Organ and tissue donation from poisoned patients in the emergency department: A Canadian emergency physician survey

CJEM ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Louis Staple ◽  
Janet MacIntyre ◽  
Nancy G. Murphy ◽  
Stephen Beed ◽  
Constance LeBlanc
Keyword(s):  
Chemical Exposure ◽  
Male Gender ◽  
Tissue Donation ◽  
Physician Survey ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Physician Practices ◽  
Organ And Tissue Donation ◽  
Potential Source ◽  
Canadian Association

AbstractObjectivesScreening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4,631 Canadians were on a waiting list for a transplant, and 262 died while waiting. Canada’s donation rates are less than half of comparable countries, so it is essential to explore strategies to improve the referral of donors. Poisoned patients may be one such underutilized source for donation. This study explores physician practices and perceptions regarding the referral of poisoned patients as donors.MethodsIn this cross-sectional unidirectional survey, 1,471 physician members of the Canadian Association of Emergency Physicians were invited to participate. Physicians were presented with 20 scenarios and asked whether they would refer the patient as a potential organ or tissue donor. Results were reported descriptively, and associations between demographics and referral patterns were assessed.ResultsPhysicians totalling 208 participated in the organ or tissue donation scenarios (14.1%); 75% of scenarios involving poisoning were referred for organ or tissue donation, compared with 92% in a non-poisoning scenario. Poisons associated with lower referrals included sedatives, acetaminophen, chemical exposure, and organophosphates. A total of 175 physicians completed the demographic survey (11.9%). Characteristics associated with increased referrals included previous referral experience, donation training, donation support, >10 years of service, urban practice, emergency medicine certification, and male gender.ConclusionsScenarios involving poisoning were referred less often when compared with an ideal scenario. Because poisoning is not a contraindication for referral, this represents a potential source of donors. Targeted training and referral support may help improve donation rates in this demographic.

scholarly journals P146: Organ and tissue donation from poisoned patients in the emergency department: a Canadian perspective

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S109-S109
Author(s):  
L. J. Staple ◽  
J. MacIntyre ◽  
N. G. Murphy ◽  
S. Beed ◽  
C. LeBlanc
Keyword(s):  
Organ Donation ◽  
Chemical Exposure ◽  
Knowledge Bases ◽  
Survey Study ◽  
Tissue Donation ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Organ And Tissue Donation ◽  
Physician Characteristics ◽  
Canadian Association

Introduction: Screening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4564 individuals were on a waiting list for organ transplant and 242 died while waiting. As Canadas donation rates are less than half that of other comparable countries, it is crucial to ensure we are identifying all potential donors. Patients deceased from poisoning are a source that may not be considered for referral as often as those who die from other causes. This study aims to identify if patients dying from poisoning represent an under-referred group and determine what physician characteristics influence referral decisions. Methods: In this cross-sectional unidirectional survey study, physician members of the Canadian Association of Emergency Physicians were invited to participate. Participants were presented with 20 organ donation scenarios that included poisoned and non-poisoned deaths, as well as one ideal scenario for organ or tissue donation used for comparison. Participants were unaware of the objective to explore donation in the context of poisoning deaths. Following the organ donation scenarios, a range of follow-up questions and demographics were included to explore factors influencing the decision to refer or not refer for organ or tissue donation. Results were reported descriptively and associations between physician characteristics and decisions to refer were assessed using odds ratios and 95% confidence intervals. Results: 208/2058 (10.1%) physicians participated. 25% did not refer in scenarios involving a drug overdose (n=71). Specific poisonings commonly triggering the decision to not refer included palliative care medications (n=34, 18%), acetaminophen (n=42, 22%), chemical exposure (n=48, 27%) and organophosphates (n=87, 48%). Factors associated with an increased likelihood to refer potential donors following overdose included previous organ and tissue donation training (OR=2.6), having referred in the past (OR=4.3), available donation support (OR=3.9), greater than 10 years of service (OR=2.1), large urban center (OR=3.8), holding emergency medicine certification (OR=3.6), male gender (OR=2.2, CI), and having indicated a desire to be a donor on government identification (OR=5.8). Conclusion: Scenarios involving drug overdoses were associated with under-referral for organ and tissue donation. As poisoning is not a contraindication for referral, this represents a potential source of donors. By examining characteristics that put clinicians at risk for under-referral of organ or tissue donors, becoming aware of potential biases, improving transplant knowledge bases, and implementing support and training programs for the organ and tissue donation processes, we have the opportunity to improve these rates and reduce morbidity and mortality for Canadians requiring organ or tissue donation.

