scholarly journals P071: Emergency physician attitudes and perceived barriers to take-home naloxone programs in Canadian emergency departments

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S102-S102
Author(s):  
L. Lacroix ◽  
I.G. Stiell ◽  
L. Thurgur ◽  
A. Orkin
Keyword(s):  
At Risk ◽  
Emergency Physician ◽  
Emergency Departments ◽  
Allied Health ◽  
Physician Attitudes ◽  
Perceived Barriers ◽  
Opioid Overdose ◽  
Emergency Physicians ◽  
Canadian Association ◽  
Health Support

Introduction: Unintentional overdose is the leading cause of injurious death among Americans aged 25-64 years. A similar epidemic is underway in Canada. Community-based opioid overdose education and naloxone distribution (OOEND) programs distribute take-home naloxone kits to people at risk of overdose in several cities across Canada. Due to the high rate of drug-related visits, recurrent opioid prescribing, and routine encounters with opioid overdose, Emergency Departments (ED) may represent an under-utilized setting to deliver naloxone to people at risk of opioid overdose or likely to witness overdose. The goal of this study was to identify Canadian emergency physician attitudes and perceived barriers to the implementation of take-home naloxone programs. Methods: This was an anonymous web-based survey of physician and trainee members of the Canadian Association of Emergency Physicians. Survey questions were developed by the research team and piloted for face validity and clarity. Two reminder emails were sent to non-responders at 2-week intervals, per the modified Dillman method. Respondent demographics were collected and Likert scales used to assess attitudes and barriers to the prescription of naloxone from the ED. Results: A total of 347/1658 CAEP members responded (20.9%). Of the respondents, 62.1% were male and residents made up 15.6%. The majority (48.2%) worked in Ontario and 55.7% worked in an urban tertiary centre. Overall attitudes to OOEND were strongly positive: 86.6% of respondents identified a willingness to prescribe naloxone from the ED. Perceived barriers included allied health support for patient education (56.4%), access to follow-up (40.3%), and inadequate time in the clinical encounter (37.7%). In addition to people at risk of overdose, 78% of respondents identified that friends and family members may benefit from OOEND programs. Conclusion: Canadian emergency physicians are willing to prescribe take-home naloxone to at-risk patients, but better systems and tools are required to facilitate opioid overdose education and naloxone distribution implementation. This data will inform the development of these programs, with emphasis on allied health support, training and education.

scholarly journals Emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments

CJEM ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Lauren Lacroix ◽  
Lisa Thurgur ◽  
Aaron M. Orkin ◽  
Jeffrey J. Perry ◽  
Ian G. Stiell
Keyword(s):  
At Risk ◽  
Perceived Barriers ◽  
Face Validity ◽  
Opioid Overdose ◽  
Emergency Physicians ◽  
Web Based ◽  
Health Crisis ◽  
Canadian Association ◽  
National Public Health

AbstractObjectivesRates of opioid-related deaths have reached the level of national public health crisis in Canada. Community-based opioid overdose education and naloxone distribution (OEND) programs distribute naloxone to people at risk, and the emergency department (ED) may be an underutilized setting to deliver naloxone to these people. The goal of this study was to identify Canadian emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs.MethodsThis was an anonymous Web-based survey of members of the Canadian Association of Emergency Physicians. Survey questions were developed by the research team and piloted for face validity and clarity. Two reminder emails were sent to non-responders at 2-week intervals. Respondent demographics were collected, and Likert scales were used to assess attitudes and barriers to the prescription of naloxone from the ED.ResultsA total of 459 physicians responded. The majority of respondents were male (64%), worked in urban tertiary centres (58.3%), and lived in Ontario (50.6%). Overall, attitudes to OEND were strongly positive; 86% identified a willingness to prescribe naloxone from the ED. Perceived barriers included support for patient education (57%), access to follow-up (44%), and inadequate time (37%). In addition to people at risk of overdose, 77% of respondents identified that friends and family members may also benefit.ConclusionsCanadian emergency physicians are willing to distribute take-home naloxone, but thoughtful systems are required to facilitate opioid OEND implementation. These data will inform the development of these programs, with emphasis on multidisciplinary training and education.

scholarly journals Building and strengthening relationships between academic departments/divisions of emergency medicine and rural and regional emergency departments

