CJEM最新文献

{"title":"Improving patient care experience in the pediatric emergency department: a systematic review.","authors":"Evan Abram, Bhavan Dhaliwal, Banke Oketola, Hoda Badran, Apoorva Gangwani, Peace Eleonu, Carrie Costello, Clara Tam, Terry P Klassen, Elisabete Doyle, Alex Aregbesola","doi":"10.1007/s43678-025-00897-3","DOIUrl":"10.1007/s43678-025-00897-3","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective of the project was to summarize existing evidence on patient experiences in pediatric emergency departments (EDs). The secondary objectives were to characterize patient care experience in pediatric EDs, identify barriers to optimal patient care in pediatric EDs, and identify equity, diversity, and inclusion (EDI) principles influencing pediatric emergency care.</p><p><strong>Methods: </strong>We performed a systematic review of cohort, cross-sectional, and controlled clinical studies on children's (≤ 21 years) experience in the pediatric ED. We searched MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), Cochrane Database of Systematic Reviews (Ovid), CENTRAL (Ovid), and CINAHL (EBSCO) from inception until September 7, 2023. Two reviewers independently screened articles for primary outcomes involving any health care outcome or health care utilization, along with secondary outcomes of EDI factors influencing patient care. Data were obtained from included studies using narrative and descriptive analysis. The process was strengthened by input from patients, families, and providers on the Manitoba Emergency Advisory Committee, who proposed additional areas for consideration.</p><p><strong>Results: </strong>Six articles were included, assessing 12 experiences. All studies were from high-volume centers. The primary outcome data indicated an overall satisfaction being rated positively, with satisfaction levels exceeding 70% despite lower ratings in privacy, communication, and waiting areas. Wait times and speed of care were significantly correlated with satisfaction (r = -0.48, P < 0.01 and r = 0.38, P < 0.01, respectively), noting wait times and privacy as barriers to care. The EDI factor impacting patient experience was race, showing decreased scores for privacy and patient voice for those identifying as non-white.</p><p><strong>Conclusions: </strong>Even with a high overall satisfaction in the pediatric EDs, aspects influencing the experience can be improved. Wait times, waiting areas, privacy and EDI factor such as race should be addressed to help overcome barriers and improve the care patients receive.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"476-490"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060856","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":"Management of a positive blood culture in the pediatric emergency department: a multicenter case-based survey.","authors":"Samir Gouin, Benoit Carrière, Jocelyn Gravel","doi":"10.1007/s43678-025-00908-3","DOIUrl":"10.1007/s43678-025-00908-3","url":null,"abstract":"<p><strong>Objective: </strong>Positive blood cultures in pediatric emergency departments (ED) represent a diagnostic dilemma for clinicians as 50% are contaminants. Our goal was to characterize management of positive blood cultures by physicians working in pediatric EDs across Canada.</p><p><strong>Methods: </strong>A self-administered electronic survey was sent to all members of the Pediatric Emergency Research Canada (PERC) network in 2024 using the principles of the Dillman's tailored design method. The survey was constructed using standardized methodology. Potential risk factors of bacteremia were identified based on a literature review and consultation of multiple experts. The survey consisted of three clinical cases, modeled off real patients, and was pilot tested by a group of physicians. Each case highlighted a common clinical scenario in which physicians had to interpret the significance of a positive blood culture. There were follow-up questions to further assess clinical decision-making and provide demographic information.</p><p><strong>Results: </strong>In the final analysis, we included 153 (69%) of the 221 PERC members invited from 15 hospitals. The management of the case scenarios was heterogeneous, for example, 49% of participants would have discharged a 9-week-old with a positive culture and otherwise normal blood results while 35% suggested hospitalization with intravenous antibiotics. Most participants suggested that young age, immunocompromised status, and shorter time to blood culture positivity as risk factors for true bacteremia, though there was no consensus on time-to-positivity or influenza status. 98% of the participants reported that they would be willing to adopt a clinical decision rule if it had a high sensitivity.</p><p><strong>Conclusion: </strong>There is considerable practice variation among ED physicians for the management of positive blood cultures in children across Canada. Incongruencies in the perceived impact of clinical factors on the likelihood of a true bacteremia, such as time-to-positivity, highlight the need for a standardized decision-making tool.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"470-475"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060431","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":"Implementation of a CPR quality data collection program in the emergency department: a quality improvement initiative.","authors":"Garrick Mok, Samuel Vaillancourt, Minnie Fu, Sara Gray, Lucas B Chartier, Natalie Wong, Katherine S Allan, Farah Warsi, Celine Callender, Melissa McGowan, Andrew Petrosoniak","doi":"10.1007/s43678-025-00882-w","DOIUrl":"10.1007/s43678-025-00882-w","url":null,"abstract":"<p><strong>Objectives: </strong>We used quality improvement (QI) methodology to improve cardiopulmonary resuscitation (CPR) data collection within the emergency department (ED) for non-traumatic cardiac arrests. This novel program aimed to improve CPR data collection from a baseline of 48.7-80% between August 15th, 2023-April 14th, 2024.