scholarly journals Choosing Wisely Canada®: Five tests, procedures and treatments to question in Emergency Medicine

CJEM ◽  
2017 ◽  
Vol 19 (S2) ◽  
pp. S9-S17 ◽  
Author(s):  
Amy H. Y. Cheng ◽  
Sam Campbell ◽  
Lucas B. Chartier ◽  
Tom Goddard ◽  
Kirk Magee ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Head Injuries ◽  
Clinical Decision ◽  
Choosing Wisely ◽  
Emergency Physicians ◽  
Spinal Imaging ◽  
Canadian Association ◽  
Frequency Of Use ◽  
Expert Working Group ◽  
Adults And Children

AbstractObjectivesChoosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians’ (CAEP) top five list of recommendations, and the process undertaken to generate them.MethodsThe CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned. This list was distributed to CAEP committee chairs, revised, and then divided and randomly allocated to 107 Canadian emergency physicians (EWG nominated) who voted on each item based on: action-ability, effectiveness, safety, economic burden, and frequency of use. The EWG discussed the items with the highest votes, and generated the recommendations by consensus.ResultsThe top five CAEP CWC recommendations are: 1) Don’t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule); 2) Don’t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis; 3) Don’t order lumbosacral spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators; 4) Don’t order neck radiographs in patients who have a negative examination using the Canadian C-spine rules; and 5) Don’t prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists.ConclusionsThe CWC recommendations for emergency medicine were selected using a mixed methods approach. This top 5 list was released at the CAEP Conference in June 2015 and should form the basis for future implementation efforts.

scholarly journals Choosing Wisely Canada's emergency medicine recommendations: Time for a revision

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 717-720 ◽  
Author(s):  
Amy H. Y. Cheng ◽  
Sam Campbell ◽  
Lucas B. Chartier ◽  
Shawn Dowling ◽  
Tom Goddard ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Working Group ◽  
Ad Hoc ◽  
Choosing Wisely ◽  
Emergency Physicians ◽  
Medical Tests ◽  
Canadian Association ◽  
National Initiative ◽  
New Evidence

ABSTRACTChoosing Wisely Canada (CWC) is a national initiative designed to encourage patient-clinician discussions about the appropriate, evidence-based use of medical tests, procedures and treatments. The Canadian Association of Emergency Physicians’ (CAEP) Choosing Wisely Canada (CWC) working group developed and released ten recommendations relevant to Emergency Medicine in June 2015 (items 1–5) and October 2016 (items 6–10). In November 2016, the CAEP CWC working group developed a process for updating the recommendations. This process involves: 1) Using GRADE to evaluate the quality of evidence, 2) reviewing relevant recommendations on an ad hoc basis as new evidence emerges, and 3) reviewing all recommendations every five years. While the full review of the CWC recommendations will be performed in 2020, a number of high-impact studies were published after our initial launch that prompted an ad hoc review of the relevant three of our ten recommendations prior to the full review in 2020. This paper describes the results of the CAEP CWC working group's ad hoc review of three of our ten recommendations in light of recent publications.

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.

National survey of emergency physicians on the risk stratification and acceptable miss rate of acute aortic syndrome

CJEM ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 309-312
Author(s):  
Robert Ohle ◽  
Sarah McIsaac ◽  
Justin Yan ◽  
Krishan Yadav ◽  
Debra Eagles ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
National Survey ◽  
Decision Aid ◽  
Electronic Mail ◽  
Clinical Decision ◽  
Acute Aortic Syndrome ◽  
Emergency Physicians ◽  
Canadian Association ◽  
Academic Teaching Hospital

