Lisa Calder | University of Ottawa | Université d'Ottawa (original) (raw)
Papers by Lisa Calder
Health Care for Women International, 1997
As women become more prominent players in the health sciences, it seems logical to ask the questi... more As women become more prominent players in the health sciences, it seems logical to ask the question, How are women affecting issues of health specific to women? Few authors have addressed this important query. In this article, I look at the views of a female researcher with respect to the literature about women's health research and the impact of women researchers on the information exchange between patient and physician, provider competence, and continuity of care. These factors all affect the quality of care being received by women in many different areas of health care.
CJEM, 2004
Our objective was to determine the practice patterns of Canadian emergency physicians with respec... more Our objective was to determine the practice patterns of Canadian emergency physicians with respect to the management of traumatic corneal abrasions. After developing our instrument and pilot testing it on a sample of emergency residents, we randomly surveyed 470 members of the Canadian Association of Emergency Physicians, using a modified Dillman technique. We distributed a pre-notification letter, an 18-item survey, and appropriate follow-up surveys to non-responders. Those members with an email address (n = 400) received a Web-based survey, and those without (n = 70) received a survey by post. The survey focused on the indications and utilization of analgesics (oral and topical), cycloplegics, eye patches and topical antibiotics. Our response rate was 64% (301/470), and the median age of respondents was 38 years. Most (77.7%) were male, 71.8% were full-time emergency physicians, 76.5% were emergency medicine certified, and 64.4% practised in teaching hospitals. Pain management preferences (offered usually or always) included oral analgesics (82.1%), cycloplegics (65.1%) and topical non-steroidal anti-inflammatory drugs (NSAIDs) (52.8%). Only 21.6% of respondents performed patching, and most (71.2%) prescribed topical antibiotics, particularly for contact lens wearers and patients with ocular foreign bodies. Two-thirds of the respondents provided tetanus toxoid if a foreign body was present, and 46.2% did so even if a foreign body was not present. Most respondents (88.0%) routinely arranged follow-up. This national survey of emergency physicians demonstrates a lack of consensus on the management of traumatic corneal abrasions. Further study is indicated to determine the optimal treatment, particularly regarding the use of topical NSAIDs.
Academic Emergency Medicine, 2010
Vernakalant is a relatively atrial-selective antiarrhythmic agent that has been shown to successf... more Vernakalant is a relatively atrial-selective antiarrhythmic agent that has been shown to successfully convert atrial fibrillation (AF) to normal sinus rhythm for some patients whose onset of dysrhythmia occurred less than 7 days previously. This study sought to evaluate the efficacy and safety of vernakalant for patients with recent-onset AF. This was a post hoc analysis of patients with recent-onset AF (> 3 to ≤ 48 hours) enrolled in the double-blind, placebo-controlled Atrial arrhythmia Conversion Trial (ACT) I and the open-label ACT IV trials. The studies enrolled adults presenting with AF to 78 emergency departments (ED) and cardiac clinics in six countries. Patients received a 10-minute intravenous infusion of vernakalant or placebo, followed by an additional infusion if necessary. Efficacy assessments included conversion to sinus rhythm within 90 minutes and median time to conversion. Safety evaluations included telemetry, Holter monitoring, and adverse events (AEs). Of the 290 patients, 229 received vernakalant, 61 received placebo, and the overall mean age was 59 years. The vernakalant and placebo groups were similar. Of all patients given vernakalant, 136 (59.4%) converted to sinus rhythm within 90 minutes, compared with three (4.9%) placebo patients. The median time to conversion with vernakalant was 12 minutes (interquartile range = 7-24.5 minutes). Clinically significant bradycardia and hypotension were uncommon, and no cases of torsade de pointes or ventricular fibrillation occurred. Vernakalant rapidly converted recent-onset AF to sinus rhythm in over half of patients, was well tolerated, and has the potential to offer an important therapeutic option for rhythm control of recent-onset AF in the ED.
