CJEM最新文献

{"title":"Creating an inventory of emergency virtual care initiatives in Canada: National CAEP survey.","authors":"Jackie Tsang, Rochelle F McAdam, Kiran L Grant, Kendall Ho","doi":"10.1007/s43678-025-00948-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00948-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health system utilization following medical advice from Alberta's Virtual MD: a descriptive analysis.","authors":"Richard Golonka, Mary V Modayil, Razieh Mansouri, Fayaz Kurji, Jane Q Huang, Wei Zhao, Denise Watt, Jake Hayward, Patricia Chambers, Carolyn Grolman, Judy Seidel, Robin L Walker","doi":"10.1007/s43678-025-00928-z","DOIUrl":"10.1007/s43678-025-00928-z","url":null,"abstract":"<p><strong>Objectives: </strong>Alberta's Virtual MD program was established to enhance nurse tele-triage and divert low-acuity patients from the emergency department (ED). This study describes the use of Virtual MD and its impact on healthcare utilization.</p><p><strong>Methods: </strong>Demographic and clinical characteristics of Virtual MD patients were compared with Health Link 811 callers and the overall Alberta population between April 1, 2022, and March 31, 2023. Virtual MD recommendations included seeing a primary care provider, going to ED/urgent care, and self-management at home. Concordance with recommendations was determined using linked health administrative data.</p><p><strong>Results: </strong>Virtual MD patients (n = 19,312) had a mean age of 34.8 years and were mostly female (62.3%). Compared to Health Link 811 callers, Virtual MD patients were slightly older (≥ 55 years) (20.8% vs. 25.0%). Of patients called within 4 h, 55.7% visited primary care within 14 days as advised, 60.0% visited ED within 2 days as advised and 52.5% of those advised to self-manage care at home did not use any healthcare within 14 days. Those advised to seek primary care had a higher odds [OR = 1.65 (95%CI: 1.24-2.21)] of family practice-sensitive conditions when they presented at ED compared to those advised to seek ED care. Hospitalization within 2 weeks was lower for patients advised to see primary care compared to those advised to see ED [4 h callback: OR = 0.33 (95%CI: 0.26 - 0.43), 24 h callback: OR = 0.15 (95%CI 0.08 - 0.28)].</p><p><strong>Conclusion: </strong>Virtual MD effectively triaged patients, with over half following through on recommendations to see primary care, see ED, or self-manage care at home. Patients referred to primary care, but instead choosing to visit ED, were more likely to present with family practice-sensitive conditions, demonstrating appropriateness of the initial primary care advice. Overall, the Virtual MD service enables patients to access more appropriate levels of care for their healthcare needs.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter review of antimicrobial stewardship in the emergency department through pharmacist-led culture review and follow-up programs in Alberta.","authors":"Ivy Nhan, Tracy Chin, Elissa Rennert-May, Thomas Brownlee, Micheal Guirguis, Irina Rajakumar","doi":"10.1007/s43678-025-00940-3","DOIUrl":"https://doi.org/10.1007/s43678-025-00940-3","url":null,"abstract":"<p><strong>Background: </strong>In some emergency departments (EDs), pharmacists review and follow-up on microbiological test results for recently discharged patients, intervening when empiric therapy is missing or inadequate to ensure appropriate antimicrobial use. Currently, this practice is not well described in Canada. Characterizing these ED pharmacist activities can help identify antimicrobial stewardship opportunities and allow for more tailored education and training.</p><p><strong>Objectives: </strong>The primary objective of this study was to describe culture review and follow-up pharmacy practice in terms of antimicrobial stewardship interventions. Secondary objectives included describing the types of cultures being managed and the antimicrobials prescribed empirically and post-culture review.</p><p><strong>Methods: </strong>A retrospective chart review was conducted using pharmacist workload tracking documentation to identify patients with eligible cultures from six EDs in Alberta.</p><p><strong>Results: </strong>Three hundred cultures were included in this study, and one hundred twenty-nine interventions (40.7% of all cultures reviewed) were performed by ED pharmacists. Initiation of therapy was the most common (33.3%), followed by tailoring therapy (21.7%). Urine cultures were predominant (55.7%), and the antibiotics most prescribed, empirically, and post-culture for urine, were cefixime (44%) and trimethoprim-sulfamethoxazole (34%), respectively. Five patients with asymptomatic bacteriuria were treated with antibiotics. Five patients with skin and soft tissue infections were treated with dual oral antibiotics when culture and sensitivity results indicated monotherapy would have been sufficient. Eight extra days of cefixime therapy were prescribed due to unaccounted doses administered in the ED.