ABSTRACTObjectivesOne in four cases of acute aortic syndrome are missed. This national survey examined Canadian Emergency physicians’ opinion on risk stratification, the need for a clinical decision aid to risk stratify patients, and the required sensitivity of such a tool.MethodsWe surveyed 1,556 members of the Canadian Association of Emergency Physicians. We used a modified Dillman technique with a prenotification email and up to three survey attempts using electronic mail. Physicians were asked 21 questions about demographics, importance of certain high-risk features, investigation options, threshold for investigation, and if a clinical decision tool is requiredResultsWe had a response rate of 32%. Respondents were 66% male, and 49% practicing >10 years, with 59% in an academic teaching hospital. A total of 93% reported a need for a clinical decision aid to risk stratify for acute aortic syndrome. A total of 99.6% of physicians were pragmatic accepting a non-zero miss-rate, two-thirds accepting <1%, and the remaining accepting a higher miss-rate.ConclusionsOur national survey determined that emergency physicians would use a highly sensitive clinical decision aid to determine which patients are at low, medium, or high-risk for acute aortic syndrome. The majority of clinicians have a low threshold (<1%) for investigating for acute aortic syndrome, but accept that a zero miss-rate is not feasible.

scholarly journals Important returns on investment: an evaluation of a national research grants competition in emergency medicine

CJEM ◽  
2010 ◽  
Vol 12 (01) ◽  
pp. 33-38 ◽  
Author(s):  
Jaime Bawden ◽  
Namdar Manouchehri ◽  
Cristina Villa-Roel ◽  
Eric Grafstein ◽  
Brian H. Rowe
Keyword(s):  
Emergency Medicine ◽  
Research Funding ◽  
Emergency Physicians ◽  
Research Grants ◽  
Annual Basis ◽  
Canadian Association ◽  
Additional Funding ◽  
Study Completion ◽  
Returns On Investment ◽  
Median Amount

ABSTRACTObjective:We sought to examine scholarly outcomes of the projects receiving research grants from the Canadian Association of Emergency Physicians (CAEP) during the first 10 years of national funding (i.e., between 1996 and 2005).Methods:We sent email surveys to 62 emergency medicine (EM) researchers who received funding from CAEP. We focused our data collection on grant deliverables and opinions using a 1–7 Likert scale with regard to the value of the award.Results:Fifty-eight recipients responded to our survey. Grants were most commonly awarded to residents (21 [36%]), followed by senior (16 [28%]) and junior (13 [22%]) emergency staff. Twenty-six applicants from Ontario and 11 from Quebec received the majority of the grants. Overall, 51 projects were completed at the time of contact and, from these, 39 manuscripts were published or in press. Abstract presentations were more common, with a median of 2 abstracts presented per completed project. Abstract presentations for the completed projects were documented locally (23), nationally (39) and internationally (37). Overall, 19 projects received additional funding. The median amount funded was Can$4700 with an interquartile range of $3250–$5000. Respondents felt CAEP funding was critical to completing their projects and felt strongly that dedicated EM research funding should be continued to stimulate productivity.Conclusion:Overall, the CAEP Research Grants Competition has produced impressive results. Despite the small sums available, the grants have been important for ensuring study completion and for securing additional funding. CAEP and similar EM organizations need to develop a more robust funding approach so that larger grant awards and more researchers can be supported on an annual basis.

scholarly journals P037: Adherence to the Canadian CT Head Rule in a Nova Scotian emergency and trauma centre

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S77-S78
Author(s):  
C. LeBlanc ◽  
A. Sampalli ◽  
S. Campbell
Keyword(s):  
Nova Scotia ◽  
Head Injuries ◽  
Clinical Decision ◽  
Trauma Centre ◽  
Choosing Wisely ◽  
Current Status ◽  
Chart Audit ◽  
Charles V ◽  
Retrospective Audit ◽  
Ct Head

