CJEM最新文献

{"title":"Does an intraosseous access-first strategy improve 30-day survival in out-of-hospital cardiac arrests?","authors":"Hailey Newton, Justin Godbout, Christian Vaillancourt","doi":"10.1007/s43678-025-00938-x","DOIUrl":"10.1007/s43678-025-00938-x","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"698-700"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621595","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":"McGill healthcare-management case competition: an educational innovation addressing critical healthcare issues in operations management.","authors":"Saad Razzaq, Khadija Brouillette, Arielle Grossman, Lucy Pu, Julia Phillipp, Laurence Robert, Lauren Perlman, Shanti Rumjahn-Gryte, Sébastien Lamarre-Tellier, Bernard Unger, Anali Maneshi, Robert Primavesi, Laurie Hayes Plotnick","doi":"10.1007/s43678-025-00987-2","DOIUrl":"https://doi.org/10.1007/s43678-025-00987-2","url":null,"abstract":"<p><p>The McGill Healthcare-Management Case Competition was developed to increase exposure and understanding of medical learners to operations management and quality improvement. The case competition was designed and implemented based on Kern's curriculum development framework focusing on experiential learning and case-based gamification. Informed by the Medical Council of Canada's objectives, it enabled participants to critically analyze real-world healthcare operations and associated challenges. Evaluation of the effectiveness of case competition using Kirkpatrick's model (level 1 and 2) demonstrated significant improvements in participants' perceived knowledge, comfort, and confidence addressing quality improvement issues and management of flow and overcrowding. The McGill Healthcare-Management Case Competition is an educational innovation that represents a curricular tool for integrating healthcare operations management and quality improvement education into medical training.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982405","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":"Just the facts: Shiga toxin-producing Escherichia coli infection in children.","authors":"Mohamed Eltorki, Jennifer Thull-Freedman, Stephen B Freedman","doi":"10.1007/s43678-025-00993-4","DOIUrl":"https://doi.org/10.1007/s43678-025-00993-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982374","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":"Just the facts: Mass Gathering Events and why they matter to emergency physicians.","authors":"Harmine Christina Léo, Marc-Antoine Pigeon, Cara Taubman","doi":"10.1007/s43678-025-00983-6","DOIUrl":"https://doi.org/10.1007/s43678-025-00983-6","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982439","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":"Aortic dissection in the ED: a medico-legal perspective on diagnostic delays and failures.","authors":"Jacqueline H Fortier, Mehrnaz Mostafapour, Robert Ohle, Kate Barbosa, Richard Liu, Ming Guo, Gary E Garber, Heather E Murray","doi":"10.1007/s43678-025-00999-y","DOIUrl":"https://doi.org/10.1007/s43678-025-00999-y","url":null,"abstract":"<p><strong>Purpose: </strong>Aortic dissection is a life-threatening emergency and delayed or missed diagnoses can result in significant morbidity and mortality for patients.</p><p><strong>Methods: </strong>We conducted a quantitative and qualitative analysis of medico-legal cases from a national repository involving thoracic aortic dissection seen in the emergency department during a 10-year period. We thematically analyzed peer expert criticism of the care in these cases, including provider, team, and systems factors related to diagnostic issues. We also applied two clinical decision tools to explore whether use of these tools could have affected the diagnostic process.</p><p><strong>Results: </strong>Of 3,531 medico-legal cases in the emergency department during our study period, just 43 were related to aortic dissection. Patients were primarily male (68.2%), presented for care at large urban centers (65.1%), and were triaged as urgent or emergent (72.1%). Thirty-six patients died of their aortic dissection. A thematic analysis identified atypical presentations, diagnostic anchoring, misinterpretation or misuse of tests, communication breakdowns, and resource limitations as common in these cases.</p><p><strong>Conclusions: </strong>Missed diagnoses of aortic dissection in the ED often result from a combination of cognitive, communication, and system-level factors. Understanding these contributors can inform evidence-based, systems-level supports and strategies to enhance diagnostic accuracy and reduce patient harm.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982376","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":"Lullaby in the chaos.","authors":"Paul Parks","doi":"10.1007/s43678-025-01002-4","DOIUrl":"https://doi.org/10.1007/s43678-025-01002-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982402","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":"Hidden beneath the surface: what are the knowledge and skills for successful transition to practice.","authors":"Stella Yiu, Marianne Yeung, Warren Cheung, Jason R Frank","doi":"10.1007/s43678-025-01000-6","DOIUrl":"https://doi.org/10.1007/s43678-025-01000-6","url":null,"abstract":"<p><strong>Purpose: </strong>The transition from training to independent practice in Emergency Medicine is challenging. Early career physicians need specific knowledge to function in new roles. However, this knowledge can be unwritten and implicit. It is unclear what skills newly graduated emergency physicians need to succeed in their early independent practice. We wished to understand these elements in order to inform further development of the current transition to practice curriculum.</p><p><strong>Methods: </strong>We interviewed 23 emergency physicians in their first 5 years of practice at an urban academic center to explore the knowledge they acquired in early practice. Employing a constructivist stance, data collection and analysis occurred iteratively until thematic saturation. We constructed themes using inductive thematic analysis.