Our objective was to identify the individual and community health effects of educating laypeople to deliver emergency care in low-resource settings.
Methods: We conducted a systematic review to address this question: in low-resource populations P , does emergency care education for laypeople I confer any measurable effect on patient morbidity and mortality, or community capacity and resilience for emergency health conditions O , in comparison with no training or other education C? We searched 12 electronic databases and grey literature for quantitative studies. We conducted duplicate and independent title and abstract screening, methodological and outcomes extraction, and study quality assessment using the Effective Public Health Practice Tool.
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We developed a narrative summary of findings. Most topically relevant papers were excluded because they assessed educational outcomes.
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Cardiopulmonary resuscitation training 6 papers improved cardiac arrest survival and enhanced capacity to respond to cardiac arrest in rural Norway, Denmark and commercial aircraft operations. A public education campaign in remote Denmark improved absolute cardiac arrest survival by 5. Lay trauma training 12 papers reduced absolute injury mortality and improved community capacity in Iraq, Cambodia, Iran and Indigenous New Zealand communities.
Similar training improved access to care for paediatric malnutrition, malaria, pneumonia, and gastrointestinal disease in Nigeria, Kenya, Senegal, Burkina Faso, Mali, and India 13 papers. Overdose education and naloxone distribution was associated with reductions in opioid overdose deaths 3 papers , including in Massachusetts where high-uptake communities for overdose education had significantly lower overdose fatality rates than no-uptake communities rate ratio 0.
Community education improved measures of access to emergency care for remote Indigenous populations in Canada, Alaska and Nepal 3 papers and adolescent mental health capacity in Australia 1 paper. Studies were of low or medium quality. Conclusion: In addition to established interventions for injury and cardiac arrest, emergency care training can improve community capacity in underserviced populations, and save lives in opioid overdose, paediatric infectious disease and malnutrition. Introduction: Understanding the spatial distribution of opioid abuse at the local level may facilitate community intervention strategies.
The purpose of this analysis was to apply spatial analytical methods to determine clustering of opioid-related emergency medical services EMS responses in the City of Calgary. Methods: Using opioid-related EMS responses in the City of Calgary between January 1st through October 31st, , we estimated the dissemination area DA specific spatial randomness effects by incorporating the spatial autocorrelation using intrinsic Gaussian conditional autoregressive model and generalized linear mixed models GLMM.
Global spatial autocorrelation was evaluated by Morans I index. Two models were applied: 1 Poisson regression with DA-specific non-spatial random effects; 2 Poisson regression with DA-specific G-side spatial random effects. A pseudolikelihood approach was used for model comparison. Two types of cluster analysis were used to identify the spatial clustering. Results: There were opioid-related EMS responses available for analysis. The global Morans Index implied the presence of global spatial autocorrelation. Comparing the two models applied suggested that the spatial model provided a better fit for the adjusted opioid-related EMS response rate.
Calgary Center and East were identified as hot spots by both types of cluster analysis. Conclusion: Spatial modeling has a better predictability to assess potential high risk areas and identify locations for community intervention strategies. The clusters identified in Calgarys Center and East may have implications for future response strategies. Some of the 17 primary interventions included computerized physician order entry optimization, staff schedule realignment, physician scorecards and a novel initial assessment process.
Some interventions have only been partially implemented due to persistent access block. This project was designed to examine the effect of partial EDST implementation on patient experience of emergency department visits. Patient satisfaction has been linked to improved patient outcomes, improved adherence to physician instruction, and improved provider satisfaction.
Original Research Articles
Methods: Semi structured interviews were conducted over three distinct time periods summer , and to encompass progressive levels of EDST implementation. The interviews focused on the patients perceptions in each of 4 stages of their ED visit - Check-in, assessment, reassessment, and disposition. Patients were asked a list of positive respected, listened to, supported, safe and negative in pain, worried, confused, frustrated emotions frequently experienced and asked if they felt any of these emotions during their ED stay. Open ended questions were also asked about their overall visit.
Descriptive statistics were calculated as differences in the proportion of patients feeling each emotion across timeframes. The open-ended question was coded by two reviewers as positive, negative or mixed. A kappa score was calculated to determine reviewer agreement. Results: interviews were completed. In general, the proportion of patients feeling negative emotions remained consistent while positive emotions increased as EDST implementation progressed.
Reviewers agreed in the coding of the open-ended responses in The kappa score for reviewer agreement was 0. Conclusion: Partial implementation of EDST positively impacted patients experience of emergency department visits. This program provides an opportunity to identify possible adverse events AEs and quality issues, which can then be addressed to improve patient care.
Using the general inductive method, we conducted a qualitative analysis with Health Quality Ontario HQO , and HQO completed an independent analysis of the submitted narrative reports. Results: There were 36, hour RVs flagged, which represent 0. Overall, 2, audits were conducted. Over one hundred local QI projects were completed or planned as a result of the audits performed. Conclusion: The RVQP promotes a culture of quality by highlighting potential AEs and quality themes that can then be targeted to increase patient safety and quality of care in Ontario EDs.