Introduction: Choosing Wisely Nova Scotia (CWNS), an affiliate of Choosing Wisely Canada™ (CWC), aims to address unnecessary care and testing through literature-informed lists developed by various disciplines. CWC has identified unnecessary head CTs among the top five interventions to question in the Emergency Department (ED). Zyluk (2015) determined the Canadian CT Head Rule (CCHR) as the most effective clinical decision rule in adults with minor head injuries. To better understand the current status of CCHR use in Nova Scotia, we conducted a retrospective audit of patient charts at the Charles V. Keating Emergency and Trauma Center, in Halifax, Nova Scotia. Methods: Our mixed methods design included a literature review, retrospective chart audit, and a qualitative audit-feedback component with participating physicians. The chart audit applied the guidelines for adherence to the CCHR and reported on the level of compliance within the ED. Analysis of qualitative data is included here, in parallel with in-depth to contextualize findings from the audit. Results: 302 charts of patients having presented to the surveyed site were retrospectively reviewed. Of the 37 cases where a CT head was indicated as per the CCHR, a CT was ordered 32 (86.5%) times. Of the 176 cases where a CT head was not indicated, a CT was not ordered 155 (88.1%) times. Therefore, the CCHR was followed in 187 (87.8%) of the total 213 cases where the CCHR should be applied. Conclusion: Our study reveals adherence to the CCHR in 87.8% of cases at this ED. Identifying contextual factors that facilitate or hinder the application of CCHR in practice is critical for reducing unnecessary CTs. This work has been presented to the physician group to gain physician engagement and to elucidate enablers and barriers to guideline adherence. In light of the frequency of CT heads ordered EDs, even a small reduction would be impactful.

scholarly journals The core emergency ultrasound curriculum project: A report from the Curriculum Working Group of the CAEP Emergency Ultrasound Committee

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 176-182 ◽  
Author(s):  
Paul Olszynski ◽  
Dan Kim ◽  
Jordan Chenkin ◽  
Louise Rang
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Working Group ◽  
Focused Ultrasound ◽  
Position Statement ◽  
Emergency Ultrasound ◽  
Emergency Physicians ◽  
The Core ◽  
Canadian Association ◽  
Curriculum Project

Emergency ultrasound (EUS) is now widely considered to be a “skill integral to the practice of emergency medicine.”1The Canadian Association of Emergency Physicians (CAEP) initially issued a position statement in 1999 supporting the availability of focused ultrasound 24 hours per day in the emergency department (ED).2

scholarly journals “The Future of Emergency Medicine” Inaugural address to the First Canadian EM Residents Workshop

CJEM ◽  
2000 ◽  
Vol 2 (04) ◽  
pp. 262-264 ◽  
Author(s):  
Isser Dubinsky
Keyword(s):  
Emergency Medicine ◽  
Emergency Services ◽  
Emergency Physicians ◽  
Inaugural Address ◽  
Health Network ◽  
Canadian Association ◽  
The Future ◽  
National Forum ◽  
The University

On June 10 to 11 this year, the Residents’ Section of the Canadian Association of Emergency Physicians (CAEP-RS) held its first official national forum for future emergency physicians — the First Canadian EM Residents Workshop, in conjunction with CAEP 2000. To celebrate the event, the RS decided to invite a nationally recognized emergency medicine leader, advocate, and teacher to be the first to address the Annual Residents’ Dinner. We were grateful for the privilege of having Dr. Isser Dubinsky be that person. Dr. Dubinsky, currently Chief of Emergency Services at the University Health Network in Toronto, was asked to speak about “The Future of Emergency Medicine.” Dr. Dubinsky's speech, filled with warmth, wisdom, and humanity, is transcribed below. — Jason Frank, MD, Chair CAEP-RS

scholarly journals CAEP 2015 Academic Symposium: Recommendations for University Governance and Administration for Emergency Medicine

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S18-S25 ◽  
Author(s):  
David Petrie ◽  
Anil Chopra ◽  
Alecs Chochinov ◽  
Jennifer D. Artz ◽  
Michael Schull ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Good Governance ◽  
Local Environment ◽  
Essential Elements ◽  
Current Status ◽  
Emergency Physicians ◽  
Canadian Association ◽  
Academic Units ◽  
Research And Education ◽  
Exceptional Patient

