Pre-analytical specimen labelling and processing errors in the ICU

Introduction: Specimen rejections have been associated with increased in-hospital stay and cost. The majority of errors occur in the pre-analytic phase. Specimen rejection can lead to high rate of recollection, delay in result availability, and high rate of test abandonment. These factors affect patient care and safety. Methods: This study conducted a retrospective review of Patient Safety Learning System (PSLS) reports for the intensive care unit (ICU) at The Ottawa Hospital General Campus (TOH) between 2010 and 2018, and a prospective review using interviews, surveys, and process mapping. Results: From 2098 PSLS reports, 52.6% were related to laboratory specimen collection and processing (pre-analytic phase). Specimen mislabelling with the wrong patient identifier accounted for 9.8% of pre-analytical error reports, while 16.4% of errors were due to non-sufficient quantity (NSQ) of specimen. 12.2 % of pre-analytical error reports involved cytology specimens. Conclusions: Pre-analytical errors are not only costly and resource draining, but may also place a burden on patients. Areas where errors were found include labels and requisitions stored in bedside cabinets, inconsistencies between specimen labels and requisitions, out-dated and difficult to access laboratory manuals, and non-sufficient quantity specimen collection. In the future we hope to start new initiatives to tackle these issues to improve patient safety and hospital efficiencies. This includes the development of a website for the laboratory manual, so that it is more easily accessible and user-friendly. With a new electronic medical record (EMR) system at TOH in 2019, we will explore the affects of pre-analytical processing of specimens.

P.166 Assessment of External Ventricular Catheter Associated Infections at the Ottawa Hospital: Literature Review and Quality Improvement Initiative

Background: External ventricular drains are a lifesaving intervention in the management of acute hydrocephalus. EVD associated infections vary significantly, and expert panels recommend reviewing institutional policies if infection rates exceed 10%. The audit aims to identify the infection rate at our institution, whereas the literature review aims to synthesize a new institutional EVD best practice guideline. Methods: An audit of EVD catheters inserted in the time period between 07/01/2019 and 10/25/2020 was conducted. Statistical analysis to calculate absolute incidence, infections per 1000 days of catheter use. A literature review to identify best practices for the insertion and management of EVDs was conducted. Results: 75 patients required a total of 105 EVD catheters. There were 16 (15.3%) EVD related infections, equating to 14.3 infections per 1000 days. Fifty percent of patients developed an EVD related infection within 9 days of insertion. Most infections were induced by skin flora (87.5%). A comprehensive step-by-step EVD insertion and management protocol was developed aiming to reduce the risk of infection. Conclusions: The incidence of EVD associated infections at the Ottawa Hospital is significantly higher than acceptable rates as suggested by expert panels. A new evidence-based best practice guidelines should be implemented. A follow-up audit is necessary.

P.204 Integration of patient directed approach in pituitary tumor management – The Ottawa Hospital experience

Background: Pituitary adenomas are common and often require complex multidisciplinary care with multiple specialists. This may result in a health care system that is challenging for patients to navigate. Audits of care at our institution revealed opportunities for improvement to better align care with patients’ needs. Methods: A quality improvement initiative that incorporated a patient advisory committee of patients who had received treatment for pituitary adenoma at our center and their family members was used to help identify opportunities for improvement. The patient-identified gaps in care included the need to coordinate and minimize appointments and the desire for better communication and education. Based on this information, changes were implemented to the pituitary program, including increasing access to the multidisciplinary clinic and developing a standardized and centralized triage process. Results: A pre and post-intervention analysis consisting of retrospective chart reviews revealed that these changes had an impact on wait times for first assessment, and a significant shift in location of this first visit – with a larger proportion of patients being seen in the multidisciplinary clinic after intervention. Conclusions: We demonstrate that patient involvement, beyond individual patient-physician interactions, can lead to meaningful and observable changes, and can improve the quality of care for pituitary adenoma.

Does Diabetes Alter CSF Total Protein Levels? A Retrospective Cohort Study

Background and Purpose: Elevation of total protein level in cerebrospinal fluid (CSF-TP) in diabetic patients is often disregarded by clinicians. However, existing studies on the topic have significant limitations, and therefore we aimed to explore the relationship between diabetes and CSF-TP in a large database of CSF samples. Methods: Retrospective review of all diagnostic lumbar punctures at the Ottawa Hospital between 1996-2016. Patients were excluded if they had elevated CSF cell counts, or a condition known to elevate CSF-TP. Multivariate linear regression modeling considered the effects of age, sex, and diabetes. Results: Among 6124 patients (746 with diabetes, 5378 without), mean CSF-TP did not differ significantly between groups (0.39 and 0.35 mmol/L, p = 0.2). When controlled for age and sex, there was no significant effect of diabetes on CSF-TP and no significant correlation between mean serum glucose and CSF-TP (R2 = 0.12). Conclusions: CSF-TP did not differ significantly between diabetic and non-diabetic groups, once the influence of age and sex was controlled. Elevated CSF-TP should be regarded as pathologic, even in the setting of diabetes.