Emergency Medicine Journal, 2015
Sexual assault is disturbingly common, yet little is known about those occurring at mass gatherin... more Sexual assault is disturbingly common, yet little is known about those occurring at mass gatherings, defined as a group of people congregated for a common purpose. Our objectives were to examine patterns of variation in sexual assault associated with mass gatherings and to determine factors associated with assaults occurring at mass gatherings. We performed a case series analysis from January to December, 2013. We included all patients >16 years presenting within 30 days of their sexual assault to the Ottawa Hospital Sexual Assault and Partner Abuse Care Program (SAPACP). Cases were stratified by whether or not they occurred at mass gatherings. We abstracted from the SAPACP records: patient and sexual assault characteristics, alcohol or drug consumption and medical and forensic care accepted. We performed descriptive analyses and multiple logistical regression to identify factors associated with mass gathering assaults. We found 204 cases of sexual assault, of which 53 (26%) occurred at mass gatherings. Relative frequencies of mass gathering sexual assaults peaked during New Year's Eve, Canada Day, university frosh week and Halloween. We found the following factors were statistically significantly associated with sexual assault at mass gatherings: younger age (OR=0.95, 95% CI 0.91 to 0.99); voluntary consumption of drugs and alcohol (3.88, 95% CI 1.34 to 11.23); assault occurring on a holiday (2.37, 95% CI 1.00 to 5.64) and the assailant unknown to the victim (2.43, 95% CI 1.15 to 5). This study is the first to describe patterns of variation in sexual assault incidents associated with occurrence of mass gatherings as well as factors associated with such assaults. We will disseminate these results to key stakeholders in order to develop prevention-minded policies for future mass gatherings.
CJEM, 2015
The vision of the recently created Canadian Association of Emergency Physicians (CAEP) Academic S... more The vision of the recently created Canadian Association of Emergency Physicians (CAEP) Academic Section is to promote high-quality emergency patient care by conducting world-leading education and research in emergency medicine. The Academic Section plans to achieve this goal by enhancing academic emergency medicine primarily at Canadian medical schools and teaching hospitals. It seeks to foster and develop education, research, and academic leadership amongst Canadian emergency physicians, residents, and students. In this light, the Academic Section began in 2013 to hold the annual Academic Symposia to highlight best practices and recommendations for the three core domains of governance and leadership, education scholarship, and research. Each year, members of three panels are asked to review the literature, survey and interview experts, achieve consensus, and present their recommendations at the Symposium (2013, Education Scholarship; 2014, Research; and 2015, Governance and Funding...
CJEM, 2015
We sought to 1) identify best practices for training and mentoring clinician researchers, 2) char... more We sought to 1) identify best practices for training and mentoring clinician researchers, 2) characterize facilitators and barriers for Canadian emergency medicine researchers, and 3) develop pragmatic recommendations to improve and standardize emergency medicine postgraduate research training programs to build research capacity. We performed a systematic review of MEDLINE and Embase using search terms relevant to emergency medicine research fellowship/graduate training. We conducted an email survey of all Canadian emergency physician researchers. The Society for Academic Emergency Medicine (SAEM) research fellowship program was analysed, and other similar international programs were sought. An expert panel reviewed these data and presented recommendations at the Canadian Association of Emergency Physicians (CAEP) 2014 Academic Symposium. We refined our recommendations based on feedback received. Of 1,246 potentially relevant citations, we included 10 articles. We identified five ke...
