Can J Emerg Med
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Randomized Controlled Trial Comparative Study
The effectiveness of training with an emergency department simulator on medical student performance in a simulated disaster.
Training in practical aspects of disaster medicine is often impossible, and simulation may offer an educational opportunity superior to traditional didactic methods. We sought to determine whether exposure to an electronic simulation tool would improve the ability of medical students to manage a simulated disaster. ⋯ Participation in an electronic disaster simulation using the disastermed.ca software package appears to increase the speed at which medical students triage simulated patients and increase their score on a structured command-and-control performance indicator instrument. Participants indicated that the simulation-based curriculum in disaster medicine is preferable to a lecture-based curriculum. Overall student satisfaction with the simulation-based curriculum was high.
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Comparative Study
Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses.
We sought to assess the applicability of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the prehospital setting by comparing CTAS scores as--signed during ambulance transportation by base hospital (BH) nurses with CTAS scores given by emergency department (ED) nurses on patients' arrival. ⋯ The moderate interrater agreement we obtained may be a result of the changing conditions of patients during transport or may indicate that CTAS scoring requires direct contact to produce reliable triage scores. Our study casts a serious doubt on the appropriateness of BH nurses performing triage with CTAS in the prehospital setting.
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Comparative Study
Understanding hospital and emergency department congestion: an examination of inpatient admission trends and bed resources.
Patients in the emergency department (ED) who have been admitted to hospital (inpatient "boarders") are associated with ED overcrowding. They are also a symptom of a hospital-wide imbalance between demand and supply of resources. We analyzed the trends of inpatient admissions, ED boarding volumes, lengths of stay and bed resources of 3 major admitting services at our teaching institution. ⋯ Without bed capacity to admit more patients, our specialty services relied on GIM to serve as a safety net. At the same time, GIM was cited as a main source of ED congestion as their patients occupied more ED beds for longer periods than any other admitting service. The data presented in this study has helped effect positive change within our institution. Other hospitals running at or near capacity and faced with similar ED congestion may apply the methods we used in this study to analyze the cause and nature of their situation.
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Despite successful large-scale immunization programs in North America, there remains a significant population without active immunity to tetanus toxins because immunizations have been refused or delayed, and because of waning immunity. We report the case of a 7-year-old boy who presented to the emergency department with a chin laceration and a 7-day history of repeated falls of increasing frequency. ⋯ The patient was subsequently diagnosed with tetanus and treated accordingly. Tetanus presentations to emergency departments may vary from mild muscular rigidity to advanced respiratory failure and thus clinicians should consider the diagnosis in various clinical presentations, especially in areas remote from advanced supportive care.
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Comparative Study
Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.
In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. ⋯ Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.