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Machine learning to identify attributes that predict patients who leave without being seen in a pediatric emergency department. 机器学习识别属性,预测没有在儿科急诊科看到的患者离开。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-08-01 DOI: 10.1007/s43678-023-00545-8
Julia Sarty, Eleanor A Fitzpatrick, Majid Taghavi, Peter T VanBerkel, Katrina F Hurley

Purpose: To characterize patients who left without being seen (LWBS) from a Canadian pediatric Emergency Department (ED) and create predictive models using machine learning to identify key attributes associated with LWBS.

Methods: We analyzed administrative ED data from April 1, 2017, to March 31, 2020, from IWK Health ED in Halifax, NS. Variables included: visit disposition; Canadian Triage Acuity Scale (CTAS); triage month, week, day, hour, minute, and day of the week; sex; age; postal code; access to primary care provider; visit payor; referral source; arrival by ambulance; main problem (ICD10); length of stay in minutes; driving distance in minutes; and ED patient load. The data were randomly divided into training (80%) and test datasets (20%). Five supervised machine learning binary classification algorithms were implemented to train models to predict LWBS patients. We balanced the dataset using Synthetic Minority Oversampling Technique (SMOTE) and used grid search for hyperparameter tuning of our models. Model evaluation was made using sensitivity and recall on the test dataset.

Results: The dataset included 101,266 ED visits where 2009 (2%) records were excluded and 5800 LWBS (5.7%). The highest-performing machine learning model with 16 patient attributes was XGBoost which was able to identify LWBS patients with 95% recall and 87% sensitivity. The most influential attributes in this model were ED patient load, triage hour, driving minutes from home address to ED, length of stay (minutes since triage), and age.

Conclusion: Our analysis showed that machine learning models can be used on administrative data to predict patients who LWBS in a Canadian pediatric ED. From 16 variables, we identified the five most influential model attributes. System-level interventions to improve patient flow have shown promise for reducing LWBS in some centres. Predicting patients likely to LWBS raises the possibility of individual patient-level interventions to mitigate LWBS.

目的:描述加拿大儿科急诊科(ED)的无诊离开(LWBS)患者的特征,并使用机器学习创建预测模型,以识别与LWBS相关的关键属性。方法:我们分析了2017年4月1日至2020年3月31日来自哈利法克斯IWK Health ED的行政ED数据。变量包括:访问处置;加拿大分诊敏锐度量表(CTAS);分类月、周、日、时、分、日;性;年龄;邮政编码;获得初级保健提供者的服务;访问付款人;推荐来源;救护车到达;主要问题(ICD10);停留时间(以分钟为单位);行车距离(分钟);和急诊科的病人负荷。数据随机分为训练数据集(80%)和测试数据集(20%)。采用五种监督式机器学习二分类算法训练模型预测LWBS患者。我们使用合成少数派过采样技术(SMOTE)平衡数据集,并使用网格搜索进行模型的超参数调整。利用灵敏度和召回率对测试数据集进行模型评价。结果:该数据集包括101,266例ED就诊,其中2009年(2%)的记录被排除,5800例LWBS(5.7%)的记录被排除。具有16个患者属性的表现最好的机器学习模型是XGBoost,它能够以95%的召回率和87%的灵敏度识别LWBS患者。该模型中影响最大的属性是急诊科患者负荷、分诊时间、从家庭住址到急诊科的驾车分钟数、住院时间(分诊后的分钟数)和年龄。结论:我们的分析表明,机器学习模型可以用于管理数据来预测加拿大儿科急诊科的LWBS患者。从16个变量中,我们确定了五个最具影响力的模型属性。在一些中心,改善病人流动的系统级干预措施已显示出减少LWBS的希望。预测可能发生LWBS的患者提高了个体患者水平干预以减轻LWBS的可能性。
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引用次数: 0
Hydrocortisone in severe community-acquired pneumonia. 氢化可的松治疗重度社区获得性肺炎。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-08-01 DOI: 10.1007/s43678-023-00548-5
Kevin Guo, Krishan Yadav, Hans Rosenberg
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引用次数: 0
Just the facts: indications and technique for emergency tracheotomy. 事实是:紧急气管切开术的指征和技术。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-08-01 DOI: 10.1007/s43678-023-00538-7
Audrey Marcotte, Marco A Mascarella, L H Nguyen, Joe Nemeth
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引用次数: 0
Global Research Highlights. 全球研究亮点。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-08-01 DOI: 10.1007/s43678-023-00561-8
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引用次数: 0
Cold-related injuries among patients experiencing homelessness in Toronto: a descriptive analysis of emergency department visits. 在多伦多经历无家可归的病人中与寒冷相关的伤害:对急诊科访问的描述性分析。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-08-01 DOI: 10.1007/s43678-023-00546-7
Lucie Richard, Haley Golding, Refik Saskin, Jesse I R Jenkinson, Katherine Francombe Pridham, Evie Gogosis, Carolyn Snider, Stephen W Hwang

