Healthcare providers' perceptions of a situational awareness display for emergency department resuscitation: a simulation qualitative study.

Importance: Emergency resuscitation of critically ill patients can challenge team communication and situational awareness. Tools facilitating team performance may enhance patient safety.

Objectives: To determine resuscitation team members' perceptions of the Situational Awareness Display's utility.

The feasibility of an interactive voice response system (IVRS) for monitoring patient safety after discharge from the ED.

Background: Return ED visits are frequent and may be due to adverse events: adverse outcomes related to healthcare received. An interactive voice response system (IVRS) is a technology that translates human telephone input into digital data. Use of IVRS has been explored in many healthcare settings but to a limited extent in the ED.

Can teamwork and situational awareness (SA) in ED resuscitations be improved with a technological cognitive aid? Design and a pilot study of a team situation display.

Unlabelled: Effective teamwork in ED resuscitations, including information sharing and situational awareness, could be degraded. Technological cognitive aids can facilitate effective teamwork.

Objective: This study focused on the design of an ED situation display and pilot test its influence on teamwork and situational awareness during simulated resuscitation scenarios.

Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis.

Background: In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs.

Methods: We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations.

Evaluating a medical directive for nurse-initiated analgesia in the Emergency Department.

Objectives: Although acute pain is a common presentation in the Emergency Department (ED), analgesics are often delayed until the patient is seen by a physician. We assessed the effect of a medical directive for nurse-initiated analgesia on time to first dose of analgesics, proportion of patients receiving analgesics in less than 30min, and total length of stay in the ED.

Methods: A medical directive for nurse-initiated analgesia was introduced in our ED in October 2011.

Implementation of a structured hospital-wide morbidity and mortality rounds model.

Importance: There is a paucity of literature on the quality and effectiveness of institutional morbidity & mortality (M&M) rounds processes.

Objective: We sought to implement and evaluate the effectiveness of a hospital-wide structured M&M rounds model at improving the quality of M&M rounds across multiple specialties.

Design, Setting, Participants: We conducted a prospective interventional study involving 24 clinical groups (1584 physicians) at a tertiary care teaching hospital from January 2013 to June 2015.

Teaching M&M rounds skills: enhancing and assessing patient safety competencies using the Ottawa M&M model.

Background: Postgraduate medical education bodies and national patient safety institutes recommend that trainees develop patient safety competencies such as those for Morbidity and Mortality (M&M) rounds, yet there exists no model for their educational delivery.

Objective: We studied the effect of a single educational intervention on emergency medicine residents' aptitudes in selecting and analysing M&M rounds cases.

Methods: In this before-and-after study, participants attended an 1 h educational session based on the previously described Ottawa Morbidity and Mortality Model (OM3).

Adverse events in patients with return emergency department visits.

Objectives: This study describes the proportion of emergency department (ED) returns within 7 days due to adverse events, defined as adverse outcomes related to healthcare received.

Design: Prospective cohort study.

Setting: We used an electronically triggered adverse event surveillance system at a tertiary care ED from May to June 2010 to examine ED returns within 7 days of index visit.

Stroke prenotification is associated with shorter treatment times for warfarin-associated intracerebral hemorrhage.

Background: Warfarin-associated intracerebral hemorrhage (WAICH) is a devastating disease with increasing incidence. In this setting, treatment with prothrombin complex concentrates (PCC) is essential to correct coagulopathy. Yet despite the availability of coagulopathy correction strategies, significant treatment delays can occur in emergency departments (EDs), which may be overcome using stroke prenotification strategies.

Hospital Emergency Readiness Overview study.

In 2001, a survey of Canadian emergency departments indicated significant deficiencies in disaster preparedness. Since then, there have been efforts on the part of Provincial governments to remedy this situation. This survey repeats the original study with minor modifications to determine if there has been improvement.

Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study.

Objective: To enhance patient safety, it is important to understand the frequency and causes of adverse events (defined as unintended injuries related to health care management). We performed this study to describe the types and risk of adverse events in high-acuity areas of the emergency department (ED).

Methods: This prospective cohort study examined the outcomes of consecutive patients who received treatment at 2 tertiary care EDs.

Comparison of CT head interpretation between emergency physicians and neuroradiologists.

Cranial computed tomography (CT) of the head is widely used in the emergency department 24 h a day. We compared the accuracy of CT head interpretation between staff emergency physicians (EPs) and neuroradiologists. We conducted a health records review of patients who required head CT in the emergency department.

Prevalence of information gaps for seniors transferred from nursing homes to the emergency department.

Objective: Information gaps, defined as previously collected information that is not available to the treating physician, have implications for patient safety and system efficiency. For patients transferred to an emergency department (ED) from a nursing home or seniors residence, we determined the frequency and type of clinically important information gaps and the impact of a regional transfer form.

