Can J Emerg Med
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Meta Analysis
Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review.
The objective of this study was to systematically review the published literature for risk factors associated with adverse outcomes in older adults sustaining blunt chest trauma. ⋯ While blunt chest wall trauma in older adults is relatively common, the literature on prognostic factors for adverse outcomes in this patient population remains inadequate due to a paucity of high quality studies and lack of consistent reporting standards.
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Reviews help scholars consolidate evidence and guide their educational practice. However, few papers describe how to effectively publish review papers. We completed a scoping review to develop a set of quality indicators that will assist junior authors to publish reviews and integrative scholarship. ⋯ In emergency medicine education, review articles can help synthesize educational research so that educators can engage in evidence-based scholarly teaching. We hope that this work will act as an introduction to those interested in engaging in integrative scholarship by providing them with a guide to key quality markers and important checklists for improving their research.
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Multicenter Study
Return visits to the pediatric emergency department: A multicentre retrospective cohort study.
Return visits to the emergency department (RTED) for the same clinical complaint occur in 2.7% to 8.1% of children presenting to pediatric emergency departments (PEDs). Most studies examining RTEDs have focused solely on PEDs and do not capture children returning to other local emergency departments (EDs). Our objective was to measure the frequency and characterize the directional pattern of RTED to any of 18 EDs serving a large geographic area for children initially evaluated at a PED. ⋯ A significant proportion of RTED occur at a site other than where the original ED visit occurred. Examining RTED to and from only PEDs underestimates its burden on emergency health services.
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Health care costs are on the rise in Canada and the sustainability of our health care system is at risk. As gatekeepers to patient care, emergency department (ED) physicians have a direct impact on health care costs. We aimed to identify current levels of cost awareness among ED physicians. By understanding the current level of physician cost awareness, we hope to identify areas where cost education would provide the greatest benefit in reducing ordering costs. ⋯ The average percentage of correct cost estimates among ED physicians was 14% across the four ordering categories. Where cost-effective alternatives exist, ED physicians overestimated the cost of the more cost-effective item. They also underestimated the cost of low-yield tests.InterpretationED physicians demonstrated limited cost awareness of common health care costs. Further studies that characterize utilization of hospital resources based on ED physician awareness of cost-effective alternatives and cost of "low yield" tests are needed.
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The Collaborative Emergency Centre (CEC) model of care was implemented in Nova Scotia without an identifiable, directly comparable precedent. It features interprofessional teams working towards the goal of providing improved access to primary health care, and appropriate access to 24/7 emergency care. One important component of CEC functioning is overnight staffing by a paramedic and registered nurse (RN) team consulting with an off-site physician. Our objective was to ascertain the attitudes, feelings and experiences of paramedics working within Nova Scotia’s CECs. ⋯ Paramedics report largely positive interprofessional relationships in Nova Scotia’s CECs. They expressed enjoyment working in these centres and believe this work aligns with their professional identity. High levels of patient and community satisfaction were reported. Paramedics believe future expansion of the model would benefit from development of continuing education and improved communication between leadership and front-line workers.