Emergency Physician Use of the Alberta Netcare Portal, a Province-Wide Interoperable Electronic Health Record: Multi-Method Observational Study.

Background: The adoption and use of an electronic health record (EHR) can facilitate real-time access to key health information and support improved outcomes. Many Canadian provinces use interoperable EHRs (iEHRs) to facilitate health information exchange, but the clinical use and utility of iEHRs has not been well described.

Objective: The aim of this study was to describe the use of a provincial iEHR known as the Alberta Netcare Portal (ANP) in 4 urban Alberta emergency departments.

Nursing duties and accreditation standards and their impacts: The nursing perspective.

Background: Medical advances and increasingly complex patients presenting to the Emergency Department (ED) make nursing challenging. Gaining new knowledge and skills is a perpetual requirement. New quality initiatives to improve patient safety and care are being constantly introduced and create significant work and time pressures for healthcare providers involved.

Factors influencing time to computed tomography in emergency department patients with suspected subarachnoid haemorrhage.

Background: CT has excellent sensitivity for subarachnoid haemorrhage (SAH) when performed within 6 hours of headache onset, but it is unknown to what extent patients with more severe disease are likely to undergo earlier CT, potentially inflating estimates of sensitivity. Our objective was to evaluate which patient and hospital factors were associated with earlier neuroimaging in alert, neurologically intact ED patients with suspected SAH.

Methods: We analysed data from two large sequential prospective cohorts of ED patients with acute headache undergoing CT for suspected SAH.

Differentiation between traumatic tap and aneurysmal subarachnoid hemorrhage: prospective cohort study.

Objectives: To describe the findings in cerebrospinal fluid from patients with acute headache that could distinguish subarachnoid hemorrhage from the effects of a traumatic lumbar puncture.

Design: A substudy of a prospective multicenter cohort study.

Setting: 12 Canadian academic emergency departments, from November 2000 to December 2009.

Clinical decision rules to rule out subarachnoid hemorrhage for acute headache.

Importance: Three clinical decision rules were previously derived to identify patients with headache requiring investigations to rule out subarachnoid hemorrhage.

Objective: To assess the accuracy, reliability, acceptability, and potential refinement (ie, to improve sensitivity or specificity) of these rules in a new cohort of patients with headache.

Design, Setting, And Patients: Multicenter cohort study conducted at 10 university-affiliated Canadian tertiary care emergency departments from April 2006 to July 2010.

Pilot study comparing sepsis management with and without electronic clinical practice guidelines in an academic emergency department.

Background: Sepsis is a potentially life-threatening condition that requires urgent management in an Emergency Department (ED). Evidence-based guidelines for managing sepsis have been developed; however, their integration into routine practice is often incomplete. Care maps may help clinicians meet guideline targets more often.

Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study.

Objective: To measure the sensitivity of modern third generation computed tomography in emergency patients being evaluated for possible subarachnoid haemorrhage, especially when carried out within six hours of headache onset.

Design: Prospective cohort study.

Setting: 11 tertiary care emergency departments across Canada, 2000-9.

The role of triage nurse ordering on mitigating overcrowding in emergency departments: a systematic review.

Objectives: The objective was to examine the effectiveness of triage nurse ordering (TNO) on mitigating the effect of emergency department (ED) overcrowding.

Methods: Electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, HealthSTAR, Dissertation Abstracts, ABI/INFORM Global), controlled trial registry websites, conference proceedings, study references, experts in the field, and correspondence with authors were used to identify potentially relevant studies. Interventional studies in which TNO was used to influence ED overcrowding metrics (length of stay [LOS] and physician initial assessment [PIA]) were included in the review.

The role of a rapid assessment zone/pod on reducing overcrowding in emergency departments: a systematic review.

Objective: To evaluate the effectiveness of a rapid assessment zone (RAZ) to mitigate emergency department (ED) overcrowding.

Methods: Electronic databases, controlled trial registries, conference proceedings, study references, experts in the field and correspondence with authors were used to identify potentially relevant studies. Intervention studies, in which a RAZ was used to influence length of stay, physician initial assessment and patients left without being seen, were included.

