scholarly journals P108: Fast track in Calgary hospitals: measures for quality improvement

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S114-S115
Author(s):  
P. Rogers ◽  
A. Oster ◽  
D. Wang
Keyword(s):  
Back Pain ◽  
Fast Track ◽  
Medical Center ◽  
Lower Extremity Injury ◽  
Administrative Databases ◽  
Extremity Injury ◽  
Admission Rates ◽  
Left Without Being Seen ◽  
Consultation Request ◽  
Discharge From Hospital

Introduction: Fast track (FT) implementation in emergency departments (ED) has shown a decrease in patient wait times, length of stay (LOS), left without being seen rates, and has increased patient satisfaction. The objective of this study was to analyze the demographics and presenting complaints of patients presenting to FT in Calgary EDs using local administrative databases to understand the current selection of FT patients, as well as to uncover potential throughput efficiencies through LOS analysis. Methods: Sunrise Clinical Manager data was pulled from the Foothills Medical Center (FMC), Peter Lougheed Center (PLC), and Rockyview General Hospital (RGH) EDs between October 2015 and September 2016. Based on consensus achieved by the Calgary FT-Minor Treatment Sub-committee, data was descriptively analyzed based on the following criteria: (1) triage profiles of the Calgary ED sites; (2) site admission rates by complaint, Canadian Triage and Acuity Scale (CTAS), vitals, and age; (3) LOS for orthopedic patients admitted from FT/Minor; and, (4) LOS in FT for non-admitted back pain patients. Results: A total of 53911 patients were triaged to FT, with 16224 patients triaged to FMC, 18299 to PLC, and 19388 to RGH. 6.9% of FT patients were admitted to hospital at FMC, 4.8% at PLC and 4.8% at RGH. 14.4% of patients at FMC, 18.3% at PLC and 17.6% at RGH were CTAS 2; 40.9% of patients at FMC, 46.2% at PLC and 37.9% at RGH were CTAS 3; 34.0% of patients at FMC, 27.8% at PLC and 33.3% at RGH were CTAS 4; 10.7% of patients at FMC, 7.7% from PLC and 11.2% for RGH were CTAS 5. For FT patients 80 years or older, 10.4% were admitted at FMC, 13.1% at PLC and 9.4% at RGH. The top FT presenting complaints at all sites were lower extremity injury, upper extremity injury, and laceration/puncture. The annual FT bed hours for patients admitted to orthopedic surgery (consultation request to time of orthopedic admission) was 802.3 hours at FMC, 441.1 PLC and 705.1 from RGH. The annual FT bed hours for patients with non-admitted back pain (FT bed to time of discharge) was 2144.3 hours from FMC, 3367.9 from PLC and 1134.9 from RGH. Conclusion: The efficiency of FT is based on streamlining low acuity patients with an expected rapid discharge from hospital. The results of this investigation will be presented to the FT-Minor Treatment Sub-committee in order to utilize current admission rates, patient profiles, and aggregate LOS to potentially improve throughput.

Lower-Extremity Injury Increases Risk of First-Time Low Back Pain in the US Army

2018 ◽  
Vol 50 (5) ◽  
pp. 987-994 ◽  
Author(s):  
JOSEPH F. SEAY ◽  
TRACIE SHING ◽  
KRISTEN WILBURN ◽  
RICHARD WESTRICK ◽  
JOSEPH R. KARDOUNI
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lower Extremity ◽  
Lower Extremity Injury ◽  
Low Back ◽  
Extremity Injury ◽  
Us Army ◽  
The Us ◽  
First Time

scholarly journals LO64: Variation in Alberta emergency department patient populations

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S29-S29
Author(s):  
B. R. Holroyd ◽  
G. Innes ◽  
A. Gauri ◽  
S. E. Jelinski ◽  
M. J. Bullard ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Resource Utilization ◽  
Emergency Department Patient ◽  
Administrative Databases ◽  
Case Mix ◽  
Care Needs ◽  
Free Standing ◽  
Admission Rates ◽  
Left Without Being Seen ◽  
Icd 10

