scholarly journals P071: Choosing Wisely in the emergency department: exploring the reach, support and potential for the Choosing Wisely Canada® campaign among emergency physicians

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S102
Author(s):  
L. Krebs ◽  
L.B. Chartier ◽  
B.R. Holroyd ◽  
S. Dowling ◽  
A.H. Cheng ◽  
...  
Keyword(s):  
Online Survey ◽  
Response Rate ◽  
Tertiary Care ◽  
Legal Protection ◽  
Barriers And Facilitators ◽  
Choosing Wisely ◽  
Emergency Physicians ◽  
High Quality ◽  
Severe Condition ◽  
Canadian Association

Introduction: Choosing Wisely Canada® (CWC) launched in April 2012. Since then, the Emergency Medicine (EM) top-10 list of tests, treatments and procedures to avoid has been released and initiatives are on-going. This study explored CWC awareness and support among emergency physicians. Methods: A 60-question online survey was distributed to Canadian Association of Emergency Physicians (CAEP) members with valid e-mails. The survey collected information on demographics, awareness/support for CWC as well as physicians’ perceived barriers and facilitators to implementation. Descriptive statistics were performed in SPSS (Version 24). Results: Overall, 324 surveys were completed (response rate: 18%). Respondents were more often male (64%) and practiced at academic/tertiary care hospitals (56%) with mixed patient populations (74%) with annual ED volumes of >50,000 (70%). Respondents were familiar with campaigns to improve care (90%). Among these respondents, 98% were specifically familiar with CWC and 73% felt these campaigns assisted them in providing high-quality care. Respondents felt that the top-5 EM recommendations were supported by high quality evidence, specifically the first 4 recommendations (>90% each). The most frequently reported barriers to implementation were: patients’ expectations/requests (33%), the possibility of missing severe condition(s) (20%), and requirements of ED consultations (12%). Potential facilitators were identified as: strong evidence-base for recommendations (37%), medico-legal protection for clinicians who adhere to guidelines (13%), and support from institutional leadership (11%). Conclusion: CWC is well-known and supported by emergency physicians. Despite the low response rate, exploring the barriers and facilitators identified here could enhance CWC’s uptake in Canadian emergency departments.

scholarly journals P022: Physician reporting of medically unfit drivers: barriers and incentives

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S85
Author(s):  
J.R. Brubacher ◽  
C. Renschler ◽  
A.M. Gomez ◽  
B. Huang ◽  
W.C. Lee ◽  
...  
Keyword(s):  
Public Education ◽  
Online Survey ◽  
Legal Protection ◽  
Time Factors ◽  
Free Text ◽  
Emergency Physicians ◽  
Fitness To Drive ◽  
Legal Requirements ◽  
Study Physician ◽  
Lack Of Knowledge

Introduction: Most medically unfit drivers are not reported to licensing authorities. In BC, physicians are only obligated to report unfit drivers who continue to drive after being warned to stop. This study investigates barriers to and incentives for physician reporting of medically unfit drivers. Methods: We used an online survey to study physician-reported barriers to reporting medically unfit drivers and their idea of incentives that would improve reporting. Email invitations to participate in the survey were sent to all physicians in BC through DoctorsofBC and to all emergency physicians (EPs) in the UBC Department of Emergency Medicine. Results: We received responses from 242 physicians (47% EPs, 40% GPs, 13% others). The most common barrier to reporting was not knowing which unfit drivers continue to drive (79% of respondents). Other barriers included lack of time (51%), lack of knowledge of the process, guidelines, or legal requirement for reporting (51%, 50%, 45% respectively), fearing loss of rapport with patients (48%), pressure from patients not to report (34%), lack of remuneration (27%), and pressure from family members not to report (25%).EPs were significantly less likely than other physicians to cite loss of rapport, pressure from patients, or pressure from family as barriers, but more likely to cite not being aware of drivers who continue to drive after being warned, lack of knowledge (regarding legal requirements to report, guidelines for determining fitness, and the reporting process), and lack of time. Factors that would increase reporting unfit drivers included better understanding of criteria for fitness to drive (70%), more information regarding how to report (67%), more information on when to report (65%), and compensation (43%).Free text comments from respondents identified other barriers/incentives. Reporting might be simplified by telephone hotlines or allowing physician designates to report. Physicians feared legal liability and suggested the need for better medico-legal protection. Loss of patient rapport might be minimized by public education. Failure of response from licensing authorities to a report (long wait times, lack of feedback to physician) was seen as a barrier to reporting. Conclusion: We identified barriers to physician reporting of medically unfit drivers and incentives that might increase reporting. This information could inform programs aiming to improve reporting of unfit drivers.

