IF 2

CJEM Pub Date : 2025-07-25 DOI: 10.1007/s43678-025-00964-9

Niloofar Taghizadeh, Jeffrey Bakal, Patrick McLane, Marisa Vigna, Carina Vigna, Andrew D McRae, Shawn Dowling, Brian R Holroyd, Eddy Lang

{"title":"The relationship between prolonged emergency department (ED) wait times and short-term all-cause mortality: an analysis of multi-institutional administrative data in Alberta.","authors":"Niloofar Taghizadeh, Jeffrey Bakal, Patrick McLane, Marisa Vigna, Carina Vigna, Andrew D McRae, Shawn Dowling, Brian R Holroyd, Eddy Lang","doi":"10.1007/s43678-025-00964-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00964-9","url":null,"abstract":"Objective: ED wait times have been linked to adverse patient outcomes, including increased mortality. We sought to assess the consequences of ED wait times on patient outcomes.Methods: We conducted a cohort study using administrative data from the 14 Alberta highest-volume adult EDs (2017-2022). The relationships between different components of ED wait times and patient short-term all-cause mortality (primary outcome:7-day mortality, and secondary outcome: 30-day mortality) were assessed using Multi-level logistic regression with adjustment for age, gender, the Canadian Triage and Acuity Scale (CTAS), Deprivation Index, Charlson Comorbidity Index, disposition status, hospital EDs, and visit date.Results: Among 1,358,935 unique adult patient ED visits, 22,692 (1.7%) deaths occurred within 7 days, and 47,441 (3.5%) occurred within 30 days after leaving the EDs. Among the entire cohort, there were no associations between prolonged total length of stay, boarding time or time from arrival to physician initial assessment, and an increased risk of the primary outcome. However, in subgroup analyses, among discharged patients, total length of stay of more than 6 hours was associated with an increased risk of 7-day mortality, and demonstrated a dose-response association with an increased risk of 30-day mortality [odds ratio (OR), 95% confidence interval (CI), (reference<6 hrs.): 1.3 (1.2-1.5) at 6-10 h, 1.8 (1.6-2.0), at 10-19 h, and 2.2 (1.8-2.7) at ≥ 19 h].Conclusions: We did not observe an association between ED wait times and 7-day mortality across the overall patient population. Future work should identify specific patient groups that may be at risk of harm from ED wait times to tailor ED crowding and risk mitigation strategies to reduce adverse outcomes among the most at-risk patients.","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736076","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}

引用次数: 0

DPIs cannot replace pMDIs in the management of obstructive airways disease. 在梗阻性气道疾病的治疗中，DPIs不能取代pmdi。

IF 2.4

CJEM Pub Date : 2025-07-22 DOI: 10.1007/s43678-025-00968-5

Alan Kaplan

引用次数: 0

Rheumatic heart disease in Addis Ababa, Ethiopia, and the role of point-of-care ultrasound: a case series. 风湿性心脏病在亚的斯亚贝巴，埃塞俄比亚，和点护理超声的作用：一个病例系列。

IF 2.4

CJEM Pub Date : 2025-07-22 DOI: 10.1007/s43678-025-00973-8

Kanisha Cruz-Kan, Muzeen Ismath, Eden Solomon, Hannah Girdler, Temesgen Beyene, Tigist Zewdu, Inderjeet Sahota

引用次数: 0

Acute code stroke activations seen in the emergency department: how often are we missing the mark? 急诊科看到的急性码脑卒中激活：我们错过标记的频率有多高？

IF 2.4

CJEM Pub Date : 2025-07-21 DOI: 10.1007/s43678-025-00972-9

Emily Li, Mohitt Khinda, Aikta Verma, Garrick Mok, Angela Jerath, Fatima Quraishi, Yasmin Visram, Amy Y X Yu, Manav V Vyas

