CJEM
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Emergency department (ED) crowding is a significant problem in Canada and internationally and is associated with the potential for patient harm. Although pediatric patients represent a significant proportion of overall ED visits, there is limited research on pediatric ED crowding. The Canadian Association of Emergency Physicians defines department crowding as a mismatch between the required and available resources to provide timely emergency care. We propose that rather than crowding, it is better to think of ED patient populations as being more or less "complex" as defined by proxies of the human and physical resources needed for patient management. The study objectives are to explore the utility of a simple and easily available retrospective metric of ED complexity, and to assess the relationship this measure has on patient outcomes in a pediatric ED. ⋯ The departmental complexity score has promise as a retrospective measure of departmental resource requirement and may have a role in the ongoing assessment of patient flow.
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Escalation of care is the timely recognition and communication of deterioration in a previously stable patient. Delays in escalating care may lead to unnecessary patient morbidity and mortality. There is currently a paucity of synthesis of work focused on the initiation of escalation of care in the emergency department (ED), where unique challenges may be present. We sought to complete a scoping review to investigate: (1) factors (barriers and/or facilitators) affecting clinicians in escalating care in the ED; and (2) tools that support clinicians in ED escalation of care processes. ⋯ This scoping review identified 13 studies that contained information on processes, factors influencing and/or tools used to facilitate escalation of care in the ED. They may serve as valuable starting points for ED clinicians and administrators who are building or reforming local escalation of care processes.
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A previous survey of Canadian emergency medicine (EM) physicians during the first wave of the COVID-19 pandemic documented less than 20% experienced high levels of burnout. This study examined the experience of a similar group of physicians during the second pandemic wave. We reported the associations between burnout and physician age, gender, having children at home and training route. ⋯ Most Canadian emergency physicians participating in our study during the COVID-19 pandemic reported high burnout levels. Younger physicians and female physicians were more likely than their coworkers to report high burnout levels. Hospitals should address emergency physician burnout during the pandemic because it is a threat to quality of patient care and retention of the workforce for the future.
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Editorial Comment
From STEMI to occlusion MI: paradigm shift and ED quality improvement.