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 595-599 ◽  
Author(s):  
Aaron Johnston ◽  
Kylie Booth ◽  
Jim Christenson ◽  
David Fu ◽  
Shirley Lee ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Emergency Departments ◽  
Academic Departments ◽  
List Type ◽  
Emergency Physicians ◽  
Common Value ◽  
Rural And Urban ◽  
Canadian Association ◽  
Rural Physicians ◽  
Training Opportunities

ABSTRACTObjectivesMake recommendations on approaches to building and strengthening relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.MethodsA panel of leaders from both rural and urban/academic practice environments met over 8 months. Draft recommendations were developed from panel expertise as well as survey data and presented at the 2018 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. Symposium feedback was incorporated into final recommendations.ResultsSeven recommendations emerged and are summarized below: 1)CAEP should ensure engagement with other rural stakeholder organizations such as the College of Family Physicians of Canada and the Society of Rural Physicians of Canada.2)Engagement efforts require adequate financial and manpower resources.3)Training opportunities should be promoted.4)The current operational interface between the academic department of Emergency Medicine and the emergency departments in the catchment area must be examined and gaps addressed as part of building and strengthening relationships.5)Initial engagement efforts should be around projects with common value.6)Academic Departments should partner with and support rural scholars.7)Academic departments seeking to build or strengthen relationships should consider successful examples from elsewhere in the country as well as considering local culture and challenges.ConclusionThese recommendations serve as guidance for building and strengthening mutually beneficial relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.

Cardioversion of uncomplicated paroxysmal atrial fibrillation: a survey of practice by Canadian emergency physicians

CJEM ◽  
2004 ◽  
Vol 6 (03) ◽  
pp. 155-160 ◽  
Author(s):  
Bjug Borgundvaag ◽  
Howard Ovens
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Paroxysmal Atrial Fibrillation ◽  
Emergency Departments ◽  
Practice Patterns ◽  
High Volume ◽  
Electrical Cardioversion ◽  
Emergency Physicians ◽  
Optimal Care ◽  
Canadian Association

ABSTRACT Objective: Paroxysmal atrial fibrillation (PAF) is the rhythm disturbance most commonly encountered by emergency physicians, yet the role played by emergency physicians in the management of this condition has not been well described. The purpose of this study was to describe the management of uncomplicated PAF by Canadian emergency physicians. Methods: All members of the Canadian Association of Emergency Physicians with a Canadian address (n = 1255) were mailed a 15-point questionnaire regarding training/certification, hospital demographics and practice patterns regarding the management of uncomplicated PAF. Chisquared analysis and Fisher’s Exact test were performed to identify significant differences in reported practice patterns in relation to demographic variables. Significant associations were tested for interaction using the Mantel–Haenszel test. Results: We received 663 responses, representing a 52.8% response rate. Six hundred and twenty-two (95%), 514 (78%) and 242 (38%) respondents reported routine performance of rate control, chemical cardioversion and electrical cardioversion respectively. Physicians working in high-volume emergency departments (>50 000 visits/yr) were significantly more likely to self-manage rate control and chemical/electrical cardioversion than those working in lower volume emergency departments. Residency training was associated with higher performance of electrical (44% v. 31%, p < 0.01) but not chemical cardioversion or rate control, although, amongst residency trained physicians, those with FRCP-level training were significantly more likely to perform both chemical (86% v. 76%, p < 0.05) and electrical (57% v. 37%, p < 0.01) cardioversion. Conclusion: Canadian emergency physicians surveyed in this study actively manage uncomplicated PAF. We found significant variations in practice, especially related to the use of electrical cardioversion. This may reflect different practice environments, levels of training, and lack of evidence to guide best practice. Further research is required to determine the optimal care of PAF in the emergency department setting.

scholarly journals Understanding Steps and Challenges to Take-home Naloxone and Buprenorphine/naloxone Implementation in Québec Emergency Rooms: Suboxed Project

2020 ◽  
Author(s):  
Annie Talbot ◽  
Rania Khemiri ◽  
Luc Londei-Leduc ◽  
Christine Robin ◽  
Suzanne Marcotte ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Departments ◽  
Governance Structure ◽  
The United States ◽  
Opioid Overdose ◽  
Drug Supply ◽  
Emergency Rooms ◽  
Opioid Agonist ◽  
Clinical Algorithm ◽  
Opioid Agonist Treatment