CJEM, 2015
Outcome feedback is the process of learning patient outcomes after their care within the emergenc... more Outcome feedback is the process of learning patient outcomes after their care within the emergency department. We conducted a national survey of Canadian Royal College emergency medicine (EM) residents and program directors to determine the extent to which active outcome feedback and follow-up occurred. We also compared the perceived educational value of outcome feedback between residents and program directors. We distributed surveys to all Royal College-accredited adult and pediatric EM training programs using a modified Dillman method. We analyzed the data using student's t-test for continuous variables and Fisher's exact test for categorical variables. We received 210 completed surveys from 260 eligible residents (80.8%) and 21 of 24 program directors (87.5%) (overall 81.3%). Mandatory active outcome feedback was not present in any EM training program for admitted or discharged patients (0/21). Follow-up was performed electively by 89.4% of residents for patients admitted to the hospital, and by 44.2% of residents for patients discharged home. A majority of residents (76.9%) believed that patient follow-up should be mandatory compared to 42.9% of program directors (p=0.002). The perceived educational value of outcome feedback was 5.8/7 for residents and 5.1/7 for program directors (difference 0.7; p=0.002) based on a seven-point Likert scale (1=not important; 7=very important). While Canadian EM training programs do not mandate follow-up, it is performed electively by the majority of residents surveyed. Residents place a significantly greater educational value on outcome feedback than their program directors, and believe that follow-up should be a mandatory component of EM residencies.
International journal of emergency medicine, 2015
Patient safety in the context of emergency medicine is a relatively new field of study. To date, ... more Patient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting. A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an...
Critical care (London, England), 1999
OBJECTIVES: To determine the degree of interinstitutional transfusion practice variation and reas... more OBJECTIVES: To determine the degree of interinstitutional transfusion practice variation and reasons why red cells are administered in critically ill patients. STUDY DESIGN: Multicentre cohort study combined with a cross-sectional survey of physicians requesting red cell transfusions for patients in the cohort. STUDY POPULATION: The cohort included 5298 consecutive patients admitted to six tertiary level intensive care units in addition to administering a survey to 223 physicians requesting red cell transfusions in these units. MEASUREMENTS: Haemoglobin concentrations were collected, along with the number and reasons for red cell transfusions plus demographic, diagnostic, disease severity (APACHE II score), intensive care unit (ICU) mortality and lengths of stay in the ICU. RESULTS: Twenty five per cent of the critically ill patients in the cohort study received red cell transfusions. The overall number of transfusions per patient-day in the ICU averaged 0.95 +/- 1.39 and ranged fro...
CJEM, 2010
We sought to assess sex differences in clinical presentation, management and outcome in emergency... more We sought to assess sex differences in clinical presentation, management and outcome in emergency department (ED) patients with chest pain, and to measure the association between female sex and coronary angiography within 30 days. We conducted a prospective cohort study in an urban academic ED between Jul. 1, 2007, and Apr. 1, 2008. We enrolled patients over 24 years of age with chest pain and possible acute coronary syndrome (ACS). Among the 970 included patients, 386 (39.8%) were female. Compared with men, women had a lower prevalence of known coronary artery disease (21.0% v. 34.2%, p < 0.001) and a lower frequency of typical pain (37.1% v. 45.7%, p = 0.01). Clinicians classified a greater proportion of women as having a low (< 10%) pretest probability for ACS (85.0% v. 76.4%, p = 0.001). Despite similar rates of electrocardiography, troponin T and stress testing between sexes, there was a lower rate of acute myocardial infarction (AMI) (4.7% v. 8.4%, p = 0.03) and positive...
CJEM, 2010
To enhance patient safety, it is important to understand the frequency and causes of adverse even... more To enhance patient safety, it is important to understand the frequency and causes of adverse events (defined as unintended injuries related to health care management). We performed this study to describe the types and risk of adverse events in high-acuity areas of the emergency department (ED). This prospective cohort study examined the outcomes of consecutive patients who received treatment at 2 tertiary care EDs. For discharged patients, we conducted a structured telephone interview 14 days after their initial visit; for admitted patients, we reviewed the inpatient charts. Three emergency physicians independently adjudicated flagged outcomes (e.g., death, return visits to the ED) to determine whether an adverse event had occurred. We enrolled 503 patients; one-half (n = 254) were female and the median age was 57 (range 18-98) years. The majority of patients (n = 369, 73.3%) were discharged home. The most common presenting complaints were chest pain, generalized weakness and abdomi...