scholarly journals P005: Regional anesthesia in Canadian emergency departments: Emergency physician practices and impressions

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S66-S66
Author(s):  
D. Wiercigroch ◽  
S. Friedman ◽  
D. Porplycia ◽  
M. Ben-Yakov
Keyword(s):  
Regional Anesthesia ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Physician Practices ◽  
Canadian Association ◽  
Modifiable Factors ◽  
Barriers To Use

Introduction: The use of regional anesthesia (RA) by emergency physicians (EPs) is expanding in frequency and range of application as expertise in point-of-care ultrasound (POCUS) grows, but widespread use remains limited. We sought to characterize the use of RA by Canadian EPs, including practices, perspectives and barriers to use in the ED. Methods: A cross-sectional survey of Canadian EPs was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical responses. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables. Results: The survey was completed by 149/1144 staff EPs, with a response rate of 13%. EPs used RA a median of 2 (IQR 0-4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of EPs, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). EPs agreed that RA is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had POCUS available, however less than half (49.0%) felt comfortable using it for RA. EPs indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use. Conclusion: Canadian EPs engage in limited use of RA but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake of RA in the ED.

scholarly journals P049: Post-intubation sedation in the emergency department: a survey of national practice patterns

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S80
Author(s):  
S. Freeman ◽  
M. Columbus ◽  
T. Nguyen ◽  
S. Mal ◽  
J. Yan
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Respiratory Failure ◽  
Improve Patient Safety ◽  
Teaching Hospitals ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Canadian Association ◽  
Clinical Scenarios ◽  
Post Intubation

Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.

scholarly journals Intra-hospital organ and tissue donation coordination project: cost-effectiveness and social benefits

2015 ◽  
Vol 49 (0) ◽  
Author(s):  
Vanessa Silva e Silva ◽  
Luciana Carvalho Moura ◽  
Renata Fabiana Leite ◽  
Priscilla Caroliny de Oliveira ◽  
Janine Schirmer ◽  
...  
Keyword(s):  
Brain Death ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Economic Research ◽  
Tissue Donation ◽  
Southeastern Brazil ◽  
Hourly Wage ◽  
Cross Sectional ◽  
Organ And Tissue Donation ◽  
Public Policy Implementation

OBJECTIVE To evaluate the viability of a professional specialist in intra-hospital committees of organ and tissue donation for transplantation. METHODS Epidemiological, retrospective and cross-sectional study (2003-2011 and 2008-2012), which was performed using organ donation for transplants data in the state of Sao Paulo, Southeastern Brazil. Nine hospitals were evaluated (hospitals 1 to 9). Logistic regression was used to evaluate the differences in the number of brain death referrals and actual donors (dependent variables) after the professional specialist started work (independent variable) at the intra-hospital committee of organ and tissue donation for transplantation. To evaluate the hospital invoicing, the hourly wage of the doctor and registered nurse, according to the legislation of the Consolidation of Labor Laws, were calculated, as were the investment return and the time elapsed to do so. RESULTS Following the nursing specialist commencement on the committee, brain death referrals and the number of actual donors increased at hospital 2 (4.17 and 1.52, respectively). At hospital 7, the number of actual donors also increased from 0.005 to 1.54. In addition, after the nurse started working, hospital revenues increased by 190.0% (ranging 40.0% to 1.955%). The monthly cost for the nurse working 20 hours was US$397.97 while the doctor would cost US$3,526.67. The return on investment was 275% over the short term (0.36 years). CONCLUSIONS This paper showed that including a professional specialist in intra-hospital committees for organ and tissue donation for transplantation proved to be cost-effective. Further economic research in the area could contribute to the efficient public policy implementation of this organ and tissue harvesting model.

