CJEM最新文献

{"title":"Disparities in emergency department boarding: contrasting mental health and non-mental health patients.","authors":"Cassandra Chisholm, Xiaoming Wang, Conné Lategan, Zoe Hsu, Amelia Ridout, Eddy Lang","doi":"10.1007/s43678-024-00852-8","DOIUrl":"10.1007/s43678-024-00852-8","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency department (ED) boarding is a major threat to timely and safe care delivery. Addressing boarding requires an understanding of which patient populations are significantly impacted to formulate solutions. Our objective was to evaluate the median ED boarding time of mental health compared to non-mental health patients.</p><p><strong>Methods: </strong>We performed a database analysis using the National Ambulatory Care Reporting System data from 96 EDs from September 1, 2018, to September 30, 2023. International Classification of Diseases 10th Revision codes were used to define mental health and non-mental health subgroups for all patients admitted from the ED who were greater than 18 years old. Boarding was defined as the elapsed time between the admission decision to when patients departed the ED. Descriptive statistics summarized ED visit characteristics and median (IQR) boarding time throughout three study periods. An interrupted time series analysis evaluated boarding trends to account for COVID-19 variation.</p><p><strong>Results: </strong>During the study period, 887,494 patients were admitted from an ED with mental health (113,209; 13%) or non-mental health (774,285; 87%) diagnoses. The mental health subgroup was younger, with a median age of 40, and predominantly male (57.1%). The median (IQR) boarding time for mental health patients was 120% longer (282 min (79-1113)) compared to non-mental health (128 min (58-420)). When comparing the initial and final study periods, mental health patient boarding increased by 76% (199 min), and non-mental health patient boarding increased by 24% (29 min).</p><p><strong>Conclusion: </strong>This is the most extensive Canadian study comparing ED boarding for mental health and non-mental patients. The results demonstrate that mental health patients experience disproportionately longer ED boarding compared to other patient presentations, and the trend remains consistent over time. This emphasizes the need to address inequities in resourcing inpatient beds and adjust the current care model for mental health patients.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400923","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 scholarship points program to encourage academic productivity in your emergency department.","authors":"Jeffrey J Perry, Christian Vaillancourt, Krishan Yadav, Guy Hebert, Warren J Cheung, Hans Rosenberg, Debra Eagles, Venkatesh Thiruganasambandamoorthy, Cheryl Geymonat, Ian Stiell","doi":"10.1007/s43678-025-00869-7","DOIUrl":"https://doi.org/10.1007/s43678-025-00869-7","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366939","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":"Ultrasound in pediatric emergency medicine simulation: evaluation of a longitudinal curriculum.","authors":"Hadas Katz-Dana, Dana Singer-Harel, Elana Thau, Maduomethaa Pathmaraj, Laura Simone, Paul Olszynski, Jonathan Pirie, Maya Harel-Sterling","doi":"10.1007/s43678-024-00854-6","DOIUrl":"https://doi.org/10.1007/s43678-024-00854-6","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric resuscitations involving shock and trauma are rare but they are high-stakes events in the pediatric emergency department (ED). Effective use of point-of-care ultrasound (POCUS) can expedite diagnosis and treatment in such cases. This study aimed to assess the impact of a longitudinal pediatric emergency medicine simulation curriculum and high-fidelity POCUS simulator on residents' clinical practice, comfort level, and motivation to learn resuscitative ultrasound.</p><p><strong>Methods: </strong>This mixed-methods study involved 12 pediatric emergency medicine residents who participated in a 12-month simulation curriculum integrating resuscitative ultrasound. The POCUS simulator was integrated and made available for use during all simulations. Assessment and program evaluation occurred at multiple levels, according to Kirkpatrick's hierarchy, using both qualitative and quantitative methods. The residents were surveyed at baseline, 4, 8 and 12 months. Semi-structured interviews were conducted at the end of the 12-month study period.