The role of full capacity protocols on mitigating overcrowding in EDs.

Objective: Overcrowding is an important issue facing many emergency departments (EDs). Access block (admitted patients occupying ED stretchers) is a leading contributor, and expeditious placement of admitted patients is an area of research interest. This review examined the effectiveness of full capacity protocols (FCPs) on mitigating ED overcrowding.

Comparison between Canadian Triage and Acuity Scale and Taiwan Triage System in emergency departments.

Background/purpose: Since the implementation of National Health Insurance in Taiwan, Emergency Department (ED) volume has progressively increased, and the current triage system is insufficient and needs modification. This study compared the prioritization and resource utilization differences between the four-level Taiwan Triage System (TTS) and the standardized five-level Canadian Triage and Acuity Scale (CTAS) among ED patients.

Methods: This was a prospective observational study.

High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study.

Objective: To identify high risk clinical characteristics for subarachnoid haemorrhage in neurologically intact patients with headache.

Design: Multicentre prospective cohort study over five years.

Setting: Six university affiliated tertiary care teaching hospitals in Canada.

Febrile neutropenia in EDs: the role of an electronic clinical practice guideline.

Purpose: Evidence-based clinical practice guidelines (CPGs) for managing febrile neutropenia (FN) are widely available; however, the integration of guidelines into routine practice is often incomplete. This study evaluated the uptake and clinical impact of implementing an electronic CPG on the management and outcomes of patients presenting with FN at 4 urban emergency departments (ED).

Methods: A retrospective chart review over a 3-year period at 4 hospitals in Edmonton, Alberta, was performed.

Delphi consensus on the feasibility of translating the ACEP clinical policies into computerized clinical decision support.

Clinical practice guidelines are developed to reduce variations in clinical practice, with the goal of improving health care quality and cost. However, evidence-based practice guidelines face barriers to dissemination, implementation, usability, integration into practice, and use. The American College of Emergency Physicians (ACEP) clinical policies have been shown to be safe and effective and are even cited by other specialties.

Tracking emergency department overcrowding in a tertiary care academic institution.

Despite the release of a national report describing key markers of emergency department (ED) overcrowding, limited linear data using these markers have been published. We sought to report the degree and trends of ED overcrowding in a typical academic hospital and to highlight some of the key markers of ED patient flow and care. We conducted a prospective study in a large Canadian urban tertiary care teaching hospital that receives approximately 55,000 annual adult ED visits.

Development of a flexible healthcare form builder using Ruby on Rails.

A collaboratively maintained, centralized web-based clinical decision support system (CDSS) repository could lead to improved quality and standardization of care and decrease duplication of resources. Ruby on Rails (RoR) is an open source web application framework that enables rapid iterative development of database backed applications. We have created a prototype form building application in RoR that has the potential to create and maintain such a CDSS repository.

How usability of a web-based clinical decision support system has the potential to contribute to adverse medical events.

Introduction: Clinical decision support systems (CDSS) have the potential to reduce adverse medical events, but improper design can introduce new forms of error. CDSS pertaining to community acquired pneumonia and neutropenic fever were studied to determine whether usability of the graphical user interface might contribute to potential adverse medical events.

Methods: Automated screen capture of 4 CDSS being used by volunteer emergency physicians was analyzed using structured methods.

Assessing the sensibility of two clinical decision support systems.

Clinicians in Emergency Medicine (EM) are increasingly exposed to guidelines and treatment recommendations. To help access and recall these recommendations, electronic Clinical Decision Support Systems (CDSS) have been developed. This study examined the use and sensibility of two CDSS designed for emergency physicians.

Consultation outcomes in the emergency department: exploring rates and complexity.

Objective: Consultation is a common and important aspect of emergency department (ED) care. We prospectively examined the consultation rates, the admission rates of consulted patients, the emergency physician (EP) disposition prediction of consulted patients and the difficult consultations rates in 2 tertiary care hospitals.

Methods: Attending EPs recorded consultations during 5 randomly selected shifts over an 8-week period using standardized forms.