scholarly journals Registration for deceased organ and tissue donation among Ontario immigrants: a population-based cross-sectional study

CMAJ Open ◽  
2016 ◽  
Vol 4 (4) ◽  
pp. E551-E561
Author(s):  
A. H.-t. Li ◽  
N. N. Lam ◽  
S. Dhanani ◽  
M. Weir ◽  
V. Prakash ◽  
...  
Keyword(s):  
Population Based ◽  
Cross Sectional Study ◽  
Tissue Donation ◽  
Sectional Study ◽  
Cross Sectional ◽  
Organ And Tissue Donation

Resource barriers to the facilitation of organ and tissue donation reported by Australian emergency clinicians

2013 ◽  
Vol 37 (1) ◽  
pp. 60 ◽  
Author(s):  
Claudia H. Marck ◽  
George A. Jelinek ◽  
Sandra L. Neate ◽  
Bernadine M. Dwyer ◽  
Bernadette B. Hickey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Online Survey ◽  
Tissue Donation ◽  
Donor Pool ◽  
Potential Donor ◽  
Cross Sectional ◽  
Work Related ◽  
Organ And Tissue Donation ◽  
Ed Overcrowding ◽  
Related Stress

Objective. To explore emergency department clinicians’ perceived resource barriers to facilitating organ and tissue donation (OTD). Methods. A cross-sectional national online survey of Australian emergency department (ED) clinicians. Results. ED clinicians reported a range of resource barriers that hinder the facilitation of OTD, most notably a lack of time to discuss OTD with a patient’s family (74.6%). Those reporting more resource barriers had been less involved in OTD-related tasks. For example, those reporting a lack of time to assess a patient’s suitability to be a potential donor had less experience with OTD-related tasks in the last calendar year than did those who reported that they often or always have enough time for this (P < 0.01). In addition, ED clinicians working in DonateLife network hospitals were more involved in OTD-related tasks (P < 0.01) and reported fewer resource shortages in the ED and the hospital overall. Conclusions. Resource shortages hinder the facilitation of OTD in the ED and are related to decreased involvement in OTD-related tasks. In addition, ED clinicians working in DonateLife hospitals are more involved in OTD-related tasks and report fewer resource shortages overall. Addressing resource shortages and extending the DonateLife network could benefit OTD rates initiated from the ED. What is known about the topic? Increasing the rate of organ and tissue donation (OTD) has become progressively more urgent as waiting lists for organs and tissues are growing globally. Recently a missed potential donor pool was recognised in emergency departments (EDs) and the Organ and Tissue Authority implemented a ‘clinical trigger’ tool to aid with the identification of potential donors in EDs. However, many Australian studies have reported worsening ED overcrowding and resource shortages in recent years with an adverse effect on patient care and satisfaction as well as on ED clinicians’ work-related stress and satisfaction. International literature has identified that certain resource barriers hinder the facilitation of organ and tissue in EDs. However, there is currently no literature available on how resource barriers in Australian EDs affect the facilitation of OTD. What does this paper add? Our study shows that Australian ED clinicians perceive a range of resource barriers that hinder the facilitation of OTD, most notably a lack of time to discuss OTD with a patient’s family or to identify potential donors. We also found that those reporting more resource barriers had been less involved in OTD-related tasks in the last calendar year. In addition, those that work in hospitals that are part of the DonateLife network, and thus have dedicated staff available for OTD-related tasks, were more involved in OTD-related tasks and reported fewer resource shortages in the ED and the hospital overall. What are the implications for practitioners? To maximize the number of potential donors recognised and referred from the ED, it may be important to decrease the resource barriers identified in this study. Notably, the presence of specialist OTD staff, a function of being part of a DonateLife network hospital, may result in a decreased perception of resource barriers in the ED and more engagement with OTD-related tasks by ED clinicians.

