CJEM最新文献

Purpose: Canadian hospitals often plan to use an alternate triage tool, opposed to the standard Canadian Triage Acuity Scale (CTAS), in the event of a mass casualty incident despite lack of study or validation for this setting. It is not known whether these alternate triage strategies have ever been utilized by hospitals during disaster response. We sought to identify the type and frequency of alternate triage tools used during Canadian mass casualty incident responses.

Methods: A scoping review of scientific databases and the gray literature was conducted to find information regarding the triage strategy employed during real mass casualty incidents in Canada from January 1, 1983 to December 31, 2024. A survey of healthcare providers was conducted if data could not be obtained through literature review.

Results: The literature reviews yielded 358 reports: four met inclusion criteria. Twenty-two incidents were identified from media reports and contacts for 15 of these events were surveyed; data were retrieved regarding six events. In total, data were collected for nine separate mass casualty incidents. Five (55.5%) cited a plan to use an alternate triage tool during a disaster, but only 1 (11.1%) utilized it (triage tags) during real-time response. The remaining used CTAS, with or without clinician judgment.

Conclusions: Secondary disaster triage may not require an alternate algorithm, potentially saving time and financial resources associated with training. We strongly suggest the increased publication of reports either in peer-reviewed journals or through the creation of a national repository as available data on this subject are very limited.

Introduction: Canada's emergency departments (EDs) face extreme overcrowding, with older adults (65 +) comprising up to 25% of visits and often presenting with cognitive disorders, multiple comorbidities, and complex care needs. Personal support workers assist people needing help with daily activities, typically in homes or long-term care, but not EDs. The objective of this study was to describe patients, family members, and providers' perspectives on the implementation and impact of a novel Geriatric Personal Support Worker program in an ED setting in Toronto, Ontario.

Methods: This qualitative descriptive study used semi-structured interviews and focus groups with older adult patients, caregivers, and healthcare providers (n = 30). The guiding framework for the study was the Consolidated Framework for Implementation Research. Data were analyzed using an inductive thematic analysis.

Results: Both patients and providers valued personal support worker support in the ED, noting improvements in care efficiency and patient-centered service. Participants noted that personal support workers reduced nurses' workload by supporting patients' activities of daily living, which enabled nurses to prioritize clinical tasks, thereby improving the ED care experience for both patients and providers. The key factors identified to influence the program's implementation were organizational cohesiveness (personal support workers as unionized employees), the need for sustainable funding, and clearer role description.

Conclusions: Integrating Geriatric Personal Support Workers in the ED improved patient-centered care as well as nursing care efficiency. While well received, there are organizational, logistical and funding issues that require further exploration to sustain a Geriatric Personal Support Worker program in EDs.