Purpose: Homelessness increases the risk of cold-related injuries. We examined emergency department visits for cold-related injuries in Toronto over a 4-year period, comparing visits for patients identified as homeless to visits for patients not identified as homeless.

Methods: This descriptive analysis of visits to emergency departments in Toronto between July 2018 and June 2022 used linked health administrative data. We measured emergency department visits with cold-related injury diagnoses among patients experiencing homelessness and those not identified as homeless. Rates were expressed as a number of visits for cold-related injury per 100,000 visits overall. Rate ratios were used to compare rates between homeless vs. not homeless groups.

Results: We identified 333 visits for cold-related injuries among patients experiencing homelessness and 1126 visits among non-homeless patients. In each of the 4 years of observation, rate ratios ranged between 13.6 and 17.6 for cold-related injuries overall, 13.7 and 17.8 for hypothermia, and 10.3 and 18.3 for frostbite. Rates per 100,000 visits in the fourth year (July 2021 to June 2022) were significantly higher than in the pre-pandemic period. Male patients had higher rates, regardless of homelessness status; female patients experiencing homelessness had higher rate ratios than male patients experiencing homelessness.

Conclusion: Patients experiencing homelessness visiting the emergency department are much more likely to be seen for cold-related injuries than non-homeless patients. Additional efforts are needed to prevent cold-related exposure and consequent injury among people experiencing homelessness.

目的:无家可归增加了感冒相关伤害的风险。我们检查了多伦多4年期间因感冒相关伤害的急诊科就诊情况,比较了被确定为无家可归的患者和未被确定为无家可归的患者的就诊情况。方法:对2018年7月至2022年6月期间多伦多急诊科的就诊情况进行描述性分析,使用相关的卫生管理数据。我们测量了无家可归和未被确定为无家可归的患者中与感冒相关的损伤诊断的急诊就诊情况。比率表示为每10万次访问中与感冒有关的伤害的访问次数。比率比率用于比较无家可归者和非无家可归者群体之间的比率。结果:我们在无家可归的患者中确定了333次与感冒相关的伤害就诊,在非无家可归的患者中确定了1126次就诊。在4年的观察中,与寒冷相关的损伤的发生率在13.6 - 17.6之间,低温的发生率在13.7 - 17.8之间,冻伤的发生率在10.3 - 18.3之间。第四年(2021年7月至2022年6月)每10万次就诊的比率显著高于大流行前时期。无论无家可归状况如何,男性患者的发病率更高;无家可归的女性患者的比例高于无家可归的男性患者。结论:与非无家可归的患者相比,无家可归的患者到急诊室就诊的可能性更大。需要作出更多努力,防止无家可归者遭受与寒冷有关的暴露和由此造成的伤害。
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引用次数: 1
Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice. 我们是在说练习吗?一项比较基于模拟的刻意练习和掌握式学习与自主练习的随机研究。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-08-01 DOI: 10.1007/s43678-023-00531-0
Andrew Petrosoniak, Jonathan Sherbino, Thomas Beardsley, James Bonz, Sara Gray, Andrew K Hall, Christopher Hicks, Julie Kim, George Mastoras, Melissa McGowan, Julian Owen, Ambrose H Wong, Sandra Monteiro

Objectives: Simulation-based technical skills training is now ubiquitous in medicine, particularly for high acuity, low occurrence (HALO) procedures. Mastery learning and deliberate practice (ML + DP) are potentially valuable educational methods, however, they are resource intensive. We sought to compare the effect of deliberate practice and mastery learning versus self-guided practice on skill performance of the rare, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC).

Methods: We conducted a multi-center, randomized study at five North American emergency medicine (EM) residency programs. We randomly assigned 176 EM residents to either the ML + DP or self-guided practice groups. Three blinded airway experts independently evaluated BAC skill performance by video review before (pre-test), after (post-test) and 6-12 months (retention) after the training session. The primary outcome was post-test skill performance using a global rating score (GRS). Secondary outcomes included performance time and skill performance at the retention test.

