Can J Emerg Med
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Emergency department (ED) access block, the inability to provide timely care for high acuity patients, is the leading safety concern in First World EDs. The main cause of ED access block is hospital access block with prolonged boarding of inpatients in emergency stretchers. Cumulative emergency access gap, the product of the number of arriving high acuity patients and their average delay to reach a care space, is a novel access measure that provides a facility-level estimate of total emergency care delays. Many health leaders believe these delays are too large to be solved without substantial increases in hospital capacity. Our objective was to quantify cumulative emergency access blocks (the problem) as a fraction of inpatient capacity (the potential solution) at a large sample of Canadian hospitals. ⋯ ED access gaps are large and jeopardize care for high acuity patients, but they are small relative to hospital operating capacity. If access block were viewed as a "whole hospital" problem, capacity or efficiency improvements in the range of 1% to 3% could profoundly mitigate emergency care delays.
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A cricothyroidotomy is a life-saving procedure, performed as a final option to emergency airway algorithms, and is essential for all clinicians who perform emergency airway management. The bougie-assisted cricothyroidotomy (BAC) is a novel technique that may be performed faster and with fewer complications than other traditional approaches. There is no established standard set of steps to guide the instruction of BAC performance. This study sought to systematically develop a BAC checklist for novice instruction using a modified Delphi methodology and international airway experts. ⋯ This modified Delphi-derived checklist is the first systematically developed list of essential steps for guiding BAC instruction for novice learners. This tool serves to standardize BAC skill instruction and provide learners with a structured and consistent set of steps for deliberate practice.
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Take-home naloxone (THN) reduces deaths from opioid overdose. To increase THN distribution to at-risk emergency department (ED) patients, we explored reasons for patients' refusing or accepting THN. ⋯ ED patients refusing THN felt "not at risk" for overdose or felt their ED visit was not the right time or place for THN. Most accepting THN wanted to save others.
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Enhanced skills training in emergency medicine through the Canadian College of Family Physicians, CCFP(EM), has existed since the 1980s. Accreditation standards define what every program "must" and "should" have, yet little is known on what is currently done across Canada. Our objectives were to 1) describe major components of CCFP(EM) programs and 2) determine how curricular components are taught. ⋯ This study demonstrates the diverse structures of CCFP(EM) programs across Canada. Programs have similar clinical rotations, ultrasound, and simulation requirements. Variation exists in administrative structure and financial resources of programs, academic project requirements, and programs' competency-based curricula.