</p><p><strong>Results: </strong>Newly graduated emergency physicians identified the knowledge needed in early clinical practice. This knowledge was unwritten, dynamic, nuanced, difficult to transfer, and vital for them to function effectively. Knowledge was needed in four facets of clinical practice: patient interaction, learner supervision, institutional processes and group culture. Within patient interaction, they required skills and knowledge for their responsibility, gestalt, decision-making and communication. They needed skills to supervise learners, delegate them with tasks and provide feedback. To function effectively, they needed to learn institutional processes and how to manage departmental tasks. They also required knowledge of tacit group norms about work efficiency, code of conduct and patient care. Newly graduated physicians sought strategies to manage aspects within each of these four facets.</p><p><strong>Conclusion: </strong>Specific knowledge is necessary in multiple facets of independent Emergency Medicine practice. Such knowledge is often unwritten and contextual, but the associated skills and strategies can be made explicit. Educators should incorporate these components in their transition-to-practice curriculum to support graduating trainees in becoming successful attending physicians.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982383","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":"Barriers and facilitators to use of the HEARTRISK6 Scale for acute heart failure presentations in the emergency department: a qualitative study.","authors":"Hassan Sheikh, Warren J Cheung, Debra A Eagles, Ian G Stiell","doi":"10.1007/s43678-025-00981-8","DOIUrl":"10.1007/s43678-025-00981-8","url":null,"abstract":"<p><strong>Objective: </strong>Acute heart failure is the second most common reason for return visits to the emergency department (ED) in Canada. Half of all acute heart failure patients presenting to the ED can be discharged, suggesting admission is not always necessary. The HEARTRISK6 Scale was recently developed from prospectively collected data of 2,246 acute heart failure patients from 10 Canadian EDs. This tool comprises six routine ED criteria and aids disposition decisions by estimating the risk of poor outcomes. Currently, it is not known what ED clinicians think of the tool. This study aimed to determine the factors impacting emergency physician use of the HEARTRISK6 Scale, and to identify the relevant opportunities to increase uptake of the tool.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with ED attending and resident physicians at The Ottawa Hospital and nearby community sites. An interview guide based on the theoretical domains framework (TDF) was used to capture factors within the 14 domains that may influence the use of HEARTRISK6. Interview transcripts were coded using direct content analysis, and belief statements were generated to capture similar responses. Relevant and non-relevant domains were identified based on their frequencies, presence of conflicting ideas, and perceived influence.</p><p><strong>Results: </strong>Sixteen interviews (thirteen attendings, three residents) were conducted with ED physicians. Eleven of the fourteen TDF domains were identified as relevant. Participants described key facilitators to be teaching about the tool, positive colleague views, increased objectivity of disposition decision, ease of access, and feeling it benefited their work. Desire for more evidence, competing demands, and need for consultant buy-in were noted as important barriers.</p><p><strong>Conclusion: </strong>This study identified key barriers and facilitators to use of HEARTRISK6 Scale for acute heart failure patients. These factors provide targets for developing interventions aimed at encouraging routine use of HEARTRISK6 among ED physicians in clinical practice.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884455","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":"A qualitative study on the perspectives of patients and providers on the integration of geriatric personal support workers for improving quality of care in the emergency department.","authors":"Marina Motsenok, Sander L Hitzig, Eva Cohen, Justin N Hall, Miranda Lamb, Clare Atzema, Jean Sugarbroad, Leanne Hughes, Winny Li, Laila Nasser, Ivy Cheng","doi":"10.1007/s43678-025-00988-1","DOIUrl":"10.1007/s43678-025-00988-1","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877293","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":"Improving the rate of use of fascia iliaca compartment blocks in patients presenting with hip fractures.","authors":"Kristin O'Neill, Joseph Boyle, Logan Haynes, Brittany Ellis, Rob Woods, Taofiq Oyedokun, Sachin V Trivedi","doi":"10.1007/s43678-025-00990-7","DOIUrl":"10.1007/s43678-025-00990-7","url":null,"abstract":"<p><strong>Background: </strong>Patients presenting to the emergency department (ED) with hip fractures are typically treated with opioids, which are associated with adverse events such as delirium and respiratory depression. The fascia iliaca compartment block (hereafter fascia iliaca block) is a regional analgesia technique which avoids these negative outcomes. We sought to increase the rate of use of this technique to 50% of all patients with hip fractures who presented to our EDs within an 18-month period.</p><p><strong>Methods: </strong>We held three Plan-Do-Study-Act cycles designed in accordance with surveys sent to our physician group. The first cycle consisted of the dissemination of educational materials and standardization of equipment carts. Next, we held educational sessions for staff and trainee physicians. The third cycle consisted of additional education, Audit and Feedback methodology and incentives. Our outcome measure was the rate of fascia iliaca blocks performed. We tracked the number of unique physicians performing the fascia iliaca block as well as physician-reported comfort with the procedure for our process measures. Our balancing measure was the rate of adverse events.</p><p><strong>Results: </strong>We went from a baseline rate of 2.0% to 22.6% of patients receiving fascia iliaca blocks. The number of physicians doing this increased from 6 pre-project to 35. Only one adverse event occurred (arterial puncture), which did not cause any significant patient harm. Our statistical process control chart revealed special cause variation in the form of a shift.</p><p><strong>Conclusion: </strong>Although we did not meet our goal, we were able to significantly improve the rate of fascia iliaca blocks performed at our center. This was largely achieved through educational interventions. Our approach can be adapted by other centers looking to pursue a similar project.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877294","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}