BMJ quality & safety, 2015
This study describes the proportion of emergency department (ED) returns within 7 days due to adv... more This study describes the proportion of emergency department (ED) returns within 7 days due to adverse events, defined as adverse outcomes related to healthcare received. Prospective cohort study. We used an electronically triggered adverse event surveillance system at a tertiary care ED from May to June 2010 to examine ED returns within 7 days of index visit. One of three trained nurses determined whether the visit was related to index emergency care. For such records, one of three trained emergency physicians conducted adverse event determinations. We determined adverse event type and severity and analysed the data with descriptive statistics, χ(2) tests and logistic regression. Of 13 495 index ED visits, 923 (6.8%) were followed by ED returns within 7 days. The median age of all patients was 47 years and 52.8% were women. After nursing review, 211 cases required physician review. Of these, 53 visits were adverse events (positive predictive value (PPV)=5.7%, 95% CI 4.4% to 7.4%) an...
Objective: To review the evidence describing practice variation in the transfusion of allogeneic ... more Objective: To review the evidence describing practice variation in the transfusion of allogeneic red blood cells as well as the risks, benefits, harms and costs associated with anemia and transfusion. Literature search and selection: Searches of MEDLINE from January 1966 to December 1996 were combined with manual searches of bibliographies and references from experts. Two reviewers examined the abstracts of citations to identify those related to clinical practice involving red blood cell transfusions. Disagreement was resolved through consensus. Literature synthesis: Selected articles were classified by study design and topic. Inferences were derived from the evidence. Results: Of the 189 articles reviewed, 78 (41%) were interventional and 111 (59%)
BMJ Open, 2014
8,9 on behalf of Pediatric Emergency Research Canada (PERC) To cite: Plint AC, Newton A, Stang A,... more 8,9 on behalf of Pediatric Emergency Research Canada (PERC) To cite: Plint AC, Newton A, Stang A, et al. How safe are our paediatric emergency departments? Protocol for a national prospective cohort study.
International Journal of Emergency Medicine, 2014
Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions rem... more Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions remain about its impact on patient care. In this study, we aimed to determine if ED crowding influenced patient triage destination and intensity of investigation, as well as rates of unscheduled returns to the ED. We focused on patients presenting with chest pain or shortness of breath, triaged as high acuity, and who were subsequently discharged home. This pilot study was a health records review of 500 patients presenting to two urban tertiary care EDs with chest pain or shortness of breath, triaged as high acuity and subsequently discharged home. Data extracted included triage time, date, treatment area, time to physician initial assessment, investigations ordered, disposition, and return ED visits within 14 days. We defined ED crowding as ED occupancy greater than 1.5. Data were analyzed using descriptive statistics and the χ(2) and Fisher exact tests. Over half of the patients, 260/500 (52.0%) presented during conditions of ED crowding. More patients were triaged to the non-monitored area of the ED during ED crowding (65/260 (25.0%) vs. 39/240 (16.3%) when not crowded, P = 0.02). During ED crowding, mean time to physician initial assessment was 132.0 minutes in the non-monitored area vs. 99.1 minutes in the monitored area, P &amp;amp;amp;amp;amp;amp;amp;lt;0.0001. When the ED was not crowded, mean time to physician initial assessment was 122.3 minutes in the non-monitored area vs. 67 minutes in the monitored area, P = 0.0003. Patients did not return to the ED more often when triaged during ED crowding: 24/260 (9.3%) vs. 29/240 (12.1%) when ED was not crowded (P = 0.31). Overall, when triaged to the non-monitored area of the ED, 44/396 (11.1%) patients returned, whereas in the monitored area 9/104 (8.7%) patients returned, P = 0.46. ED crowding conditions appeared to influence triage destination in our ED leading to longer wait times for high acuity patients. This did not appear to lead to higher rates of return ED visits amongst discharged patients in this cohort. Further research is needed to determine whether these delays lead to adverse patient outcomes.
