CJEM Articles: survey
Displaying 1-10 of 11 results
ALaRMED: adverse events in low-risk chest pain patients receiving continuous ECG monitoring in the emergency department: a survey of Canadian emergency physiciansSeptember 2008 10 5Clare L. Atzema, Michael J. Schull
Objective: Current guidelines suggest that most patients who present to an emergency department (ED) with chest pain should be placed on a continuous electrocardiographic monitoring (CEM) device. We surveyed emergency physicians to determine their perception of current occupancy rates of CEM and to assess their attitudes toward prescribing monitors for low-risk chest pain patients in the ED.
Methods: We conducted a cross-sectional, self-administered Internet and mail survey of a random sample of 300 members of the Canadian Association of Emergency Physicians. Main outcome measures included the perceived frequency of fully occupied monitors in the ED and physicians' willingness to forgo CEM in certain chest pain patients.
Results: The response rate was 66% (199 respondents). The largest group of respondents (43%; 95% confidence interval [CI] 36%-50%) indicated that monitors were fully occupied 90%-100% of the time during their most recent ED shift. When asked how often they were forced to choose a patient for monitor removal because of the limited number of monitors, 52% (95% CI 45%-60%) of respondents selected 1-3 times per shift. Ninety percent (95% CI 84%-93%) of respondents indicated that they would forgo CEM in certain cardiac chest pain patients if there was good evidence that the risk of a monitor-detected adverse event was very low.
Conclusion: Emergency physicians report that monitors are often fully occupied in Canadian EDs, and most are willing to forgo CEM in certain chest pain patients. A large prospective study of CEM in low-risk chest pain patients is warranted.
Denise Watt, Hude Quan, Timothy Cooke, William Wertzler
Objectives: To explore emergency department (ED) patient expectations regarding staff communication with patients, wait times, the triage process and information management.
Methods: We conducted a cross-sectional English-language telephone survey among patients aged 18 years or older who visited the EDs in the Calgary Health Region in 2002. Survey items were based on a preceding qualitative study.
Results: Of the 941 surveys, 837 were analyzed. Patients placed the highest importance on the explanation of test results (96.5%), a description of circumstances that would require the patient to return to the ED (94.4%), the use of plain language (92.1%) and the reason for the tests (90.8%). Seventy-six percent of patients felt that ED staff should update patients every 30 minutes or less, 51.3% expected patients with non-life threatening problems should wait <1 hour, and 58.3% expected that the tests should be done within 1 hour. Almost two-thirds of the patients (64.4%) believed that the most serious patients should be seen first; 59.3% felt that the seriousness of medical concern should be determined by a triage nurse, and 63.9% thought that their personal health records should be immediately available to the emergency physician without their consent. The actual length of stay was significantly longer than expected length of stay for all patient groups, with Canadian Emergency Department Triage and Acuity Scale Levels IV and V patients expecting a shorter wait than patients in more urgent triage groups. Triage level effects on other expectations were not observed.
Conclusions: ED patient expectations appear to be similar across all triage levels. Patients value effective communication and short wait times over many other aspects of care. They have expectations for short wait times that are met infrequently and are currently unattainable in many Canadian EDs. Although it may be neither feasible nor desirable to meet all patient expectations, increased focus on wait times and staff communication may increase both ED efficiency and patient satisfaction.
A survey of one CCFP-EM program's graduates: their background, intended type of practice and actual practiceSeptember 2005 7 5Julia K. Burden, Lisa G. Shepherd
Objectives: Our primary objective was to survey the graduates of one residency program with respect to anticipated versus actual medical practice.
Methods: Using a modified Dillman technique, we surveyed all 83 physicians who had completed one year of residency training that led to certification of special competency in Emergency Medicine (CCFP-EM) at the University of Western Ontario (UWO) from 1982-2004. Respondents were asked what type of medicine they had thought they would practise before beginning their emergency medicine training. They were then asked to describe their employment from graduation to present time. Additional demographic information was collected. Correlation between demographic factors and other selected factors of influence upon career decisions was analyzed.
Results: Our response rate was 87% (72/83), with 71% (51/72) respondents being male. At the start of their CCFP-EM residency training, 50% of respondents intended to practise emergency medicine exclusively and 47% intended to blend family and emergency medicine. For each of the respondents' first 4 positions of employment, the greatest percentage were practising emergency medicine only (ranging from 72% in position 1 to 53% in position 4), while the number engaging in a blended family/emergency medicine practice never exceeded 20%. No demographic factors surveyed had significant correlation with intended or actual practice. In all positions of employment, "type of practice" was ranked as the most influential factor in choosing that position.
