CJEM Articles: Xiaoqing Xue
Displaying 1-3 of 3 results
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July
2010
12
4
Antoinette Colacone, Bernard Unger, Eddy Lang, Eli Segal, Eric Grafstein, Jean François Boivin, Marc Afilalo, Michael Bullard, Michael Schull, Nathalie Soucy, Xiaoqing Xue
Objective: Managers of emergency departments (EDs), governments and researchers would benefit from reliable data sets that characterize use of EDs. Although Canadian ED lists for chief complaints and triage acuity exist, no such list exists for diagnosis classification. This study was aimed at developing a standardized Canadian Emergency Department Diagnosis Shortlist (CED-DxS), as a subset of the full International Classification of Diseases, 10th revision, with Canadian Enhancement (ICD-10-CA).
Methods: Emergency physicians from across Canada participated in the revision of the ICD-10-CA through 2 rounds of the modified Delphi method. We randomly assigned chapters from the ICD-10-CA (approximately 3000 diagnoses) to reviewers, who rated the importance of including each diagnosis in the EDspecific diagnosis list. If 80% or more of the reviewers agreed on the importance of a diagnosis, it was retained for the final revision. The retained diagnoses were further aggregated and adjusted, thus creating the CED-DxS.
Results: Of the 83 reviewers, 76% were emergency medicine (EM)–trained physicians with an average of 12 years of experience in EM, and 92% were affiliated with a university teaching hospital. The modified Delphi process and further adjustments resulted in the creation of the CED-DxS, containing 837 items. The chapter with the largest number of retained diagnoses was injury and poisoning (n = 292), followed by gastrointestinal (n = 59), musculoskeletal (n = 55) and infectious disease (n = 42). Chapters with the lowest number retained were neoplasm (n = 18) and pregnancy (n = 12).
Conclusion: We report the creation of the uniform CED-DxS, tailored for Canadian EDs. The addition of ED diagnoses to existing standardized parameters for the ED will contribute to homogeneity of data across the country.
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March
2007
9
2
Alain Vandal, Antoinette Colacone, Bernard Unger, Eddy Lang, Jean-François Boivin, Marc Afilalo, Nathalie Soucy, Ruth Léger, Xiaoqing Xue
Objective: It has been suggested that continuity of care is hampered because of the lack of communication between emergency departments (EDs) and primary care providers. A web-based, standardized communication system (SCS) that enables family physicians (FPs) to visualize information regarding their patients' ED visits was developed. This paper aims to evaluate the impact of this SCS on continuity of care.
Methods: We conducted an open, 4-period crossover, cluster-randomized controlled trial of 23 FP practices. During the intervention phase, FPs received detailed reports via SCS, while in the control phase they received mailed copies of the ED notes. Continuity of care was evaluated with a web questionnaire completed by FPs 21 days after the ED visit. The primary measures of continuity of care were knowledge of ED visit (quality and quantity), patient management and follow-up rate.
Results: We analyzed a total of 2022 ED visits (1048 intervention and 974 control). The intervention group received information regarding the ED visit more often (odds ratio [OR] 3.14, 95% confidence interval [CI] 2.6-3.79), found the information more useful (OR 5.1, 95% CI 3.49-7.46), possessed a better knowledge of the ED visit (OR 6.28, 95% CI 5.12-7.71), felt they could better manage patients (OR 2.46, 95% CI 2.02-2.99) and initiated actions more often following receipt of information (OR 1.62, 95% CI 1.36-1.93). However, there was no significant difference in the follow-up rate at FPs offices (OR 1.25, 95% CI 0.97-1.61).
Conclusion: The use of SCS between an ED and FPs led to significant improvements in continuity of care by increasing the usefulness of transferred information and by improving FPs' perceived patient knowledge and patient management.
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September
2004
6
5
Danielle Blouin, François Dufresne, Marc Afilalo, Xiaoqing Xue
Objective: Acetylsalicylic acid (ASA) is a simple and cost-effective treatment for acute coronary syndromes (ACS). Our objectives were to determine the frequency of ASA administration in the emergency department (ED) for patients with acute myocardial infarction or unstable angina, and to identify patient characteristics associated with its administration.
Methods: This is a retrospective chart review of patients discharged with a final diagnosis of ACS. Data on age, gender, mode of presentation, presence of chest pain at triage, administration of ASA or not in the ED, dosage and form of ASA received, timing of administration, presence of contraindications to ASA and use of regular ASA prior to ED presentation were recorded.
Results: Six hundred and one charts were analyzed. Five hundred and fifty patients (91.5%) received ASA. Only 444 (73.9%) of these 550 patients were administered the ASA appropriately, according to the American Heart Association / American College of Cardiology (AHA/ACC) guidelines. Univariate analysis showed that chart notes "Transport by ambulance," "Allergy to ASA" and "Gastrointestinal bleed" were associated with a lower probability of the patient being administered ASA. If a patient was noted as taking ASA regularly, it increased the chance of this patient being administered ASA in the ED.
Conclusion: Although the study ED performed well, administering ASA to 91.5% of patients with ACS, only 73.9% of the patients who received ASA were administered the ASA appropriately, as recommended in the AHA/ACC guidelines. Educational strategies and system changes are necessary to increase the proportion of eligible ACS patients who receive appropriate ASA therapy.
