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Expanding access to buprenorphine/naloxone in the emergency department. 扩大急诊室丁丙诺啡/纳洛酮的使用范围。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00543-w
Justin J Koh, James Chenoweth, Isabelle Miles
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引用次数: 0
Potential novel therapy in acute decompensated heart failure with volume overload. 急性失代偿性心力衰竭伴容量超载的潜在新疗法。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00527-w
Sophie Gilbert, Francis Desmeules, Marcel Émond, Pierre-Gilles Blanchard
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引用次数: 0
Waiting in Atta. 在阿塔等待。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00525-y
Hashim Kareemi
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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 : 2023-07-01 DOI: 10.1007/s43678-023-00544-9
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引用次数: 0
Intersectional characterization of emergency department (ED) staff experiences of racism: a survey of ED healthcare workers for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators. 急诊科(ED)工作人员种族主义经历的交叉特征:急诊科医护人员对急诊医学中破坏种族主义(DRiEM)调查员的调查。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00533-y
Kanisha Cruz-Kan, Brenden Dufault, Lula Fesehaye, Jodi Kornelsen, Carmen Hrymak, Shelly Zubert, Paul Ratana, Murdoch Leeies

Introduction: The impact of racism on patient outcomes in Emergency Medicine has been examined but there have been few studies exploring the experiences of racism in health care workers. This survey aims to explore the experience of racism by interdisciplinary staff in a tertiary ED. By characterizing the staff experience of racism in the ED, we hope to inform the design of strategies to disrupt racism and ultimately improve the health and wellness of both staff and patients.

Methods: We conducted a self-administered, cross-sectional survey to explore the reported experience of racism by healthcare workers in a single urban ED in an academic trauma centre. We employed classification and regression tree analyses to evaluate predictors of racism through an intersectional lens.

Results: A majority (n = 200, 75%) of all ED staff reported experiencing interpersonal racism (including physical violence, direct verbal violence, mistreatment and/or microaggressions) in the workplace. Respondents who identified as racialized self-reported significantly more racism at work than white respondents (86% vs. 63%, p < 0.001). Occupation, race, migrant status and age were identified through intersectional machine-learning models to be significantly predictive of the experience of racism. Nearly all respondents felt that the disruption of racism in Emergency medicine is important to them (90%, n = 207) and (93%, n = 214) were willing to participate in further training in anti-racism.

Conclusions: Racism against interdisciplinary staff working in EDs is common and the burden on healthcare workers is high. Intersections of occupation, race, age and migrant status are uniquely predictive of the experience of racism for EM staff. Interventions to disrupt racism should be informed by intersectional considerations to create a safe working environment and target populations most at risk. ED healthcare workers are willing to take steps to disrupt racism in their workplace and need institutional support to do so.

引言:在急诊医学中,种族主义对患者预后的影响已经得到了检验,但很少有研究探索卫生保健工作者的种族主义经历。本调查旨在探讨高等教育急诊科跨学科工作人员的种族主义经历。通过描述急诊科工作人员的种族主义经历,我们希望为设计破坏种族主义的策略提供信息,最终改善工作人员和患者的健康和福祉。方法:我们进行了一项自我管理的横断面调查,以探讨在一个学术创伤中心的单个城市急诊科的医护人员所报告的种族主义经历。我们采用分类和回归树分析,通过交叉视角来评估种族主义的预测因素。结果:大多数(n = 200,75%)的ED员工报告在工作场所经历过人际种族主义(包括身体暴力、直接言语暴力、虐待和/或微侵犯)。被认为是种族化的受访者自我报告的工作中的种族主义明显多于白人受访者(86%比63%)。结论:针对急诊室跨学科工作人员的种族主义很常见,卫生保健工作者的负担很高。职业、种族、年龄和移民身份的交集,对新兴市场员工的种族主义经历具有独特的预测性。破坏种族主义的干预措施应综合考虑各种因素,以创造一个安全的工作环境,并以风险最大的人群为目标。急诊科医护人员愿意采取措施,在他们的工作场所破坏种族主义,并需要机构的支持。
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引用次数: 0
Medico-legal risk and use of medical directives in the emergency department. 医疗法律风险和急诊科医疗指示的使用。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00522-1
Miguel A Cortel-LeBlanc, Karen Lemay, Sue Woods, Francis Bakewell, Richard Liu, Gary Garber

Purpose: The medico-legal risk associated with application of medical directives in the emergency department (ED) is unknown. The objective of this study was to describe and analyze factors associated with medico-legal risk in cases involving medical directives in the ED.