scholarly journals P075: Emergency physicians’ self-reported management of benign headache in Alberta emergency departments

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S90
Author(s):  
L. Krebs ◽  
C. Villa-Roel ◽  
S. Couperthwaite ◽  
M. Ospina ◽  
B. Holroyd ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Online Survey ◽  
Management Practices ◽  
Treatment Preferences ◽  
Emergency Physicians ◽  
Severe Condition ◽  
Convenience Sample ◽  
Patient Expectation ◽  
Traditional Therapy ◽  
Clinical Scenarios

Introduction: Benign headache (BHA) management varies across emergency departments (EDs). This study documented current BHA management by Alberta emergency physicians (EP) in order to develop a provincial intervention to improve standardized practice. Methods: A convenience sample of Alberta EPs completed an online survey exploring their ED BHA management practices. Results are expressed as proportions. Results: A total of 73 EPs (73/192; 38%) who were mostly male (63%) and practiced emergency medicine for at least 15 years (51%) responded. EPs reported routine ED orders for metoclopramide (97%), ketorolac (90%) and IV fluids (85%) for patients with BHA showing no signs of pathological headache. For moderate-severe BHA's that did not improve with routine treatment, preferences were: IV narcotic (58%), IV dexamethasone (44%), and IV/IM dihydroergotamine (27%). Typically, EPs reported not ordering investigations for moderate-severe BHA presentations (88%); however, for those not improving the most common investigation was computed tomography (CT; 47%). CT ordering was associated with the following clinical scenarios: 1) not responding to traditional therapy and consulted to specialist (64%); 2) not responding to traditional therapy and being admitted (64%); 3) first presentation and afebrile (19%); 4) severe pain (11%); and 5) responding to traditional therapy and febrile (11%). One-quarter of EPs (27%) believed their patients usually or frequently expected a CT. Most EPs (60%) reported being completely or mostly comfortable discussing CT risks. Only 44% reported always or usually discussing risks prior to ordering. EPs reported that they were most frequently prevented from discussing risks because the patient was critically ill (42%) or because they believed explaining risks would not alter patient expectations (21%). These concerns were mirrored in the barriers EPs anticipated to limiting imaging, specifically the fear of missing a severe condition (62%), and patient expectation/request for imaging (48%). Conclusion: Self-reported treatment preferences for uncomplicated BHAs appear to be relatively consistent. Chart reviews could help assessing the reliability of self-reported BHA management practices. Perceived patient expectation appears to be an important influence on EP imaging ordering. Studies examining the communication between EPs and their patients are needed to explore how these expectations and perceived expectations are negotiated in the ED.

scholarly journals Canadian Association of Emergency Physicians sepsis treatment checklist: optimizing sepsis care in Canadian emergency departments

CJEM ◽  
2012 ◽  
Vol 14 (01) ◽  
pp. 36-39 ◽  
Author(s):  
Dennis Djogovic ◽  
Robert Green ◽  
Robert Keyes ◽  
Sara Gray ◽  
Robert Stenstrom ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Tertiary Care ◽  
Venous Access ◽  
Care Practice ◽  
Emergency Physicians ◽  
Tertiary Care Centre ◽  
Canadian Association ◽  
Level I ◽  
Practice Committee ◽  
Sepsis Care