Results: Immediately following training, GRS scores were significantly higher as mean performance improved from pre-test, (22, 95% CI = 21-23) to post-test (27, 95% CI = 26-28), (p < 0.001) for all participants. However, there was no difference between the groups on GRS scores (p = 0.2) at the post-test or at the retention test (p = 0.2). At the retention test, participants in the ML + DP group had faster performance times (66 s, 95% CI = 57-74) compared to the self-guided group (77 s, 95% CI = 67-86), (p < 0.01).

Conclusions: There was no significant difference in skill performance between groups. Residents who received deliberate practice and mastery learning demonstrated an improvement in skill performance time.

目的:基于模拟的技术技能培训现在在医学中无处不在,特别是对于高敏度,低发生率(HALO)手术。精通学习和刻意练习(ML + DP)是潜在的有价值的教育方法,然而,它们是资源密集型的。我们试图比较刻意练习和掌握学习与自我指导练习对罕见的救命手术环甲状腺切开术(BAC)的技能表现的影响。方法:我们在五个北美急诊医学(EM)住院医师项目中进行了一项多中心随机研究。我们随机将176名EM居民分配到ML + DP或自我指导实践组。三位盲法气道专家分别在培训前(测试前)、后(测试后)和培训后6-12个月(保留期)通过视频评估独立评估BAC技能表现。主要结果是使用全局评分(GRS)的测试后技能表现。次要结果包括在记忆测验中的表现、时间和技能表现。结果:训练后,GRS得分显著提高,平均表现从测试前(22,95% CI = 21-23)到测试后(27,95% CI = 26-28), (p)结论:组间技能表现无显著差异。接受刻意练习和掌握学习的住院医生在技能表现方面表现出改善。
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引用次数: 1
Marine envenomation by a Pacific red octopus in Vancouver, British Columbia. 在不列颠哥伦比亚省温哥华,一只太平洋红章鱼的海洋中毒。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00523-0
Matthew B Douglas-Vail, William N Morley, Jan Hajek
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引用次数: 0
Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial. 实施儿科脑震荡急性护理临床路径对医疗保健的影响:阶梯式楔形聚类随机试验
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00530-1
Keith Owen Yeates, Karen M Barlow, Bruce Wright, Ken Tang, Olesya Barrett, Edward Berdusco, Amanda M Black, Brenda Clark, Alf Conradi, Heather Godfrey, Ashley T Kolstad, Anh Ly, Angelo Mikrogianakis, Ross Purser, Kathryn Schneider, Antonia S Stang, Roger Zemek, Jennifer D Zwicker, David W Johnson

Objectives: To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs.

Methods: Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care.

Results: A total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change - 23.76 min, 95% CI - 37.99, - 9.52). Total physician claims increased significantly at only 1 of 5 sites.

Conclusions: Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient.

Trial registration: ClinicalTrials.gov NCT05095012.

