An interdisciplinary program for familiar faces with chronic pain visiting the emergency department-randomized controlled trial.

Objectives: To evaluate the effect of a collaborative interdisciplinary pain assessment program on pain and health-related quality of life among individuals with chronic pain who frequently visit the emergency department (ED).

Methods: Individuals with chronic pain who frequented the ED (ie, ≥8 visits within the previous 12 months) were randomly assigned to a collaborative chronic pain management program or treatment as usual. Primary outcomes were change in physical function and visits to the ED from baseline to 12 months using validated measures.

Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department.

Introduction: Acute heart failure patients often have an uncertain or delayed follow-up after discharge from the ED. Our goal was to introduce rapid-access specialty clinics to ensure acute heart failure patients were seen within 7 days, in an effort to reduce admissions and improve follow-up care.

Methods: This prospective cohort study was conducted at two campuses of a large tertiary care hospital.

Characteristics of frequent users of the emergency department with chronic pain.

Objectives: To identify the proportion of high-frequency users of the emergency department (ED) who have chronic pain.

Methods: We reviewed medical records of adult patients with ≥ 12 visits to a tertiary-care, academic hospital ED in Canada in 2012-2013. We collected the following demographics: 1) patient age and sex; 2) visit details - number of ED visits, inpatient admissions, length of inpatient admissions, diagnosis, and primary location of pain; 3) current and past substance abuse, mental health and medical conditions.

Use of conventional cardiac troponin assay for diagnosis of non-ST-elevation myocardial infarction: 'The Ottawa Troponin Pathway'.

Background: Serial conventional cardiac troponin (cTn) measurements 6-9 hours apart are recommended for non-ST-elevation MI (NSTEMI) diagnosis. We sought to develop a pathway with 3-hour changes for major adverse cardiac event (MACE) identification and assess the added value of the HEART [History, Electrocardiogram (ECG), Age, Risk factors, Troponin] score to the pathway.

Methods: We prospectively enrolled adults with NSTEMI symptoms at two-large emergency departments (EDs) over 32-months.

Alcohol Medical Intervention Clinic: A Rapid Access Addiction Medicine Model Reduces Emergency Department Visits.

Objectives: Problematic alcohol use accounts for a large proportion of Emergency Department (ED) visits and revisits. We developed the Alcohol Medical Intervention Clinic (AMIC), a Rapid Access Addiction Medicine (RAAM) service, to reduce alcohol-related ED re-utilization and improve care for individuals with alcohol problems. This article describes the AMIC model and reports on an evaluation of its impact on patients and the ED system.

Using structured incentives to increase value for money in an academic health sciences centre.

As healthcare continues to consume more and more of provincial government spending, there is a continuing pressure to improve efficiency and cut overall costs. In this increasingly constrained healthcare system, value for money is a growing focus of discussions around accountability and system sustainability; healthcare leaders are required to find ways of measuring, enforcing, and reporting on that value. In 2014, our organization began implementing an innovative system of structured incentives, linking distribution of Ministry of Health and Long-Term Care academic physician funding to quality and performance goals.

Impact of an in-house emergency radiologist on report turnaround time.

Background: One of the many challenges facing emergency departments (EDs) across North America is timely access to emergency radiology services. Academic institutions, which are typically also regional referral centres, frequently require cross-sectional studies to be performed 24 hours a day with expedited final reports to accelerate patient care and ED flow.

Objective: The purpose of this study was to determine if the presence of an in-house radiologist, in addition to a radiology resident dedicated to the ED, had a significant impact on report turnaround time.

Pooling procurement in the Belgian hospital sector.

The Belgian hospital sector is following the example of a number of other European countries and for more than ten years now, has been striving to pool its medical supplies and equipment purchases in a bid to reduce costs. The various experiments of which we are aware come under both opportunist purchases and initiatives which are designed to encourage local-regional contracts. These attempts have now all come to nothing or are struggling in the absence of a structured and professional approach.

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.

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.