Abstract BackgroundDeaths attributable to drug abuse are on the rise across Canada. It is estimated that there were more than 13,900 opioid-related deaths from January 2016 to June 2019 in the country. Emergency departments (EDs) are often on the frontline of care provided to people at risk of opioid overdose within Québec’s healthcare system. A variety of programs to implement take-home naloxone distribution and/or the provision of opioid agonist treatment for ED patients who are at risk for overdose have been created in the United States and in Europe. However, few EDs in Canada have developed protocols for the provision of take-home naloxone and/or opioid agonist treatment by ED doctors.MethodsA clinical algorithm for take home naloxone (THN) and prescription of buprenorphine/naloxone (B/N) was implemented in three EDs of Québec, Canada. This first phase of the SuboxED project required selecting clinical experts, describing the patient population, and creating partnerships with pharmacists and opioid agonist treatment clinics.Results:The clinical experts developed tools based on literature reviews and national and international guidelines. They also created educational tools and trained over 328 ED clinical staff. In addition, SuboxED ensured that a supply of take-home naloxone and B/n was available in the three ED sites for the study.ConclusionImplementing the proposed clinical algorithm for THN and prescription of B/N was challenging: drug supply and ED staff’s buy-in were among the most notable difficulties of SuboxED. Planning training sessions at three different institutions, each with its own governance structure and clinical culture, local realities and harm reduction priorities was complicated. Engaging already overworked ED teams consistently working in a gridlocked environments, revealed in itself to be a difficult endeavour.In the next phase of SuboxED, we will focus on data collection and analysis to evaluate both the implementation of the protocol through a retrospective review of electronic health records and satisfaction surveys of patients and healthcare professionals.Trial registration: noneContribution to the literatureIn the midst of the opioid overdose crisis, initiating a clinical algorithm for take-home naloxone and prescription of B/n in three operationally different Canadian emergency departments was feasible.Implementing a clinical algorithm for take-home naloxone and prescription of B/n is challenging; significant barriers involve drug supply, ED staff buy-in, training, engaging already overworked ED team.

31. The birth of a new specialty: The history of emergency medicine in Canada

2007 ◽  
Vol 30 (4) ◽  
pp. 44 ◽  
Author(s):  
R. Elyas
Keyword(s):  
Emergency Medicine ◽  
Royal College ◽  
Emergency Departments ◽  
Clinical Medicine ◽  
Task Force ◽  
Family Physicians ◽  
Care Providers ◽  
Emergency Physicians ◽  
Canadian Association ◽  
History Of

Modern day emergency rooms across Canada have almost completely transformed over the past 30 years; perhaps more so than any other specialty. Before the 1970’s, it was primarily general practitioners working on a part-time basis who ran our emergency departments. Some hospitals used interns and residents as first-line emergency care providers, often under the direction of a surgeon or internist. Emergency Medicine has evolved into a highly sophisticated and respected medical specialty that extends beyond clinical medicine, into both research and academia. The appeal of Emergency Medicine is so great that it is now one of the most sought after specialties in the annual CaRMS match. The success story of Emergency Medicine is characterized by the tireless efforts and determination of its founders across the country. They fought for adequate and supervised care of the acutely ill or traumatized patient, believing in a special body of knowledge that should be available to physicians who spend most, if not all, their time in Emergency Departments. In 1977, these founders formally united and The Canadian Association of Emergency Physicians was born. A few years later, in 1980, Emergency Medicine was finally designated as a free-standing specialty by the Royal College of Physicians and Surgeons of Canada. Meanwhile, the College of Family Physicians of Canada also sought to establish a parallel route for Emergency Training of Family Physicians, feeling that Emergency Medicine lay within the realm of Family Medicine. The result was that both colleges established Emergency Medicine training programs that exist until this day. Using journals, archives, a survey, and interviews, the paper will trace the history of the professionalization of Emergency Medicine in Canada. Johnson R. The Canadian Association of Emergency Physicians. The Journal of Emergency Medicine 1993; 11:362-364. Reudy J, Seaton T, Walker D, Rowat B, Cassie J. Report of the Task Force on Emergency Medicine: RCPSC Accreditation Section, 1988. Walker DMC. History and Development of the Royal College Specialty of Emergency Medicine. Annals Royal College of Physicians and Surgeons of Canada 1987; 20:349-352.