ABSTRACT Objective: The Canadian Association of Emergency Physicians (CAEP) sepsis guidelines created by the CAEP Critical Care Practice Committee (C4) and published in the Canadian Journal of Emergency Medicine (CJEM) form the most definitive publication on Canadian emergency department (ED) sepsis care to date. Our intention was to identify which of the care items in this document are specifically necessary in the ED and then to provide these items in a tiered checklist that can be used by any Canadian ED practitioner. Methods: Practice points from the CJEM sepsis publication were identified to create a practice point list. Members of C4 then used a Delphi technique consensus process over May to October 2009 via e-mail to create a tiered checklist of sepsis care items that can or could be completed in a Canadian ED when caring for the septic shock patient. This checklist was then assessed for use by a survey of ED practitioners from varying backgrounds (rural ED, community ED, tertiary ED) from July to October 2010. Results: Twenty sepsis care items were identified in the CAEP sepsis guidelines. Fifteen items were felt to be necessary for ED care. Two levels of checklists were then created that can be used in a Canadian ED. Most ED physicians in community and tertiary care centres could complete all parts of the level I sepsis checklist. Rural centres often struggle with the ability to obtain lactate values and central venous access. Many items of the level II sepsis checklist could not be completed outside the tertiary care centre ED. Conclusion: Sepsis care continues to be an integral and major part of the ED domain. Practice points for sepsis care that require specialized monitoring and invasive techniques are often limited to larger tertiary care EDs and, although heavily emphasized by many medical bodies, cannot be reasonably expected in all centres. When the resources of a centre limit patient care, transfer may be required.

scholarly journals Knowledge gaps in the diagnosis and management of patients with tropical diseases presenting to Canadian emergency departments: are the gaps being met?

CJEM ◽  
2014 ◽  
Vol 16 (06) ◽  
pp. 458-466 ◽  
Author(s):  
Nazanin Meshkat ◽  
Shikha Misra ◽  
Cheryl Hunchak ◽  
Paula Cleiman ◽  
Yasmin Khan ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Online Survey ◽  
Comfort Level ◽  
Tropical Diseases ◽  
Emergency Physicians ◽  
Further Training ◽  
Knowledge Gaps ◽  
Perceived Need ◽  
Canadian Association ◽  
Case Vignettes

ABSTRACTObjective:We conducted a needs assessment to identify knowledge gaps in the management of tropical diseases by Canadian emergency physicians and identify available, related continuing medical education (CME) resources.Methods:A literature review was conducted to summarize challenges in the management of commonly encountered tropical diseases. An anonymous online survey was administered to Canadian emergency physicians using the Canadian Association of Emergency Physicians survey deployment service in July and August 2012. The survey identified self-reported gaps in knowledge and assessed knowledge using case-based vignettes. A list of CME resources was generated from a review of major academic emergency medicine journals, online cases, and conference topics from emergency medicine associations during 2010– 2011. Two independent reviewers assessed the relevance of the resources; differences were resolved by consensus.Results:From 635 citations, 47 articles were selected for full review; the majority (66%) were retrospective chart reviews, few (10.6%) had an emergency medicine focus, and fewer still were Canadian (8.5%). In total, 1,128 surveys were distributed, and 296 (27%) participants were included in the study. Most respondents reported ‘‘no’’ (52.4%) or ‘‘some’’ (45.9%) training in tropical medicine. Most (69.9%) rated their comfort in managing patients with tropical diseases as ‘‘low.’’ Few (11.1%) respondents reported a tropical disease being misdiagnosed or mismanaged; 44.1% indicated malaria. The perceived need for further training was high (76.7%). Conference workshops were the most highly requested CME modality, followed by case studies and podcasts. Correct answers to case vignettes ranged from 30.7 to 58.4%. Although 2,038 CME titles were extracted from extensive searches, only 6 were deemed relevant.Conclusions:Most Canadian emergency physicians have had minimal training in tropical diseases, reported a low comfort level in their management, and identified a high need for CME opportunities, which are lacking.