</p><p><strong>Conclusion: </strong>This study highlights the critical role of ED pharmacists in culture review and follow-up activities and their contributions to antimicrobial stewardship. By characterizing culture review and follow-up practices, several opportunities for minimizing unnecessary antimicrobial use were identified. These findings will help inform the development of targeted education and training programs to help strengthen the stewardship capabilities of ED pharmacists and prescribers.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are paramedics comfortable and confident in their ability to provide emergency healthcare to transgender and gender diverse populations? A cross-sectional survey.","authors":"Lyon Kengis, Michael Kruse, Robin Urquhart, Judah Goldstein","doi":"10.1007/s43678-025-00947-w","DOIUrl":"https://doi.org/10.1007/s43678-025-00947-w","url":null,"abstract":"<p><strong>Introduction: </strong>Transgender and gender diverse people report high rates of healthcare avoidance, yet they also access emergency departments at higher rates than the general population. Our research explores the paramedic perspective of providing care to transgender and gender diverse populations. The objectives were to assess paramedic comfort, confidence, and knowledge in providing healthcare to transgender and gender diverse communities.</p><p><strong>Methods: </strong>A descriptive, cross-sectional electronic survey was administered to paramedics licensed with the College of Paramedics of Nova Scotia (n = 1281) between April 9 and May 7, 2018. A 4-point Likert scale and open-ended questions about paramedic comfort, confidence, and knowledge were included. Descriptive statistics were used to describe respondent characteristics. Open-ended questions pertaining to paramedic knowledge needs were evaluated using constant comparative analyses employing open coding to identify themes.</p><p><strong>Results: </strong>The response rate for the survey was 30%, with 387 licensed paramedics participating. Most respondents (66.2%) reported providing care to a patient who identified as transgender and gender diverse. A few respondents (4.9%) felt very confident in their knowledge regarding transgender and gender diverse identities and only 26.6% felt very comfortable in providing optimal care. Of those surveyed, 74.7% had no formal education on transgender and gender diverse health. Close to half (41.9%) reported observing transphobia in the workplace. Most respondents (70%) were interested in obtaining formal education and believed that it should be included in formative education curricula. Paramedics identified four distinct barriers to delivering equitable healthcare to transgender and gender diverse populations: (1) systemic, (2) personal, (3) socio-cultural, and (4) educational barriers.</p><p><strong>Conclusion: </strong>Paramedics provide emergency healthcare to transgender and gender diverse patients. Comfort and confidence in providing this care were relatively low and identifiable barriers inhibit paramedic capacity to provide equitable healthcare. There was strong interest for education on transgender and gender diverse health and emergency presentations.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The increased mortality of older patients with moderate traumatic brain injury.","authors":"Chartelin Jean Isaac, Axel Benhamed, Valérie Boucher, Samuel Lauzon, Pierre-Gilles Blanchard, Christian Malo, Francis Bernard, Jean-Marc Chauny, Mélanie Bérubé, Eric Mercier, Amaury Gossiome, Myreille D'Astous, Marcel Émond","doi":"10.1007/s43678-025-00941-2","DOIUrl":"https://doi.org/10.1007/s43678-025-00941-2","url":null,"abstract":"<p><strong>Purpose: </strong>Higher mortality has been reported in older patients with moderate traumatic brain Injuries (TBI) compared to younger patients. To identify the risk factors associated with in-hospital mortality, complications and extended length of stay in moderate TBI patients.</p><p><strong>Methods: </strong>DESIGN: a multicentre observational cohort study using the Quebec Trauma Registry.</p><p><strong>Population: </strong>Hospitalized patients aged ≥ 16 with a moderate TBI (a head injury with an Abbreviated Injury Scale (AIS) ≥ 3, and a GCS score of 9-12).</p><p><strong>Outcomes: </strong>In-hospital mortality, complications and prolonged length of stay.</p><p><strong>Analyses: </strong>Multivariable logistic regression.