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":"https://doi.org/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":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","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":"Development of a scoring tool for emergency department note quality: a modified Delphi approach.","authors":"Daniel Z Foster, Stuart L Douglas, Akshay Rajaram","doi":"10.1007/s43678-025-00914-5","DOIUrl":"https://doi.org/10.1007/s43678-025-00914-5","url":null,"abstract":"<p><strong>Objective: </strong>Emergency department (ED) documentation is essential for patient care. Accepted standards are required to teach best practices; however, tools to assess ED note quality are deficient, either lacking validation or performing poorly. We sought to develop a tool for assessing ED note quality for lower acuity visits in patients 16 years of age or older.</p><p><strong>Methods: </strong>We employed a modified Delphi approach with two rounds of electronic surveys. We invited 40 Canadian emergency physicians to serve as experts. In round one, we gathered feedback on dimensions (content elements, attributes, and scoring) relevant to ED note quality. Using these data, we derived a draft tool which was shared with the experts in round two, and then modified based on their feedback. Outcome data included survey response rates, and quantitative and qualitative feedback.</p><p><strong>Results: </strong>Response rates were 44% (n = 17) and 47% (n = 8) for the first and second rounds. Key perspectives from round one emphasized differences between broadly applicable (\"universal\") versus context-specific (\"conditional\") elements, the importance of certain attributes, and a binary scoring system. The authors drew on perspectives to develop a tool with eight universal and 16 conditional elements, four attributes, scored using a binary system. Feedback from the second round recommended minor changes, but demonstrated consensus on the tool's stated function.</p><p><strong>Conclusion: </strong>We developed the Tool for ED Note Quality. Limitations include a small sample size and a focus on physician perspectives. Next steps include generation of evidence for validity and refinement of the scoring system. Once validated, the tool may be used in assessing ED note quality for the purposes of medical education, quality improvement, and digital health research.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031783","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":"CAEP position statement on pregnancy and parental leave: executive summary.","authors":"Erin Brennan, Kyla Caners, Christopher Bennett Heyd, Aimee Kernick, Emma McIlveen-Brown, Alim Pardhan, Chau Pham, Éliane Raymond-Dufresne, Gillian Sheppard, Hannah Shoichet, Kelly Van Diepen","doi":"10.1007/s43678-025-00901-w","DOIUrl":"https://doi.org/10.1007/s43678-025-00901-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059736","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":"https://doi.org/10.1007/s43678-024-00816-y","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-16","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":"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":"https://doi.org/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":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-16","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":"Analysis of secondary trauma transfers within a Canadian regional trauma network: room for improvement?","authors":"Ryan McAleer, Rachel Stephenson, Melissa McGowan, Brodie Nolan, Johannes von Vopelius-Feldt","doi":"10.1007/s43678-025-00900-x","DOIUrl":"https://doi.org/10.1007/s43678-025-00900-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines secondary trauma transfers of critically injured patients to an adult regional trauma centre in a mixed urban-suburban setting, to examine if these could be avoided through the provision of prehospital critical care at the scene of injury.</p><p><strong>Methods: </strong>This is a cohort study of trauma activations at an adult regional trauma centre in Toronto, Canada, over a 5-year period. We included all secondary trauma transfers of patients who were either admitted to the ICU, had surgery within 4 h of arrival or died within 48 h of admission. Baseline demographics, injury data, geospatial data and interventions provided were extracted from the hospital's trauma registry.</p><p><strong>Results: </strong>659 cases met the inclusion criteria during the five-year study period. 364 (55%) patients underwent secondary transfer from non-trauma centres located in relatively close proximity of 80 km or less. Within this group, patients had a median injury severity score of 22 (IQR 16-29) and the mortality was 17%. 188 (52%) received at least one critical care intervention at the sending facility prior to secondary transfer to the trauma centre. The most frequently performed interventions were emergency anesthesia and intubation (37%), blood transfusion (27%), and finger and/or tube thoracostomy (13%).</p><p><strong>Conclusion: </strong>A significant proportion of critically injured patients in our mixed urban-suburban trauma network are transferred from non-trauma hospitals in relatively close proximity to the trauma centre. Non-trauma hospitals frequently provide time-critical and life-saving interventions prior to secondary transfer. A prehospital critical care scene response for major trauma should be explored as an option to deliver critical care interventions at the scene, followed by direct transport to a trauma centre.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061498","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":"https://doi.org/10.1007/s43678-025-00907-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055298","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":"https://doi.org/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":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-15","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":"Global Research Highlights.","authors":"","doi":"10.1007/s43678-025-00905-6","DOIUrl":"10.1007/s43678-025-00905-6","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"309-313"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775210","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":"Self-administered intranasal etripamil: a new treatment to keep SVT out of the ED?","authors":"Lauren Roberts, Sam Savard, Stephan Wardell, Rob Woods","doi":"10.1007/s43678-025-00864-y","DOIUrl":"10.1007/s43678-025-00864-y","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"257-259"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560321","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}