Improving care for residents in long term care facilities experiencing an acute change in health status.

Background: Long term care (LTC) facilities provide health services and assist residents with daily care. At times residents may require transfer to emergency departments (ED), depending on the severity of their change in health status, their goals of care, and the ability of the facility to care for medically unstable residents. However, many transfers from LTC to ED are unnecessary, and expose residents to discontinuity in care and iatrogenic harms.

Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study.

Background: This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada.

Methods: Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011-2016. Random samples of patients not in the HSU groups were selected as controls.

Updated framework on quality and safety in emergency medicine.

Objectives: Quality and safety of emergency care is critical. Patients rely on emergency medicine (EM) for accessible, timely and high-quality care in addition to providing a 'safety-net' function. Demand is increasing, creating resource challenges in all settings.

Patient race, ethnicity, and care in the emergency department: A scoping review.

Objectives: Health disparities between racial and ethnic groups have been documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there are no comprehensive literature reviews in this area. The objective of this review is to provide an overview of the literature on the impact of patient ethnicity and race on the processes of ED care.

A Patient-focused Information Design Intervention to Support the Minor Traumatic Brain Injuries (mTBI) Choosing Wisely Canada Recommendation.

Introduction The first Choosing Wisely Canada (CWC) recommendation for Emergency Medicine states: "Don't order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule)". In order to provide patients with information on the risks and benefits of computed tomography (CT) scans in minor traumatic brain injuries (mTBI) and to encourage discussions between patients and their doctor, we designed a patient-focused mTBI infographic for the emergency department (ED). Methods Stakeholders worked with content experts to co-design the infographic, which was posted in two emergency department (ED) waiting rooms.

Template for uniform reporting of emergency department measures, consensus according to the Utstein method.

Objective: To develop a template for uniform reporting of standardized measuring and describing of care provided in the emergency department (ED).

Methods: An international group of experts in emergency medicine, with broad experience from different clinical settings, met in Utstein, Norway. Through a consensus process, a limited number of measures that would accurately describe an ED were chosen and a template was developed.

Frequent emergency department use and mortality in patients with substance and opioid use in Alberta: A population-based retrospective cohort study.

Objectives: In the current opioid epidemic, identifying high-risk patients among those with substance and opioid use may prevent deaths. The objective of this study was to determine whether frequent emergency department (ED) use and degree of frequent use are associated with mortality among ED patients with substance and opioid use.

Methods: This cohort study used linked population-based ED (National Ambulatory Care Reporting System) and mortality data from Alberta.

Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department.

Introduction: The 72-hour unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in emergency medicine. We sought to determine if URVs with admission to hospital (URVA) represent a distinct subgroup compared to unscheduled return visits with no admission (URVNA).

Methods: We performed a retrospective cohort study of all 72-hour URVs in adults across 10 EDs in the Edmonton Zone (EZ) over a one-year period (January 1, 2015 - December 31, 2015) using ED information-system data.

Learning to lead: a review and synthesis of literature examining health care managers' use of knowledge.

Background: Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice.

Methods: We carried out a systematic review and focus groups to validate the review findings.

Descriptive analysis of cochrane child-relevant systematic reviews: an update and comparison between 2009 and 2013.

Background: Systematic reviews support health systems and clinical decision-making by identifying and summarizing all existing studies on a particular topic. In 2009, a comprehensive description of child-relevant systematic reviews published in the Cochrane Database of Systematic Reviews was compiled. This study aims to provide an update, and to describe these systematic reviews according to their content and methodological approaches.

Presentations for hypoglycemia associated with diabetes mellitus to emergency departments in a Canadian province: A database and epidemiological analysis.

Aims: The prevalence of diabetes mellitus was reportedly 9% in 2014, making it one of the most common global chronic conditions. Hypoglycemia is an important complication of diabetes treatment. The objective of this study was to quantify and characterize hypoglycemia presentations associated with type 1 or 2 diabetes made to emergency departments (EDs) by adults in a Canadian province.

Limitations of pulmonary embolism ICD-10 codes in emergency department administrative data: let the buyer beware.

Background: Administrative data is a useful tool for research and quality improvement; however, validity of research findings based on these data depends on their reliability. Diagnoses assigned by physicians are subsequently converted by nosologists to ICD-10 codes (International Statistical Classification of Diseases and Related Health Problems, 10th Revision). Several groups have reported ICD-9 coding errors in inpatient data that have implications for research, quality improvement, and policymaking, but few have assessed ICD-10 code validity in ambulatory care databases.

Weight bias reduction in health professionals: a systematic review.

Innovative and coordinated strategies to address weight bias among health professionals are urgently needed. We conducted a systematic literature review of empirical peer-reviewed published studies to assess the impact of interventions designed to reduce weight bias in students or professionals in a health-related field. Combination sets of keywords based on three themes (1: weight bias/stigma; 2: obesity/overweight; 3: health professional) were searched within nine databases.

Does Reducing Inpatient Length of Stay Have Upstream Effects on the Emergency Room: Exploring the Impact of the General Internal Medicine Care Transformation Initiative.

Objective: The General Internal Medicine (GIM) Care Transformation Initiative implemented at one of four teaching hospitals in the same city resulted in improved efficiency of in-hospital care. Whether it had beneficial effects upstream in the emergency department (ED) is unclear.

Methods: Controlled before-after study of ED length of stay (LOS) and crowding metrics for the intervention site (n = 108,951 visits) compared to the three other teaching hospitals (controls, n = 300,930 visits).

Pre-hospital management of anaphylaxis in one Canadian Urban Centre.

Study Aim: Anaphylaxis requires prompt recognition and management to improve patient outcomes. This study examined the diagnosis and treatment of anaphylactic reactions by the Emergency Medical Services (EMS) in a Canadian urban centre.

Methods: Electronic patient care records (ePCRs), identifying allergy-related calls in the Edmonton-Zone for the year 2011, were retrospectively reviewed to confirm anaphylaxis diagnosis and record treatments.

An environmental scan of medical assessment units in Canada.

Many initiatives have been proposed to improve emergency department (ED) overcrowding. One such strategy has been to implement medical assessment units (MAUs). This study reports on an environmental scan of MAU distribution and characteristics across Canada.