Um ano de e-mails não solicitados: o modus operandi de revistas e editoras predatórias

Objectives: To quantify, characterize and analyze e-mail from predatory journals (PJ) received by an academic in dentistry. Materials and methods: E-mails received in 2019 and suspected of being potentially predatory were pre-selected. The Ottawa Hospital Research Institute (OHRI) checklist was applied to identify the suspected biomedical PJ, including the following criteria: article processing charge (APC), fake impact factor, the journal being listed in the Directory of Open Access Journals (DOAJ) and the Committee on Publication Ethics (COPE). We also extracted information on the lack of an impact factor on Journal Citations Reports, non-journal affiliated contact e-mail address, flattering language, article and/or personal citation, unsubscribe link, being listed in the National Library of Medicine (NLM) current catalog and indexed on Medline. Results: A total of 2,812 unsolicited suspected e-mails were received, and 1,837 requested some sort of manuscript; among these, 1,751 met some of the OHRI criteria. Less than half (780/1,837, 42%) referred to some area of dentistry. The median APC was US$399. A false impact factor was mentioned in 11% (201/1,837) of the e-mails, and 27% (504/1,837) corresponded to journals currently listed in the NLM catalog. Journals listed in DOAJ and COPE sent 89 e-mails. Conclusions: The email campaign from PJ was high and recurrent. Researchers should be well informed about PJ’ modus operandi to protect their own reputation as authors and that of science.

A Mobile App for Wound and Symptom Surveillance After Colorectal Surgery: Protocol for a Feasibility Randomized Controlled Trial (Preprint)

BACKGROUND Surgical site infections (SSIs) are the most common nosocomial infection and occur in 16.3% of patients undergoing colorectal surgery at our institution (The Ottawa Hospital), the majority of which are identified after discharge from hospital. Patients who suspect having an SSI generally present to the emergency department or surgery clinic. Both options for in-person interaction are costly to the health care system and patients. A mobile app, how2trak, has proven to be beneficial for patients with complex wounds at our institution by facilitating at-home monitoring and virtual consultations. OBJECTIVE This study aims to assess the feasibility of a randomized controlled trial to assess if how2trak can improve patients’ experience and increase detection of SSIs after colorectal surgery while reducing patients’ risk of COVID-19 exposure. METHODS In this single-center prospective feasibility trial, eligible patients undergoing colorectal surgery will be randomized to either standard care or how2trak postoperative monitoring of their incision, symptoms, and ostomy function. Patient self-assessments will be monitored by a nurse specialized in wound and ostomy care who will follow-up with patients with a suspected SSI. The primary outcome is feasibility as measured by enrollment, randomization, app usability, data extraction, and resource capacity. RESULTS This study was approved by our institution’s ethics board on February 26, 2021, and received support from The Ottawa Hospital Innovation and Care Funding on November 12, 2021. Recruitment started June 3, 2021, and 29 were patients enrolled as of September 2021. We expect to publish results in spring 2022. CONCLUSIONS This study will determine the feasibility of using a mobile app to monitor patients’ wounds and detect SSIs after colorectal surgery. If feasible, we plan to assess if this mobile app facilitates SSI detection, enhances patient experience, and optimizes their care. CLINICALTRIAL ClinicalTrials.gov NCT04869774; https://clinicaltrials.gov/ct2/show/NCT04869774 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/26717

Receptiveness to participating in cannabis research in pregnancy: a survey study at The Ottawa Hospital

Background: The prevalence of cannabis use among pregnant individuals in Canada is increasing. In the design of new cohort studies to evaluate the patterns and outcomes of cannabis use in pregnancy, consideration must be given to the factors influencing participation, data sharing, and contribution of biological samples. Our objective was to assess the willingness of pregnant individuals to participate in prospective research during pregnancy. Methods: We surveyed pregnant individuals receiving obstetrical care through The Ottawa Hospital in Ottawa, Canada. The survey consisted of 23 dichotomous (yes/no), multiple-choice, Likert scale, and open-ended questions. Individuals were provided with a hypothetical research scenario and asked to report on the likelihood of their participation, use and storage of personal health information and contribution of maternal and newborn samples. Individuals provided motivating and deterring factors related to research participation. Descriptive statistics included frequencies (n) and percentages (%) for categorical variables. Continuous variables were described using means and standard deviations. Results: A total of 84 survey responses were collected. The mean age of respondents was 32.6(±5.3) years. Respondents were predominantly Caucasian (79%), college/university educated (85%) with a household income of ≥$100,000 (64%). There was a high degree of willingness to participate in prospective research by sharing data and biological samples. The most commonly cited motivating and deterring factors for participating in future research were a desire to contribute to science and health information (79%) and fear of privacy invasion (17%), respectively. Conclusions: Pregnant individuals receiving care at The Ottawa Hospital are willing to participate in prospective research studies, including those related to cannabis use. Survey respondents were predominantly of higher socioeconomic status, and few individuals reported cannabis use during pregnancy. Future studies should accommodate multiple recruitment strategies and flexible study designs to encourage enrollment from and retention across diverse sociodemographic communities.