Introduction: Increasing pressures on the health care system, particularly in emergency departments (EDs), make it critical to understand changing ED case-mix, patient demographics and care needs, and resource utilization. Our objective is to assess Alberta (AB) ED volumes, utilization and case mix, stratified by ED type. This knowledge will help identify opportunities for system change and quality improvement. Methods: Data from Alberta Health Services administrative databases, including the National Ambulatory Care Reporting System, ED Admission/Discharge/Transfer data, and Comprehensive Ambulatory Care Classification System codes, were linked for all ED visits from 2010-17. Data were stratified by seven facility categories: tertiary referral (TR), regional referral (RR), community<5,000 inpatient discharges (CL), community>600 inpatient discharges (CM), community <600 inpatient discharges (CS), community ambulatory care (CA), and free-standing EDs (FS). Results: We analyzed 11,327,258 adult patient visits: 13% at TR, 34 % at RR, 24% at CL, 16% at CM, 9% at CS, 1% at CA, and 3% at FS sites. Acuity was highest at TR and RR hospitals, with 76%, 63%, 25%, 26%, 22%, 12% and 55% of patients falling into CTAS levels 1-3, for TR, RR, CL, CM, CS, CA, and FS respectively. Admission rates were highest at TR and RR hospitals, (23%, 13%, 5%, 5%, 4%, 0% and 0%), as were left without being seen rates, (5%, 4%, 1%, 2%, 1%, 0% and 5%). The most common ICD-10 diagnoses were chest pain/abdominal pain in TR and RR centres, and IV (antibiotic) therapy in all levels of community and FS EDs. Conclusion: Acuity and case-mix are highly variable across ED categories. Acuity, admission rates and LWBS rates are highest in TR and RR centres. Administrative data can reveal opportunities for health system re-engineering, e.g. potentially avoidable IV antibiotic visits. Further investigation will clarify the type of ED care provided, variability in resource utilization by case-mix, and allocation, and will help identify the optimal metrics to describe ED case-mix.

scholarly journals Concussion in National Football League Athletes Is Not Associated With Increased Risk of Acute, Noncontact Lower Extremity Musculoskeletal Injury

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110034
Author(s):  
Toufic R. Jildeh ◽  
Fabien Meta ◽  
Jacob Young ◽  
Brendan Page ◽  
Kelechi R. Okoroha
Keyword(s):  
Lower Extremity ◽  
National Football League ◽  
Field Performance ◽  
Return To Play ◽  
Lower Extremity Injury ◽  
Extremity Injury ◽  
Lower Extremity Injuries ◽  
Increased Risk ◽  
Extremity Injuries ◽  
And Control

Background: Impaired neuromuscular function after concussion has recently been linked to increased risk of lower extremity injuries in athletes. Purpose: To determine if National Football League (NFL) athletes have an increased risk of sustaining an acute, noncontact lower extremity injury in the 90-day period after return to play (RTP) and whether on-field performance differs pre- and postconcussion. Study Design: Cohort study, Level of evidence, 3. Methods: NFL concussions in offensive players from the 2012-2013 to the 2016-2017 seasons were studied. Age, position, injury location/type, RTP, and athlete factors were noted. A 90-day RTP postconcussive period was analyzed for lower extremity injuries. Concussion and injury data were obtained from publicly available sources. Nonconcussed, offensive skill position NFL athletes from the same period were used as a control cohort, with the 2014 season as the reference season. Power rating performance metrics were calculated for ±1, ±2, and ±3 seasons pre- and postconcussion. Conditional logistic regression was used to determine associations between concussion and lower extremity injury as well as the relationship of concussions to on-field performance. Results: In total, 116 concussions were recorded in 108 NFL athletes during the study period. There was no statistically significant difference in the incidence of an acute, noncontact lower extremity injury between concussed and control athletes (8.5% vs 12.8%; P = .143), which correlates with an odds ratio of 0.573 (95% CI, 0.270-1.217). Days (66.4 ± 81.9 days vs 45.1 ± 69.2 days; P = .423) and games missed (3.67 ± 3.0 vs 2.9 ± 2.7 games; P = .470) were similar in concussed athletes and control athletes after a lower extremity injury. No significant changes in power ratings were noted in concussed athletes in the acute period (±1 season to injury) when comparing pre- and postconcussion. Conclusion: Concussed, NFL offensive athletes did not demonstrate increased odds of acute, noncontact, lower extremity injury in a 90-day RTP period when compared with nonconcussed controls. Immediate on-field performance of skill position players did not appear to be affected by concussion.