Methods: We conducted a descriptive analysis of closed medico-legal cases [hospital complaints, regulatory authority (i.e., College) complaints, and civil legal actions] involving emergency physicians in Canadian EDs involving medical directives (alternate terms including "standing order", "nursing initiated", "nurse initiated", "nursing order", "triage initiated", "triage ordered", "directive", "ED protocol", and "ED's protocol"). We used data from closed cases involving the Canadian Medical Protective Association from January 2016 until December 2021. We abstracted descriptive factors of the cases and used a framework for contributing factors classification.

Results: From 2016 until 2021, 43,332 cases were closed and 1957 involved emergency physicians for which there was medico-legal information available for analysis. In all, 28 involved emergency physicians and medical directives. Situational awareness, team communication, and issues with clinical decision-making were the most important factors contributing to harm and medico-legal risk. Peer experts were critical of physicians not reviewing all results available for patients when initiated through a directive, misinterpreting test results, a less than thorough initial assessment, and of failing to reassess patients or re-order investigations when indicated.

Conclusion: Our findings suggest that the medico-legal risk exposure from the use of medical directives in the ED is low. Emergency departments may consider implementing systems to support adherence to medical directive policies, ensure physicians are alerted when medical directives are completed in a timely fashion, and leverage tools to notify the healthcare team when results have not been reviewed.

目的:与在急诊科(ED)应用医疗指令相关的医疗法律风险是未知的。本研究的目的是描述和分析在急诊科中涉及医疗指示的病例中与医疗法律风险相关的因素。我们对涉及加拿大急诊科急诊医生的已结案医疗法律案件(医院投诉、监管机构(即大学)投诉和民事法律诉讼)进行了描述性分析,这些案件涉及医疗指令(替代术语包括“常设命令”、“护理启动”、“护士启动”、“护理命令”、“分诊启动”、“分诊命令”、“指令”、“急诊科协议”和“急诊科协议”)。我们使用了2016年1月至2021年12月期间涉及加拿大医疗保护协会的结案病例的数据。我们对病例的描述性因素进行了抽象,并使用了一个框架来进行因素分类。结果:从2016年到2021年,共结案43332例,其中1957例涉及有法医学信息可供分析的急诊医师。总共有28起案件涉及急诊医生和医疗指示。情境意识、团队沟通和临床决策问题是造成伤害和医疗法律风险的最重要因素。同行专家批评医生在根据指示启动时没有审查患者可获得的所有结果,误解测试结果,不彻底的初步评估,以及在需要时未能重新评估患者或重新安排调查。结论:我们的研究结果表明,在急诊科使用医疗指示的医疗法律风险暴露是低的。急诊部门可以考虑实施系统,以支持遵守医疗指示政策,确保医生在医疗指示及时完成时得到警报,并利用工具在未审查结果时通知医疗团队。
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引用次数: 1
Just the facts: ultrasound-guided peripheral intravenous catheter placement. 事实是:超声引导外周静脉置管。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00540-z
Michael Gottlieb, Evelyn K Schraft, James R O'Brien, Daniel J Kim
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引用次数: 0
Navigating gaps in practice: consensus recommendations for educational and support structures for emergency physicians returning from gaps in practice. 在实践中导航差距:从实践差距中返回的急诊医生的教育和支持结构的共识建议
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00536-9
Andrew K Hall, Nicole Rocca, Raluca Alexandra Stefan, Tegan Turner, Timothy Chaplin, Teresa M Chan, Tamara McColl, Teresa Wawrykow, Jill McEwen, Shirley Lee, Heather Murray

Objective: The purpose of this study was to identify the learning needs of emergency physicians returning to Emergency Medicine (EM) practice after clinical leaves of less than 2 years, summarize existing return to practice programs, and propose recommendations regarding ideal educational and support structures for these physicians both during their practice gaps and upon return to EM.

Methods: A multiple-phased study was conducted to establish recommendations regarding ideal educational and support structures for emergency physicians returning from practice gaps of less than 2 years. The overall design involved an initial environmental scan of existing and exemplar programs and regulatory body positions, followed by interviews with EM Department Heads from across Canada, and then subsequent content analysis and recommendation derivation by EM medical education expert group consensus. These summary recommendations were further revised by consensus at the 2022 CAEP conference academic symposium to derive a final set of consensus recommendations.