目的:探讨积极实施儿童脑震荡急性护理临床路径对医疗服务利用和成本的影响。方法:2019年2月1日至11月30日,在加拿大阿尔伯塔省5个急诊科(ED)开展临床路径的楔形聚类随机试验。临床路径强调对持续症状的风险进行标准化评估,向患者和家属提供一致的信息,并转介门诊随访。去识别的行政数据测量了6个结果:ED回访;门诊随访;急诊科住院时间,包括总时间,从分诊到医生初步评估的时间,以及从医生初步评估到处置的时间;在一次护理中,医生的总索赔。结果:2878例患者(女性1164例,男性1713例)符合病例标准,年龄5-17岁(中位数11.00,IQR 8,14)。他们完成了对5个地点的3009次访问和781次门诊随访,共2910次护理。实施并没有改变急诊科复诊的可能性(OR 0.77, 95% CI 0.39, 1.52),但增加了门诊随访的可能性(OR 1.84, 95% CI 1.19, 2.85)。急诊科的总住院时间没有变化,但从医生最初评估到处置的时间显著减少(平均变化- 23.76分钟,95% CI - 37.99, - 9.52)。在5个站点中,只有1个站点的医生总索赔显著增加。结论:在急诊科实施临床路径增加了门诊随访,减少了从医生初步评估到处置的时间,而没有增加医生的成本。临床路径的实施可以使儿童脑震荡的急性护理更紧密地与现有的临床实践指南保持一致,同时提高护理效率。试验注册:ClinicalTrials.gov NCT05095012。
{"title":"Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial.","authors":"Keith Owen Yeates,&nbsp;Karen M Barlow,&nbsp;Bruce Wright,&nbsp;Ken Tang,&nbsp;Olesya Barrett,&nbsp;Edward Berdusco,&nbsp;Amanda M Black,&nbsp;Brenda Clark,&nbsp;Alf Conradi,&nbsp;Heather Godfrey,&nbsp;Ashley T Kolstad,&nbsp;Anh Ly,&nbsp;Angelo Mikrogianakis,&nbsp;Ross Purser,&nbsp;Kathryn Schneider,&nbsp;Antonia S Stang,&nbsp;Roger Zemek,&nbsp;Jennifer D Zwicker,&nbsp;David W Johnson","doi":"10.1007/s43678-023-00530-1","DOIUrl":"https://doi.org/10.1007/s43678-023-00530-1","url":null,"abstract":"<p><strong>Objectives: </strong>To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs.</p><p><strong>Methods: </strong>Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care.</p><p><strong>Results: </strong>A total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change - 23.76 min, 95% CI - 37.99, - 9.52). Total physician claims increased significantly at only 1 of 5 sites.</p><p><strong>Conclusions: </strong>Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05095012.</p>","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":"25 7","pages":"627-636"},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9995910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Call to action: equity, diversity, and inclusion in emergency medicine resident physician selection. 呼吁行动:公平,多样性和包容性在急诊医学住院医师的选择。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00528-9
Robert Primavesi, Catherine Patocka, Adam Burcheri, Alexandre Coutin, Alexandre Morizio, Amir Ali, Anjali Pandya, Austin Gagné, Bobby Johnston, Brent Thoma, Constance LeBlanc, Frédéric Fovet, John Gallinger, Juan Mohadeb, Mirna Ragheb, Sandy Dong, Sheila Smith, Taofiq Oyedokun, Tate Newmarch, Vanessa Knight, Tamara McColl

Objectives: This call to action seeks to improve emergency care in Canada for equity-deserving communities, enabled by equitable representation among emergency physicians nationally. Specifically, this work describes current resident selection processes and makes recommendations to enhance the equity, diversity, and inclusion (EDI) of resident physician selection in Canadian emergency medicine (EM) residency programs.

Methods: A diverse panel of EM residency program directors, attending and resident physicians, medical students, and community representatives met monthly from September 2021 to May 2022 via videoconference to coordinate a scoping literature review, two surveys, and structured interviews. This work informed the development of recommendations for incorporating EDI into Canadian EM resident physician selection. At the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, these recommendations were presented to symposium attendees composed of national EM community leaders, members, and learners. Attendees were divided into small working groups to discuss the recommendations and address three conversation-facilitating questions.

Results: Symposium feedback informed a final set of eight recommendations to promote EDI practices during the resident selection process that address recruitment, retention, mitigating inequities and biases, and education. Each recommendation is accompanied by specific, actionable sub-items to guide programs toward a more equitable selection process. The small working groups also described perceived barriers to the implementation of these recommendations and outlined strategies for success that are incorporated into the recommendations.

Conclusion: We call on Canadian EM training programs to implement these eight recommendations to strengthen EDI practices in EM resident physician selection and, in doing so, help to improve the care that patients from equity-deserving groups receive in Canada's emergency departments (EDs).