The panoramic dental radiograph for emergency physicians

2019 ◽  
Vol 36 (9) ◽  
pp. 565-571 ◽  
Author(s):  
Anton Sklavos ◽  
Daniel Beteramia ◽  
Seth Navinda Delpachitra ◽  
Ricky Kumar
Keyword(s):  
Diagnostic Tool ◽  
Emergency Physician ◽  
Emergency Departments ◽  
Patient Management ◽  
Panoramic Radiograph ◽  
Emergency Setting ◽  
Emergency Physicians ◽  
Hospital Emergency ◽  
Odontogenic Infections ◽  
Hospital Emergency Departments

Dental emergencies are common reasons for presenting to hospital emergency departments. Here, we discuss the panoramic radiograph (orthopantomogram (OPG, OPT) as a diagnostic tool for the assessment of mandibular trauma and odontogenic infections. In this article, we review the radiographic principles of image acquisition, and how to conduct a systematic interpretation of represented maxillofacial anatomy. The aim is to equip the emergency physician with the skills to use the OPG radiograph when available, and to rapidly assess the image to expedite patient management. Included is a discussion of a number of cases seen in the emergency setting and some common errors in diagnosis.

scholarly journals PHArmacists’ perspective oN the Take hOme naloxone prograM (The PHANTOM Study)

2017 ◽  
Vol 150 (4) ◽  
pp. 259-268 ◽  
Author(s):  
Jenny Edwards ◽  
Duane Bates ◽  
Brett Edwards ◽  
Sunita Ghosh ◽  
Mark Yarema
Keyword(s):  
At Risk ◽  
Online Survey ◽  
Large Population ◽  
Perceived Barriers ◽  
Opioid Overdose ◽  
Full Time ◽  
Willingness To Participate ◽  
Survey Response Rate ◽  
Positive Attitudes ◽  
Barriers To Implementation

Objective: To evaluate pharmacists’ attitudes toward the Take Home Naloxone (THN) program and identify areas that could be improved to support pharmacists’ involvement. Methods: Pharmacists on the Alberta College of Pharmacists’ directory were invited to complete an online survey between July 10 and August 8, 2016. The survey consisted of 19 questions. Descriptive statistics were used to analyze the data. Results: Four hundred seventy pharmacists completed the survey (response rate = 11.2%). A total of 76.8% of respondents strongly agreed or agreed that pharmacists should be screening patients to identify those at risk of opioid overdose. Full-time pharmacists were more likely to agree ( p = 0.02). A total of 79.8% of respondents strongly agreed or agreed that pharmacists should be recommending THN kits. Pharmacists working in large population centres ( p = 0.008) and full-time pharmacists ( p = 0.02) were more likely to agree with this statement. Furthermore, 60.6% of pharmacists were extremely willing or very willing to participate in the THN program. Pharmacists in practice for ≤15 years were more willing to participate in the THN program than pharmacists in practice >15 years ( p = 0.03). The most common perceived barriers to implementation of the THN program were lack of time in pharmacists’ current work environment and education about the program. Conclusions: Overall, pharmacists had positive attitudes toward screening patients to identify those at risk of opioid overdose, recommending THN kits and willingness to participate in the program. Factors that may facilitate increased participation in the program include addressing time issues and improving education about the THN program.

scholarly journals Emergency Department Management of Heart Failure and COPD: A National Survey of Attitudes and Practice

CJEM ◽  
2016 ◽  
Vol 18 (6) ◽  
pp. 429-436 ◽  
Author(s):  
Michael K.P. Hale ◽  
Ian G. Stiell ◽  
Catherine M. Clement
Keyword(s):  
Heart Failure ◽  
Outcome Measures ◽  
Physician Attitudes ◽  
Secondary Outcome ◽  
Emergency Physicians ◽  
Medical Risk ◽  
Canadian Association ◽  
Emergency Department Management ◽  
Physician Rating ◽  
Risk Scale

