scholarly journals Understanding communication between emergency and consulting physicians: a qualitative study that describes and defines the essential elements of the emergency department consultation-referral process for the junior learner

CJEM ◽  
2013 ◽  
Vol 15 (01) ◽  
pp. 42-51 ◽  
Author(s):  
Teresa Chan ◽  
Donika Orlich ◽  
Kulamakan Kulasegaram ◽  
Jonathan Sherbino
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Simple Model ◽  
Focus Group ◽  
Essential Elements ◽  
Referral Process ◽  
Clinical Specialty ◽  
Consultation Request ◽  
Initial Preparation

ABSTRACT Objectives: To define the important elements of an emergency department (ED) consultation request and to develop a simple model of the process. Methods: From March to September 2010, 61 physicians (21 emergency medicine [EM], 20 general surgery [GS], 20 internal medicine [IM]; 31 residents, 30 attending staff) were questioned about how junior learners should be taught about ED consultation. Two investigators independently reviewed focus group and interview transcripts using grounded theory to generate an index of themes until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. All transcripts were coded using this index of themes; 30% of transcripts were coded in duplicate to determine the agreement. Results: A total of 245 themes and subthemes were identified. The agreement between reviewers was 77%. Important themes in the process were as follows: initial preparation and review of investigations by EM physician (overall endorsement 87% [range 70–100% in different groups]); identification of involved parties (patient and involved physicians) (100%); hypothesis of patient's diagnosis (75% [range 62–83%]) or question for the consulting physician (70% [range 55–95%]); urgency (100%) and stability (74% [range 62–80%]); questions from the consultant (100%); discussion/communication (98% [range 95–100%]); and feedback (98% [range 95–100%]). These components were reorganized into a simple framework (PIQUED). Each clinical specialty significantly contributed to the model (χ2 = 7.9; p value = 0.019). Each group contributed uniquely to the final list of important elements (percent contributions: EM, 57%; GS, 41%; IM, 64%). Conclusions: We define important elements of an ED consultation with input from emergency and consulting physicians. We propose a model that organizes these elements into a simple framework (PIQUED) that may be valuable for junior learners.

Nasce uma nova especialidade : osteopatia

2016 ◽  
Vol 2 (3) ◽  
Author(s):  
Marco Antônio Guimarães Da Silva
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Preventive Medicine ◽  
Rio De Janeiro ◽  
Obstetrics And Gynecology ◽  
Physical Medicine ◽  
National Board ◽  
Physical Medicine And Rehabilitation ◽  
Allergy And Immunology ◽  
Medical Examiners

Por circunstâncias relacionadas à minha titulação, acabei designado pela Universidade Castelo Branco do Rio de Janeiro (UCB) para avaliar uma parceria proposta pela Escola de Osteopatia de Madri (EOM). À época, em 1997, a EOM propunha que a UCB passasse a organizar academicamente os cursos de osteopatia que a referida Escola já vinha ministrando no Brasil, com vistas a, no futuro, torná-lo um curso de pós-graduação. Algumas viagens à Madri para observar a estrutura acadêmica e pedagógica da sede da EOM, condição imposta pela UCB para concretizar a parceria, me levaram a conhecer esta modalidade terapêutica, com resultados efetivamente comprovados através de trabalhos científicos.Realizadas as adaptações que se faziam necessárias, a UCB aprovou, em 2000, o curso de osteopatia, com uma carga horária de 1050 horas para a titulação de especialização acadêmica, nível Lato Sensu. A resolução do COFITO, que estabelece a osteopatia como uma especialidade da fisioterapia, levou-nos a propor ao CEPE da UCB uma complementação de 450 horas, alcançando, assim, as 1.500 horas, distribuídas ao longo de cinco anos, exigidas pela referida resolução do COFITO. A introdução desta técnica terapêutica no Brasil pela corrente Européia e a pronta intervenção do COFITO foram fatores decisivos para nos brindar com mais uma especialidade. Houvera sido a Osteopatia implantada no Brasil por influência da escola americana, talvez os rumos tomados fossem outros. Senão, vejamos. Nos EUA, a osteopatia é normalmente exercida pelo médico, que deve obter sua permissão através do National Board of Osteopatic Medical Examiners, e está dividida em Sociedades Osteopáticas que se distribuem por todas as modalidades médicas; a saber: Allergy and Immunology, Anesthesiology, Dermatology ,Emergency Medicine, Internal Medicine, Neurologists and Psychiatrists, Obstetrics and Gynecology, Occupational and Preventive Medicine, Ophthalmology and Otolaryngology, Orthopedics Pathology, Pediatrics Proctology, Radiology, Physical Medicine and Rehabilitation, Rheumatology Sports Surgery Medicine.Com o objetivo de incentivar as linhas de pesquisas na área da osteopatia, estará sendo criado, durante as III Jornadas Hispano-Lusas de Fisioterapia em Terapia Manual (Sevilha-Espanha, 5 de outubro de 2001), o Centro Internacional de Pesquisas em Osteopatia. O referido Centro, dirigido por um fisioterapeuta brasileiro com Doutorado, terá sua sede na Espanha e manterá núcleos, vinculados a Universidades, na Argentina, no Brasil, na Itália, em Portugal e na Venezuela. Esperamos, desta forma, ao lado do reconhecimento profissional já oferecido pela resolução COFITO, dar mais um passo na consolidação acadêmica da nossa mais nova modalidade terapêutica.