Methods: During a 6-month period, we studied consecutive patients who were identified through the National Ambulatory Care Reporting System database.

Irreducible lateral patellar dislocation: the importance of impaction fracture recognition.

Irreducible lateral patellar dislocation may occur in the older patient with a previous history of patellofemoral arthritis. The only subtle finding on physical examination to suggest this diagnosis will be positioning of the knee in less flexion than a typical lateral patellar dislocation, anterolateral position of the patella and internal rotation of the patella from the coronal plane. That is, the patella is dislocated laterally but the lateral border comes to lie in a position of variable degrees of anterior displacement relative to the medial patellar border.

Food-dependent exercise-induced anaphylaxis.

Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of exercise-induced anaphylaxis that requires both vigorous physical activity and the ingestion of specific foods within the preceding several hours. When patients present to the emergency department (ED) with allergic reactions, careful history regarding these 2 factors is required to establish the correct diagnosis. Correct diagnosis of FDEIA will allow patients to take control of their lifestyles and avert repeated events and ED visits.

Mild head injury: a misnomer.

Despite controversy surrounding the concept of mild head injury (MHI), it is becoming evident that even a head trauma termed 'mild' may result in significant behavioural sequelae. The present study was an attempt at documenting structural cerebral damage, by way of computerized tomography, in a group of patients having suffered a MHI as defined by the Glasgow Coma Scale (GCS) score. A 1-year retrospective chart review identified 80 MHI patients who presented to the Emergency department of a lead hospital for trauma.

Aortic dissection and Turner's syndrome: case report and review of the literature.

Cardiovascular abnormalities are frequently encountered in patients with Turner's syndrome. These include coarctation of the aorta, aortic root dilatation, bicuspid aortic valve, atrial and ventricular septal defects. Aortic dissection is a rare but devastating complication of Turner's syndrome that usually occurs in adulthood.

Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.

Context: The Ottawa Knee Rule is a previously validated clinical decision rule that was developed to allow physicians to be more selective and efficient in their use of plain radiography for patients with acute knee injuries.

Objective: To assess the impact on clinical practice of implementing the Ottawa Knee Rule.

Design: Controlled clinical trial with before-after and concurrent controls.

Prospective validation of a decision rule for the use of radiography in acute knee injuries.

Objective: To validate a previously derived decision rule for the use of radiography in patients with acute knee injury.

Design: Prospectively administered survey.

Setting: Emergency departments of two university hospitals serving adults.

Use of radiography in acute knee injuries: need for clinical decision rules.

Objectives: To study: 1) the efficiency of the current use of radiography in acute knee injuries, 2) the judgments and attitudes of experienced clinicians in their use of knee radiography, and 3) the potential for decision rules to improve efficiency.

Methods: This two-stage study of adults with acute knee injuries involved: 1) a retrospective review of all 1,967 patients seen over a 12-month period in the EDs of one community and two teaching hospital, and 2) a prospective survey of another 1,040 patients seen by attending emergency physicians. The prospective survey assessed each clinician's estimate of the probability of a knee or patella fracture; 120 patients were independently assessed by two physicians.

Derivation of a decision rule for the use of radiography in acute knee injuries.

Study Objective: To derive a highly sensitive decision rule for the selective use of radiography in acute knee injuries.

Design: Prospectively administered survey.

Setting: Emergency departments of two university hospitals.

Visualization of C7-T1 on portable lateral cervical spine radiographs using a lead-lined acrylic filter.

Objective: To determine whether lead-lined acrylic cervical filters can improve the quality of portable lateral cervical spine (c-spine) radiographs for trauma patients.

Methods: Twenty trauma patients who required portable c-spine x-rays had these taken with a lead filter attached to the collimator of the portable x-ray machine to improve penetration and visualization of lower cervical structures without overpenetrating upper cervical structures. The radiographs of these patients were compared with the first portable c-spine radiographs without filters for 20 controls matched for gender and injury severity.

Prehospital care at a major international airport.

Medical emergencies at a major metropolitan airport have a significant impact on prehospital care capabilities for the rest of the community in which the airport is located. Stapleton International Airport in Denver, Colorado, is a facility that in 1985 had 14.4 million passengers and a static employee population of 12,000 to 15,000.

Toxic shock syndrome following diagnostic peritoneal lavage.

We report the case of a 15-year-old girl who developed high fever, syncope, abdominal pain, nausea and vomiting, myalgia, pharyngitis, and a desquamating rash eight days after a diagnostic peritoneal lavage. The diagnostic peritoneal lavage wound was erythematous and tender. Incision of the site yielded 10 mL of exudate that cultured Staphylococcus aureus.