Exploring Stroke Outcomes Following a Door-to-Needle Quality Improvement Project.

Background: Although stroke rates in Canada are expected to increase dramatically over the next decade, time-driven hyperacute stroke care with thrombolysis increases the likelihood of a good clinical outcome. Following a period of suboptimal performance results for stroke care, our tertiary care center undertook a door-to-needle (DTN) quality improvement initiative. The purpose of our study was to determine if the resulting improved median DTN times and greater proportion of patients treated within 60 minutes of arrival at our emergency department were associated with improved clinical outcomes.

Patterns of emergency department utilization by patients on chronic dialysis: A population-based study.

Importance: Patients on dialysis are often elderly and frail, with multiple comorbid conditions, and are heavy users of Emergency Department (ED) services. However, objective data on the frequency and pattern of ED utilization by dialysis patients are sparse. Such data could identify periods of highest risk for ED visits and inform health systems interventions to mitigate these risks and improve outcomes.

Predictors of Emergency Department Use by Persons with Inflammatory Bowel Diseases: A Population-based Study.

Background: To describe the patterns and predictors of emergency department (ED) attendance and post-ED hospitalization by persons with inflammatory bowel disease (IBD).

Methods: We linked the University of Manitoba IBD Epidemiology Database with the Emergency Department Information System of the Winnipeg Regional Health Authority to determine the rates of presentation to the ED by persons with IBD from January 01, 2009 to March 31, 2012. Incident cases were diagnosed during the study period and all others were considered prevalent cases.

Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services.

Objectives: Triage is fundamental to emergency patient assessment. Effective triage systems accurately prioritize patients and help predict resource utilization. CTAS is a validated five-level triage score utilized in Emergency Departments (EDs) across Canada and internationally.

Development of an Emergency Department Violence Intervention Program for Youth: An Integrated Knowledge Translation Approach.

Background: Violent interpersonal injury is a common presentation to emergency departments (EDs) and is increasingly being treated as a preventable condition. Given the complexity of the issue, it is key to ensure interventions are feasible and acceptable within the communities that are affected by violence. Our team consists of ED staff, community members who work with youth affected by violence, people who were affected by violence in their youth, and researchers.

Wraparound care for youth injured by violence: study protocol for a pilot randomised control trial.

Introduction: Injury by violence is the fourth cause of death and the leading reason for a youth to visit an emergency department (ED) in Canada. In Winnipeg, 20% of youth who visit an ED with an injury due to violence have a second visit for a subsequent violent injury within 1 year. Youth injured by violence are in a reflective and receptive state of mind, rendering the ED setting appropriate for intervention.

Frequent users of an inner-city emergency department.

Background: Within the emergency department (ED) patient population there is a subset of patients who make frequent visits. This chart review sought to characterize this population and identify strategies to reduce frequent ED visits.

Methods: Frequent use at an urban tertiary care centre was defined as 15 or more visits over 1 year.

Application of Lean principles to improve early cardiac care in the emergency department.

Objective: To achieve our goal of excellent emergency cardiac care, our institution embarked on a Lean process improvement initiative. We sought to examine and quantify the outcome of this project on the care of suspected acute coronary syndrome (ACS) patients in our emergency department (ED).

Methods: Front-line ED staff participated in several rapid improvement events, using Lean principles and techniques such as waste elimination, supply chain streamlining, and standard work to increase the value of the early care provided to patients with suspected ACS.

"Google flu trends" and emergency department triage data predicted the 2009 pandemic H1N1 waves in Manitoba.

Objectives: We assessed the performance of syndromic indicators based on Google Flu Trends (GFT) and emergency department (ED) data for the early detection and monitoring of the 2009 H1N1 pandemic waves in Manitoba.

Methods: Time-series curves for the weekly counts of laboratory-confirmed H1N1 cases in Manitoba during the 2009 pandemic were plotted against the three syndromic indicators: 1) GFT data, based on flu-related Internet search queries, 2) weekly count of all ED visits triaged as influenza-like illness (ED ILI volume), and 3) percentage of all ED visits that were triaged as an ILI (ED ILI percent). A linear regression model was fitted separately for each indicator and correlations with weekly virologic data were calculated for different lag periods for each pandemic wave.

Load Balancing at Emergency Departments using 'Crowdinforming'.

Background: Emergency Department (ED) overcrowding is an important healthcare issue facing increasing public and regulatory scrutiny in Canada and around the world. Many approaches to alleviate excessive waiting times and lengths of stay have been studied. In theory, optimal ED patient flow may be assisted via balancing patient loads between EDs (in essence spreading patients more evenly throughout this system).

Patients presenting to the emergency department: the use of other health care services and reasons for presentation.

Objective: Some low-acuity emergency department (ED) presentations are considered convenience visits and potentially avoidable with improved access to primary care services. This study assessed the frequency and determinants of patients' efforts to access alternative care before ED presentation.

Methods: Patients aged 17 years and older were randomly selected from 2 urban ED sites in Edmonton.

Reviewer agreement trends from four years of electronic submissions of conference abstract.

Background: The purpose of this study was to determine the inter-rater agreement between reviewers on the quality of abstract submissions to an annual national scientific meeting (Canadian Association of Emergency Physicians; CAEP) to identify factors associated with low agreement.

Methods: All abstracts were submitted using an on-line system and assessed by three volunteer CAEP reviewers blinded to the abstracts' source. Reviewers used an on-line form specific for each type of study design to score abstracts based on nine criteria, each contributing from two to six points toward the total (maximum 24).