</p><p><strong>Results: </strong>We included 1005 patients, 38.1% of whom were aged ≥ 65. The in-hospital mortality rate was 20.1%. Male sex (OR = 1.6 [95% CI:1.02-2.6], age (≥ 85 years old VS < 65 years) (OR = 18.7 [95% CI: 9.2-38.1]), ≥ 2 comorbidities (OR = 2.3 [95% CI: 1.3-4.0]), Injury Severity Score (OR = 1.04 [95% CI: 1.01-1.1]), presence of intraparenchymal hematoma (OR = 3.5 [95% CI: 2.2-5.5]) or other CT scan findings (cerebral edema, pneumocephalus, subpial hemorrhage, and pituitary injury) (OR = 1.9 [95% CI: 1.2-3.1]) were associated with increased odds of mortality. Male sex (OR = 1.8 [95% CI: 1.2-2.6]), age (65-74: OR = 1.7 [95% CI: 1.1-2.8] & 75-84: OR = 1.6 [95% CI: 1.03-2.6]), ≥ 2 comorbidities (OR = 2.9 [95% CI: 1.8-4.7]), thoraco-abdominal concomitant injury (OR = 2.0 [95% CI: 1.01-3.8]), and subarachnoid hemorrhage (OR = 7.6 [95% CI:1.5-38.5]) were associated with increased odds of complications. The number of comorbidities (≥ 2 OR = 1.7 [95% CI: 1.1-2.7]), spine injury (OR = 2.4 [95% CI: 1.4-4.1]), and delirium (OR = 3.1 [95% CI:1.8-5.2]) were associated with an increased odd of extended length of stay.</p><p><strong>Conclusions: </strong>This study identified risk factors of in-hospital mortality, complications and extended length of stay, most of which are quickly available in the Emergency Department (ED). These factors could help clinicians identify moderate TBI patients at high risk of in-hospital mortality and guide shared decision-making regarding goals of care.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process mapping as a framework to define critical care delivery steps in massive transfusion in trauma.","authors":"Matthew A Bergens, Jessica D Guo, Bruce W Rogers, Ursula A Rogers, Jessica L Poisson, Emily C Sterrett, Zachary Ginsberg","doi":"10.1007/s43678-025-00898-2","DOIUrl":"10.1007/s43678-025-00898-2","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this quality improvement initiative was to use process mapping to identify the critical process steps for executing massive transfusion in trauma patients with hemorrhagic shock in an academic emergency department. Understanding the relationships and complexity of care delivery steps in massive transfusion is needed to inform the development of performance metrics and improve care delivery.</p><p><strong>Methods: </strong>This process mapping exercise was conducted in the academic emergency department of a verified trauma center using the Institute for Healthcare Improvement framework. Interviews were conducted with emergency department staff members, including nurses, technicians, pharmacists, and blood bank staff. Data collection included structured stakeholder interviews and real-time observation of massive transfusion protocol deployment.</p><p><strong>Results: </strong>Seventeen interviews and real-time observations yielded 87 pages of interview text and 533 objects mapped. Two key clinical decision points were identified: the decision to transfuse and the decision to image. The process was segmented into initial protocol-based care and subsequent physician-driven care. High-level and mid-level process maps, incorporating swim lanes, were created to highlight the process steps to deliver of massive transfusion to trauma patient in our academic emergency department.</p><p><strong>Conclusion: </strong>Process mapping resulted in the creation of an agreed upon standard process that outlines critical steps and distinct phases of care in delivery of the massive transfusion protocol. These findings provide benchmarks for future improvement work and performance measurement efforts.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"465-469"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Working towards consistency and clarity in pediatric blood culture management.","authors":"Seyara Shwetz, Lauren Roberts","doi":"10.1007/s43678-025-00942-1","DOIUrl":"https://doi.org/10.1007/s43678-025-00942-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 6","pages":"414-415"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-induced neurotoxicity and delirium in the emergency department.","authors":"Lisa Fischer","doi":"10.1007/s43678-024-00816-y","DOIUrl":"10.1007/s43678-024-00816-y","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"435-437"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social emergency medicine: delivering equity-oriented health care in Canada.","authors":"Dylan Collins, Matthew Douglas-Vail","doi":"10.1007/s43678-025-00899-1","DOIUrl":"10.1007/s43678-025-00899-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"423-425"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Development and evaluation of a clinical simulation-based educational innovation on sexual orientation and gender identity in emergency medicine.","authors":"Juan Mohadeb, Luke Brueton-Campbell, Kris Doucet, Anna Reed, Devon Mitchell, Tamara McColl, Carys Massarella, Blair Bigham, Nadia Primiani, Robert Primavesi, Michael Kruse, Rusty Souleymanov, Ben Klassen, Adam Brandt, Colleen Dawson, Luca Gheorghica, Noé Prefontaine, Jess Crawford, Seth Kamabu, Jordn-Micheal McCarthy, Carmen Hrymak, Murdoch Leeies","doi":"10.1007/s43678-024-00725-0","DOIUrl":"10.1007/s43678-024-00725-0","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"501"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}