59. General medicine residents' perception of the mini-CEXs

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
S. Malhotra ◽  
R. Hatala ◽  
C.-A. Courneya
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Focus Group ◽  
Qualitative Study ◽  
Focus Groups ◽  
General Medicine ◽  
Clinical History ◽  
Phenomenological Approach ◽  
Medical Teacher ◽  
The Impact

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

52. Simulation based training improves resident competence in the performance of critical resuscitation procedures

2007 ◽  
Vol 30 (4) ◽  
pp. 56
Author(s):  
I. Rigby ◽  
I. Walker ◽  
T. Donnon ◽  
D. Howes ◽  
J. Lord
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Medical Education ◽  
Family Medicine ◽  
Training Program ◽  
Correlation Coefficient ◽  
Training Programs ◽  
Self Assessment ◽  
Procedural Skills ◽  
Simulation Based

We sought to assess the impact of procedural skills simulation training on residents’ competence in performing critical resuscitation skills. Our study was a prospective, cross-sectional study of residents from three residency training programs (Family Medicine, Emergency Medicine and Internal Medicine) at the University of Calgary. Participants completed a survey measuring competence in the performance of the procedural skills required to manage hemodynamic instability. The study intervention was an 8 hour simulation based training program focused on resuscitation procedure psychomotor skill acquisition. Competence was criterion validated at the Right Internal Jugular Central Venous Catheter Insertion station by an expert observer using a standardized checklist (Observed Structured Clinical Examination (OSCE) format). At the completion of the simulation course participants repeated the self-assessment survey. Descriptive Statistics, Cronbach’s alpha, Pearson’s correlation coefficient and Paired Sample t-test statistical tools were applied to the analyze the data. Thirty-five of 37 residents (9 FRCPC Emergency Medicine, 4 CCFP-Emergency Medicine, 17 CCFP, and 5 Internal Medicine) completed both survey instruments and the eight hour course. Seventy-two percent of participants were PGY-1 or 2. Mean age was 30.7 years of age. Cronbach’s alpha for the survey instrument was 0.944. Pearson’s Correlation Coefficient was 0.69 (p < 0.001) for relationship between Expert Assessment and Self-Assessment. The mean improvement in competence score pre- to post-intervention was 6.77 (p < 0.01, 95% CI 5.23-8.32). Residents from a variety of training programs (Internal Medicine, Emergency Medicine and Family Medicine) demonstrated a statistically significant improvement in competence with critical resuscitation procedural skills following an intensive simulation based training program. Self-assessment of competence was validated using correlation data based on expert assessments. Dawson S. Procedural simulation: a primer. J Vasc Interv Radiol. 2006; 17(2.1):205-13. Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med. 2004; 11(11):1149-54. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003; 78(8):783-8.

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 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.

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