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Numerous QI projects were undertaken in the first year of the program, and future efforts will monitor the completion and success of these. The program can be easily adapted in other jurisdictions. Introduction: Patient-reported outcome measures PROM are questionnaires that can be used to elicit care outcome information from patients. We sought to develop and validate the first PROM for adult patients without a primary mental health or addictions presentation receiving emergency department ED care and who were not hospitalized. Phase 1: ED outcome conceptual framework qualitative interviews with ED patients post-discharge informed four core domains previously published.
Phase 2: Item generation scoping review of the literature and existing instruments identified candidate questions relevant for each domain for inclusion in tool. Phase 3: Cognitive debriefing existing and newly written questions were tested with ED patients post-discharge for comprehension and wording preference. Phase 4: Field and validity testing revised tool pilot tested on a national online survey panel and then again at 2 weeks test-retest.
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Phase 5: Final item reduction using a Delphi process involving ED clinicians, researchers, patients and system administrators. Results: Four core outcome domains were defined in Phase 1: 1 understanding; 2 symptom relief; 3 reassurance and 4 having a plan. The domains informed a review of existing relevant questionnaires and instruments and the writing of additional questions creating an initial long-form questionnaire. Eight patients participated in cognitive debriefing of the long-form questionnaire. Expert clinicians, researchers and patient partners provided input on item refinement and reduction.
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Four hundred forty-four patients completed a second version of the long-form questionnaire add in retest numbers which informed the final item reduction process by a modified Delphi method involving 21 diverse contributors. Conclusion: Using accepted PROM instrument development methodology, we developed the first outcome questionnaire for use with adult ED patients who are not hospitalized. This questionnaire can be used to systematically gather patient-reported outcome information that could support and inform improvement work in ED care. Introduction: Resource allocation planning RAP for emergency medical services EMS systems determines optimal resources for patient needs in order to minimize morbidity and mortality.
The revised RAP was implemented on a pan provincial basis in fall of It is unknown how the modifications will affect outcomes of EMS cases.
Population-based analysis was used to determine the effect of a comprehensive RAP changes by comparing hour mortality before and after province-wide implementation of the revised RAP. Methods: The primary outcome, hour mortality, was obtained through linked provincial health administrative data. All adult cases with evaluable outcome data were included in the analysis. Multivariable logistic regression was used to adjust for variations in other significant factors associated with hour mortality. The interrupted time series ITS estimated any immediate changes in the level or trend of outcome after the start of the revised RAP implementation fall of , while simultaneously controlling for pre-existing trends.
Results: The cohort is comprised of , cases April March Despite considerable change in crew level response and resource allocation, there was significant decrease in 24 hour mortality in a large pan-provincial population based patient cohort. Introduction: Maintaining and enhancing competence in the breadth of Emergency Medicine EM is an ongoing challenge for all clinicians.
In particular, resuscitative care in EM involves high-stakes clinical encounters that demand strong procedural skills, effective leadership, and up-to-date knowledge. However, Canadian emergency physicians are not required to complete any specific ongoing training for these encounters beyond general CPD requirements of professional colleges.
Simulation-based medical education SBME is an effective modality for enhancing technical e. Crisis Resource Management skills in crisis situations, and has been embedded in undergraduate and postgraduate medical curricula worldwide. We present a novel comprehensive curriculum of simulation-based CPD designed specifically for academic emergency physicians AEPs at our centre. Methods: The curriculum development involved a departmental needs assessment survey, focus groups with AEPs, data from safety metrics and critical incidents, and consultations with senior departmental leadership.
Based on the results of the needs assessment, a two-year curriculum was mapped out and tailored to the available resources. Results: CPD simulation commenced in January and occurs monthly for three hours, immediately following departmental Grand Rounds to provide convenient scheduling. Our needs assessment identified two key types of educational needs: 1 Crisis Resource Management skills and 2 frequent practice of high-stakes critical care procedures e.
The first six months of implementation was dedicated to low-fidelity skills labs to facilitate the transition to SBME. After this, the program transitioned to a hybrid model involving two high-fidelity simulated resuscitations and one skills lab per session. Conclusion: We have introduced a comprehensive curriculum of ongoing simulation-based CPD in our department based on the educational needs of our AEPs. Key to our successful implementation has been support from educational and administrative leadership within our department. Ongoing challenges include securing adequate protected time from clinical duties for program facilitators and participants.
Future work will include establishing permanent funding, CPD accreditation, and a formal program evaluation. Introduction: A proportion of Emergency Department ED visits may be treated in out-of-hospital settings.
The objective of this curriculum was to expand paramedic competencies to safely risk stratify patients and divert low risk, low acuity patients from EDs with and without physician oversight. We used this data to identify competencies e. These were translated to c goals and objectives.
Results: Our d educational strategies involved a week intensive patient-type and case-based curriculum. Evaluation outcomes included student performance scores across 7-dimensions, clinical placement and student feedback. Challenges included provincial stakeholder consensus, and formally addressing clinical suspicion in a protocol based field within a limited time frame. Conclusion: A curriculum for expanded paramedic practice to risk stratify and divert targeted low risk patients from EDs resulted in new paramedic competencies and scope of practice.
It received high evaluations from clinical staff and students. Successful candidates will undergo a 1-year study for validation and safety. Introduction: Medical journals are an essential venue for knowledge translation.