</p><p><strong>Results: </strong>Twelve residents participated in 23 simulation cases over the 12-month longitudinal curriculum. The hybrid POCUS simulator was used by participants in 18/23 (78.2%) cases. Comparing pre- and post-curriculum changes, large effect sizes were seen in residents' comfort using ultrasound in resuscitation (including in cases of trauma and undifferentiated shock). Accordingly, the mean number of POCUS scans performed per resident clinically on shift increased from a mean (SD) of 5.7 (± 2.3) scans/month to 12.4 (± 5.1) scans/month. Qualitative analysis highlighted several themes, including the value of simulation for teaching the integration of resuscitative ultrasound in high-acuity low-occurrence events and the effect of repeat exposures to resuscitative ultrasound.</p><p><strong>Conclusion: </strong>Our study demonstrated that a longitudinal, simulation-based curriculum focused on resuscitative ultrasound increased residents' confidence, their motivation and likelihood of using these skills in the clinical setting. Repeated simulation exposures to resuscitative ultrasound can help participants translate this critical skill into use at the bedside, especially in high-acuity low-occurrence events.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366978","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":"Validity and reliability of an abbreviated Copenhagen Burnout Inventory in Canadian emergency physicians and residents.","authors":"Henry Li, Erica Dance, Zafrina Poonja, Isabelle Colmers-Gray","doi":"10.1007/s43678-024-00849-3","DOIUrl":"https://doi.org/10.1007/s43678-024-00849-3","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency physicians have the highest rates of burnout among all medical specialties. There is a need for accurate and reliable burnout assessment tools to monitor changes and assess the effects of interventions. However, existing tools are typically long and/or costly. We sought to validate an abbreviated Copenhagen Burnout Inventory among emergency physicians and trainees in Canada.</p><p><strong>Methods: </strong>We conducted a planned secondary analysis of a national, cross-sectional survey of emergency physicians and trainees in Canada. Exploratory factor analysis was performed followed by confirmatory factor analysis. Kaiser's eigenvalues rule, a scree plot, and Horn's parallel analysis guided the number of factors to extract. Structural validity fit indices and internal consistency were compared to pre-specified cutoffs. Criterion validity was assessed compared to the full Copenhagen Burnout Inventory (burnout defined as mean ≥ 50/100).</p><p><strong>Results: </strong>One hundred eighty-two responses were randomly split into separate cohorts for exploratory factor analysis and confirmatory factor analysis. Data were confirmed to be statistically suitable for factor analysis. Using exploratory factor analysis, a ten-item, two-factor abbreviated Copenhagen Burnout Inventory was reached after removing items based on over correlation (≥ 0.80), cross-loading (≥ 75%), and low factor loading (< 0.60). In confirmatory testing, the abbreviated inventory had a good Comparative Fit Index (0.91) though did not meet cutoffs for the remaining fit indices. Internal consistency was 0.92 (95%CI 0.90-0.95). Using a cutoff of 33/50, sensitivity was 0.99, specificity was 0.82, and area under the ROC curve was 0.86.</p><p><strong>Conclusion: </strong>With further validation, an abbreviated ten-item Copenhagen Burnout Inventory has potential to serve as a short, freely available burnout assessment tool among Canadian emergency physicians and trainees. This abbreviated inventory has evidence to support its internal consistency and criterion validity, albeit with inconsistent structural validity. Future validation with larger samples is required, with special attention paid to content validity, test-retest reliability, and correlation with important outcomes.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191470","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":"Esmolol for treatment of caffeine overdose: a case report.","authors":"Christina Botros, Anthony Lau, Jesse Godwin, Asha Olmstead","doi":"10.1007/s43678-024-00848-4","DOIUrl":"https://doi.org/10.1007/s43678-024-00848-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191540","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":"POCUS literature primer: key papers on aorta and deep vein thrombosis POCUS.","authors":"Daniel J Kim, Tomislav Jelic, Claire L Heslop, Joey Newbigging, Steven Skitch, Talia Burwash-Brennan, Gillian Sheppard, Jordan Chenkin, Rajiv Thavanathan, Colin R Bell, Paul Atkinson, David Lewis, Frank Myslik, Elizabeth Lalande, Paul Olszynski","doi":"10.1007/s43678-025-00865-x","DOIUrl":"https://doi.org/10.1007/s43678-025-00865-x","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to identify the top five most influential papers published on the use of aorta point of care ultrasound (POCUS) and deep vein thrombosis (DVT) POCUS in adult patients.