目标:这一行动呼吁旨在通过全国急诊医生的公平代表权,改善加拿大应享有公平待遇的社区的急诊护理。具体来说,这项工作描述了当前的住院医师选择过程,并提出建议,以提高加拿大急诊医学(EM)住院医师选择的公平性、多样性和包容性(EDI)。方法:从2021年9月至2022年5月,由EM住院医师项目主任、主治医师和住院医师、医学生和社区代表组成的多元化小组每月通过视频会议召开一次会议,以协调范围文献综述、两次调查和结构化访谈。这项工作为将EDI纳入加拿大EM住院医师选择的建议提供了信息。在2022年加拿大急诊医师协会(CAEP)学术研讨会上,这些建议被提交给由全国急诊社区领导人、成员和学习者组成的研讨会与会者。与会者被分成几个工作小组,讨论这些建议,并解决三个促进对话的问题。结果:研讨会反馈形成了最终的八项建议,以在住院医师选择过程中促进EDI实践,解决招聘、保留、减轻不公平和偏见以及教育问题。每一项建议都附有具体的、可操作的分项,以指导项目朝着更公平的选择过程发展。小型工作组还描述了执行这些建议所遇到的障碍,并概述了纳入建议的成功战略。结论:我们呼吁加拿大急诊培训计划实施这八项建议,以加强急诊住院医师选择中的EDI实践,这样做有助于改善加拿大急诊科(EDs)公平群体患者的护理。
{"title":"Call to action: equity, diversity, and inclusion in emergency medicine resident physician selection.","authors":"Robert Primavesi,&nbsp;Catherine Patocka,&nbsp;Adam Burcheri,&nbsp;Alexandre Coutin,&nbsp;Alexandre Morizio,&nbsp;Amir Ali,&nbsp;Anjali Pandya,&nbsp;Austin Gagné,&nbsp;Bobby Johnston,&nbsp;Brent Thoma,&nbsp;Constance LeBlanc,&nbsp;Frédéric Fovet,&nbsp;John Gallinger,&nbsp;Juan Mohadeb,&nbsp;Mirna Ragheb,&nbsp;Sandy Dong,&nbsp;Sheila Smith,&nbsp;Taofiq Oyedokun,&nbsp;Tate Newmarch,&nbsp;Vanessa Knight,&nbsp;Tamara McColl","doi":"10.1007/s43678-023-00528-9","DOIUrl":"https://doi.org/10.1007/s43678-023-00528-9","url":null,"abstract":"<p><strong>Objectives: </strong>This call to action seeks to improve emergency care in Canada for equity-deserving communities, enabled by equitable representation among emergency physicians nationally. Specifically, this work describes current resident selection processes and makes recommendations to enhance the equity, diversity, and inclusion (EDI) of resident physician selection in Canadian emergency medicine (EM) residency programs.</p><p><strong>Methods: </strong>A diverse panel of EM residency program directors, attending and resident physicians, medical students, and community representatives met monthly from September 2021 to May 2022 via videoconference to coordinate a scoping literature review, two surveys, and structured interviews. This work informed the development of recommendations for incorporating EDI into Canadian EM resident physician selection. At the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, these recommendations were presented to symposium attendees composed of national EM community leaders, members, and learners. Attendees were divided into small working groups to discuss the recommendations and address three conversation-facilitating questions.</p><p><strong>Results: </strong>Symposium feedback informed a final set of eight recommendations to promote EDI practices during the resident selection process that address recruitment, retention, mitigating inequities and biases, and education. Each recommendation is accompanied by specific, actionable sub-items to guide programs toward a more equitable selection process. The small working groups also described perceived barriers to the implementation of these recommendations and outlined strategies for success that are incorporated into the recommendations.</p><p><strong>Conclusion: </strong>We call on Canadian EM training programs to implement these eight recommendations to strengthen EDI practices in EM resident physician selection and, in doing so, help to improve the care that patients from equity-deserving groups receive in Canada's emergency departments (EDs).</p>","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":"25 7","pages":"550-557"},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9995914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments. 丁丙诺啡/纳洛酮作为改善阿片类药物使用障碍患者质量的干预措施的启动和转诊:对艾伯塔省 107 个农村和城市急诊部门的省级推广情况进行定量评估。
IF 2 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 Epub Date: 2023-05-28 DOI: 10.1007/s43678-023-00520-3
Kayla D Stone, Ken Scott, Brian R Holroyd, Eddy Lang, Karen Yee, Niloofar Taghizadeh, Janjeevan Deol, Kathryn Dong, Josh Fanaeian, Monty Ghosh, Keysha Low, Marshall Ross, Robert Tanguay, Peter Faris, Nathaniel Day, Patrick McLane

Objectives: Opioid use disorder is a major public health concern that accounts for a high number of potential years of life lost. Buprenorphine/naloxone is a recommended treatment for opioid use disorder that can be started in the emergency department (ED). We developed an ED-based program to initiate buprenorphine/naloxone for eligible patients who live with opioid use disorder, and to provide unscheduled, next-day follow-up referrals to an opioid use disorder treatment clinic (in person or virtual) for continuing patient care throughout Alberta.

Methods: In this quality improvement initiative, we supported local ED teams to offer buprenorphine/naloxone to eligible patients presenting to the ED with suspected opioid use disorder and refer these patients for follow-up care. Process, outcome, and balancing measures were evaluated over the first 2 years of the initiative (May 15, 2018-May 15, 2020).

