CJEM

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OBJECTIVES: We sought to identify emergency department interventions that lead to improvement in door-to-electrocardiogram (ECG) times for adults presenting with symptoms suggestive of acute coronary syndrome. METHODS: Two reviewers searched Medline, Embase, CINAHL, and Cochrane CENTRAL from inception to April 2018 for studies in adult emergency departments with an identifiable intervention to reduce median door-to-ECG times when compared with the institution's baseline...

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No abstract text is available yet for this article.

OBJECTIVES: There is increasing evidence to support integration of simulation into medical training; however, no national emergency medicine (EM) simulation curriculum exists. Using Delphi methodology, we aimed to identify and establish content validity for adult EM curricular content best suited for simulation-based training, to inform national postgraduate EM training. METHODS: A national panel of experts in EM simulation iteratively rated potential curricular topics, on a 4-point scale, to determine those best suited for simulation-based training...

OBJECTIVE: Our objectives were to identify barriers to the organ donation registration process in Ontario; and to determine the acceptability of using the emergency department (ED) waiting room to provide knowledge and offer opportunities for organ and tissue donor registration. METHODS: We conducted a paper based in-person survey over nine days in March and April 2017. The survey instrument was created in English using existing literature and expert opinion, pilot tested and then translated into French...

OBJECTIVE: Delays in triage processes in the emergency department (ED) can compromise patient safety. The aim of this study was to provide proof-of-concept that a self-check-in kiosk could decrease the time needed to identify ambulatory patients arriving in the ED. We compared the use of a novel automated self-check-in kiosk to identify patients on ED arrival to routine nurse-initiated patient identification. METHODS: We performed a prospective trail with random weekly allocation to intervention or control processes during a 10-week study period...

OBJECTIVE: Use of personal mobile devices to record patient data appears to be increasing, but remains poorly studied. We sought to determine the extent and reasons that Canadian emergency physicians (EPs) and emergency medicine residents use personal mobile devices to record patient data in the emergency department (ED). METHODS: A national survey was distributed to Canadian EPs and residents between 27/02/17 and 23/03/17. This captured demographics, frequency, and purpose of personal mobile device use to record patient data in the ED...

OBJECTIVE: A new non-invasive bladder stimulation technique has been described to obtain clean-catch urine specimens in infants. This study aimed to evaluate if point-of-care ultrasound (POCUS) guided feeding protocol to measure bladder volume prior to stimulation techniques improves clean-catch urine collection success. METHODS: A prospective randomized controlled trial study was conducted in a tertiary care pediatric emergency department. Infants aged less than 6 months needing a urine sample were randomized to either POCUS group or feeding group (standard procedure) before performing a standardized clean-catch urine stimulation technique...

OBJECTIVES: Opioid-related emergency department (ED) visits have increased significantly in recent years. Our objective was to evaluate an ED-initiated buprenorphine/naloxone program, which provided rapid access to an outpatient community-based addictions clinic, for patients in opioid withdrawal. METHODS: A retrospective chart review was completed within a health system encompassing four community EDs in Ontario, Canada. Patients were screened for opioid withdrawal between April 2017-December 2017 and offered buprenorphine/naloxone treatment and referral to outpatient addictions follow-up...

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OBJECTIVES: In the current opioid epidemic, identifying high-risk patients among those with substance and opioid use may prevent deaths. The objective of this study was to determine whether frequent emergency department (ED) use and degree of frequent use are associated with mortality among ED patients with substance and opioid use. METHODS: This cohort study used linked population-based ED (National Ambulatory Care Reporting System) and mortality data from Alberta...

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OBJECTIVES: The purpose of this study was to identify 1) the proportion of patients discharged from the emergency department (ED) with a diagnosis of concussion and return within 14 days, and 2) the characteristics that prompt a return. METHODS: A health records review was conducted on adult patients with a discharge diagnosis of a concussion who accessed care through Hamilton Health Sciences EDs and Urgent Care Centre in 2016. Subsequent data were collected from those who returned to the ED within 14 days...

ABSTRACTIntroductionAcute aortic dissection (AAD) is a time sensitive, difficult to diagnose, aortic emergency. We sought to explore the quality of history taking in AAD and assess its impact on misdiagnosis. METHODS: We studied a retrospective cohort of patients >18 years old who presented to two tertiary care emergency departments from January 1st 2004 - December 31st 2012 and were diagnosed with an acute aortic dissection (AAD) on CT, MRI or TEE. Trained reviewers' extracted data using a standardized data collection form...

OBJECTIVES: The aim of this study is to identify the types of community paramedicine programs and the training for each. METHODS: A systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies' methodological quality (full methodology on PROSPERO: CRD42017051774)...

OBJECTIVES: Transesophageal echocardiography (TEE) is a relatively new resuscitation tool in the emergency department. Recent studies have demonstrated that it can impact diagnosis and management of critically ill patients. The objective of this study is to determine the effectiveness of a simulation-based curriculum for teaching emergency medicine residents a five-view TEE protocol. METHODS: Emergency medicine residents with previous ultrasound experience were invited to attend a 1-hour TEE training session...

OBJECTIVES: Emergency medicine residents may be transitioning to practice with minimal training on how to supervise and assess trainees. Our study sought to examine: 1) physician comfort with supervision and assessment, 2) what the current training gaps are within these competencies, and 3) what barriers or enablers might exist in implementing curricular improvements. METHODS: Qualitative data were collected in two phases through individual interviews from September 2016 to November 2017, at the University of Toronto and McMaster University after receiving ethics approval from both sites...

OBJECTIVE: Emergency department (ED) and hospital overcrowding cause offload delays that remove emergency medical services (EMS) crews from service and compromise care delivery. Prolonged ED boarding and delays to inpatient care are associated with increased hospital length of stay (LOS) and patient mortality, but the effects of EMS offload delays have not been well studied. METHODS: We used administrative data to study all high-acuity Canadian Triage Acuity Scale 2-3 EMS arrivals to Calgary adult EDs from July 2013 to June 2016...

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