Can J Emerg Med
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ABSTRACTIntroduction:Although emergency departments (EDs) in Canada's rural areas serve approximately 20% of the population, a serious problem in access to health care services has emerged. Objective:The objective of this project was to compare access to support services in rural EDs between British Columbia and Quebec. Methods:Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. ⋯ Rural EDs in Quebec are also supported by a greater proportion of intensive care units (88% versus 15%); however, British Columbia appears to have more medevac aircraft/helicopters than Quebec. Conclusions:The results suggest that major differences exist in access to support services in rural EDs in British Columbia and Quebec. A nationwide study is justified to address this issue of variability in rural and remote health service delivery and its impact on interfacility transfers and patient outcomes.
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ABSTRACTObjectives:Long-term care (LTC) patients are often sent to emergency departments (EDs) by ambulance. In this novel extended care paramedic (ECP) program, specially trained paramedics manage LTC patients on site. The objective of this pilot study was to describe the dispatch and disposition of LTC patients treated by ECPs and emergency paramedics. ⋯ In the ECP group, 6 of 98 (6%) patients not transported triggered a 911 call within 48 hours for a related clinical reason, although none of the patients not transported by emergency paramedics relapsed. Conclusion:ECP involvement in LTC calls was found to reduce transports to the ED with a low rate of relapse. These pilot data generated hypotheses for future study, including determination of appropriate populations for ECP care and analysis of appropriate and safe nontransport.
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ABSTRACTObjective:To assess the prevalence of an unfavourable outcome among children leaving without being seen by a physician in the emergency department (ED). Method:This was a prospective cohort study conducted over a complete year in a pediatric tertiary care ED. A random sample of all children younger than 19 years of age who left without being seen by a physician was contacted by phone 4 to 6 days following the ED visit. ⋯ Thirty-eight (2.4%; 95% CI 1.7-3.2) patients fulfilled the criteria for an unfavourable outcome. On multiple logistic regression, chief complaints related to trauma and absence of nurse counseling had higher risks of unfavourable outcome. Conclusions:Approximately 2% of children who left without being seen by a physician at a tertiary care pediatric ED had an unfavourable outcome.
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ABSTRACTBackground:Low socioeconomic status (SES) is associated with adverse health outcomes. Possible explanations include differences in health status, access to health care, and care provided by clinicians. We sought to determine whether SES is associated with computed tomography (CT) use in the emergency department (ED). ⋯ For patients presenting with complex abdominal pain, no significant difference in CT use was observed. Conclusion:Lowest SES ED patients were less likely to receive CT scans overall and in headache and abdominal pain subgroups. No difference was seen among complex abdominal pain patients, suggesting that as clinical indications for the test become more clearcut, use across SES quintiles differs less.
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ABSTRACTBackground:The RAPID approach (Resuscitation, Analgesia and assessment, Patient needs, Interventions, Disposition) was developed as an approach to managing emergency department patients. It is a mental checklist to help trainees provide comprehensive care, addressing issues in priority. Its impact on trainee performance has not been assessed. ⋯ Conclusions:Students exposed to the RAPID approach at the start of their emergency medicine rotation performed better on the one component of the written examination for which it was designed to improve performance. Students found it to be a useful mental checklist for comprehensive care, possibly addressing the hidden curriculum. Emergency medicine educators should consider further study and careful implementation of the RAPID approach.