Results: The program was implemented at 107 sites across Alberta during our evaluation period. Buprenorphine/naloxone initiations in the ED increased post-intervention at most sites with baseline data available (11 of 13), and most patients (67%) continued to fill an opioid agonist prescription at 180 days post-ED visit. Of the 572 referrals recorded at clinics, 271 (47%) attended their first follow-up visit. Safety events were reported in ten initiations and were all categorized as no harm to minimal harm.

Conclusions: A standardized provincial approach to initiating buprenorphine/naloxone in the ED for patients living with opioid use disorder was spread to 107 sites with dedicated program support staff and adjustment to local contexts. Similar quality improvement approaches may benefit other jurisdictions.

目标:阿片类药物使用障碍是一个重大的公共卫生问题,造成大量潜在的生命损失。丁丙诺啡/纳洛酮是治疗阿片类药物使用障碍的推荐疗法,可在急诊科(ED)开始使用。我们制定了一项以急诊科为基础的计划,为符合条件的阿片类药物使用障碍患者启动丁丙诺啡/纳洛酮治疗,并在第二天向阿片类药物使用障碍治疗诊所(面对面或虚拟)提供计划外的后续转诊,以便在整个艾伯塔省继续为患者提供护理:在这项质量改进计划中,我们支持当地急诊室团队为急诊室符合条件的疑似阿片类药物使用障碍患者提供丁丙诺啡/纳洛酮,并转介这些患者接受后续治疗。在倡议实施的前两年(2018 年 5 月 15 日至 2020 年 5 月 15 日),我们对过程、结果和平衡措施进行了评估:在评估期间,该计划在艾伯塔省的 107 个地点实施。在大多数有基线数据的医疗点(13 个医疗点中的 11 个),干预后在急诊室开始使用丁丙诺啡/纳洛酮的人数有所增加,大多数患者(67%)在急诊室就诊后 180 天内继续使用阿片类激动剂处方。在诊所记录的 572 例转诊患者中,有 271 例(47%)参加了首次随访。有10例转诊报告了安全事件,均被归类为无伤害或伤害极小:在急诊室为阿片类药物使用障碍患者启动丁丙诺啡/纳洛酮的标准化省级方法已推广到 107 个地点,并配备了专门的项目支持人员和根据当地情况进行的调整。类似的质量改进方法可能会使其他辖区受益。
{"title":"Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments.","authors":"Kayla D Stone, Ken Scott, Brian R Holroyd, Eddy Lang, Karen Yee, Niloofar Taghizadeh, Janjeevan Deol, Kathryn Dong, Josh Fanaeian, Monty Ghosh, Keysha Low, Marshall Ross, Robert Tanguay, Peter Faris, Nathaniel Day, Patrick McLane","doi":"10.1007/s43678-023-00520-3","DOIUrl":"10.1007/s43678-023-00520-3","url":null,"abstract":"<p><strong>Objectives: </strong>Opioid use disorder is a major public health concern that accounts for a high number of potential years of life lost. Buprenorphine/naloxone is a recommended treatment for opioid use disorder that can be started in the emergency department (ED). We developed an ED-based program to initiate buprenorphine/naloxone for eligible patients who live with opioid use disorder, and to provide unscheduled, next-day follow-up referrals to an opioid use disorder treatment clinic (in person or virtual) for continuing patient care throughout Alberta.</p><p><strong>Methods: </strong>In this quality improvement initiative, we supported local ED teams to offer buprenorphine/naloxone to eligible patients presenting to the ED with suspected opioid use disorder and refer these patients for follow-up care. Process, outcome, and balancing measures were evaluated over the first 2 years of the initiative (May 15, 2018-May 15, 2020).</p><p><strong>Results: </strong>The program was implemented at 107 sites across Alberta during our evaluation period. Buprenorphine/naloxone initiations in the ED increased post-intervention at most sites with baseline data available (11 of 13), and most patients (67%) continued to fill an opioid agonist prescription at 180 days post-ED visit. Of the 572 referrals recorded at clinics, 271 (47%) attended their first follow-up visit. Safety events were reported in ten initiations and were all categorized as no harm to minimal harm.</p><p><strong>Conclusions: </strong>A standardized provincial approach to initiating buprenorphine/naloxone in the ED for patients living with opioid use disorder was spread to 107 sites with dedicated program support staff and adjustment to local contexts. Similar quality improvement approaches may benefit other jurisdictions.</p>","PeriodicalId":55286,"journal":{"name":"Canadian Journal of Emergency Medicine","volume":"25 7","pages":"598-607"},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10048911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Canadian Journal of Emergency Medicine
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