Health Care for Women International, 1997
As women become more prominent players in the health sciences, it seems logical to ask the questi... more As women become more prominent players in the health sciences, it seems logical to ask the question, How are women affecting issues of health specific to women? Few authors have addressed this important query. In this article, I look at the views of a female researcher with respect to the literature about women's health research and the impact of women researchers on the information exchange between patient and physician, provider competence, and continuity of care. These factors all affect the quality of care being received by women in many different areas of health care.
CJEM, 2004
Our objective was to determine the practice patterns of Canadian emergency physicians with respec... more Our objective was to determine the practice patterns of Canadian emergency physicians with respect to the management of traumatic corneal abrasions. After developing our instrument and pilot testing it on a sample of emergency residents, we randomly surveyed 470 members of the Canadian Association of Emergency Physicians, using a modified Dillman technique. We distributed a pre-notification letter, an 18-item survey, and appropriate follow-up surveys to non-responders. Those members with an email address (n = 400) received a Web-based survey, and those without (n = 70) received a survey by post. The survey focused on the indications and utilization of analgesics (oral and topical), cycloplegics, eye patches and topical antibiotics. Our response rate was 64% (301/470), and the median age of respondents was 38 years. Most (77.7%) were male, 71.8% were full-time emergency physicians, 76.5% were emergency medicine certified, and 64.4% practised in teaching hospitals. Pain management preferences (offered usually or always) included oral analgesics (82.1%), cycloplegics (65.1%) and topical non-steroidal anti-inflammatory drugs (NSAIDs) (52.8%). Only 21.6% of respondents performed patching, and most (71.2%) prescribed topical antibiotics, particularly for contact lens wearers and patients with ocular foreign bodies. Two-thirds of the respondents provided tetanus toxoid if a foreign body was present, and 46.2% did so even if a foreign body was not present. Most respondents (88.0%) routinely arranged follow-up. This national survey of emergency physicians demonstrates a lack of consensus on the management of traumatic corneal abrasions. Further study is indicated to determine the optimal treatment, particularly regarding the use of topical NSAIDs.
Academic Emergency Medicine, 2010
Vernakalant is a relatively atrial-selective antiarrhythmic agent that has been shown to successf... more Vernakalant is a relatively atrial-selective antiarrhythmic agent that has been shown to successfully convert atrial fibrillation (AF) to normal sinus rhythm for some patients whose onset of dysrhythmia occurred less than 7 days previously. This study sought to evaluate the efficacy and safety of vernakalant for patients with recent-onset AF. This was a post hoc analysis of patients with recent-onset AF (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3 to ≤ 48 hours) enrolled in the double-blind, placebo-controlled Atrial arrhythmia Conversion Trial (ACT) I and the open-label ACT IV trials. The studies enrolled adults presenting with AF to 78 emergency departments (ED) and cardiac clinics in six countries. Patients received a 10-minute intravenous infusion of vernakalant or placebo, followed by an additional infusion if necessary. Efficacy assessments included conversion to sinus rhythm within 90 minutes and median time to conversion. Safety evaluations included telemetry, Holter monitoring, and adverse events (AEs). Of the 290 patients, 229 received vernakalant, 61 received placebo, and the overall mean age was 59 years. The vernakalant and placebo groups were similar. Of all patients given vernakalant, 136 (59.4%) converted to sinus rhythm within 90 minutes, compared with three (4.9%) placebo patients. The median time to conversion with vernakalant was 12 minutes (interquartile range = 7-24.5 minutes). Clinically significant bradycardia and hypotension were uncommon, and no cases of torsade de pointes or ventricular fibrillation occurred. Vernakalant rapidly converted recent-onset AF to sinus rhythm in over half of patients, was well tolerated, and has the potential to offer an important therapeutic option for rhythm control of recent-onset AF in the ED.
