CJEM最新文献

Objectives: This quality improvement initiative aimed to address nursing retention in the emergency department (ED) at The Ottawa Hospital by providing accessible, in-house advanced cardiovascular life support (ACLS) training. The program sought to reduce barriers to certification, increase job satisfaction, and improve clinical confidence.

Methods: Funded through an Ottawa Hospital strategic plan initiative, 16 subsidized ACLS courses were offered over 2 years (2023-2024), including both full courses and recertifications. The program utilized a blended learning model, combining online modules with hands-on, ED-specific scenarios facilitated by local ED physicians. A total of 172 nurses completed the program. Participants were surveyed to assess the program's impact on retention, job satisfaction, and confidence in ACLS skills.

Results: Among 65 survey respondents (40.4% response rate), 73% reported that the program was important to their decision to remain in the ED, while 69% felt more valued by the organization. Participants reported increased confidence in ACLS skills (92%), with 98% rating the hands-on practice as sufficient for skill development. Course satisfaction was high, with 98% rating the program as excellent or good, and 83% strongly preferring the blended learning model as compared to the traditional didactic course. Qualitative feedback highlighted the program's role in reducing barriers to professional development and enhancing preparedness for critical care scenarios.

Conclusion: The in-house ACLS program at The Ottawa Hospital was associated with higher self-reported nursing retention, job satisfaction, and skill confidence while addressing logistical and financial barriers to ACLS certification. Feedback on the blended learning model and ED-specific scenarios was highly positive. This program serves as a model for other institutions seeking to implement similar initiatives to enhance nursing retention.

Background: Language barriers in pediatric emergency medicine discharge instructions can impact patient safety, leading to poorer post-discharge outcomes. Google Translate has been widely used clinically as an alternative to professional translations but is prone to errors. ChatGPT-4 is a large language model that has been shown to offer improved translation abilities in various domains. This study compares ChatGPT-4 and Google Translate for translating discharge instructions into Arabic and Simplified Chinese.

Methods: 15 standardized pediatric emergency department discharge instructions from our institution were translated from English to both Simplified Chinese and Arabic, using both ChatGPT-4 and Google Translate. Eight bilingual medical professionals (four per language group) were recruited as participants and presented with the English and the translated discharge instructions in a blinded manner. Participants rated the translations on a 5-point Likert scale for accuracy, safety, and understandability, followed by their overall translation preference.

Results: In Arabic, ChatGPT-4 was found to be more accurate than Google Translate, (mean 4.1 vs. 3.7, mean difference = 0.43, 95% CI 0.15, 0.72, p = 0.003). Similarly for Simplified Chinese, ChatGPT-4 was found to be more accurate than Google Translate (mean 4.4 vs. 4.2; mean difference = 0.28, 95% CI 0.07, 0.50, p = 0.010). There were no significant differences in safety or understandability between ChatGPT-4 and Google Translate in either language. ChatGPT-4-generated translations were consistently preferred over Google Translate in both languages.

Conclusion: Overall, ChatGPT-4 is a more accurate alternative to Google Translate in translating written pediatric discharge instructions from English to Simplified Chinese and Arabic. ChatGPT-4 could be a particularly valuable translation tool in healthcare settings with limited access to translation resources such as professional interpreters.

Background: Patients with symptoms of acute coronary syndrome make up a significant proportion of emergency department (EDs) presentations. High-sensitivity troponin testing is a standard component of evaluating patients with suspected symptomatic coronary disease. We sought to synthesize the evidence of the accuracy of 0/2-h and 0/3-h algorithms using the Beckman Access high-sensitivity cardiac troponin I (hs-cTnI) assay.

Methods: We developed an electronic search strategy retrieving research from three electronic databases (Medline, Embase, and Wiley Cochrane Library). Relevant research studies were screened and data extracted by a team of reviewers. Study quality and risk assessment were appraised using the QUADAS-2 tool. Findings were reported according to PRISMA guidelines.

Results: Five studies met inclusion criteria. No studies directly compared the 0 h/2 h and 0 h/3 h algorithms using the Beckman Coulter Access hs-cTnI assay, and heterogeneity in study design precluded meta-analysis. Included studies variably used 2-h, 3-h, or intermediate timepoints for serial troponin measurement. All studies reported consistently high sensitivity (> 97.7%) and NPV (> 98.9%) for ruling out acute myocardial infarction, supporting the reliability of both 0/2 h and 0/3 h hs-cTnI algorithms in the ED.

Conclusions: Of the five studies included, two studies suggest that a two-hour hs-TnI algorithm can effectively rule out myocardial infarction with similar accuracy to a longer three-hour protocol. Use of a 2-h hs-cTnI algorithm may lead to operational gains compared to a 3-h serial testing algorithm.

Objective: Although minimal sedation with midazolam is frequently performed in the pediatric emergency department (ED) for various procedures, limited research exists regarding its safety profile, and no clear guidelines define the resources required for minimal sedation. The main objective of this study was to determine the proportion of children who developed adverse events after receiving oral or intranasal midazolam for minimal sedation in our pediatric ED.

Methods: We conducted an observational, single center study including all children who presented to the pediatric ED between January 1, 2015, and December 31, 2021, and underwent minimal sedation with oral or intranasal midazolam.

Results: A total of 2544 children with a median age of 4 years (IQR 2-6 years) were included. We identified a total of 12 (0.47%) adverse events: 9 (0.35%) minimal, 2 (0.08%) minor, and 1 (0.04%) moderate. There were no sentinel adverse events. All children were discharged home from the pediatric ED, and none required hospitalization.

Conclusion: The incidence of adverse events during minimal sedation with oral or intranasal midazolam in our pediatric ED was low, and interventions were rarely required. Minimal sedation with oral or intranasal midazolam appears to be a safe and well-tolerated procedure. Our findings support the safety of minimal sedation with midazolam in a structured, well-monitored ED setting.