CJEM
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Multicenter Study Observational Study
Clinical failure in abscess treatment: the role of ultrasound and incision and drainage.
Skin and soft tissue abscesses are commonly treated in emergency departments (ED). The use of bedside ultrasound may improve patient outcomes. The primary objective of this study was to examine the relationship between ultrasound use and risk of treatment failure in ED patients treated for abscesses. ⋯ The use of ultrasound in diagnosing and or/treating patients with abscesses in the ED is associated with decreased treatment failure risk when utilized with incision and drainage. Consideration of ultrasound use in other studies which assess treatment methods in relation to patient outcomes may be warranted.
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Multicenter Study
The mean abnormal result rates of laboratory tests ordered in the emergency department: shooting percentage insights from a multi-centre study.
While there is concern about excessive laboratory test ordering in the ED, it is difficult to quantify the problem. One solution involves the Mean Abnormal Result Rate (MARR), which is the proportion of tests ordered that return abnormal results. The primary objective of this study was to calculate MARR scores, and factors associated with MARR scores, for tests ordered between April 2014 and March 2019 at adult EDs in Calgary. ⋯ This is the first study to measure MARR scores in an ED setting. While lower scores (close to 5%) are less optimal in principle, ideal scores will depend on the clinical context in which tests are used. However, once departmental benchmarks are established, MARR score-monitoring allows efficient tracking of ordering practices across millions of tests.
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Emergency department (ED) crowding compromises patient outcomes. Existing crowding measures are complex and difficult to use in real-time. This study evaluated readily available single flow variables as crowding measures. ⋯ ED occupancy as a single measure has similar predictive accuracy to complex crowding scores and is easily generalizable to diverse emergency departments. Real-time tracking of this simple indicator could be used to prompt investigation and implementation of crowding interventions.
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We sought to compare strengths of association among multiple emergency department (ED) input, throughput and output metrics and the outcome of 72-h ED re-visits. ⋯ Input, throughput and output metrics are all associated with 72-h re-visits. Delays in any of these operational phases have detrimental effects on patient outcomes. ED waiting time, ED occupancy, and boarding times are the most meaningful input, throughput and output metrics. These should be the preferred metrics for quantifying ED crowding in research and quality improvement efforts, and for clinicians to monitor ED crowding in real time.
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In 2018, Canadian post-graduate Emergency Medicine (EM) programs transitioned to Competence-by-Design. Residents are now assessed using Entrustable Professional Activities (EPAs). We developed and implemented simulation for assessment to mitigate anticipated challenges with residents completing the required number of observations of resuscitation-based EPAs. Our survey of trainees who participated in these sessions suggests that it may be a feasible and acceptable method for EPA assessment.