Embedding a culture of research in Canadian community hospitals: a qualitative study.

Background: In Canada, academic hospitals are the principal drivers of research and medical education, while community hospitals provide patient care to a majority of the population. Benefits of increasing community hospital research include improved patient outcomes and access to research, enhanced staff satisfaction and retention and increased research efficiency and generalizability. While the resources required to build Canadian community hospital research capacity have been identified, strategies for strengthening organizational research culture in these settings are not well defined.

Factors influencing community intensive care unit research participation: a qualitative descriptive study.

Purpose: Community hospitals account for 90% of hospitals in Canada, but clinical research is mainly conducted in academic hospitals. Increasing community hospital research participation can improve generalizability of study results, while also accelerating study recruitment and increasing staff engagement. We aimed to identify and describe the factors that influence community intensive care unit (ICU) research participation and the development, implementation, and sustainability of a community ICU research program.

"I don't feel fully prepared": a qualitative study of recently graduated students' mental health experiences of the transition out of university.

Objective: This study aimed to better understand the mental health experiences of students as they prepared to transition out of university.

Participants: Participants included 18 recently graduated students from a Canadian university.

Methods: Virtual one-on-one semi-structured qualitative interviews were conducted and analyzed following the protocol for content analysis and using QSR NVivo.

Reducing Unnecessary Transfusions of RBCs in Inpatients Admitted Across Niagara Health Community Hospitals.

Background And Objectives: Blood products are scarce resources. Audits on the use of red blood cells (RBCs) in tertiary centers have repeatedly highlighted inappropriate use. Earlier retrospective audit at our local community hospitals has demonstrated that only 85% and 54% of all requests met Choosing Wisely Canada guidelines for pre-transfusion hemoglobin (Hb) of 80 g/L or less and single unit, respectively.

Examining perceptions of a telemedicine network for pediatric emergency medicine: a mixed-methods pilot study.

Background: Use of telemedicine for healthcare delivery in the emergency department can increase access to specialized care for pediatric patients without direct access to a children's hospital. Currently, telemedicine is underused in this setting.

Objectives: This pilot research project aimed to evaluate the perceived effectiveness of a telemedicine program in delivering care to critically ill pediatric patients in the emergency department by exploring the experiences of parents/caregivers and physicians.

What Factors Increase Odds of Long-Stay Delayed Discharge in Alternate Level of Care Patients?

Objective: The objective of this study was to determine the factors that increase the odds of long-stay delayed discharge in alternate level of care (ALC) patients using data collected from the Ontario Wait Time Information System (WTIS) database.

Design: Retrospective cohort study utilizing data from Niagara Health's WTIS database. WTIS includes individuals admitted to any of the Niagara Health sites that have been designated as ALC.

Shaping the future design of paramedicine: A knowledge to action framework to support paramedic system modernization.

Background: Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance.

Public health emergency preparedness for infectious disease emergencies: a scoping review of recent evidence.

Background: The COVID-19 pandemic continues to demonstrate the risks and profound health impacts that result from infectious disease emergencies. Emergency preparedness has been defined as the knowledge, capacity and organizational systems that governments, response and recovery organizations, communities and individuals develop to anticipate, respond to, or recover from emergencies. This scoping review explored recent literature on priority areas and indicators for public health emergency preparedness (PHEP) with a focus on infectious disease emergencies.

The impact of the Caremongering social media movement: A convergent parallel mixed-methods study.

Public health responses to the COVID-19 pandemic, such as business restrictions, social distancing and lockdowns, had social and economic impacts on individuals and communities. Caremongering Facebook groups spread across Canada to support vulnerable individuals by providing a forum for sharing information and offering assistance. We sought to understand the specific impacts of Caremongering groups on individuals 1 year after the pandemic began.

Rising through the pandemic: a scoping review of quality improvement in public health during the COVID-19 pandemic.

Background: The COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) is a key framework and philosophy to guide organizational emergency response efforts; however, the nature and extent to which it has been used in public health settings during the COVID-19 pandemic remains unclear.

Methods: We conducted a scoping review of literature published January 2020 - February 2021 and focused on the topic of QI at public health agencies during the COVID-19 pandemic.

Impact of a multifaceted and multidisciplinary intervention on pain, agitation and delirium management in an intensive care unit: an experience of a Canadian community hospital in conducting a quality improvement project.

Background: Clinical guidelines suggest that routine assessment, treatment, and prevention of pain, agitation, and delirium (PAD) is essential to improving patient outcomes as delirium is associated with increased mortality and morbidity. Despite the well-established improvements on patient outcomes, adherence to PAD guidelines is poor in community intensive care units (ICU). This quality improvement (QI) project aims to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community ICU and to describe the experience of a Canadian community hospital in conducting a QI project.

Using the QI Maturity Tool - Modified Ontario Version to assess the state of QI maturity in Ontario's public health units.

Background: Implementation of quality improvement (QI) practices varies considerably among public health units (PHUs) in Ontario. With the emphasis on continuous quality improvement (CQI) in the revised Ontario Public Health Standards (OPHS), there is a need to understand the level of QI maturity in Ontario's PHUs. The objective of this research was to establish a baseline understanding of QI maturity in Ontario's PHUs.

The Use of a Palliative Care Screening Tool to Improve Referrals to Palliative Care Services in Community-Based Hospitals: A Quality Improvement Initiative.

