of the services. Results: Of providers surveyed, 84% never used a traditional scribe or telescribe, while 85% indicated a desire to work with them. Furthermore, 95% agreed that learning to use a scribe would benefit them in the future and 75% agreed to adjust workflow to accommodate a scribe. Despite willingness to use a traditional scribe, 45% indicated they would not use the telescribe service (free-text rationales related to inconvenience). Secondly, 95% hospital volunteer respondents were interested in the scribe position. Finally, a patient survey showed zero were uncomfortable with presence of a scribe and 16% and 25% were uncomfortable with an audio or video scribe, respectively. Conclusion: Our results indicate patients and providers are more comfortable with a traditional scribe model and implementation of a telescribe model requires addressing workflow and privacy concerns of provider and patient

BACKGROUND: Mobile devices have been shown to assist patients with comprehension of health information, yet sparse data exist on what mobile devices patients own and preferences for receiving health information. OBJECTIVES: To determine the prevalence of mobile devices capable of receiving health information among patients/visitors presenting to an urban Emergency Department (ED). METHODS: A random sample of patients/visitors >/=18 years was surveyed. The primary outcome was prevalence of mobile devices capable of receiving health information among patient/visitor units presenting to the ED. Means and 95% confidence intervals were derived for continuous data; proportions with Fisher's exact 95% confidence intervals were derived for categorical data. Institutional review board approval was received before study initiation. RESULTS: Surveyors approached 1307 subjects: 68% (885) were eligible; 70% (620) agreed to participate; 4 participants were excluded, leaving 70% (616) in the final sample. Of the 616 participants, 82% stated cell phone ownership (95% confidence interval [CI] 0.79-0.85). Among cell phone owners (n = 507), 90% had the device with them (95% CI 0.87-0.92) in the ED. Of these participants (n = 456), 77% had text messaging (95% CI 0.73-0.81), 51% had Internet (95% CI 0.47-0.56), 51% had e-mail (95% CI 0.46-0.56), 39% could download audio content (95% CI 0.34-0.43), and 35% could download videos (95% CI 0.31-0.40). Even among those having an annual income