scholarly journals LO84: Ready to run the show: development of a new instrument for assessing resident competence in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S38
Author(s):  
W. Cheung ◽  
W. Gofton ◽  
T. Wood ◽  
M. Duffy ◽  
S. Dewhirst ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Independent Practice ◽  
Validity Evidence ◽  
Training Level ◽  
Multiple Sources ◽  
Treatment Area ◽  
New Instrument

Innovation Concept: The outcome of emergency medicine training is to produce physicians who can competently run an emergency department (ED) shift. While many workplace-based ED assessments focus on discrete tasks of the discipline, others emphasize assessment of performance across the entire shift. However, the quality of assessments is generally poor and these tools often lack validity evidence. The use of entrustment scale anchors may help to address these psychometric issues. The aim of this study was to develop and gather validity evidence for a novel tool to assess a resident's ability to independently run an ED shift. Methods: Through a nominal group technique, local and national stakeholders identified dimensions of performance reflective of a competent ED physician. These dimensions were included in a new tool that was piloted in the Department of Emergency Medicine at the University of Ottawa during a 4-month period. Psychometric characteristics of the items were calculated, and a generalizability analysis used to determine the reliability of scores. An ANOVA was conducted to determine whether scores increased as a function of training level (junior = PGY1-2, intermediate = PGY3, senior = PGY4-5), and varied by ED treatment area. Safety for independent practice was analyzed with a dichotomous score. Curriculum, Tool or Material: The developed Ottawa Emergency Department Shift Observation Tool (O-EDShOT) includes 12-items rated on a 5-point entrustment scale with a global assessment item and 2 short-answer questions. Eight hundred and thirty-three assessment were completed by 78 physicians for 45 residents. Mean scores differed significantly by training level (p < .001) with junior residents receiving lower ratings (3.48 ± 0.69) than intermediate residents who received lower ratings (3.98 ± 0.48) than senior residents (4.54 ± 0.42). Scores did not vary by ED treatment area (p > .05). Residents judged to be safe to independently run the shift had significantly higher mean scores than those judged not to be safe (4.74 ± 0.31 vs 3.75 ± 0.66; p < .001). Fourteen observations per resident, the typical number recorded during a 1-month rotation, were required to achieve a reliability of 0.80. Conclusion: The O-EDShOT successfully discriminated between junior, intermediate and senior-level residents regardless of ED treatment area. Multiple sources of evidence support the O-EDShOT producing valid scores for assessing a resident's ability to independently run an ED shift.

scholarly journals Barriers to implementing motivational interviewing in addiction treatment: A nominal group technique process evaluation

2021 ◽  
Vol 2 ◽  
pp. 263348952110184
Author(s):  
Melissa R Hatch ◽  
Kristine Carandang ◽  
Joanna C Moullin ◽  
Mark G Ehrhart ◽  
Gregory A Aarons
Keyword(s):  
Motivational Interviewing ◽  
Process Evaluation ◽  
Nominal Group Technique ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Nominal Group ◽  
Management Level ◽  
Implementation Program ◽  
Ebp Implementation ◽  
Staff Level

Background: The successful implementation of evidence-based practices (EBPs) in real-world settings requires an adaptive approach and ongoing process evaluation and tailoring. Although conducting a needs assessment during the preparation phase of implementation is beneficial, it is challenging to predict all barriers to EBP implementation that may arise over the course of implementation and sustainment. This article describes a process evaluation that identified emergent and persistent barriers that impacted the implementation of an EBP across multiple behavioral health organizations and clinics. Methods: This study was conducted during the first cohort of a cluster randomized controlled trial testing the effectiveness of the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI) in substance use disorder treatment agencies and clinics. We used a modified nominal group technique (NGT) in which clinic leaders identified barriers faced during the implementation process. Barriers were categorized, then ranked and rated according to leaders’ perceptions of each barrier’s influence on implementation. The barriers were then contextualized through individual qualitative interviews. Results: Fifteen barriers were identified, grouped into staff-level barriers, management-level barriers, and implementation program barriers. Time and resistance to MI were rated as the most influential staff-level barriers. Among management-level barriers, time was also rated highest, followed by turnover and external contractual constraints. The most influential implementation barrier was client apprehension of recording for fidelity assessment and feedback. Individual interviews supported these findings and provided suggested adaptations for future implementation efforts. Conclusion: EBP implementation is an ongoing process whereby implementation strategies must be proactively and strategically tailored to address emergent barriers. This research described a process evaluation that was used to identify 15 emergent and/or persistent barriers related to staff, management, and the implementation program. Using implementation strategies that can be tailored and/or adapted to such emergent barriers is critical to implementation effectiveness. Plain Language Summary Unforeseen barriers often arise during the course of implementation. Conducting evaluations during implementation allows for tailoring the implementation strategy. As part of a larger study using the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI), we collected data from the first cohort of LOCI clinic leaders to identify barriers to MI implementation that persisted despite advanced planning and to understand unanticipated barriers that arose during implementation. Leaders identified 15 barriers faced during the implementation process that fell into three categories: staff-level barriers, management-level barriers, and implementation program barriers. The leaders ranked time as the most influential barrier at both the staff and management levels. Staff apprehension, resistance to MI implementation, and staff turnover were also of significant concern to leaders. Future implementation efforts may benefit from conducting a similar process evaluation during the implementation phase.

