Alcohol is a frequent contributing factor to motor vehicle collision injuries. Our objective was to determine the proportion of intoxicated drivers hospitalized following motor vehicle crashes who were subsequently convicted of an impaired driving criminal code offence.

We reviewed British Columbia Trauma Registry records from Jan. 1, 1992, to Mar. 31, 2000, and identified drivers of motor vehicles who were hospitalized for treatment of crash-related injuries. Patient identifiers were then used to link with the Insurance Corporation of British Columbia’s (ICBC) contraventions database and the ICBC Traffic Accident System collisions database.

Of 6067 patients identified in the Trauma Registry, 4042 had not been administered a blood ethanol test, 209 had no driver’s licence match in the relevant databases and 119 died, leaving 1697 eligible patients. Mean age was 34 years, and 79.6% were male. The average Injury Severity Score was 20, the average hospital stay was 14 days and, among ethanol-positive patients, the mean ethanol level was 34.0 mmol/L (156.4 mg/dL). In patients with levels >17.3 mmol/L, the police had listed ethanol as a contributing factor in 70.6% of cases. Despite this, only 11.0% were convicted of impaired driving and 8.4% of another criminal offence; 10.7% received a 24-hour roadside prohibition, 3.9% received a 90-day administrative driving prohibition and 25.0% were convicted of a contravention of the Motor Vehicle Act. Forty-one percent were not convicted of any offence at all.

Intoxicated drivers in British Columbia requiring hospitalization as a result of alcohol-related motor vehicle crashes are seldom convicted of impaired driving or other criminal code offences.

This study was designed to determine the prevalence of HIV and hepatitis C virus (HCV) in a specific population, and to distinguish between known and previously unrecognized infections in the emergency department (ED) setting.

Consecutive patients aged 15 to 54 years who had presented to the EDs of 2 urban hospitals during a 6-week period were enrolled in a prospective cross-sectional study if a complete blood count had been obtained as part of their care. The study patients were initially cross-referenced against local databases of known HIV and HCV seropositive patients. After removal of all personal identifiers, the study patients’ leftover blood was serotested for HIV and HCV, and seroprevalences were calculated. Univariate and multivariate analyses were performed to identify factors associated with HIV and HCV infection.

Of 3057 individuals whose files were analyzed, 1457 (48%) were male and 7% (213) were Aboriginal. Overall, 302 patients (10%; 95% confidence interval [CI], 9%–11%) were seropositive for HCV and, of these, only 132 (44%) were previously known to be. HCV seropositivity was associated with Aboriginal status, age, male gender, hospital site and HIV infection (all p < 0.001). In contrast, 39 patients (1%; 95% CI, 1%–2%) were HIV seropositive. Of these, 32 (82%) were previously known to be HIV positive, and 27 (69%) were HCV seropositive. HIV seropositivity was only associated with HCV infection (p < 0.001).

The rate of previously undetected infections was relatively low for HIV but high for HCV. Emergency physicians in urban settings will frequently encounter patients not known to be HCV positive and not identified as such. These results emphasize the need for more effective preventive measures in the community and the importance of observing standard (universal) precautions in ED practice.

The joint Canadian Infectious Diseases Society and Canadian Thoracic Society guidelines for community-acquired pneumonia (CAP) recommend 48–72 hour telephone follow-up of patients discharged from the emergency department (ED). The guidelines provide no evidence supporting this practice, and neither the clinical utility nor the effectiveness of such recommendations has been assessed. Our objective was to assess the utility of a 48–72 hour telephone follow-up protocol for patients discharged from the ED with CAP.

This was a retrospective chart audit covering a 2-year period (Jan. 3, 1999 to Jan. 3, 2001) after the introduction of a clinical practice guideline (CPG) that included routine 48–72 hour telephone follow-up of patients discharged from the ED with CAP. Eligible patients were identified in the ED database, rates of referral for telephone follow-up were recorded, and 30-day outcomes (death and readmission) for patients referred versus not referred were compared.

During the study period, 867 patients were identified as being eligible for the study. The mean age was 55.7 years (range 16–98 yr), and mean pneumonia severity index (PSI) was 68.9 (range 6–187). Despite the CPG, only 148 patients (17.1%) were referred for telephone follow-up. Age, demographics, comorbidity, clinical status and pneumonia severity were similar for referred and non-referred patients. Thirty-day death (2.5%) and readmission rates (3%) were strongly related to PSI score, but did not differ significantly in the 2 comparison groups.

In this setting, physicians were poorly compliant with a routine telephone follow-up protocol. The likelihood of referral for follow-up did not correlate with pneumonia severity, and follow-up referral did not appear to affect patient outcome. These findings do not support recommendations for routine early follow-up mechanisms beyond those already existing in the community.

Drug abuse is a frequent factor in emergency department (ED) visits. Although commonly performed, qualitative testing of urine for drugs of abuse (u-DOA) is inherently limited in its ability to establish the identity, timing or dose of substances used. Previous studies have demonstrated these limitations, but their designs cannot be used to determine whether the results of u-DOA tests affect physicians’ patient care decisions. Our objective was to determine the impact of u-DOA testing on the care of patients who present to the ED.

All adults 18 years of age or older who had u-DOA testing in 2 urban teaching EDs were eligible. Victims of vehicular trauma or sexual assault were excluded. Just prior to communicating the results of u-DOA testing for a patient, an investigator interviewed the ordering physician or consultant physician about the patient care plans for that patient. Test results were then revealed, and the questions immediately repeated. This design isolated the impact of knowledge of u-DOA test results on physicians’ patient care decisions. Any intended changes in patient care plans reported by the interviewed physician were compared to a priori criteria for substantive change and then subsequently reviewed by an independent expert to determine whether that change was justified.

Of the 110 u-DOA test results studied and the resultant 133 opportunities to influence physician management plans, there were 4 reported changes in management. One management change was judged to be substantive, but none of the 4 reported changes were considered by the independent expert reviewer to be justified. Urine-DOA testing thus led to a justified change in management in 0/133 instances (95% confidence interval 0%–2.3%).

Urine-DOA is rarely helpful in guiding patient care decisions in the ED. The results of this study call into question the need for this test in the ED setting.

Laboratory investigations are essential to patient care and are conducted routinely in emergency departments (EDs). This study reports the turnaround times at an academic, tertiary care ED, using root cause analysis to identify potential areas of improvement. Our objectives were to compare the laboratory turnaround times with established benchmarks and identify root causes for delays.

Turnaround and process event times for a consecutive sample of hemoglobin and potassium measurements were recorded during an 8-day study period using synchronized time stamps. A log transformation (ln [minutes + 1]) was performed to normalize the time data, which were then compared with established benchmarks using one-sample t tests.

The turnaround time for hemoglobin was significantly less than the established benchmark (n = 140, t = –5.69, p < 0.001) and that of potassium was significantly greater (n = 121, t = 12.65, p < 0.001). The hemolysis rate was 5.8%, with 0.017% of samples needing recollection. Causes of delays included order-processing time, a high proportion (43%) of tests performed on patients who had been admitted but were still in the ED waiting for a bed, and excessive laboratory process times for potassium.

The turnaround time for hemoglobin (18 min) met the established benchmark, but that for potassium (49 min) did not. Root causes for delay were order-processing time, excessive queue and instrument times for potassium and volume of tests for admitted patients. Further study of these identified causes of delays is required to see whether laboratory TATs can be reduced.