AbstractObjective1) To identify the strengths and challenges of governance structures in academic emergency medicine (EM), and 2) to make recommendations on principles and approaches that may guide improvements.MethodsOver the course of 9 months, eight established EM leaders met by teleconference, reviewed the literature, and discussed their findings and experiences to arrive at recommendations on governance in academic units of EM. The results and recommendations were presented at the annual Canadian Association of Emergency Physicians (CAEP) Academic Symposium, where attendees provided feedback. The updated recommendations were subsequently distributed to the CAEP Academic Section for further input, and the final recommendations were decided by consensus.ResultsThe panel identified four governance areas of interest: 1) the elements of governance; 2) the relationships between emergency physicians and academic units of EM, and between the academic units of EM and faculty of medicine; 3) current status of governance in Canadian academic units of EM; and 4) essential elements of good governance. Six recommendations were developed around three themes, including 1) the importance of good governance; 2) the purposes of an academic unit of EM; and 3) essential elements for better governance for academic units of EM. Recommendations included identifying the importance of good governance, recognizing the need to adapt to the different models depending on the local environment; seeking full departmental status, provided it is mutually beneficial to EM and the faculty of medicine (and health authority); using a consultation service to learn from the experience of other academic units of EM; and establishing an annual forum for EM leaders.ConclusionAlthough governance of academic EM is complex, there are ways to iteratively improve the mission of academic units of EM: providing exceptional patient care through research and education. Although there is no one-size-fits-all guide, there are practical recommended steps for academic units of EM to consider.

scholarly journals Building a national organization of future emergency medicine physicians

CJEM ◽  
1999 ◽  
Vol 1 (02) ◽  
pp. 132
Author(s):  
Jason R. Frank
Keyword(s):  
Emergency Medicine ◽  
Family Medicine ◽  
Royal College ◽  
Training Programs ◽  
Emergency Physicians ◽  
National Organization ◽  
New Family ◽  
Canadian Association ◽  
Family Medicine Residents

Resident interest in emergency medicine (EM) is on the rise. Each year, postgraduate matches add to the ranks of Canadian EM residents, and the Canadian Association of Emergency Physicians (CAEP) Residents’ Section (RS) continues to expand. The numbers are inspiring. This year, 16 residents accepted Royal College EM postgraduate year-1 (PGY-1) slots. Many more began their CCFP(EM) PGY-3 year, and this doesn’t include the residents who matched separately to EM training programs in Quebec. At the same time, the Canadian Resident Matching Service (CaRMS) matched about 433 new Family Medicine residents and 63 new Pediatrics residents. A significant number of these groups will also go on to develop interests and skills in EM.

scholarly journals Executive summary of the CAEP 2014 Academic Symposium: How to make research succeed in your department

CJEM ◽  
2015 ◽  
Vol 17 (3) ◽  
pp. 328-333 ◽  
Author(s):  
Ian G. Stiell ◽  
Jennifer D. Artz ◽  
Jeffrey Perry ◽  
Christian Vaillancourt ◽  
Lisa Calder
Keyword(s):  
Emergency Medicine ◽  
Best Practices ◽  
Leadership Education ◽  
Teaching Hospitals ◽  
Diagnostic Tools ◽  
Emergency Physicians ◽  
Executive Summary ◽  
Medicine Research ◽  
Canadian Association ◽  
Funding Opportunities

AbstractThe vision of the recently created Canadian Association of Emergency Physicians (CAEP) Academic Section is to promote high-quality emergency patient care by conducting world-leading education and research in emergency medicine. The Academic Section plans to achieve this goal by enhancing academic emergency medicine primarily at Canadian medical schools and teaching hospitals. It seeks to foster and develop education, research, and academic leadership amongst Canadian emergency physicians, residents, and students. In this light, the Academic Section began in 2013 to hold the annual Academic Symposia to highlight best practices and recommendations for the three core domains of governance and leadership, education scholarship, and research. Each year, members of three panels are asked to review the literature, survey and interview experts, achieve consensus, and present their recommendations at the Symposium (2013, Education Scholarship; 2014, Research; and 2015, Governance and Funding).Research is essential to medical advancement. As a relatively young specialty, emergency medicine is rapidly evolving to adapt to new diagnostic tools, the challenges of crowding in emergency departments, and the growing needs of emergency patients. There is significant variability in the infrastructure, support, and productivity of emergency medicine research programs across Canada. All Canadians benefit from an investigation of the means to improve research infrastructure, training programs, and funding opportunities. Such an analysis is essential to identify areas for improvement, which will support the expansion of emergency medicine research. To this end, physician-scientist leaders were gathered from across Canada to develop pragmatic recommendations on the improvement of emergency medicine research through a comprehensive analysis of current best practices, systematic literature reviews, stakeholder surveys, and expert interviews.

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