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      Availability and use of institutional support programs for emergency department healthcare personnel during the COVID-19 pandemic

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          Abstract

          Objectives

          The COVID-19 pandemic placed health care personnel (HCP) at risk for stress, anxiety, burnout, and post-traumatic stress disorder (PTSD). To address this, hospitals developed programs to mitigate risk. The objectives of the current study were to measure the availability and use of these programs in a cohort of academic emergency departments (EDs) in the United States early in the pandemic and identify factors associated with program use.

          Methods

          Cross-sectional survey of ED HCP in 21 academic EDs in 15 states between June and September 2020. Site investigators provided data on the availability of 28 programs grouped into 9 categories. Individual support programs included: financial, workload mitigation, individual COVID-19 testing, emotional (e.g., mental health hotline), and instrumental (e.g., childcare) Clinical work support programs included: COVID-19 team communication (e.g., debriefing critical incident), patient-family communication facilitation, patient services (e.g., social work, ethics consultation), and system-level exposure reduction. Participants provided corresponding data on whether they used the programs. We used generalized linear mixed models clustered on site to measure the association between demographic and facility characteristics and program use.

          Results

          We received 1,541 survey responses (96% response rate) from emergency physicians or advanced practice providers, nurses, and nonclinical staff. Program availability in each of the 9 categories was high (>95% of hospitals). Program use was variable, with clinical work support programs used more frequently (28–50% of eligible HCP across categories) than individual employee support programs (6–13% of eligible HCP across categories). Fifty-seven percent of respondents reported that the COVID-19 pandemic had affected their stress and anxiety, and 12% were at elevated risk for PTSD. Program use did not significantly differ for HCP who reported symptoms of anxiety and/or stress compared to those who did not.

          Conclusions

          Early in the pandemic, support programs were widely available to ED HCP, but program use was low. Future work will focus on identifying barriers and facilitators to use and specific programs most likely to be effective during periods of highest occupational stress.

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          Most cited references40

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          Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

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            Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic

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              No Adjustments Are Needed for Multiple Comparisons

              Adjustments for making multiple comparisons in large bodies of data are recommended to avoid rejecting the null hypothesis too readily. Unfortunately, reducing the type I error for null associations increases the type II error for those associations that are not null. The theoretical basis for advocating a routine adjustment for multiple comparisons is the "universal null hypothesis" that "chance" serves as the first-order explanation for observed phenomena. This hypothesis undermines the basic premises of empirical research, which holds that nature follows regular laws that may be studied through observations. A policy of not making adjustments for multiple comparisons is preferable because it will lead to fewer errors of interpretation when the data under evaluation are not random numbers but actual observations on nature. Furthermore, scientists should not be so reluctant to explore leads that may turn out to be wrong that they penalize themselves by missing possibly important findings.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: SoftwareRole: Writing – original draft
                Role: MethodologyRole: SoftwareRole: Writing – review & editing
                Role: Data curationRole: Project administrationRole: Writing – review & editing
                Role: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: SoftwareRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: SupervisionRole: Writing – review & editing
                Role: Funding acquisitionRole: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: Project administrationRole: ResourcesRole: Writing – original draft
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 April 2024
                2024
                : 19
                : 4
                : e0298807
                Affiliations
                [1 ] Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
                [2 ] Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, United States of America
                [3 ] Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, United States of America
                [4 ] Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
                [5 ] Olive View-UCLA Education and Research Institute, Los Angeles, CA, United States of America
                [6 ] Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, United States of America
                [7 ] Department of Emergency Medicine, Ronald Reagan-UCLA Medical Center, Los Angeles, CA, United States of America
                [8 ] Division of Infectious Disease Readiness and Innovation, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
                Kasturba Medical College Mangalore, Manipal Academy of Higher Education, INDIA
                Author notes

                Competing Interests: The authors have declared no competing interests exist.

                ¶ Membership in the Project COVERED Emergency Department Network is provided in the Acknowledgments.

                Author information
                https://orcid.org/0000-0002-4261-5308
                https://orcid.org/0000-0002-5041-0708
                https://orcid.org/0000-0001-7438-0243
                https://orcid.org/0000-0003-1468-6501
                https://orcid.org/0000-0003-0497-5828
                Article
                PONE-D-23-20195
                10.1371/journal.pone.0298807
                11020772
                38626053
                97771d26-2d5c-445c-914c-97348dadff0f

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                : 30 June 2023
                : 30 January 2024
                Page count
                Figures: 1, Tables: 2, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000030, Centers for Disease Control and Prevention;
                Award ID: U01CK000480
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100006108, National Center for Advancing Translational Sciences;
                Award ID: UL1TR002537
                This project was funded by a cooperative agreement from the Centers for Disease Control and Prevention (CDC) (U01CK000480, MPI: DAT, NMM, www.cdc.gov) and the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537, https://icts.uiowa.edu/). Support was additionally provided by NIH grant UM1TR004403. The sponsors played no role in the study design, data collection or analysis, decision to publish, or preparation of the manuscript. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
                Categories
                Research Article
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Psychological Stress
                Biology and Life Sciences
                Psychology
                Psychological Stress
                Social Sciences
                Psychology
                Psychological Stress
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Neuropsychiatric Disorders
                Anxiety Disorders
                Post-Traumatic Stress Disorder
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Neuroses
                Anxiety Disorders
                Post-Traumatic Stress Disorder
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Custom metadata
                The deidentified data upon which this manuscript is based has been posted on Open Science Framework ( osf.io) and can be accessed from the following DOI: https://osf.io/dr2kj/.
                COVID-19

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