3 results
LO28: Innovating for overcrowding: analyzing the impact of a novel emergency physician role on patient flow
- L. Green-Harrison, Z. Polsky, T. Fung, E. Lang, C. Patocka
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S17
- Print publication:
- May 2020
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Introduction: Overcrowding in the Emergency Department (ED) results in delays in care, and increased patient morbidity and mortality. Innovative departmental approaches have the potential to make patient flow through the ED more efficient and reduce overcrowding by improving patient throughput. The Calgary zone ED recently piloted a new physician role, the Emergency Physician Lead (EPL), a senior physician working closely with the charge nurse and consulting services to provide physician leadership, and to troubleshoot flow issues and safety breeches such as EMS offload delays and long emergency inpatient (EIP) stays. The objective of this study was to evaluate the efficacy of the EPL by determining its effect on key metrics of patient flow, and by identifying which specific EPL interventions were most effective at improving patient throughput. Methods: A retrospective cohort design was used to compare Foothills Medical Centre (FMC) ED patients seen by the EPL from March-June 2019 (n = 1343 patients) with a control group from the same period in 2018 (n = 5530). An EMR search was used to collect patient data and generate descriptive statistics, which were compared between groups by Mann-Whitney U-test. Patient handover notes left by the EPL were also collected and analyzed by two independent assessors to develop a list of actions taken by the EPL. Each patient was then coded based on the actions in the handover note, and means for each coded group were compared to control to find correlations between action and changes in key flow metrics. Results: Patients whose care involved the EPL had a 40% shorter average ED length of stay (ELOS) compared to control (515 vs 865 min, p < 0.001). The EPL was especially effective for patients with ELOS above the 90th percentile, with a 58% relative reduction. EPL patients also had lower average times from first contact with the department to first order being placed (79 vs 143 min, p < 0.001), and spent less time as EIPs after being admitted (390 vs 515 mins, p < 0.001). EPL actions aimed at early ordering of investigations or early management showed the largest relative reductions in ELOS, followed by actions related to resolving issues with consulting services (56% and 48% respectively, p < 0.001). Conclusion: The EPL role appears to be associated with improvements in several key metrics of patient flow. Specific EPL actions were correlated with marked decreases in length of stay. The EPL may be an effective strategy to improve patient throughput and combat ED overcrowding.
MP01: The canary in the coal mine: Does palliative care consultation influence emergency department utilization?
- Z. Polsky, E. Lang, A. Sinnarajah, T. Fung, B. Thomas
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S65
- Print publication:
- May 2017
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Introduction: For cancer patients undergoing active treatment, emergency department (ED) visits may be an indicator of a breakdown in continuity and quality of care. Palliative care (PC) may be an important resource for patients in need of symptom management even during treatment with curative intent. This study aims to describe ED utilization by cancer patients and determine if PC consults impact ED use. Methods: Patient data from the Tom Baker Cancer Center (TBCC) was linked to PC and ED data as a retrospective cohort study. ED data was obtained from two administrative databases and PC data was obtained from four administrative databases and restricted to the first four hundred days following diagnosis. Univariate and Multivariate analyses were used. Results: Three actively treated cancer patient cohorts were identified based on first presentation following intake at the TBCC: 1) Used ED first (n=1637), 2) Used PC first (n=539), and 3) Only used services at the TBCC (n=2153). Using Multivariate analysis, patients living alone or who had a diagnosis of prostate or breast cancer were more likely to access the ED first or to only use services at the TBCC rather than access PC first. Patients who were divorced, on income support, or diagnosed with a lung or GI cancer, were more likely to access PC first rather than access the ED or only use services at the TBCC. A subgroup analysis was performed on those who accessed the ED at some point during their care, consisting of three groups: 1) ED Only Users (n=1091), 2) ED First Users, who also accessed PC (n=546), and 3) PC First Users, who also accessed the ED. There was a significant difference in rates of ED visits between the three groups: ED Only Users went to the ED at a rate of 3.8 per 1000 patient days; ED First Users, who also accessed PC, went to the ED at a rate of 7.7 per 1000 patient days; and PC First Users, who also accessed the ED, went to the ED at a rate of 9.2 per 1000 patient days (p< 0.001). Conclusion: In a tertiary cancer centre, patients who were divorced, on income support, or diagnosed with lung or GI cancer were more likely to access PC. Amongst those patients who presented to the ED, those who accessed PC first had higher rates of ED use. Further explorations of presenting complaints, utilization patterns, and symptom burdens will be analyzed to determine if early PC consults can influence or decrease ED utilization.
LO20: Student Run Simulation Team: A near-peer approach to simulation education
- M. Bouwsema, S. Turner, D. Saleh, P. Rogers, J. Franke, J.A. Nicholas, Z. Polsky, M. Pfaff, I. Charania, M. Clark
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S34
- Print publication:
- May 2017
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Introduction/Innovation Concept: Student Run Simulation Team (SRST) is an extracurricular medical student group that provided peers with opportunities to learn and teach principles of acute care medicine in a simulated environment. Early exposure to simulation has been identified as a way for medical students to engage in self-directed education. SRST operated through a peer-led model. Senior medical students designed and delivered didactic sessions, simulation scenarios, and debriefed the scenarios to emphasise targeted objectives. Methods: Informal interviews conducted by the SRST as part of a needs analysis identified barriers to an effective transition from pre-clerkship to clerkship. Specifically, principles of team dynamics including effective communication and role clarification in emergency situations were identified as areas where students lacked confidence. The curriculum focused on leadership and an effective team approach to common acute presentations. SRST members acquired simulation skills under the guidance of a simulation team at the University of Calgary. In the inaugural year, 8 second year students developed and delivered the curriculum to 16 first year students. Quality improvement surveys and participant feedback contributed to ongoing program review and refinement. Curriculum, Tool, or Material: Didactic lectures and task-trainer based skills sessions were created to assist the medical students in developing a foundational approach to a patient presenting to the emergency department. Three distinct simulations of increasing complexity were designed for students to build on their skills. SRST members worked with simulation consultants during 4 custom designed training sessions to develop simulation skills (design and debriefing). The distinguishing aspect of SRST is an emphasis on the non-technical skills of teamwork, leadership, and communication, rather than knowledge acquisition alone. The structure also included a succession plan for continued peer-led education where the student participants will form the next year’s team and will receive similar simulation education. Conclusion: SRST is the first student-run simulation initiative to be established in a Canadian medical school. This near-peer team allowed for early practice of non-technical skills in emergency settings. SRST facilitated opportunities for simulation education for both the junior students as participants, and the senior medical students as educators. This is an ongoing initiative, with plans to continue program development in future years.