Conclusions: We have developed a set of recommendations regarding ideal educational and support structures for physicians experiencing gaps in practice of less than 2 years. This set of recommendations was informed by review of existing and exemplar programs, policies and experience of regulatory bodies, interviews with EM Department Heads across Canada, and a subsequent process of consensus at the 2022 CAEP conference academic symposium. It is hoped that this set of recommendations will inform discussions and potential strategies employed by departments to facilitate the smooth and effective return to EM practice for individuals experiencing gaps.

目的:本研究的目的是确定临床休假不到2年的急诊医生重返急诊医学(EM)实践的学习需求,总结现有的重返实践计划,并提出关于这些医生在实习间隙和重返EM后的理想教育和支持结构的建议。开展了一项多阶段的研究,旨在为实习不足2年的急诊医生提供理想的教育和支持结构建议。总体设计包括对现有和示范项目以及监管机构职位进行初步环境扫描,随后与加拿大各地的EM部门负责人进行访谈,然后由EM医学教育专家组共识进行内容分析和建议推导。这些总结建议在2022年CAEP会议学术研讨会上经共识进一步修订,得出最终的共识建议。结论:我们已经制定了一套关于理想的教育和支持结构的建议,以供医生在实践中经历不到2年的差距。这组建议是通过审查现有和示范项目、政策和监管机构的经验,采访加拿大各地的EM部门负责人,以及随后在2022年CAEP会议学术研讨会上达成共识的过程得出的。希望这组建议能够为各部门的讨论和可能采用的策略提供信息,以促进经历差距的个人顺利有效地回归电子商务实践。
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引用次数: 0
ED overcrowding: "Hey, remember that canary we had? It died in the coal mine." 人满为患:“嘿,还记得我们养的那只金丝雀吗?它死在煤矿里了。”
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00542-x
John S Rose, Samantha K Brown, Eddy Lang
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引用次数: 0
Ready for practice? National recommendations for emergency medicine transition to practice curriculum. 准备好练习了吗?急诊医学向实践课程过渡的国家建议。
IF 2.4 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-01 DOI: 10.1007/s43678-023-00534-x
Tamara McColl, Quinten Paterson, Stella Yiu, Alkarim Velji, Rob Woods, Jason Frank, Kirk Magee, Avik Nath, Mackenzie Russell, Lisa Thurgur, Daniel K Ting, Fareen Zaver, Warren J Cheung

Background: Transition from residency to unsupervised practice represents a critical stage in learning and professional identity formation, yet there is a paucity of literature to inform residency curricula and emergency department transition programming for new faculty.

Objective: The objective of this study was to develop consensus-based recommendations to optimize the transition to practice phase of emergency medicine training.

Methods: A literature review and results of a survey of emergency medicine (EM) residency program directors informed focus groups of recent (within 5 years) EM graduates. Focus group transcripts were analyzed following conventional content analysis. Preliminary recommendations, based on identified themes, were drafted and presented at the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium on Education. Through a live presentation, symposium attendees representing the Canadian national EM community participated in a facilitated discussion of the recommendations. The authors incorporated this feedback to construct a final set of 14 recommendations, 8 targeted toward residency training programs and 6 specific to department leadership.

Conclusion: The Canadian EM community used a structured process to develop 14 best practice recommendations to enhance the transition to practice phase of residency training as well as the transition period in the career of junior attending physicians.

背景:从住院医师到无监督实习的过渡是学习和职业认同形成的关键阶段,然而,关于住院医师课程和新教师急诊科过渡规划的文献很少。目的:本研究的目的是制定基于共识的建议,以优化急诊医学培训向实践阶段的过渡。方法:对急诊医学(EM)住院医师项目主任的调查结果进行文献回顾,并告知最近(5年内)急诊医学毕业生的焦点小组。焦点小组记录按照常规内容分析进行分析。根据确定的主题,起草了初步建议,并在2022年加拿大急诊医师协会(CAEP)教育学术研讨会上提出。通过现场演示,代表加拿大国家新兴市场社区的研讨会与会者参与了对建议的便利讨论。作者将这些反馈纳入了最终的14条建议,其中8条针对住院医师培训项目,6条针对部门领导。结论:加拿大EM社区采用结构化流程制定了14项最佳实践建议,以加强住院医师培训向实践阶段的过渡,以及初级主治医生职业生涯的过渡期。
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Canadian Journal of Emergency Medicine
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