CJEM Articles: treatment outcome

Displaying 1-4 of 4 results

  • "I never hear what happens, even if they die": a survey of emergency physicians about outcome feedback
    November 2009 11 6
    Amy C. Plint, Curtis F. Lavoie, Isabelle Gaboury, Tammy J. Clifford

    Objective: Emergency physicians (EPs) rarely find out what happens to patients after the patients leave their care, a process we call "outcome feedback." Some suggest this hin ders the practice of emergency medicine (EM); however, evi dence is lacking. We sought to evaluate EPs' perception of the current and potential role of outcome feedback in EM.

    Methods: We surveyed practising French- and English-speaking EPs from emergency departments within 100 km of Ottawa, Ont., in the provinces of Ontario and Quebec. The main outcomes included the prevalence, role and effect of outcome feedback.

    Results: Of the 297 physicians surveyed, 231 (77.8%) re spond ed. The sample contained good representation of lan guage groups, practice settings, sexes and age groups. All participants indicated that knowing outcomes is "essential" (62.6%) or "beneficial" (37.4%) to gaining experience in EM. Participants reported currently receiving passive outcome feedback in 10.0% of all cases, and seeking out (active) outcome feedback in 7.5% of all cases. The great majority of participants (97.3%) stated that they would like to re ceive more outcome feedback and believed that this would improve diagnostic accuracy (97.3%), clinical efficiency (85.5%), treatment outcomes (95.6%) and job satisfaction (95.1%). When asked to indicate "any possible negative effects that might arise from increased outcome feedback," 62.1% indicated none. However, 17.9% hypothesized nega tive emotional effects and 11.5% suggested increased time requirements.

    Conclusion: The overwhelming majority of EPs receive very little outcome feedback. Most would like more outcome feed back and believe it would improve the practice of EM.

  • Does outcome feedback make you a better emergency physician? A systematic review and research framework proposal
    November 2009 11 6
    Aviva T. Stewart, Curtis F. Lavoie, Howard Schachter, Jessie McGowan

    Objective: The organization of emergency medical care limits the ability of emergency physicians to know the outcomes of most of their patients after the patients leave the emergency department. This lack of outcome feedback may hinder the practice of emer gency medicine (EM) by preventing “calibration” of the decision tools of practitioners. We sought to determine what is currently known about outcome feedback in EM, including its incidence, impact and modifiers.

    Data source: We searched the following databases: PreMED-LINE, MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO, DARE, Health Technology Assessment Database and AMED. We performed manual searches on abstract databases, reference lists, various health information and research websites, and nonin dexed journals. Study selection: Selection entailed a 2-step screening pro cess to exclude articles not pertaining to outcome feedback in EM.

    Data extraction: Our search yielded 1128 bibliographic records, from which screening identified 7 relevant reports: 5 surveys, 1 system level evaluation and 1 intervention trial.

    Data synthesis: All studies were found to have “inadequate” or “unable to assess” reporting and study quality. Systems for out come feedback to EM residents have been increasingly available since 1984, though they are perceived to be inadequate. Com monly used mechanisms for outcome feedback include automatic routing of discharge summaries, case conferences for admitted patients and telephone calls to patients or families for discharged patients. With respect to attending emergency physicians, no con clusions or clinical recommendations can be made given the level of available evidence.

    Conclusion: The potential importance of outcome feedback remains, at this time, underevaluated. We propose a research framework, and hypothesize that increasing outcome feedback would increase emergency physician diagnostic accuracy, therapeutic outcomes, clinical efficiency and job satisfaction. Future research in this area should include surveys and focus groups, as well as simulated or real-world intervention trials.

  • No news is bad news
    November 2009 11 6
    Curtis F. Lavoie
  • Type I Monteggia lesion and associated fracture of the distal radius and ulna metaphysis in a child
    September 2007 9 5
    Noel Peter, Sein Myint

    We report a rare case of a type I Monteggia lesion with an associated fracture of the distal radius and ulna metaphysis in a child. We discuss the mechanism of injury and the importance of thorough clinical examination in childhood injuries.