scholarly journals Choosing Wisely Canada's emergency medicine recommendations: Time for a revision

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 717-720 ◽  
Author(s):  
Amy H. Y. Cheng ◽  
Sam Campbell ◽  
Lucas B. Chartier ◽  
Shawn Dowling ◽  
Tom Goddard ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Working Group ◽  
Ad Hoc ◽  
Choosing Wisely ◽  
Emergency Physicians ◽  
Medical Tests ◽  
Canadian Association ◽  
National Initiative ◽  
New Evidence

ABSTRACTChoosing Wisely Canada (CWC) is a national initiative designed to encourage patient-clinician discussions about the appropriate, evidence-based use of medical tests, procedures and treatments. The Canadian Association of Emergency Physicians’ (CAEP) Choosing Wisely Canada (CWC) working group developed and released ten recommendations relevant to Emergency Medicine in June 2015 (items 1–5) and October 2016 (items 6–10). In November 2016, the CAEP CWC working group developed a process for updating the recommendations. This process involves: 1) Using GRADE to evaluate the quality of evidence, 2) reviewing relevant recommendations on an ad hoc basis as new evidence emerges, and 3) reviewing all recommendations every five years. While the full review of the CWC recommendations will be performed in 2020, a number of high-impact studies were published after our initial launch that prompted an ad hoc review of the relevant three of our ten recommendations prior to the full review in 2020. This paper describes the results of the CAEP CWC working group's ad hoc review of three of our ten recommendations in light of recent publications.

scholarly journals A survey to describe sleep-facilitating substances used by Canadian emergency physicians

CJEM ◽  
2005 ◽  
Vol 7 (02) ◽  
pp. 93-99 ◽  
Author(s):  
Benoit Bailey ◽  
Lubomir Alexandrov
Keyword(s):  
Response Rate ◽  
Night Shift ◽  
Emergency Physicians ◽  
Inclusion Criteria ◽  
Shift Workers ◽  
Postal Address ◽  
Factors Associated ◽  
Canadian Association ◽  
Sleep Management ◽  
Night Shifts

ABSTRACTBackground:Because night shifts disrupt the normal circadian rhythm, sleep management is crucial for emergency physicians. The purpose of the survey was to describe the use of sleep-facilitating substances (SFSs) by emergency physicians before or after a night shift and to evaluate factors associated with their use.Methods:All members of the Canadian Association of Emergency Physicians with a Canadian postal address were mailed a copy of the survey. Canadian physicians were eligible if they worked at least one night shift per month and spent 50% or more of their time in emergency medicine. Logistic regression was used to identify characteristics most predictive of using SFSs before or after a night shift.Results:Of the 1621 surveys mailed, 805 were returned completed, for a response rate of 49.6%. Of these, 628 respondents met inclusion criteria and 215 respondents (34%) reported consuming at least one SFS in their career to help them sleep around a night shift. The use of an SFS before a night shift was associated with the use of SFSs after a night shift (odds ratio [OR] 3.8; 95% confidence interval [CI] 2.4–5.9) and the use of SFSs at other times (OR 3.8; 95% CI 2.1–6.6). The use of SFSs after a night shift was associated with the use of a sleep-facilitating technique before a night shift (OR 2.1; 95% CI 1.3–3.3); use of an SFS before a night shift (OR 4.0; 95% CI 2.4–6.4); use of SFSs at other times (OR 4.7; 95% CI 2.6–8.4); and success of a nap before the night shift (OR 0.46; 95% CI 0.25–0.83).Conclusion:The rate of SFS use is similar in emergency physicians and other shift workers. Emergency physicians who use SFSs before or after a night shift are more likely to use them at other times as well, and less likely to use them if they nap successfully prior to a night shift.

scholarly journals Outcomes in the age of competency-based medical education: Recommendations for emergency medicine training in Canada from the 2019 symposium of academic emergency physicians

