Do Financial Incentives Change Length-of-stay Performance in Emergency Departments? A Retrospective Study of the Pay-for-performance Program in Metro Vancouver.

Background: Pay-for-performance (P4P) programs have been implemented in various forms to reduce emergency department (ED) patient length of stay (LOS). This retrospective study investigated to what extent the timing of patient disposition in Metro Vancouver EDs was influenced by a LOS-based P4P program.

Methods: We analyzed ED visit records of four major hospitals in Metro Vancouver, Canada.

Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone.

Objective: Take-home naloxone (THN) reduces deaths from opioid overdose. To increase THN distribution to at-risk emergency department (ED) patients, we explored reasons for patients' refusing or accepting THN.

Methods: In an urban teaching hospital ED, we identified high opioid overdose risk patients according to pre-specified criteria.

Bicycling crash circumstances vary by route type: a cross-sectional analysis.

Background: Widely varying crash circumstances have been reported for bicycling injuries, likely because of differing bicycling populations and environments. We used data from the Bicyclists' Injuries and the Cycling Environment Study in Vancouver and Toronto, Canada, to describe the crash circumstances of people injured while cycling for utilitarian and leisure purposes. We examined the association of crash circumstances with route type.

Public bicycle share programs and head injuries.

Objectives: We evaluated the effect of North American public bicycle share programs (PBSPs), which typically do not offer helmets with rentals, on the occurrence of bicycle-related head injuries.

Methods: We analyzed trauma center data for bicycle-related injuries from 5 cities with PBSPs and 5 comparison cities. We used logistic regression models to compare the odds that admission for a bicycle-related injury would involve a head injury 24 months before PBSP implementation and 12 months afterward.

Engaging pediatric intensive care unit (PICU) clinical staff to lead practice improvement: the PICU participatory action research project (PICU-PAR).

Background: Despite considerable efforts, engaging staff to lead quality improvement activities in practice settings is a persistent challenge. At British Columbia Children's Hospital (BCCH), the pediatric intensive care unit (PICU) undertook a new phase of quality improvement actions based on the Community of Practice (CoP) model with Participatory Action Research (PAR). This approach aims to mobilize the PICU 'community' as a whole with a focus on practice; namely, to create a 'community of practice' to support reflection, learning, and innovation in everyday work.

Comparing the effects of infrastructure on bicycling injury at intersections and non-intersections using a case-crossover design.

Background: This study examined the impact of transportation infrastructure at intersection and non-intersection locations on bicycling injury risk.

Methods: In Vancouver and Toronto, we studied adult cyclists who were injured and treated at a hospital emergency department. A case-crossover design compared the infrastructure of injury and control sites within each injured bicyclist's route.

Route infrastructure and the risk of injuries to bicyclists: a case-crossover study.

Objectives: We compared cycling injury risks of 14 route types and other route infrastructure features.

Methods: We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip.

Personal and trip characteristics associated with safety equipment use by injured adult bicyclists: a cross-sectional study.

Background: The aim of this study was to estimate use of helmets, lights, and visible clothing among cyclists and to examine trip and personal characteristics associated with their use.

Methods: Using data from a study of transportation infrastructure and injuries to 690 adult cyclists in Toronto and Vancouver, Canada, we examined the proportion who used bike lights, conspicuous clothing on the torso, and helmets on their injury trip. Multiple logistic regression was used to examine associations between personal and trip characteristics and each type of safety equipment.

Clinical decision rules to improve the detection of adverse drug events in emergency department patients.

Objectives: Adverse drug events (ADEs) are unintended and harmful consequences of medication use. They are associated with high health resource use and cost. Yet, high levels of inaccuracy exist in their identification in clinical practice, with over one-third remaining unidentified in the emergency department (ED).

Safe cycling: how do risk perceptions compare with observed risk?

Objective: Safety concerns deter cycling. The Bicyclists' Injuries and the Cycling Environment (BICE) study quantified the injury risk associated with 14 route types, from off-road paths to major streets. However, when it comes to injury risk, there may be discordance between empirical evidence and perceptions.

Barriers to and incentives for safety event reporting in emergency departments.

Patient safety events (PSEs) are common in healthcare and may be particularly prevalent in complex care settings such as emergency departments (EDs). Systems for reporting, analyzing, learning from and responding to incidents are promoted as a means to reduce adverse events by facilitating feedback, learning and system change. However, only 4-50% of PSEs are reported.

Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department.

Objective: We sought to estimate the period prevalence of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) and evaluate risk factors for MRSA SSTI in an emergency department (ED) population.

Methods: We carried out a cohort study with a nested case-control design. Patients presenting to our ED with a wound culture and a discharge diagnosis of SSTI between January 2003 and September 2004 were dichotomized as MRSA positive or negative.

Unintended medication discrepancies associated with reliance on prescription databases for medication reconciliation on admission to a general medical ward.

Background: In a recent study, 50% of the patients who were admitted to a hospital's general medicine ward had at least one error in medication orders at the time of admission related to inaccuracies in the medication history. The use of computerized prescription databases has been suggested as a way to improve medication reconciliation at the time of admission.

Objective: To quantify and describe unintended discrepancies between a best possible medication history and medications ordered on admission to the general medicine ward in a hospital with routine access to a provincial outpatient prescription database (British Columbia's PharmaNet).

Controversies in the medical clearance of recreational scuba divers: updates on asthma, diabetes mellitus, coronary artery disease, and patent foramen ovale.

Primary care and sports medicine physicians are frequently consulted on medical clearance for prospective recreational divers. We discuss four common and controversial medical conditions--asthma, diabetes mellitus, coronary artery disease, and patent foramen ovale--as they relate to fitness to dive. For each condition we review the relevant anatomy and physiology, current recommendations, and the pertinent medical literature.

Topical glyceryl trinitrate for chronic Achilles tendinopathy.

Objective: To determine whether continuous application of topical glyceryl trinitrate decreases pain and symptoms in chronic noninsertional Achilles tendinopathy.

Design: Randomized double-blind placebo-controlled study of 6-months' duration.

Setting: Community and referral study at an Australian University Hospital.

Acute hypervolaemia improves arterial oxygen pressure in athletes with exercise-induced hypoxaemia.

The aim of this study was to determine the effect of acute plasma volume expansion on arterial blood-gas status during 6.5 min strenuous cycling exercise comparing six athletes with and six athletes without exercise-induced arterial hypoxaemia (EIAH). We hypothesized that plasma volume expansion could improve arterial oxygen pressure in a homogeneous sample of athletes - those with EIAH.