CJEM最新文献

Background: Alcohol withdrawal is a common emergency department (ED) presentation, but differences in long-term outcomes between female and male patients are not clear.

Methods: From January 1, 2015, to December 31, 2018, at three urban EDs in Vancouver, British Columbia, we studied patients who were discharged with a primary or secondary diagnosis of alcohol withdrawal. We performed a structured chart review to ascertain patient characteristics and ED treatments. We linked with regional ED and provincial data to obtain the outcomes of 1-year return ED visits and mortality, respectively. The primary outcome was at least one return visit to the ED, and secondary outcomes included ED revisits and 1-week, 1-month, and 1-year mortality. We compared female patients with male patients using descriptive methods.

Results: We identified 1,019 unique patients with 273 (26.8%) female. Median ages, ambulance arrival, initial withdrawal severity score, and index visit admission rates were similar. At 1 year, 186 (68.1%) female and 515 (69.0%) male patients reattended an ED, for a difference of 0.9%; (95% CI - 5.5 to 7.7%). A significantly greater proportion of male patients reattended at 1 week and 1 month, and the average number of male ED revisits was greater at 1 week, 1 month, and 1 year. By 1 year, a female patient (0.4%) and 19 males (2.6%) died, for a difference of 2.2% (95% CI 0.3-3.6%).

Conclusion: Despite similar ED presentations, female patients with alcohol withdrawal had fewer 1-year ED visits and lower mortality. EDs may wish to incorporate sex-specific approaches to post-discharge management.

Background: Takotsubo cardiomyopathy is a stress-induced non-ischemic cardiomyopathy that can result from trauma, stimulant use, financial strain, and opioid withdrawal. Opioid withdrawal induced cardiomyopathy is rarely reported in the literature and is thought to result from increased sympathetic activity and catecholamine surge. Early management of opioid withdrawal with opioid agonists, like methadone or buprenorphine, can be crucial. With the opioid epidemic and ongoing rise in opioid-related overdoses, emergency department physicians should maintain a high clinical suspicion for this serious cardiac complication.

Case report: This case report details a rare association of opioid withdrawal induced Takotsubo Cardiomyopathy and highlights the need for heightened clinician suspicion in the emergency department.

Objectives: Emergency physicians have a core professional responsibility to provide expert consultative advice regarding emergency medical care, but it is unclear how their consultative role manifests in health systems and whether there is potential to expand those capacities. The purpose of this study is to identify, clarify, and map key concepts related to emergency physicians acting as consultants within health systems.

Methods: This scoping review searched MEDLINE, Embase, Cochrane, CINAHL, and grey literature. No date restrictions were used and only articles in English were included. Two authors conducted screening of titles and abstracts followed by full texts independently and in duplicate. Data were narratively synthesized.

Results: We screened 8744 articles and included 67 articles which included data from 15 countries and were published between 1974 and 2023. Emergency physicians were reported to assume three main consulting roles: (1) real-time support to other clinicians providing emergency care, (2) rapid critical medical response, and (3) response to direct referrals. The most common consultation modes were via telemedicine (56 studies), activation of hospital protocols (6 studies), and referrals to the emergency department (six studies). Few studies contextualized these roles in relation to health systems or access to emergency care.

Conclusions: Emergency physicians assume multiple consultative roles within health systems. We define "consultative emergency medicine" as a core competency of emergency physicians focused on the provision of advice to other care providers on individual patient care or health services for conditions that require rapid intervention to avert death or disability, or for which delays of minutes to hours render care less effective (i.e. emergency care). As emergency care develops globally, advancing "consultative emergency medicine" may be a tool to expand emergency care expertise to other providers requesting assistance with emergency care.

Objectives: To address crowding, our pediatric emergency department (ED) implemented a triage nurse-led protocol to redirect non-urgent patients to external pediatric clinics, other healthcare providers, family physicians, or home. This study aimed to identify the proportion of redirected children who returned to the ED and identify predictors of return.

Methods: We conducted a health records review study of children under 18 years redirected from the ED of a tertiary pediatric hospital in Montreal, Canada. A random sample of 150 return visits and 300 controls was selected for a nested case-control study. The primary outcome was a return visit to the ED within 7 days. Potential predictors included demographic information, disease characteristics, triage level, and initial orientation. We calculated the proportion of return visits and performed univariate and multivariable analyses of identified predictors.

Results: Between September 2023 and August 2024, 80,221 children were triaged, of whom 6,556 (8.2%) were redirected. Within 7 days, 372 (5.7%) returned. Among the 150 reviewed return visits, 127 (85%) were related to the initial complaint: 64 (43%) were due to persistent symptoms, 49 (33%) to clinical deterioration, 6 (4%) were sent back by a physician, and 5 (3%) were for new symptoms. Seven patients (4.7%) required hospitalization on their return visit. Predictors associated with a lower probability of return included ear, nose, throat, and dental complaints, as well as redirection to specialized or pediatric clinics.

Conclusions: Approximately, 6% of redirected children returned to the ED within 7 days, most often for persistent or worsening symptoms. Identifying predictors of return visits provides evidence to refine redirection guidelines and enhance the safety and effectiveness of triage nurse-led redirection strategies.

Purpose: The primary objective is to evaluate associations between emergency department (ED) total length of stay in Alberta and multiple patient-, visit-, and facility-level factors known to contribute to overcrowding and healthcare inefficiencies. This work aims to inform ongoing efforts to optimize ED performance and patient flow and, to our knowledge, is the largest population-based Canadian study examining associations with ED length of stay at multiple levels.

Methods: We conducted a cross-sectional study of 587,419 ED visits from 14 facilities in Alberta between May 2022 and March 2023 using administrative health data from Alberta Health Services, linked to the National Ambulatory Care Reporting System. Multivariable negative binomial regression was used to examine associations between ED length of stay and patient-, visit-, and facility-level characteristics. Analyses were stratified by patient disposition (admitted, discharged, or other).

Results: Older age, greater material or social deprivation, and any mode of emergency medical services transport were associated with longer ED length of stay across all disposition categories. Higher hospital inpatient occupancy rate and a greater number of emergency inpatients were associated with increased length of stay, particularly for admitted patients. Higher nurse staffing rates were associated with shorter length of stay, though this association disappeared when accounting for random differences between facilities. Higher patient continuity to physician was associated with a lower length of stay, suggesting a potential benefit of primary care integration.

Conclusions: ED length of stay is associated with modifiable factors, including hospital capacity constraints, hours worked per nurse, and healthcare access inequities. Addressing hospital occupancy, optimizing staffing, and improving care coordination across the patient trajectory-such as between the ED, inpatient units, and post-discharge services-may enhance ED efficiency and reduce prolonged stays. Our findings align with established frameworks describing ED overcrowding and support targeted, system-level interventions to improve the efficiency of emergency care.

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.