</p><p><strong>Methods: </strong>A 15-member expert panel was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. The members of the expert panel all have ultrasound fellowship training (or equivalent), are active in POCUS research, and provide POCUS leadership locally and nationally. The panel used a modified Delphi process of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers on aorta POCUS and DVT POCUS.</p><p><strong>Results: </strong>All panel members participated in all three rounds of this modified Delphi process. The panel initially nominated 33 relevant papers on aorta POCUS and 33 relevant papers on DVT POCUS. With the completion of round two, there were 11 candidate papers for aorta POCUS and 14 candidate papers for DVT POCUS. After meeting at the CAEP 2024 annual conference to discuss these papers and to build consensus, the panel ultimately identified the top five most influential papers on aorta POCUS and DVT POCUS after the completion of round three. Included papers focused on the diagnostic test characteristics of POCUS for the workup of suspected abdominal aortic aneurysm and DVT, as well as the clinical impact of POCUS on time to diagnosis and time to disposition in emergency settings.</p><p><strong>Conclusion: </strong>This POCUS Literature Primer has generated a top-five list of the most influential papers on aorta POCUS and DVT POCUS. The papers in these lists can be considered core reading for all trainees and clinicians using these POCUS applications in their practice and serve as a foundation for future POCUS research.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191542","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 ultrasound competency assessment tool for evaluation of early pregnancy with POCUS.","authors":"Colin Bell, Natalie Wagner, Andrew Hall, Joseph Newbigging, Louise Rang, Tatiana Vukadinovic, Conor McKaigney","doi":"10.1007/s43678-024-00839-5","DOIUrl":"10.1007/s43678-024-00839-5","url":null,"abstract":"<p><strong>Objectives: </strong>POCUS is a core emergency medicine skill and mainstay of early pregnancy assessment. The ultrasound competency assessment tool was developed as an entrustment-based assessment tool for use by content experts evaluating trainees performing multiple POCUS study types. The objective of this study was to evaluate the scoring and extrapolation inferences of the tool within Kane's validity framework when used to assess trainees performing an early pregnancy POCUS.</p><p><strong>Methods: </strong>This was a multicentered study of emergency medicine residents participating in a POCUS assessment. After a background questionnaire, participants were read a case stem requesting a POCUS evaluation of an early pregnancy patient. Trainees were independently assessed by two fellowship-trained faculty. Descriptive statistics and two-way random, intraclass correlation coefficients, Cronbach's alpha were calculated on the merged data and used to assess all domains. Domain scores and an entrustment score for each participant were used to create a composite score. A one-way analysis of variance was performed.</p><p><strong>Results: </strong>36 trainees and 5 assessors completed the study. When used to assess trainee POCUS performance in early pregnancy, the tool demonstrated good to excellent interrater reliability for image acquisition, image generation, clinical integration, and entrustment (intraclass correlation coefficients 80-91 p < .001). The preparation domain had poor, but statistically significant interrater reliability (intraclass correlation coefficient 0.46 p = .04). An analysis of variance suggested the POCUS performance scores differed based on prior experience [F(2,32) = 3.74, p = .021).</p><p><strong>Conclusion: </strong>This study adds further validity evidence relating to scoring and extrapolation of the ultrasound competency assessment tool when used to assess trainees performing a POCUS study in early pregnancy.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"111-116"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923958","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":"Canadian POCUS Snapshot 2024: a picture of limited resources and untapped potential.","authors":"Colin Bell, Paul Olszynski, Daniel J Kim","doi":"10.1007/s43678-024-00814-0","DOIUrl":"10.1007/s43678-024-00814-0","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"151-152"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483179","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":"Establishing methodological standards for the development of artificial intelligence-based Clinical Decision Support in emergency medicine.","authors":"Hashim Kareemi, Henry Li, Akshay Rajaram, Jessalyn K Holodinsky, Justin N Hall, Lars Grant, Gautam Goel, Jake Hayward, Shaun Mehta, Maxim Ben-Yakov, Elyse Berger Pelletier, Frank Scheuermeyer, Kendall Ho","doi":"10.1007/s43678-024-00826-w","DOIUrl":"10.1007/s43678-024-00826-w","url":null,"abstract":"<p><strong>Objective: </strong>Artificial intelligence (AI) offers opportunities for managing the complexities of clinical care in the emergency department (ED), and Clinical Decision Support has been identified as a priority application. However, there is a lack of published guidance on how to rigorously develop and evaluate these tools. We sought to answer the question, \"What methodological standards should be applied to the development of AI-based Clinical Decision Support tools in the ED?