CJEM
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The most widely used prehospital strategy for the management of hemorrhagic shock or trauma accompanied by hypotension is fluid resuscitation. Though current guidelines suggest early and aggressive fluid resuscitation, contemporary literature suggests a more restrictive approach. Our objective was to evaluate the effectiveness of low/ no IV fluids in comparison to standard resuscitation in reducing mortality for trauma patients in the prehospital setting. ⋯ Weak, primarily observational evidence suggests that standard fluid resuscitation has no significant mortality benefit over restricting/withholding IV fluids in severe/hypotensive trauma. This review adds evidence to questioning the requirement for IV fluids in trauma given the lack of mortality benefit, in addition to demonstrating the need for more randomized studies in this area.
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Multicenter Study
Agreement and prognostic accuracy of three ED vulnerability screeners: findings from a prospective multi-site cohort study.
To evaluate the agreement between three emergency department (ED) vulnerability screeners, including the InterRAI ED Screener, ER2, and PRISMA-7. Our secondary objective was to evaluate the discriminative accuracy of screeners in predicting discharge home and extended ED lengths-of-stay (> 24 h). ⋯ ED vulnerability scores from the three instruments had a fair agreement and were associated with important patient outcomes. The interRAI ED Screener best identifies older ED patients at greatest risk, while the PRISMA-7 and ER2 are more sensitive instruments.
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Multicenter Study
The multicenter impacts of an emergency physician lead on departmental flow and provider experiences.
Emergency department (ED) flow impacts patient safety, quality of care and ED provider satisfaction. Throughput interventions have been shown to improve flow, yet few studies have reported the impact of ED physician leadership roles on patient flow and provider experiences. The study objective was to evaluate the impacts of the emergency physician lead role on ED flow metrics and provider experiences. ⋯ In this study, the emergency physician lead impacted ED flow metrics variably at different sites, but important learnings from provider experiences can guide future emergency physician lead implementation.
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The objectives of this project were to collect and analyze clinical governance documents related to family-centred care and cardiac arrest care in Canadian EMS organizations; and to improve the family-centredness of out-of-hospital cardiac arrest care through experience-based co-design. ⋯ There were few directives to support family-centred care by Canadian EMS organizations. A family-centred out-of-hospital cardiac arrest care policy and procedure template was developed using experience-based co-design to assist EMS organizations improve the family-centredness of out-of-hospital cardiac arrest care.
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Pressures related to the COVID-19 pandemic have created the need to develop innovative ways to deliver mental health care, especially for urgent needs. After the launch of a pediatric Emergency Department (ED) Virtual Care service, we aimed to evaluate pediatric ED physicians' experiences with the use of ED virtual care for mental health assessments. ⋯ While many physicians agreed that there is a potential benefit of the ED virtual care platform for urgent mental health assessments, time constraints and lack of confidence in providing satisfactory virtual mental health care with minimal mental health support limited its acceptability. These findings can inform the future implementation of mental health services using an innovative virtual ED platform.