CJEM ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 204-214 ◽  
Author(s):  
Teresa M. Chan ◽  
Quinten S. Paterson ◽  
Andrew K. Hall ◽  
Fareen Zaver ◽  
Robert A. Woods ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Clinical Outcomes ◽  
Online Survey ◽  
Emergency Physicians ◽  
Competency Based Medical Education ◽  
Canadian Association ◽  
National Implementation ◽  
Competency Based ◽  
The Impact

ABSTRACTObjectivesThe national implementation of competency-based medical education (CBME) has prompted an increased interest in identifying and tracking clinical and educational outcomes for emergency medicine training programs. For the 2019 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, we developed recommendations for measuring outcomes in emergency medicine training in the context of CBME to assist educational leaders and systems designers in program evaluation.MethodsWe conducted a three-phase study to generate educational and clinical outcomes for emergency medicine (EM) education in Canada. First, we elicited expert and community perspectives on the best educational and clinical outcomes through a structured consultation process using a targeted online survey. We then qualitatively analyzed these responses to generate a list of suggested outcomes. Last, we presented these outcomes to a diverse assembly of educators, trainees, and clinicians at the CAEP Academic Symposium for feedback and endorsement through a voting process.ConclusionAcademic Symposium attendees endorsed the measurement and linkage of CBME educational and clinical outcomes. Twenty-five outcomes (15 educational, 10 clinical) were derived from the qualitative analysis of the survey results and the most important short- and long-term outcomes (both educational and clinical) were identified. These outcomes can be used to help measure the impact of CBME on the practice of Emergency Medicine in Canada to ensure that it meets both trainee and patient needs.

scholarly journals Familiarity with radiation exposure dose from diagnostic imaging for acute pulmonary embolism and current patterns of practice

CJEM ◽  
2014 ◽  
Vol 16 (05) ◽  
pp. 393-404 ◽  
Author(s):  
Justin S. Ahn ◽  
Marcia L. Edmonds ◽  
Shelley L. McLeod ◽  
Jonathan F. Dreyer
Keyword(s):  
Pulmonary Embolism ◽  
Diagnostic Imaging ◽  
Radiation Exposure ◽  
Online Survey ◽  
Acute Pulmonary Embolism ◽  
Current Knowledge ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Radiation Doses ◽  
Emergency Physicians

ABSTRACTObjective:To assess the current level of knowledge and practice patterns of emergency physicians regarding radiation exposure from diagnostic imaging modalities for investigating acute pulmonary embolism (PE).Methods:An online survey was sent to adult emergency physicians working at two academic tertiary care adult emergency departments (EDs) to determine imaging choices for investigating PE in various patient populations and to assess their current knowledge of radiation doses and risks. A retrospective chart review was performed for all adult patients who underwent computed tomographic pulmonary angiography (CTPA) and/or ventilation-perfusion (V/Q) scanning in the same EDs.Results:The survey response rate was 72.1% (31 of 43 physicians). For patients < 30 years old, 83.9% of physicians chose V/Q scanning as their test of choice, regardless of gender. Although only a third of respondents knew the estimated radiation dose of a V/Q scan (37.5%) and a CTPA (32%), the majority were aware that V/Q scans involved less ionizing radiation than CTPAs. In the retrospective review, 663 charts were reviewed, including 201 CTPAs and 462 V/Q scans. V/Q scanning was the preferred modality in female patients (75.9% v. CTPA 24.1% [OR 2.1; 95% CI 1.5–2.9]) and in patients < 30 years old (87.9% v. CTPA 12.1% [OR 4.8; 95% CI 2.4–9.4]).Conclusions:Although surveyed physicians possessed limited knowledge of radiation doses of CTPA and V/Q scans, they preferentially used the lower radiation V/Q scans in younger patients, particularly females, in both the survey vignettes and in clinical practice. This may reflect efforts to reduce radiation exposures at our institution.