Despite efforts to improve access to palliative care services, a significant number of patients still have unmet needs throughout their continuum of care. As such, this project was conducted to increase recognition of patients who could benefit from palliative care, increase referrals, and connect regional sites. This study utilized Plan-Do-Study-Act cycles through a quality improvement approach to develop and test the Palliative Care Screening Tool and aimed to screen 100% of patients within 24 hours who were admitted to selected units by February 2017.

Assessing the Impact of ED Triage Directives on Febrile Oncology Patient Wait Times.

Introduction: Fever during chemotherapy is a common and potentially severe complication being increasingly evaluated in emergency departments to minimize morbidity and mortality. Streamlining triage of these patients may improve health outcomes and wait times in the health care system.

Methods: A retrospective chart review of febrile patients undergoing chemotherapy was conducted at a local emergency department to assess the impact of nurse-initiated protocols on wait times.

Assessing Appropriateness of CT and MRI Referrals for Headache and Lumbar: A Canadian Perspective on Patient-Centered Referrals.

Background: Inappropriate diagnostic imaging is a burgeoning problem within the Canadian healthcare system and imposes considerable burdens to efficiency and timeliness of care. Low back pain and headaches affect an immense portion of the general population and have become exceedingly common complaints from patients seeking diagnostic imaging from primary care physicians.

Methods: A total of 399 magnetic resonance imaging (MRI) and computed tomography (CT) requisitions for lumbar and head scans were reviewed and assessed for appropriateness in concordance with published Choosing Wisely guidelines for head and lumbar diagnostic imaging.

Impact of a nurse engagement intervention on pain, agitation and delirium assessment in a community intensive care unit.

Background: In 2013, the Society of Critical Care Medicine published a revised version of the ICU Pain, Agitation, and Delirium (PAD) guidelines. Immobility and sleep were subsequently added in 2018. Despite the well-established advantages of implementing these guidelines, adoption and adherence remain suboptimal.

Impact of a multifaceted and multidisciplinary intervention on pain, agitation and delirium management in a Canadian community intensive care unit: a quality improvement study protocol.

Background: Pain and agitation are closely linked to the development of delirium, which affects 60%-87% of critically ill patients. Delirium is associated with increased mortality and morbidity. Clinical guidelines that suggest routine assessment, treatment and prevention of pain, agitation and delirium (PAD) is crucial to improving patient outcomes.

Qualitative descriptive study to explore nurses' perceptions and experience on pain, agitation and delirium management in a community intensive care unit.

Objectives: The purpose of this study was to explore the experiences, beliefs and perceptions of intensive care unit (ICU) nurses on the management of pain, agitation and delirium (PAD) in critically ill patients.

Design: A qualitative descriptive study.

Setting: This study took place in a community hospital ICU located in a medium size Canadian city.

Attend: A Two-Pronged Trial to Eliminate No Shows in Diagnostic Imaging at a Community-Based Hospital.

Purpose: Diagnostic imaging (DI) at Niagara Health, like other hospitals, experiences challenges with patients who do not attend their scheduled appointments, resulting in a "no show." Reducing no show percentages presents an opportunity to improve upon wait lists within specific modalities such as magnetic resonance imaging (MRI) and to reduce the loss of productivity for this high-demand resource.

Aim: To reduce the MRI no-show percent in DI at two community hospitals from 6.

Pain, agitation and delirium assessment and management in a community medical-surgical ICU: results from a prospective observational study and nurse survey.

Background: Delirium is a common manifestation in the intensive care unit (ICU) that is associated with increased mortality and morbidity. Guidelines suggested appropriate management of pain, agitation and delirium (PAD) is crucial in improving patient outcomes. However, the practice of PAD assessment and management in community hospitals is unclear and the mechanisms contributing to the potential care gap are unknown.

Paramedics' Perspectives on Factors Impacting On-Scene Times for Trauma Calls.

Unlabelled: IntroductionAccording to Ontario, Canada's Basic Life Support Patient Care Standards, Emergency Medical Services (EMS) on-scene time (OST) for trauma calls should not exceed 10 minutes, unless there are extenuating circumstances. The time to definitive care can have a significant impact on the morbidity and mortality of trauma patients. This is the first Canadian study to investigate why this is the case by giving a voice to those most involved in prehospital care: the paramedics themselves.

Engaging Nurses in Optimizing Antimicrobial Use in ICUs: A Qualitative Study.

Antimicrobial stewardship programs (ASPs) have predominately involved infectious diseases physicians and pharmacists with little attention to the nurses. To achieve optimal success of ASPs, engagement of nurses to actively participate in initiatives, strategies, and solutions to combat antibiotic resistance across the health care spectrum is required. In this context, the experiences of local ASP teams engaging nurses in appropriate antimicrobial use were explored to inform future strategies to enhance their involvement in ASPs.

Exploring Healthcare Experiences of Transgender Individuals.

It has been widely noted that existing healthcare systems do not always function effectively for the transgender population. Despite existing healthcare barriers, however, transgender individuals have been shown to have positive healthcare experiences. This study explored a cohort of transgender individuals who had positive healthcare experiences, and those who were involved in creating a positive healthcare experience for transgender individuals.

The role of caregivers in interfacility care transitions: a qualitative study.

A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9), and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audio-taped, and transcribed.