AbstractObjectivesThe Ottawa Heart Failure Risk Scale (OHFRS) and the Ottawa COPD Risk Scale (OCRS) were developed in order to estimate medical risk and to help guide disposition decisions for patients presenting to the ED with acute exacerbations of heart failure (HF) and COPD. We sought to determine physician attitudes towards these two new risk scales and to identify potential barriers to their ED implementation.MethodsTwo self-administered online surveys were distributed to the Canadian Association of Emergency Physicians. The surveys each consisted of 16 questions relating to the OHFRS and OCRS. The primary outcome measures were the overall physician rating of the two risk scales. Secondary outcome measures assessed the likelihood of risk scale implementation into Canadian EDs, as well as the perceived barriers to such implementation. Descriptive statistics were used.ResultsFor the OHFRS survey, we received responses from 195 emergency physicians (35.7%). Overall, 74.4% approved of the risk scale based on a Likert rating of 4 or 5 and 66.7% believed that the risk scale would be implemented at their hospital. For the OCRS survey, we received responses from 208 emergency physicians (38.1%). Overall, 76.9% approved of the risk scale based on a Likert rating of 4 or 5 and 70.2% believed that the risk scale would be implemented at their hospital.ConclusionsCanadian emergency physicians are very supportive of the new OHFRS and OCRS. We believe these risk scales will assist physicians with making safe and efficient disposition decisions and improve outcomes for patients suffering from HF and COPD.

scholarly journals Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

CJEM ◽  
2015 ◽  
Vol 17 (1) ◽  
pp. 1-2 ◽  
Author(s):  
Dennis Djogovic ◽  
Shavaun MacDonald ◽  
Andrea Wensel ◽  
Rob Green ◽  
Osama Loubani ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Literature Search ◽  
Development Process ◽  
Guideline Development ◽  
Care Practice ◽  
Evidence Based ◽  
Emergency Physicians ◽  
Consensus Guidelines ◽  
Canadian Association ◽  
Practice Committee

AbstractPatients may present to Emergency Departments (ED) in shock for various reasons. Emergency medicine physicians may require the use of vasopressors or inotropes to manage these patients. The Critical Care Practice Committee of the Canadian Association of Emergency Physicians (C4) conducted an intensive literature search and guideline development process to help create an evidence based approach for use of these agents in the stabilization of shock.

scholarly journals P055: Canadian emergency physician attitudes toward endotracheal intubation for aspiration prophylaxis

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S84-S84
Author(s):  
M. Munn ◽  
J. Laraya ◽  
G. Boivin-Arcouette ◽  
E. van der Linde ◽  
A. Lund ◽  
...  
Keyword(s):  
Alcohol Intoxication ◽  
Standard Of Care ◽  
Physician Attitudes ◽  
Future Research ◽  
Emergency Physicians ◽  
Aspiration Risk ◽  
Canadian Association ◽  
Objective Evidence ◽  
Clinical Instability ◽  
Level Of Consciousness

Introduction: Emergency patients with decreased level of consciousness often undergo intubation purely for airway protection from aspiration. However, the true risk of aspiration is unclear and intubation poses risks. Anecdotally, experienced emergency physicians often defer intubation in these patients while others intubate to decrease the perceived clinical and medico-legal consequences. No literature exists on the intubation practices of emergency physicians in these cases. Methods: An online questionnaire was circulated to members of the Canadian Association of Emergency Physicians. Participants were asked questions regarding two common clinical cases with decreased level of consciousness : (1) acute, uncomplicated alcohol intoxication and (2) acute, uncomplicated seizure. For each case, providers’ perceptions of aspiration risk, the standard of care, and the need for intubation were assessed. Results: 128 of the 1546 Canadian physicians contacted (8.3%) provided responses. Respondents had a median of 15 years of experience, 88% had CCFP-EM or FRCPC certification, and most worked in urban centers. When intubating, 98% agreed they were competent and 90% agreed they were well supported. A minority (17.4%) considered GCS < 8 an independent indication for intubation. For the alcohol intoxication case, 88% agreed that aspiration risk was present but only 11% agreed they commonly intubate. Only 17% agreed intubation was standard care, and only 0.8% felt their colleagues always intubate such patients. For the seizure case, 65% agreed aspiration risk existed but only 3% agreed they commonly intubate, 1% felt colleagues always intubated, and 5% agreed intubation was standard of care. Additional factors felt to compel intubation (394 total) and support non-intubation (366 total) were compiled and categorized; the most common themes emerging were objective evidence of emesis or aspiration, other standard indications for intubation, head trauma, co-ingestions, co-morbidities and clinical instability. Conclusion: It is acceptable and standard practice to avoid intubating a select subset of intoxicated and post-seizure emergency department patients despite aspiration risk. Most physicians do not view the dogma of “GCS 8, intubate” as an absolute indication for intubation in these patients. Future research is aimed at identifying key factors and evidence supporting intubation for the prevention of aspiration, as well as the development of a validated clinical decision rule for common emergency presentations.

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