scholarly journals Photograph Based Evaluation of Consumer Expectation on Healthiness, Fullness, and Acceptance of Sandwiches as Convenience Food

Foods ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 1102
Author(s):  
Purificación García-Segovia ◽  
Mª Jesús Pagán-Moreno ◽  
Amparo Tárrega ◽  
Javier Martínez-Monzó
Keyword(s):  
Interaction Effect ◽  
Online Survey ◽  
Age Groups ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Visual Appearance ◽  
Consumer Expectation ◽  
Preference Mapping ◽  
Consumer Experiences ◽  
And Cluster Analysis

Sandwiches are the most common “casual-food” consumed by all age groups in Spain. Due to the importance of visual appearance to promote unplanned or impulse buying, foodservice and hospitality companies focus on improving the visual impression of their food menus to create an expectation that satisfies both sensory and hedonic consumer experiences. To provide a list of attributes about the visual appearance of sandwiches, 25 students were recruited from a university and were invited to participate in two nominal group technique (NGT) sessions. To understand whether a sandwiches’ appearance can influence the expectation of consumers, 259 participants completed an online survey specially designed from the results of the NGT sessions. Data were analyzed using conjoint, internal preference mapping and cluster analysis; the interaction effect by gender was also studied. The conjoint results indicate that visual perception about the filling (vegetal or pork based) plays the most key role overall in consumer expectation. When consumers choose vegetables as the filling, the consumers’ perceived sandwiches as healthier, but the pork filling was perceived as more attractive and satiating. Interaction effect by gender was observed in filling when females perceived pork filling as less healthy than vegetable. By acceptance, consumers were segmented into three groups. The first cluster (n = 80) selected the pork filling. The smaller group (cluster 3, n = 36) prioritized the vegetal filling, and the most numerous cluster 2 (n = 140) liked sandwiches with multigrain bread. These results may help companies to build tailor-made marketing strategies to satisfy consumer segments.

scholarly journals Emergency medicine airway leads: a rapid response distributed educational model for emergency department COVID-19 airway management

CJEM ◽  
2021 ◽  
Author(s):  
Adam Harris ◽  
Lorri Beatty ◽  
Nicholas Sowers ◽  
Sam G. Campbell ◽  
David Petrie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Airway Management ◽  
Rapid Response ◽  
Educational Model

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

scholarly journals Parent engagement in co-design of clinical trials: the PARENT trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Leigh M. Vanderloo ◽  
Shelley M. Vanderhout ◽  
Erika Tavares ◽  
Jonathon Maguire ◽  
Sharon Straus ◽  
...  
Keyword(s):  
Focus Group ◽  
Patient Engagement ◽  
Parent Engagement ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Future Research ◽  
Potential Barriers ◽  
Patient Engagement In Research ◽  
Diverse Individual ◽  
Parent Trial

AbstractEvidence generated from partnering with parents to design and conduct research together may be used to refine, adjust, and modify future research approaches. This study aimed to describe the initial approaches to parent engagement in the design of the PARENT trial as well as understand parent perspectives on the acceptability and relevance of the PARENT trial and potential barriers and facilitators to participation.Parents participating in the TARGet Kids! cohort were invited to participate in a focus group, called the PARENT panel, to co-design the PARENT trial. This focus group was conducted to capture diverse individual and collective parents’ experiences. Overall methodological approaches for the PARENT panel were informed by the CIHR Strategy for Patient Oriented Research (SPOR) guiding principles (mutual respect, co-building, inclusiveness, and support) for patient engagement in research, and facilitated through the Knowledge Translation Program in the Li Ka Shing Knowledge Institute at Unity Health Toronto. Using a Nominal Group Technique, the PARENT panel provided feedback on the feasibility, relevance, and acceptability of the proposed intervention. Findings from this work will be used to further refine, adjust, and modify the next iteration of the PARENT trial, which will also serve as an opportunity to discuss the efforts made by researchers to incorporate parent suggestions and what additional steps are required for improved patient engagement.