Conclusion: Most graduates of the UWO CCFP-EM program practise in emergency medicine only positions. Less than 20% are engaged in a blended family/emergency medicine practice. At training onset, one-half of the residents intended to practise emergency medicine exclusively. None of the demographic factors surveyed significantly correlated with intended or actual practice. Further examination of the practice patterns of all emergency medicine residency program graduates is an essential part of future planning for the specialty of Emergency Medicine in Canada.
Maintaining continuity of care: a look at the quality of communication between Ontario emergency departments and community physiciansMay 2005 7 3Alan J. Forster, Andrew P. Stiell, Carl van Walraven, Ian G. Stiell
Background: To maintain continuity of care when a patient's care is transferred between physicians, continuity of patient information is required. This survey determined how, and how well, Ontario emergency departments (EDs) communicate patient information to physicians in the community.
Methods: We surveyed Ontario ED chiefs to determine the most common media and methods used for disseminating information. We measured the perceived quality of their system, which was regressed against the hospital teaching status and community size using generalized logits modelling. Finally, we elicited the components of an ideal communication system for the ED.
Results: One hundred and forty-three (85.6%) Ontario ED chiefs participated. The ED record of treatment was the most commonly used medium (95%). Postal service was the most common (55%) method of disseminating information. Thirty-three chiefs (23%) perceived the quality of communicating patient information from their ED as unsatisfactory or inadequate. This perception was significantly more prevalent in larger communities (excellent v. unsatisfactory [odds ratio (OR) 44.9, 95% confidence interval (CI) 13.9-140] and satisfactory v. unsatisfactory [OR 2.9, 95% CI 1.6-5.1]) and in teaching hospitals (satisfactory v. unsatisfactory [OR 9.7, 95% CI 4.7-20.3]). Seventy-eight percent of responding chiefs felt that patient information should be disseminated using electronic means, either through email or server access.
Conclusions: To communicate patient information to community physicians, Ontario ED chiefs report that a copy of the ED record of treatment is sent by postal service. More than one-fifth of ED chiefs perceived communication from their department as unsatisfactory or inadequate. Studies that assess the completeness and accuracy of the record of treatment are required as a first step for measuring the quality of patient information communication in the Ontario ED system.
Influenza vaccination rate among emergency department personnel: a survey of four teaching hospitalsJanuary 2005 7 1Inderpal Saluja, Janusz Kaczorowski, Karl D. Theakston
Objectives: To determine influenza vaccination rates and attitudes toward vaccination among emergency department health care workers at 4 Ontario teaching hospitals.
Methods: During the influenza season of 1999-2000 a confidential 28-item survey was distributed to emergency physicians and residents, nurses, respiratory therapists, and other allied health care workers at the emergency departments of 4 London, Ontario teaching hospitals.
Results: Of 426 surveys distributed, 343 were returned, for an overall response rate of 80.5%. The mean age of respondents was 38.5 years (standard deviation = 8.3), 74.3% were female, and 86.6% were non-smokers. The overall vaccination rate was 37.0% (95% confidence interval, 31.9%-42.4%). Vaccination rates were 45.9% for respiratory therapists, 35.3% for emergency physicians and residents, 34.5% for nurses and 27.1% for other allied health care workers (p = 0.083). Multivariate logistic regression analysis revealed that age ≥41 and a chronic medical condition were positively associated with influenza vaccination (p < 0.05). Close to one-third of respondents (28.3%) believed that adverse affects were common, 51.6% believed vaccination was effective, 52% would support a program to improve vaccination rates among emergency department staff, and 24.4% would support mandatory vaccination for this population. Only 26.8% believed that patients were at increased risk of contracting influenza from emergency department staff, but 58.3% perceived that emergency department staff were at increased risk of contracting influenza through exposure to patients.
Conclusions: In this study, only 37% of emergency department health care workers were immunized against influenza, with chronic illness and older age being the only 2 significant correlates. Strategies to improve emergency department health care worker attitudes toward influenza vaccination for themselves and to increase vaccination rates for this population should be developed.
Ian Stiell, Lisa Calder, Sowmya Balasubramanian
Objectives: Our objective was to determine the practice patterns of Canadian emergency physicians with respect to the management of traumatic corneal abrasions.
Methods: 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.
Results: 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.
Conclusions: 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.
Attitude of emergency department patients with minor problems to being treated by a nurse practitionerJuly 2004 6 4Catherina A. van Beek, Meite S. Moser, Riyad B. Abu-Laban
Introduction: It may be appropriate for nurse practitioners (NPs) to provide care for a subset of emergency department (ED) patients with non-urgent problems. Our objective was to determine the attitude of ED patients with minor problems to being treated by an NP.