Emergency Medicine Journal, 2015
Sexual assault is disturbingly common, yet little is known about those occurring at mass gatherin... more Sexual assault is disturbingly common, yet little is known about those occurring at mass gatherings, defined as a group of people congregated for a common purpose. Our objectives were to examine patterns of variation in sexual assault associated with mass gatherings and to determine factors associated with assaults occurring at mass gatherings. We performed a case series analysis from January to December, 2013. We included all patients >16 years presenting within 30 days of their sexual assault to the Ottawa Hospital Sexual Assault and Partner Abuse Care Program (SAPACP). Cases were stratified by whether or not they occurred at mass gatherings. We abstracted from the SAPACP records: patient and sexual assault characteristics, alcohol or drug consumption and medical and forensic care accepted. We performed descriptive analyses and multiple logistical regression to identify factors associated with mass gathering assaults. We found 204 cases of sexual assault, of which 53 (26%) occurred at mass gatherings. Relative frequencies of mass gathering sexual assaults peaked during New Year's Eve, Canada Day, university frosh week and Halloween. We found the following factors were statistically significantly associated with sexual assault at mass gatherings: younger age (OR=0.95, 95% CI 0.91 to 0.99); voluntary consumption of drugs and alcohol (3.88, 95% CI 1.34 to 11.23); assault occurring on a holiday (2.37, 95% CI 1.00 to 5.64) and the assailant unknown to the victim (2.43, 95% CI 1.15 to 5). This study is the first to describe patterns of variation in sexual assault incidents associated with occurrence of mass gatherings as well as factors associated with such assaults. We will disseminate these results to key stakeholders in order to develop prevention-minded policies for future mass gatherings.
CJEM, 2015
The vision of the recently created Canadian Association of Emergency Physicians (CAEP) Academic S... more The vision of the recently created Canadian Association of Emergency Physicians (CAEP) Academic Section is to promote high-quality emergency patient care by conducting world-leading education and research in emergency medicine. The Academic Section plans to achieve this goal by enhancing academic emergency medicine primarily at Canadian medical schools and teaching hospitals. It seeks to foster and develop education, research, and academic leadership amongst Canadian emergency physicians, residents, and students. In this light, the Academic Section began in 2013 to hold the annual Academic Symposia to highlight best practices and recommendations for the three core domains of governance and leadership, education scholarship, and research. Each year, members of three panels are asked to review the literature, survey and interview experts, achieve consensus, and present their recommendations at the Symposium (2013, Education Scholarship; 2014, Research; and 2015, Governance and Funding...
CJEM, 2015
We sought to 1) identify best practices for training and mentoring clinician researchers, 2) char... more We sought to 1) identify best practices for training and mentoring clinician researchers, 2) characterize facilitators and barriers for Canadian emergency medicine researchers, and 3) develop pragmatic recommendations to improve and standardize emergency medicine postgraduate research training programs to build research capacity. We performed a systematic review of MEDLINE and Embase using search terms relevant to emergency medicine research fellowship/graduate training. We conducted an email survey of all Canadian emergency physician researchers. The Society for Academic Emergency Medicine (SAEM) research fellowship program was analysed, and other similar international programs were sought. An expert panel reviewed these data and presented recommendations at the Canadian Association of Emergency Physicians (CAEP) 2014 Academic Symposium. We refined our recommendations based on feedback received. Of 1,246 potentially relevant citations, we included 10 articles. We identified five ke...