COVID-19 and perinatal intimate partner violence: a cross-sectional survey of pregnant and postpartum individuals in the early stages of the COVID-19 pandemic

ObjectiveThe objectives of this study were to: (1) document violent and controlling behaviours within intimate partnerships during the perinatal period; and (2) determine individual, interpersonal and household-level factors influencing the risk of perinatal intimate partner violence (IPV).DesignCross-sectional survey.SettingThe Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada.ParticipantsPatients who gave birth at The Ottawa Hospital and were >20 days post partum between 17 March and 16 June 2020.Main outcomes and measuresPerinatal IPV was defined as regular controlling behaviours or act-based forms of emotional/physical/sexual abuse in the 12 months before pregnancy, during pregnancy and/or post partum. Log-binomial multivariable regression models were used to compute adjusted risk ratios (aRRs) and 95% CIs to identify potential risk factors for IPV: maternal age, postpartum depression, parity, increase in partner substance use and household income.ResultsAmong 216 participants, the median maternal age was 33 years (IQR: 30–36). In total, 52 (24.07%) reported some form of perinatal IPV, 37 (17.13%) reported regular controlling behaviour and 9 (4.17%) reported both. Household income below the municipal median was the strongest risk factor for perinatal IPV (aRR: 3.24, 95% CI: 1.87 to 5.59). There was no apparent association between maternal age (aRR: 0.99, 95% CI: 0.94 to 1.04), postpartum depression (aRR: 1.03, 95% CI: 1.00 to 1.07), nulliparity (aRR: 1.18, 95% CI: 0.71 to 1.97) or increases in partner substance use (aRR: 0.73, 95% CI: 0.42 to 1.25) with IPV.ConclusionOne in four individuals in this study experienced perinatal IPV. Household income was the strongest risk factor, and surprisingly, many hypothesised risk factors (eg, mental health, partner substance use, etc) were not significantly associated with perinatal IPV in this sample. This highlights the challenges in both measuring IPV and identifying individuals exposed to perinatal IPV during the high stress of the COVID-19 pandemic.

Diagnostic Utility of Creatine Kinase in Patients Presenting to the Emergency Department with Chest Pain

Introduction: Creatine Kinase (CK) is routinely performed in some emergency departments (ED) for Non-ST-elevation myocardial infarction (NSTEMI) workup. Its diagnostic utility is not well understood. The objectives of this study were to assess the value of CK in NSTEMI diagnosis in the troponin era and the association between the highest CK/Troponin values and ejection fraction (EF) during NSTEMI follow-up. Methods: A prospective cohort study conducted at the two EDs of The Ottawa Hospital from March 2014 to March 2016 enrolled adults (≥18 years) for whom troponin I (TnI) and CK were ordered for NSTEMI symptoms. We excluded those with ST-Elevation Myocardial Infarction (STEMI). The primary outcome was a NSTEMI within 30 days. We used descriptive statistics and report test diagnostic characteristics with 95% confidence intervals (CI). We compared the highest median CK/Troponin values using Wilcoxon test. Results: Of the 2,153 patients enrolled, 99 (4.6%) suffered a NSTEMI. The sensitivity and specificity were: CK (cutoff >250U/L) 31.3% (95%CI 22.2, 40.5) and 91.1% (95%CI 89.9, 92.4) respectively; TnI (cutoff >0.045µg/L) 98.0% (95%CI 95.2, 100) and 86.2% (95%CI 84.7, 87.7) respectively. The median CK values were not significantly different between those with normal (n=267) and abnormal EF (n=55) on follow-up (107 U/L and 118 U/L respectively; p=0.31), whereas the median TnI values were significantly different (0.02 µg/L and 0.1 µg/L respectively; p<0.0001). Conclusions: CK measurements do not provide any value in the ED work-up of NSTEMI and is not associated with EF on follow-up. Discontinuing routine CK measurements would improve resource utilization.