scholarly journals Regional anesthesia in Canadian emergency departments: Emergency physician practices, perspectives, and barriers to use

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 499-503 ◽  
Author(s):  
David Wiercigroch ◽  
Maxim Ben-Yakov ◽  
Danielle Porplycia ◽  
Steven Marc Friedman
Keyword(s):  
Regional Anesthesia ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
General Anesthetic ◽  
Cross Sectional Survey ◽  
Dose Requirement ◽  
Physician Practices ◽  
Canadian Association ◽  
Modifiable Factors ◽  
Barriers To Use

ABSTRACTObjectivesRegional anesthesia has many applications in the emergency department (ED). It has been shown to reduce general anesthetic dose, requirement for post-procedural opioids, and recovery time. We sought to characterize the use of regional anesthesia by Canadian emergency physicians, including practices, perspectives and barriers to use in the ED.MethodsA cross-sectional survey was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical response questions. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables.ResultsThe survey was completed by 149/1144 staff emergency physicians, with a response rate of 13%. Respondents used regional anesthesia a median of 2 (IQR 0–4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of respondents, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). Respondents agreed that regional anesthesia is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had point of care ultrasound available, however less than half (49.0%) felt comfortable using it for RA. Respondents indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use of RA.ConclusionCanadian emergency physicians use regional anesthesia infrequently but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake.

scholarly journals ALaRMED: adverse events in low-risk chest pain patients receiving continuous ECG monitoring in the emergency department: a survey of Canadian emergency physicians

CJEM ◽  
2008 ◽  
Vol 10 (05) ◽  
pp. 413-419 ◽  
Author(s):  
Clare L. Atzema ◽  
Michael J. Schull
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Mail Survey ◽  
Good Evidence ◽  
Low Risk ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Electrocardiographic Monitoring ◽  
Canadian Association ◽  
Pain Patients

ABSTRACT 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.

Understanding current practice of opioid use disorder management in emergency departments across Canada: A cross-sectional study

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 494-498
Author(s):  
Patricia Hoyeck ◽  
David Wiercigroch ◽  
Cara Clarke ◽  
Rahim Moineddin ◽  
Hasan Sheikh ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Management Practices ◽  
Cross Sectional Study ◽  
Opioid Use Disorder ◽  
Emergency Physicians ◽  
Sectional Study ◽  
Opioid Use ◽  
Current Management ◽  
Cross Sectional ◽  
Canadian Association

ABSTRACTObjectiveOpioid-related deaths are increasing at alarming rates in Canada, with a 34% increase from 2016 to 2017. Patients with opioid use disorder often visit emergency departments (ED), presenting an opportunity to engage patients in treatment. Buprenorphine-naloxone is first-line treatment for opioid use disorder, but current management in the ED is unknown. This study aimed to characterize opioid use disorder management in the ED.MethodsWe conducted a cross-sectional study of emergency physicians across Canada. A survey was circulated electronically to the Canadian Association of Emergency Physicians members. Participants were asked about their current management practices, satisfaction, and helpfulness of resources. SAS (version 9.4) was used for statistical analysis. We dichotomized Likert-scale responses to approximate relative risk ratios via a log binomial analysis.ResultsThe survey was completed by 179 participants for a response rate of 11.1%; 143 (79.9%) physicians treated patients with opioid use disorder more than once a week. Only 7% (n = 13) of respondents always/often gave buprenorphine in the ED. Referral to an addiction clinic where patients were seen quickly was deemed the most helpful (90.5%, n = 162). Physicians who reported satisfaction with opioid use disorder management were four times more likely to prescribe buprenorphine in the ED or as an outpatient script (RR = 4.41, CI = 2.33–8.33, p < 0.01; RR = 4.51, CI = 2.21–9.22, p < 0.01).ConclusionThis study found that buprenorphine is not frequently prescribed in the ED setting, which is incongruent with the 2018 guidelines. Care coordination and on-site support were helpful to ED physicians. Hospitals should use knowledge translation strategies to improve the care of patients with an opioid use disorder.

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