CJEM, 2015
Outcome feedback is the process of learning patient outcomes after their care within the emergenc... more Outcome feedback is the process of learning patient outcomes after their care within the emergency department. We conducted a national survey of Canadian Royal College emergency medicine (EM) residents and program directors to determine the extent to which active outcome feedback and follow-up occurred. We also compared the perceived educational value of outcome feedback between residents and program directors. We distributed surveys to all Royal College-accredited adult and pediatric EM training programs using a modified Dillman method. We analyzed the data using student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-test for continuous variables and Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact test for categorical variables. We received 210 completed surveys from 260 eligible residents (80.8%) and 21 of 24 program directors (87.5%) (overall 81.3%). Mandatory active outcome feedback was not present in any EM training program for admitted or discharged patients (0/21). Follow-up was performed electively by 89.4% of residents for patients admitted to the hospital, and by 44.2% of residents for patients discharged home. A majority of residents (76.9%) believed that patient follow-up should be mandatory compared to 42.9% of program directors (p=0.002). The perceived educational value of outcome feedback was 5.8/7 for residents and 5.1/7 for program directors (difference 0.7; p=0.002) based on a seven-point Likert scale (1=not important; 7=very important). While Canadian EM training programs do not mandate follow-up, it is performed electively by the majority of residents surveyed. Residents place a significantly greater educational value on outcome feedback than their program directors, and believe that follow-up should be a mandatory component of EM residencies.
International journal of emergency medicine, 2015
Patient safety in the context of emergency medicine is a relatively new field of study. To date, ... more Patient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting. A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an...
Critical care (London, England), 1999
OBJECTIVES: To determine the degree of interinstitutional transfusion practice variation and reas... more OBJECTIVES: To determine the degree of interinstitutional transfusion practice variation and reasons why red cells are administered in critically ill patients. STUDY DESIGN: Multicentre cohort study combined with a cross-sectional survey of physicians requesting red cell transfusions for patients in the cohort. STUDY POPULATION: The cohort included 5298 consecutive patients admitted to six tertiary level intensive care units in addition to administering a survey to 223 physicians requesting red cell transfusions in these units. MEASUREMENTS: Haemoglobin concentrations were collected, along with the number and reasons for red cell transfusions plus demographic, diagnostic, disease severity (APACHE II score), intensive care unit (ICU) mortality and lengths of stay in the ICU. RESULTS: Twenty five per cent of the critically ill patients in the cohort study received red cell transfusions. The overall number of transfusions per patient-day in the ICU averaged 0.95 +/- 1.39 and ranged fro...
CJEM, 2010
We sought to assess sex differences in clinical presentation, management and outcome in emergency... more We sought to assess sex differences in clinical presentation, management and outcome in emergency department (ED) patients with chest pain, and to measure the association between female sex and coronary angiography within 30 days. We conducted a prospective cohort study in an urban academic ED between Jul. 1, 2007, and Apr. 1, 2008. We enrolled patients over 24 years of age with chest pain and possible acute coronary syndrome (ACS). Among the 970 included patients, 386 (39.8%) were female. Compared with men, women had a lower prevalence of known coronary artery disease (21.0% v. 34.2%, p < 0.001) and a lower frequency of typical pain (37.1% v. 45.7%, p = 0.01). Clinicians classified a greater proportion of women as having a low (< 10%) pretest probability for ACS (85.0% v. 76.4%, p = 0.001). Despite similar rates of electrocardiography, troponin T and stress testing between sexes, there was a lower rate of acute myocardial infarction (AMI) (4.7% v. 8.4%, p = 0.03) and positive...
CJEM, 2010
To enhance patient safety, it is important to understand the frequency and causes of adverse even... more To enhance patient safety, it is important to understand the frequency and causes of adverse events (defined as unintended injuries related to health care management). We performed this study to describe the types and risk of adverse events in high-acuity areas of the emergency department (ED). This prospective cohort study examined the outcomes of consecutive patients who received treatment at 2 tertiary care EDs. For discharged patients, we conducted a structured telephone interview 14 days after their initial visit; for admitted patients, we reviewed the inpatient charts. Three emergency physicians independently adjudicated flagged outcomes (e.g., death, return visits to the ED) to determine whether an adverse event had occurred. We enrolled 503 patients; one-half (n = 254) were female and the median age was 57 (range 18-98) years. The majority of patients (n = 369, 73.3%) were discharged home. The most common presenting complaints were chest pain, generalized weakness and abdomi...