{"title":"Acute code stroke activations seen in the emergency department: how often are we missing the mark?","authors":"Emily Li, Mohitt Khinda, Aikta Verma, Garrick Mok, Angela Jerath, Fatima Quraishi, Yasmin Visram, Amy Y X Yu, Manav V Vyas","doi":"10.1007/s43678-025-00972-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00972-9","url":null,"abstract":"Background: A code stroke activation involves mobilization of finite health care resources. We evaluated the proportion of activations that were non-compliant with code stroke criteria, and the acute treatments and healthcare use after these activations in two urban comprehensive stroke centres.Methods: We conducted a multicentre health records review of adult patients seen in the context of code stroke activations in the emergency departments (ED) at two comprehensive stroke centres in Toronto, Canada, between January 1 and December 31, 2022. Code strokes activated in the field by paramedics, or by physicians or nurses in the ED were included. The primary outcome was the proportion of non-compliant activations, defined as an activation that did not meet institutional criteria. Secondary outcomes were receipt of thrombolysis or thrombectomy in code stroke activations that were non-compliant vs. compliant.Results: A total of 1028 code strokes were included, of which 768 (74.7%) were paramedic-initiated. Overall, 314 (30.5%) were non-compliant: 19.6% paramedic-initiated and 70.7% ED-staff initiated. Incorrect determination of the last seen normal time was the most common cause of non-compliant activations. Although a small number of patients received reperfusion therapy despite non-compliant activation (n = 26, 8.2%), most of these patients were less likely to receive these treatments or be admitted to a stroke unit compared to patients with compliant activations.Conclusion: One in three code stroke activations were non-compliant to activation criteria. Quality improvement strategies such as increasing adherence to code stroke protocols by simplifying the protocol, use of simulation exercises, and involving stroke team for borderline cases could help reduce non-compliant activation and conserve healthcare resources.","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683815","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}

引用次数: 0

Just the Facts: Diagnosis and management of pertussis in the emergency department. 事实真相：百日咳在急诊科的诊断和处理。

IF 2.4

CJEM Pub Date : 2025-07-18 DOI: 10.1007/s43678-025-00949-8

Francis Desmeules, Sophie Gilbert, Laurence Baril, Pierre-Gilles Blanchard

引用次数: 0

Reply to comments on "Treating intractable pain with the erector spinae plane block (ESPB): preventing recurrent emergency department visits and psychological distress in elderly population with acute zoster pain. A case report". 回复“用竖脊肌平面阻滞（ESPB）治疗顽固性疼痛：预防老年急性带状疱疹患者的反复急诊和心理困扰”评论。一份病例报告”。

IF 2.4

CJEM Pub Date : 2025-07-16 DOI: 10.1007/s43678-025-00969-4

Mauricio Forero, Laura Olejnik

引用次数: 0

A battle for attention: how do emergency physicians respond to interruptions? A scoping review. 一场争夺注意力的战斗：急诊医生如何应对干扰？范围审查。

IF 2.4

CJEM Pub Date : 2025-07-16 DOI: 10.1007/s43678-025-00950-1

Gabrielle Trépanier, Philippe Dubuc-Gaudreau, Antoine Brouillard, Rose Nadeau, Nicolas Elazhary

{"title":"A battle for attention: how do emergency physicians respond to interruptions? A scoping review.","authors":"Gabrielle Trépanier, Philippe Dubuc-Gaudreau, Antoine Brouillard, Rose Nadeau, Nicolas Elazhary","doi":"10.1007/s43678-025-00950-1","DOIUrl":"https://doi.org/10.1007/s43678-025-00950-1","url":null,"abstract":"Objectives: Managing constant interruptions is an intrinsic aspect of emergency medicine practice; however, effective physician responses to mitigate their impact remain unclear. Although interruptions are exceedingly common and closely linked to adverse patient outcomes, the approaches for managing such disruptions have yet to be established. In this study, we aimed to identify how emergency physicians and residents respond to interruptions and the factors influencing their responses.Methods: We conducted a scoping review to identify how emergency physicians and residents manage interruptions in the emergency department, searching the following databases using controlled vocabulary: Medline, APA PsycInfo, SCOPUS, and PubMed. Data extraction was conducted using the Covidence platform through a standardized and structured process.Results: The scoping review identified 18 relevant articles, the majority of which (12/18) employed observational methods, involving a total of 417 emergency physicians. These observations, amounting to 778.6 h, were conducted across 25 emergency departments in 4 countries. Physicians responded to interruptions through task switching, multitasking, deferral, acknowledgment, and rejection. Their responses were influenced by the nature of the interrupted activity, cognitive load management, use of telecommunications, physicians' perceptions, and the work environment.Conclusion: Emergency departments are inherently fast-paced and prone to interruptions; therefore, it is important to better understand how emergency physicians and residents navigate these disruptions. This study explores how physicians respond to interruptions and provides insights to support clinicians in identifying and developing effective management strategies.","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644379","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}