scholarly journals Subarachnoid hemorrhage in the emergency department

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Sima Patel ◽  
Amay Parikh ◽  
Okorie Nduka Okorie
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Subarachnoid Hemorrhage ◽  
Early Management ◽  
Vast Number ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Diagnostic Modalities ◽  
Poor Outcomes ◽  
Subarachnoid Hemorrhages

Abstract Background Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. Discussion The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. Conclusion Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.

scholarly journals The International Federation for Emergency Medicine report on emergency department crowding and access block: a brief summary

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
A. P. Javidan ◽  
◽  
K. Hansen ◽  
I. Higginson ◽  
P. Jones ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Task Force ◽  
Video Conferencing ◽  
International Federation ◽  
Emergency Physicians ◽  
Emergency Department Crowding ◽  
Comprehensive Guidance ◽  
The World ◽  
Ed Crowding

Abstract Objective To develop comprehensive guidance that captures international impacts, causes, and solutions related to emergency department crowding and access block Methods Emergency physicians representing 15 countries from all IFEM regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020. Results A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the Task Force. Conclusions The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.

scholarly journals Colpocephaly Diagnosed in a Neurologically Normal Adult in the Emergency Department

2019 ◽  
Vol 3 (4) ◽  
pp. 421-424
Author(s):  
Christopher Parker ◽  
Wesley Eilbert ◽  
Timothy Meehan ◽  
Christopher Colbert
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Clinical Symptoms ◽  
Normal Adult ◽  
Lateral Ventricles ◽  
Asymptomatic Adult ◽  
Neurologically Normal ◽  
Made In

Colpocephaly is a form of congenital ventriculomegaly characterized by enlarged occipital horns of the lateral ventricles with associated neurologic abnormalities. The diagnosis of colpocephaly is typically made in infancy. Its diagnosis in adulthood without associated clinical symptoms is exceptionally rare. We report a case of colpocephaly diagnosed incidentally in an adult without neurologic abnormalities in the emergency department. To our knowledge, this is only the ninth reported case in an asymptomatic adult and the first to be described in the emergency medicine literature.

scholarly journals Prioritization Of Research Under National Aids Control Programme In India Using Nominal Group Technique

1970 ◽  
Vol 8 (1) ◽  
pp. 20-30
Author(s):  
R Sogarwal ◽  
D Bachani
Keyword(s):  
Nominal Group Technique ◽  
Research Priorities ◽  
Control Programme ◽  
Pediatric Hiv ◽  
Nominal Group ◽  
Phase Iii ◽  
Hiv Care ◽  
Policy Makers ◽  
Research Questions ◽  
Group Technique

Introduction: During the fi rst 2 years of the fi ve year plan of India’s National AIDS Control Programme Phase-III (NACP-III; 2007-12), various interactive consultative workshops were organized in collaboration with development partners with the objective of identifying priority areas for operational research and further development of research protocols adopting mentorship approach. Methodology: This article is an attempt to present the Nominal Group Technique (NGT) which was used to identify a set of fundable and practically feasible research priorities under NACP-III specifi cally focusing on Prevention of Parent to Child Transmission (PPTCT) and Pediatric HIV Care in India. The activity was undertaken with support of UNICEF in the year 2010. A total of 110 persons participated in the consultation clustering into 37, 36 and 37 members in Group A, B and C, respectively. The participants refl ected the mix of policy makers / decision makers (8), programme managers (12), implementers (36), subject experts / researchers (28), other stakeholders (16). Results: A total of nine highest priority research questions were identifi ed by all the groups in the assigned themes. The value of Kendall’s W coeffi cient of concordance was 0.68, which shows signifi cant agreement among raters on priority research questions (chi-square=16.35; p=0.03). Conclusion: Based on our experience, we can conclude that NGT was found to be an important tool for setting research priorities that is more democratic and transparent than the traditional methods. By applying various stages of the group sessions, participants can experience the rethinking process with reference information to enhance their judgment. The results of our experience may help programme managers / policy makers to plan similar and more improved method in other element of NACP as well as other health programmes. DOI: http://dx.doi.org/10.3126/saarctb.v8i1.5888 SAARCTB 2011; 8(1): 20-30

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