BMJ quality & safety, 2015
This study describes the proportion of emergency department (ED) returns within 7 days due to adv... more This study describes the proportion of emergency department (ED) returns within 7 days due to adverse events, defined as adverse outcomes related to healthcare received. Prospective cohort study. We used an electronically triggered adverse event surveillance system at a tertiary care ED from May to June 2010 to examine ED returns within 7 days of index visit. One of three trained nurses determined whether the visit was related to index emergency care. For such records, one of three trained emergency physicians conducted adverse event determinations. We determined adverse event type and severity and analysed the data with descriptive statistics, χ(2) tests and logistic regression. Of 13 495 index ED visits, 923 (6.8%) were followed by ED returns within 7 days. The median age of all patients was 47 years and 52.8% were women. After nursing review, 211 cases required physician review. Of these, 53 visits were adverse events (positive predictive value (PPV)=5.7%, 95% CI 4.4% to 7.4%) an...
Objective: To review the evidence describing practice variation in the transfusion of allogeneic ... more Objective: To review the evidence describing practice variation in the transfusion of allogeneic red blood cells as well as the risks, benefits, harms and costs associated with anemia and transfusion. Literature search and selection: Searches of MEDLINE from January 1966 to December 1996 were combined with manual searches of bibliographies and references from experts. Two reviewers examined the abstracts of citations to identify those related to clinical practice involving red blood cell transfusions. Disagreement was resolved through consensus. Literature synthesis: Selected articles were classified by study design and topic. Inferences were derived from the evidence. Results: Of the 189 articles reviewed, 78 (41%) were interventional and 111 (59%)
BMJ Open, 2014
8,9 on behalf of Pediatric Emergency Research Canada (PERC) To cite: Plint AC, Newton A, Stang A,... more 8,9 on behalf of Pediatric Emergency Research Canada (PERC) To cite: Plint AC, Newton A, Stang A, et al. How safe are our paediatric emergency departments? Protocol for a national prospective cohort study.
International Journal of Emergency Medicine, 2014
Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions rem... more Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions remain about its impact on patient care. In this study, we aimed to determine if ED crowding influenced patient triage destination and intensity of investigation, as well as rates of unscheduled returns to the ED. We focused on patients presenting with chest pain or shortness of breath, triaged as high acuity, and who were subsequently discharged home. This pilot study was a health records review of 500 patients presenting to two urban tertiary care EDs with chest pain or shortness of breath, triaged as high acuity and subsequently discharged home. Data extracted included triage time, date, treatment area, time to physician initial assessment, investigations ordered, disposition, and return ED visits within 14 days. We defined ED crowding as ED occupancy greater than 1.5. Data were analyzed using descriptive statistics and the χ(2) and Fisher exact tests. Over half of the patients, 260/500 (52.0%) presented during conditions of ED crowding. More patients were triaged to the non-monitored area of the ED during ED crowding (65/260 (25.0%) vs. 39/240 (16.3%) when not crowded, P = 0.02). During ED crowding, mean time to physician initial assessment was 132.0 minutes in the non-monitored area vs. 99.1 minutes in the monitored area, P &amp;amp;amp;amp;amp;amp;amp;lt;0.0001. When the ED was not crowded, mean time to physician initial assessment was 122.3 minutes in the non-monitored area vs. 67 minutes in the monitored area, P = 0.0003. Patients did not return to the ED more often when triaged during ED crowding: 24/260 (9.3%) vs. 29/240 (12.1%) when ED was not crowded (P = 0.31). Overall, when triaged to the non-monitored area of the ED, 44/396 (11.1%) patients returned, whereas in the monitored area 9/104 (8.7%) patients returned, P = 0.46. ED crowding conditions appeared to influence triage destination in our ED leading to longer wait times for high acuity patients. This did not appear to lead to higher rates of return ED visits amongst discharged patients in this cohort. Further research is needed to determine whether these delays lead to adverse patient outcomes.