Introduction of a modified analgesic ladder in the emergency department: Effect on oxycodone use for back pain

2021 ◽  
Vol 17 (1) ◽  
pp. 55-61
Author(s):  
Jenny Ly, BPharm, GradCertPharmPrac ◽  
Cristina P. Roman, BPharm (Hons), MPP ◽  
Carl Luckhoff, MB, ChB, FACEM ◽  
Peter A. Cameron, MBBS, MD, FACEM, FCEM (Hon) ◽  
Michael J. BPharm, GradDipHospPharm, PhD, AdvPracPharm, FSHP, FISOPP ◽  
...  
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Outcome Measure ◽  
Interquartile Range ◽  
Post Intervention ◽  
Community Based ◽  
Analgesic Ladder ◽  
Multifaceted Interventions ◽  
Discharge From Hospital ◽  
Modest Reduction

Objective: The aim of this study was to assess the introduction of an analgesic ladder and targeted education on oxycodone use for patients presenting to the emergency department (ED).Design: A retrospective pre-post implementation study was conducted. Data were extracted for patients presenting from June to July 2016 (preintervention) and June to July 2017 (post-intervention).Setting: The EDs of a major metropolitan health service and an affiliated community-based hospital.Participants: Patients with back pain where nonpharmacological interventions such as mobilization and physiotherapy are recommended as the mainstay of treatment.Interventions: A modified analgesic ladder introduced in May 2017. The ladder promoted the use of simple analgesics such as paracetamol and nonsteroidal anti-inflammatory drug (NSAIDs) prior to opioids and tramadol in preference to oxycodone in selected patients.Main outcome measure(s): The proportion of patients prescribed oxycodone and total doses administered.Results: There were 107 patients pre and 107 post-intervention included in this study. After implementation of the analgesic ladder, 78 (72.9 percent) preintervention patients and 55 (51.4 percent) post-intervention patients received oxycodone in ED (p = 0.001). The median oxycodone doses administered in the ED was 14 mg (interquartile range: 5-20 mg) and 5 mg (interquartile range: 5-10 mg; p 0.001), respectively. On discharge from hospital, a prescription for oxycodone was issued for 36 (33.6 percent) patients preintervention and 26 (24.3 percent) patients post-intervention (p = 0.13). Conclusions: Among patients with back pain, implementation of a modified analgesic ladder was associated with a statistically significant but modest reduction in oxycodone prescription. Consideration of multifaceted interventions to produce major and sustained changes in opioid prescribing is required.

scholarly journals Upper and Lower Extremity Injury Pattern and Severity of Motorbike Accident – A Retrospective Study

2020 ◽  
pp. 34-40
Author(s):  
Alhassan Abass ◽  
Lawrence Quaye ◽  
Yussif Adams
Keyword(s):  
Lower Extremity ◽  
Lower Extremity Injury ◽  
Extremity Injury ◽  
Lower Extremity Injuries ◽  
Motorcycle Accident ◽  
Accident And Emergency ◽  
Tamale Metropolis ◽  
Extremity Injuries ◽  
Motorcycle Accidents ◽  
Crash Helmet

Aim: This study aims at determining the upper and lower extremity injury pattern and severity of motorcycle accidents in the Tamale metropolis, Ghana. Methods: A retrospective hospital-based study comprising data on 190 motorcycle accident victims at the Accident and Emergency Centres of three major hospitals (Tamale Teaching Hospital, Central and West Hospitals) in Tamale metropolis from February to April 2018. Demographic data, injury type, injury location, use of crash helmet and injury outcomes were retrieved from the medical records registry. Data was analysed using SPSS version 23.0. Categorical variables were compared using Chi-square test and One-way ANOVA test was done to compare groups. Results: From the 190 victims, 78.9% were treated and discharged, 17.4% were disabled and 3.7% died. Injury mechanism was significantly (F-test = 22.64, p = 0.00) linked with injury outcome. Victims who had frontal impact collision and died (71.4%) were significantly (p<0.05) more than those who were treated and discharged (26.7%). Accident victims with upper extremity injury who became disabled (18.2%) were more (p<0.05) than those treated and discharged (16.7%). Out of the 190 victims involved in motorcycle accidents, 64.2% were not wearing crash helmet. There was significant relationship (p<0.05) between use of crash helmet and injury outcome. More (23.0%) of accident victims disabled were not wearing crash helmet and among those who died, none (0.0%) had a crash helmet on. Conclusion: Upper and lower extremity injuries as well head and neck injuries were high among motorcycle accident victims. The study recommends capacity building for healthcare professionals to manage head, neck, upper and lower extremity injuries at the Accident and Emergency Centres. Regular training programs should be conducted by law enforcement authorities in northern Ghana to train motorcycle riders and educate them on road traffic regulations. Compliance to the use of crash helmet by motorcyclists should strongly be enforced. Further prospective studies are needed to delineate these injury patterns and ascertain reason behind non-usage of crash helmet by motorcyclist in the Metropolis.

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