Can J Emerg Med
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In Canada, there were over 60,000 long-term care facility patient transfers to emergency departments (EDs) in 2014, with up to a quarter of them being potentially preventable. Each preventable transfer exposes the patient to transport- and hospital-related complications, contributes to ED crowding, and adds significant costs to the health care system. There have been many proposed and studied interventions aimed at alleviating the issue, but few attempts to assess and evaluate different interventions across institutions. ⋯ There are several promising interventions that have successfully reduced the number of preventable transfers from long-term care facilities to EDs in a variety of health care settings. Widespread implementation of these interventions has the potential to reduce ED crowding in Canada.
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Emergency department (ED) throughput efficiency is largely dependent on staffing and process, and many operational interventions to increase throughput have been described. ⋯ Introducing a fast track and optimizing processes for important case-mix groups will likely enhance throughput efficiency. Expediting diagnostic and treatment decisions by shifting physician-patient contact to the earliest possible process point (e.g., triage) is an effective cost-neutral strategy to increase flow. Focusing ED staff on operational improvement is likely to improve performance, regardless of the intervention type.
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The Emergency Medicine (EM) Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC) specifies that resuscitation entrustable professional activities (EPAs) can be assessed in the workplace and simulated environments. However, limited validity evidence for these assessments in either setting exists. We sought to determine if EPA ratings improve over time and whether an association exists between ratings in the workplace v. simulation environment. ⋯ No correlation was observed between EPA F1 ratings in the workplace v. simulation environments. Further studies are needed to clarify the conflicting results of our study with others and build an evidence base for the validity of EPA assessments in simulated and workplace environments.
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Case Reports
Just the Facts: Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest.
A 58-year-old man is brought by the ambulance to the emergency department (ED) of a tertiary care centre following an out-of-hospital cardiac arrest. Paramedics were called by the patient's wife after he had collapsed. She immediately initiated cardiopulmonary resuscitation (CPR). ⋯ An electrocardiogram shows ST-segment elevation in the anterior leads. Just prior to arrival, the patient suffers recurrent cardiac arrest with two further rounds of unsuccessful defibrillation in the ED. At this point, a decision is made to proceed with extracorporeal cardiopulmonary resuscitation (ECPR), prior to transport for cardiac catheterization.