CJEM最新文献

{"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}

{"title":"Global research highlights.","authors":"","doi":"10.1007/s43678-025-00871-z","DOIUrl":"10.1007/s43678-025-00871-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"147-150"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375012","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 case report of the thunderclap headache: pearls and pitfalls.","authors":"David Fine, John Teijido, Joseph Honrath","doi":"10.1007/s43678-024-00844-8","DOIUrl":"10.1007/s43678-024-00844-8","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"144-146"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923291","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: diagnosis and management of superficial thrombophlebitis in the ED.","authors":"Samara Adler, Lana A Castellucci, Warren J Cheung","doi":"10.1007/s43678-024-00818-w","DOIUrl":"10.1007/s43678-024-00818-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"96-99"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257573","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":"Opening the black box: challenges and opportunities regarding interpretability of artificial intelligence in emergency medicine.","authors":"Akshay Rajaram, Henry Li, Jessalyn K Holodinsky, Justin N Hall, Lars Grant, Gautam Goel, Jake Hayward, Shaun Mehta, Maxim Ben-Yakov, Elyse Berger Pelletier, Frank Scheuermeyer, Kendall Ho, Hashim Kareemi","doi":"10.1007/s43678-024-00827-9","DOIUrl":"10.1007/s43678-024-00827-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"83-86"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442866","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":"Adopting the human factors analysis and classification system into emergency medicine morbidity and mortality rounds: a quality improvement initiative.","authors":"Nicholas Villa, Michael Baskey, Constance LeBlanc","doi":"10.1007/s43678-024-00837-7","DOIUrl":"10.1007/s43678-024-00837-7","url":null,"abstract":"<p><strong>Objectives: </strong>This initiative assessed the integration of the Human Factors Analysis and Classification System, adapted from aviation, into emergency medicine morbidity and mortality rounds. The objective was to determine whether incorporating the Human Factors Analysis and Classification System could lead to a perceived increase in the overall quality of morbidity and mortality presentations through the standardization of classifying cause factors of medical errors.</p><p><strong>Methods: </strong>This study involved eight emergency medicine residents who applied the adapted Human Factors Analysis and Classification System framework to their morbidity and mortality case presentations over 6 months. Data were collected through surveys completed by presenters and morbidity and mortality audience members. These assessed four main outcomes: relevance, feasibility, quality, and acceptability of the Human Factors Analysis and Classification System framework.</p><p><strong>Results: </strong>The integration of the Human Factors Analysis and Classification System was positively perceived across all outcome measures. Presenters and audience members rated cause factor identification as important (100%), indicating the relevance of Human Factors Analysis and Classification System in morbidity and mortality rounds. Feasibility assessments showed a mean score of 4.25 out of 5, indicating favorable ease of use. The quality assessment mean score was 3.97 out of 5, indicating perceived improvement in cause factor identification. Presenters (62.5% Strongly Agree, 37.5% Agree) and audience members (73% Yes, 21.62% Undecided, 5.4% No) expressed acceptability and support for continued Human Factors Analysis and Classification System use.</p><p><strong>Conclusion: </strong>Integrating the Human Factors Analysis and Classification System into morbidity and mortality rounds in the Department of Emergency Medicine was well-received and led to a perceived increase in the quality of cause factor identification. Both presenters and audience members endorsed the use of the Human Factors Analysis and Classification System, suggesting its desirability for sustained integration. The results of this study pave the way for future quality improvement initiatives, including the adaptability of the Human Factors Analysis and Classification System across various medical departments and its potential to enhance cause factor classification in morbidity and mortality rounds.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"129-133"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923496","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":"M&M rounds 2.0: the future of performance improvement.","authors":"Andrew Petrosoniak, Christopher Hicks","doi":"10.1007/s43678-025-00876-8","DOIUrl":"https://doi.org/10.1007/s43678-025-00876-8","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 2","pages":"77-78"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470306","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":"Enhancing staff confidence to initiate buprenorphine-naloxone for opioid use disorder in an Ontario ED.","authors":"Ovini Thomas, Megan Park, Barb McGovern, Sarah McClennan","doi":"10.1007/s43678-024-00803-3","DOIUrl":"10.1007/s43678-024-00803-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"153-154"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514692","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":"Emergency department trends for inguinal hernia and gallbladder disease before and after COVID-19 scheduled surgery interruptions: lessons for hospital capacity management.","authors":"Conné Lategan, Xiaoming Wang, Cassandra Chisholm, Zoe Hsu, Eddy Lang","doi":"10.1007/s43678-024-00832-y","DOIUrl":"10.1007/s43678-024-00832-y","url":null,"abstract":"<p><strong>Objectives: </strong>Postponing scheduled surgeries may alleviate emergency department (ED) crowding by increasing inpatient beds for ED patients but the impact of such measures are unclear. We determined if scheduled surgery cancellations for inguinal hernia and gallbladder disease during the coronavirus pandemic affected ED presentations, hospitalizations, and complications.</p><p><strong>Methods: </strong>This database review included Albertans ≥ 18 with ED presentations for inguinal hernia and gallbladder disease from March 1, 2018 to May 31, 2022. The primary outcome examined ED hospitalizations and complications in the pre- (March 1, 2018-March 18, 2020) and post-cancellation (May 4, 2020-May 31, 2022) periods utilizing interrupted time series analysis. The secondary outcome reported scheduled surgery trends.</p><p><strong>Results: </strong>78,315 (10.6% inguinal hernia n = 8268; 89.4% gallbladder disease n = 70,064; n = 17 both inguinal hernia and gallbladder disease) patients were included. The post-cancellation period experienced a decreased trend change for inguinal hernia patients who received hospital admission (- 146.0%; p < 0.001), urgent interventions (- 171.0%; p < 0.001), and hernia repairs (- 164.0%; p < 0.001). For gallbladder disease patients, the post-cancellation period demonstrated a decreased trend in hospital admission (- 106.0%; p = 0.038) and an increased trend in day surgery transfers (- 1285.0%; p = 0.015) and median ED length of stay (82.0%; p = 0.0042). During the cancellation period, inguinal hernia and gallbladder disease surgeries decreased by 66.7% and 55.6%, respectively.</p><p><strong>Conclusions: </strong>Despite a two-month surgery cancellation period, inguinal hernia and gallbladder disease patients demonstrated minimal differences in outcomes. During periods of ED boarding and crowding, scheduled surgery cancellations may be considered with minimal risk of potential adverse patient effects.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"134-143"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923941","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":"Adding YEARS to optimize emergency department pulmonary embolism diagnostic workup.","authors":"Abel Wakai, Lauren Westafer","doi":"10.1007/s43678-025-00858-w","DOIUrl":"https://doi.org/10.1007/s43678-025-00858-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 2","pages":"79-80"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470305","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}