</p><p><strong>Methods: </strong>The outcome measure was percentage of cases with CPR data available. The secondary measures included CPR rate and depth (composite measure), compression fraction, and CPR pauses < 10 s. Manual review of electronic health records and Zoll Case Review^© was utilized for data extraction. The project team was created utilizing a stakeholder matrix. Diagnostics included an Ishikawa diagram, QI huddles, simulation, and process mapping. Interventions included: introduction of an emergency medical services (EMS)-to-ED adapter, simulation and education, and data debriefing. Elements were introduced and tested with simulation prior to implementation. P-charts and x-charts were used to determine successful completion of aims.</p><p><strong>Results: </strong>CPR data were available in 48.7% (19/39) of cardiac arrest cases during the baseline period (February 15th, 2023-August 14th, 2023). Special cause variation was met during the implementation period with a shift (≥ 8 consecutive points above or below median), improving data collection to 89.1% (49/55). Improvements were identified with a shift for CPR in target for rate and depth (1.8-20.4%) and compression fraction (82.2-86.9%). No special cause variation was identified for CPR pauses < 10 s.</p><p><strong>Conclusion: </strong>Through the use of QI methodology, we successfully improved CPR data collection within our ED from 48.7-89.1% for non-traumatic cardiac arrests. Improvements were seen in CPR in target for rate and depth, and compression fraction. This program provides a foundation for reliable CPR performance measurement and improvement, and serves as an example for other ED's with similar interest in CPR performance improvement.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"451-459"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574892","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 fulcrum: a novel technique for reduction of shoulder dislocations.","authors":"Paul Carr, Jesse Maracle","doi":"10.1007/s43678-025-00907-4","DOIUrl":"10.1007/s43678-025-00907-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"491-493"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Only one chance to make a first impression: the consequence of the patient experience.","authors":"J W Lee, J Leworthy","doi":"10.1007/s43678-025-00943-0","DOIUrl":"https://doi.org/10.1007/s43678-025-00943-0","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 6","pages":"416-417"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303928","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":"How does use of a liberal or restrictive blood transfusion strategy influence neurological outcome in patients with acute brain injury?","authors":"Casey Jones, Laurel Murphy, James Nunn","doi":"10.1007/s43678-025-00909-2","DOIUrl":"10.1007/s43678-025-00909-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"438-439"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061459","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: Recommendations for patient-centered emergency care.","authors":"Sasha Litwin, Samuel Vaillancourt, Frédérique Kyomi Labelle, Shawn Mondoux, Simon Berthelot, Lindsay Clarke, Cathie Hofstetter, Stephanie VandenBerg, Eddy Lang, Lucas B Chartier","doi":"10.1007/s43678-024-00804-2","DOIUrl":"10.1007/s43678-024-00804-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"500"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201051","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":"Development and implementation of the Compassionate 1 Curriculum: an educational initiative to improve the delivery of care to patients receiving involuntary orders for mental health emergencies.","authors":"Maximilian Strauss, Rachel Sue A Quan, Taya Hyman, Liam Ishaky, Dinah Kalvari, Matthew Hecker-Teper, Tate Newmarch, Mark Unger, Aaron Orkin","doi":"10.1007/s43678-025-00912-7","DOIUrl":"10.1007/s43678-025-00912-7","url":null,"abstract":"<p><p>Compassion is an indispensable attribute of quality healthcare, but enhancing compassion is seldom the focus of emergency healthcare improvement. The Compassionate 1 Project was launched in the St. Joseph's Emergency Department, Toronto, with a goal of reducing critical agitation events among patients receiving involuntary orders for mental health emergencies. This initiative sought to enhance compassion by improving the quality of communication and material comfort for this patient group. Here, we describe the first component of this project, a novel, whole-of-department educational initiative to teach the delivery of compassionate care to patients with mental health presentations. The second component of this project will evaluate the impact of this initiative in reducing critical agitation events.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"440-443"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056157","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":"CPR quality data collection: building the foundation for a Cardiac Arrest Quality Improvement Program.","authors":"Adam Cheng, Ian R Drennan, Kasper G Lauridsen","doi":"10.1007/s43678-025-00939-w","DOIUrl":"https://doi.org/10.1007/s43678-025-00939-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 6","pages":"411-413"},"PeriodicalIF":2.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303878","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":"Where trauma and trauma-informed care collide: ethical considerations for emergency medicine.","authors":"Jeanne Webber","doi":"10.1007/s43678-025-00933-2","DOIUrl":"https://doi.org/10.1007/s43678-025-00933-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153135","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}