\".</p><p><strong>Methods: </strong>We conducted an iterative consensus-establishing activity involving a subcommittee with AI expertise followed by surveys and a live facilitated discussion with participants of the 2024 Canadian Association of Emergency Physicians Research Symposium in Saskatoon. We augmented analysis of participant feedback with large language models.</p><p><strong>Results: </strong>We established 11 recommendations AI-based Clinical Decision Support development including the selection of a relevant problem and team of experts, standards of data quality and quantity, novel AI-specific reporting guidelines, and adherence to principles of ethics and privacy. We removed the recommendation regarding model interpretability from the final list due to a lack of consensus.</p><p><strong>Conclusion: </strong>These 11 recommendations provide guiding principles and methodological standards for emergency medicine researchers to rigorously develop AI-based Clinical Decision Support tools and for clinicians to gain knowledge and trust in using them.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"87-95"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366943","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 an electronic ordering algorithm based on the YEARS criteria to optimize pulmonary embolism diagnostic workup in the emergency department.","authors":"Juliana Duffy, Ferco H Berger, Ivy Cheng, Dominick Shelton, Jean-Philippe Galanaud, Rita Selby, Tali Fedorovsky, John Matelski, Justin N Hall","doi":"10.1007/s43678-024-00840-y","DOIUrl":"10.1007/s43678-024-00840-y","url":null,"abstract":"<p><strong>Objective: </strong>The YEARS criteria combine D-dimer testing and clinical features (hemoptysis, signs of deep vein thrombosis, and pulmonary embolism as the most likely diagnosis) to risk stratify patients with symptoms of pulmonary embolism who may undergo CT pulmonary angiography in the emergency department (ED). Electronic clinical decision support can optimize CT pulmonary angiography utilization in EDs, yet its effectiveness with the YEARS criteria remains unstudied. Our goal is to increase the percentage of CT pulmonary angiograms performed with a D-dimer by 10% within six months of integrating the YEARS criteria into our electronic ordering system.</p><p><strong>Methods: </strong>Single centre quality improvement initiative for all ED patients > 18 years investigated for pulmonary embolism with a D-dimer and/or CT pulmonary angiogram between Jan 2022 - Jan 2023. An electronic clinical decision support algorithm was created based on the YEARS criteria and a plan-do-study-act cycle was completed. Using an SPC chart, the percentage of CT pulmonary angiograms ordered with a D-dimer was identified. Process measures included the rate of CT pulmonary angiograms ordered, the rate of imaging ordered in accordance with the YEARS criteria, and diagnostic yield of imaging based on YEARS status. Balancing measures included pulmonary embolism identified on CT pulmonary angiogram with a D-dimer < 500 ug/L FEU or within 30 days of index visit after being ruled out with the YEARS criteria.</p><p><strong>Results: </strong>Over 12 months, 2639 patients were investigated for pulmonary embolism and 906 underwent CT pulmonary angiogram. The percentage of CT pulmonary angiograms ordered with a screening D-dimer increased by 14.5% (63.8%, CI 59.5-68.1% vs 78.4%, CI 74.4-82.3%) without increasing the rate of imaging ordered (34.9%, CI 32.4-37.4% vs 33.7%, CI 31.1-36.3%). The YEARS criteria were properly applied in 60% (255/425) of patients who underwent CT pulmonary angiogram. The diagnostic yield of CT pulmonary angiogram was higher if patients were YEARS positive (13.2%, CI 9.0-17.4) compared to YEARS negative (0%, CI 0-28.3) or if not applied (8.1%, CI 3.9-12.4). There were two missed pulmonary embolisms at baseline and none post-intervention.</p><p><strong>Conclusions: </strong>Implementation of the YEARS criteria using electronic ordering assistance increased the percentage of CT pulmonary angiograms ordered with a D-dimer without increasing imaging use in the ED.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"123-128"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392683","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}