scholarly journals P011: Discerning perceived barriers and facilitators to goals of care discussion in the emergency department: A survey of emergency physicians and residents

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S81
Author(s):  
N. Argintaru ◽  
S. Vaillancourt ◽  
L.B. Chartier ◽  
J.S. Lee ◽  
E. O’Connor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Online Survey ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Emergency Physicians ◽  
Urban Centre ◽  
Advanced Directives ◽  
Goals Of Care ◽  
Competing Priorities

Introduction: Patients presenting to the Emergency Department (ED) may require clarification of their goals of care (GOC) to ensure they receive treatments aligned with their values. However, these discussions can be difficult to conduct for multiple reasons, including lack of time in a busy ED, competing priorities and a limited relationship with the patient. Few studies have examined the perceived challenges faced by Emergency Physicians in conducting GOC discussions. This study sought to contextualize and discern the barriers and facilitators to having these conversations as reported by Emergency physicians. Methods: An interdisciplinary team of Emergency Medicine, Palliative Care and Internal Medicine providers developed an online survey comprised of multiple choice, Likert-scale and open-ended questions to explore four domains of GOC discussions: training; communication; environment; and personal beliefs. Invitations and scheduled reminders were sent to 275 ED physicians at six academic sites in a Canadian urban centre, including 49 EM residents. Results: 105 (46%) staff physicians and 23 (47%) residents responded with similar representation from all sites. Differences were reported in the frequency of GOC discussions: 59% of staff physicians conduct several per month whereas 65% of residents conduct less than one per month. Most agreed that GOC discussions are within their scope of practice (92%), they feel comfortable (96%), and are adequately trained (73%) to have them; however, 66% reported difficulty initiating GOC discussions. 73% believed that admitting services should conduct GOC discussions, yet acuity was noted in the comments as a major determinant with initiating GOC discussions by ED physicians. Main barriers identified were lack of time, chaotic environment, lack of advanced directives and the inability to reach substitute decision makers. 54% of respondents indicated that the availability of 24-hour Palliative Care consults would facilitate GOC discussions in the ED. Conclusion: Emergency physicians are prepared to conduct goals of care discussions, but often believe they should instead be conducted by the patient’s admitting service. Multiple perceived barriers to goals of care discussion in the ED were identified, and a majority of respondents felt that the availability of Palliative Care in the ED may facilitate these discussions.

scholarly journals Choosing Wisely Canada®: Five tests, procedures and treatments to question in Emergency Medicine

CJEM ◽  
2017 ◽  
Vol 19 (S2) ◽  
pp. S9-S17 ◽  
Author(s):  
Amy H. Y. Cheng ◽  
Sam Campbell ◽  
Lucas B. Chartier ◽  
Tom Goddard ◽  
Kirk Magee ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Head Injuries ◽  
Clinical Decision ◽  
Choosing Wisely ◽  
Emergency Physicians ◽  
Spinal Imaging ◽  
Canadian Association ◽  
Frequency Of Use ◽  
Expert Working Group ◽  
Adults And Children

AbstractObjectivesChoosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians’ (CAEP) top five list of recommendations, and the process undertaken to generate them.MethodsThe CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned. This list was distributed to CAEP committee chairs, revised, and then divided and randomly allocated to 107 Canadian emergency physicians (EWG nominated) who voted on each item based on: action-ability, effectiveness, safety, economic burden, and frequency of use. The EWG discussed the items with the highest votes, and generated the recommendations by consensus.ResultsThe top five CAEP CWC recommendations are: 1) Don’t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule); 2) Don’t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis; 3) Don’t order lumbosacral spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators; 4) Don’t order neck radiographs in patients who have a negative examination using the Canadian C-spine rules; and 5) Don’t prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists.ConclusionsThe CWC recommendations for emergency medicine were selected using a mixed methods approach. This top 5 list was released at the CAEP Conference in June 2015 and should form the basis for future implementation efforts.

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