引用次数: 0

Comment on "Treating intractable pain with the erector spinae plane block: preventing recurrent emergency department visits and psychological distress in seniors with acute zoster pain-a case report. 《竖脊肌平面阻滞治疗顽固性疼痛：预防老年人急性带状疱疹复发及心理困扰一例报告》评论

IF 2.4

CJEM Pub Date : 2025-07-14 DOI: 10.1007/s43678-025-00967-6

Amiya Kumar Barik, Anju Gupta, Chitta Ranjan Mohanty, Rakesh Vadakkethil Radhakrishnan, Ranganatha Praveen

引用次数: 0

Early Pregnancy Assessment centers for care of pregnant patients: a before and after review on emergency department utilization. 早期妊娠评估中心对妊娠患者的护理：对急诊科利用前后的回顾。

IF 2.4

CJEM Pub Date : 2025-07-14 DOI: 10.1007/s43678-025-00958-7

Bryden Hughton, Lauren Roberts, Zoey Bourgeois, Sachin Trivedi

{"title":"Early Pregnancy Assessment centers for care of pregnant patients: a before and after review on emergency department utilization.","authors":"Bryden Hughton, Lauren Roberts, Zoey Bourgeois, Sachin Trivedi","doi":"10.1007/s43678-025-00958-7","DOIUrl":"https://doi.org/10.1007/s43678-025-00958-7","url":null,"abstract":"Objectives: Early Pregnancy Assessment Clinics provide gold-standard care to patients experiencing complications of early pregnancy, but their impact on emergency department (ED) volumes and consultation practices are largely unknown. The primary objective was to assess the volume of patients experiencing complications of early pregnancy presenting to the ED before and after the opening of an Early Pregnancy Assessment Clinic in Saskatoon, Saskatchewan. Secondary outcomes included inpatient prescribing practices and evaluation of Early Pregnancy Assessment Clinic referral patterns.Methods: We performed a health records review including all patients presenting to 3 Saskatoon-area EDs in the 6 months before and after the Early Pregnancy Assessment Clinic opening and examined all referrals to the center in the first 6 months of its opening. Charts were excluded if patients were directly presenting for a specialist service, were admitted, and were presenting with complications unrelated to fetal outcomes. We calculated descriptive statistics and compared using z tests.Results: We identified 1242 charts, of which 757 met eligibility criteria. There were 393 visits pre-opening and 364 visits post-opening. However, only 33% of eligible patients were referred to the Early Pregnancy Assessment Clinic in the 6-month period after it was opened. Direct referrals to obstetrics decreased 39.9% from 20.1% to 12.1% (p = 0.002).Conclusions: While patient visits were only moderately reduced and return visits were the same in the pre- and post- opening periods, the number of inpatient consults to obstetrics and gynecology were significantly reduced. This is clinically important in reducing the burden of in-hospital consults and allowing for greater flow through the ED while providing patient-centered care.","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628007","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}

引用次数: 0

Just the facts: rivastigmine for the management of anticholinergic toxicity. 事实是：利瓦斯汀用于治疗抗胆碱能毒性。

IF 2.4

CJEM Pub Date : 2025-07-14 DOI: 10.1007/s43678-025-00952-z

Jesse Godwin, Stephanie Cheung, Gregory Mah, Anthony Lau

引用次数: 0

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