Methods: Consecutive adults who presented to this tertiary ED on weekdays between 8 am and 4 pm were eligible for the study if they had 1 of the following 18 complaints: minor abrasions or lacerations, minor bites, minor burns, minor extremity trauma, cast check, earache, superficial foreign body, lice or pinworms, morning-after pill request, needlestick injury or body-fluid exposure, prescription refill, puncture wound, sore throat, subconjunctival hemorrhage, suture removal or wound check, tetanus immunization request, toothache, or urinary tract infection (women). Unless pain or a language barrier precluded study involvement, a triage nurse gave each patient a brief survey to be completed prior to physician assessment.
Results: Of 728 eligible patients during the study period, 246 (34%) were invited to participate and 213 (87%) were enrolled. The mean age was 34.5 years, and 58% were men. When asked about their willingness to be treated by an NP, 72.5% said "yes" (95% confidence interval [CI], 65.8%
-78.4%), 15.5% were "uncertain" (95% CI, 10.8%
-21.1%) and 12.1% said "no" (95% CI, 8.0%
-17.3%). Of those who said "yes," 21% expected to also see an emergency physician during their ED visit and 67% did not. Willingness to be treated by an NP was independent of age, gender or educational status.
Conclusions: A majority of ED patients with minor problems accepted being treated by an NP, often without additional physician assessment. Several factors, including impact on ED staffing and patient flow, logistics, cost and quality of care should be evaluated before implementing such strategies.
Emergency physicians' attitudes toward a clinical prediction rule for the identification and early discharge of low risk patients with chest discomfortApril 2001 3 2Cameron K. MacGougan, Grant D. Innes, James M. Christenson, Janet Raboud
Objectives: To determine Canadian emergency physicians' estimates regarding the safety and efficiency of chest discomfort management in their emergency department (ED), and their attitudes toward and perception of the need for a chest discomfort clinical prediction rule that identifies very low risk patients who are safe to discharge after a brief ED assessment.
Methods: 300 members of the Canadian Association of Emergency Physicians (CAEP) were randomly selected to receive a confidential mail survey, which invited them to provide information on current disposition of patients with chest discomfort and their opinions regarding the value of a clinical prediction rule to identify patients with chest discomfort who are safe to discharge after a brief (~2 hour) assessment.
Results: Of the 300 physicians selected, 288 were eligible for the survey and 235 (82%) responded. Only 5% follow discharged patients to measure safe practice. Overall, 165 (70%) felt the proposed prediction rule would be very useful and 43 (18%) felt it would be useful. Almost all (94%) believed a prediction rule would be useful if it identified patients safe for discharge without increasing the current rate of missed acute myocardial infarction (estimated at 2%). Most respondents (59%) believed that a clinical prediction rule should suggest a course of action, while 30% felt it should convey a probability of disease.
Conclusions: Canadian emergency physicians support the concept of a clinical prediction rule for the early discharge of patients with chest discomfort. Most believe that such a rule would be useful if it identified patients who are safe for discharge after a brief assessment, while maintaining current levels of safety. Future research should be aimed at deriving a clinical prediction rule to identify low risk patients who can be safely discharged after a limited emergency department evaluation.
David Han, Garth Dickinson, Jeffrey L. Arnold, Ming-Che Tsai
Objective: To assess the current level of development of emergency medicine (EM) systems in the world.
Design: Survey of EM professionals from 36 countries during a 90-day period from Aug. 25 to Nov. 24, 1998.
Participants: Thirty-six EM professionals from 36 countries and 6 continents completed the survey. Thirty-five (97%) were physicians, of whom 25 (69%) gave presentations at 1 of 4 international EM conferences during the study period. Three potential participants from 3 countries were excluded because of language barriers. Five additional participants from 5 other countries did not respond within the study period and were excluded.
Measurements: Respondents completed a 103-question questionnaire about the presence of EM specialty, academic, patient care, information and management systems and the factors influencing the future of EM in their countries.
Results: The overall response rate was 88%. Nearly all respondents (97%) stated that their countries had hospital-based emergency departments (EDs). More than 80% of respondents reported that their countries have emergency medical services (EMS), national EMS activation phone numbers and ED systems for pediatric emergency care. More than 70% stated that their countries had national EM organizations, EM research, ED systems for patient transfer and peer review and emergency physician (EP) training in Advanced Cardiac Life Support (ACLS) and the ability to perform rapid sequence intubation. More than 60% reported ED systems for trauma care and triage and EP training in Advanced Trauma Life Support (ATLS) and the ability to perform thrombolysis for acute myocardial infarction. Fifty percent reported EM residency training programs, official recognition of EM as an independent specialty, and EM journals.
Conclusions: Basic emergency medicine components now exist in the majority of countries
surveyed. These include many specialty, academic, patient care and administrative systems. The foundation for further EM development is widely established throughout the world.