scholarly journals LO37: Prevalence of cigarette smoking amongst adult emergency department patients

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S20-S21
Author(s):  
A. Tolmie ◽  
R. Erker ◽  
T. Oyedokun ◽  
E. Sullivan ◽  
T. Graham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cigarette Smoking ◽  
Intervention Program ◽  
Smoking Prevalence ◽  
Health Concern ◽  
Chi Square ◽  
Smoking Cessation Counselling ◽  
Chief Complaints ◽  
Statistics Canada ◽  
Emergency Department Patients

Introduction: Tobacco smoking is a priority public health concern, and a leading cause of death and disability globally. While the smoking prevalence in Canada is approximately 13-18%, the proportion of smokers among emergency department (ED) patients has been found to be significantly higher. This disparity primes the emergency department as a critical environment to provide smoking cessation counselling and support. Methods: A verbal questionnaire was administered to adult patients (18+) presenting to Royal University, Saskatoon City, and St. Paul's Hospital ED's. Patients were excluded if they were underage, too ill, or physically/mentally unable to complete the questionnaire independently. Patients’ smoking habits were also correlated with Fagerstrom tobacco dependence scores, chief complaints, Canadian Triage Acuity Scale (CTAS) scores, and willingness to partake in ED specific cessation counselling. Data were analyzed using IBM SPSS software to determine smoking prevalence and compared to Statistics Canada data using chi-square tests. Results: In total, 1190 eligible patients were approached, and 1078 completed the questionnaire. Adult Saskatoon ED patients demonstrated a cigarette smoking prevalence of 19.6%, which is significantly higher than the general adult Saskatchewan public at 15.1% (p < 0.0001). Comparing smoking and non-smoking cohorts, there are no significant differences in CTAS scores (p = 0.60). Of the proposed cessation interventions, ED cessation counselling was most popular among patients (62.4%), followed by receiving a pamphlet (56.2%), and being contacted by a smokers’ quit line (49.5%). Out of the smoking cohort, 51.4% indicated they want to quit smoking, and would be willing to partake in ED-specific cessation counselling, if available. Additionally, 88.1% of current smokers started smoking when they were less than 19 years old. Conclusion: The higher smoking prevalence demonstrated in ED patients highlights the need for a targeted intervention program that is feasible for the fast-paced environment. Quit attempts have been demonstrated to be more efficacious with repeated interventions, which could be achieved by training ED staff to conduct brief motivational interviews and faxing referrals to a smokers' quit line for follow-up. Furthermore, pediatric ED's could be a valuable location for cigarette smoking screening, as the majority began smoking in their adolescence.

scholarly journals P016: Feasibility of a nurse-led smoking cessation intervention in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S70-S70
Author(s):  
A. Tolmie ◽  
R. Erker ◽  
A. Donauer ◽  
E. Sullivan ◽  
T. Graham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Smoking Cessation ◽  
Cigarette Smoking ◽  
Thematic Analysis ◽  
Smoking Prevalence ◽  
Community Support ◽  
Support Programs ◽  
Written Responses ◽  
Smoking Cessation Counselling ◽  
Community Support Programs

Introduction: Cigarette smoking is a leading global cause of morbidity and mortality. Multiple studies internationally have established that cigarette smoking prevalence is higher in emergency department (ED) patients than their respective communities. Previously, we demonstrated the smoking prevalence among Saskatoon ED patients (19.6%) is significantly higher than the provincial average (15.1%), and over 50% of smoking patients would be receptive to ED-specific cessation support. The purpose of this project was to identify nurses’ beliefs regarding smoking cessation in the ED, and barriers to implementing it in the department. Methods: A questionnaire was administered to all nurses employed at St. Paul's Hospital ED in Saskatoon assessing attitudes towards ED cessations, as well as the benefit and feasibility of three potential interventions: brief cessation counselling, referral to community support programs, and distributing educational resources. The questionnaire included Likert scale numerical ratings, and written responses for thematic analysis. Thematic analysis was performed by creating definitions of identified themes, followed by independent review of the data by researchers. Results: 83% of eligible nurses completed the survey (n = 63). Based on Likert scores, ED nurses rarely attempt to provide cessation support, and would be minimally comfortable with personally providing this service. Barriers identified through thematic analysis included time constraints (68.3%), lack of patient readiness (19%), and lack of resources/follow-up (15.9%). Referral to community support programs was deemed most feasible and likely to be beneficial, while counselling within the ED was believed to be least feasible and beneficial. Overall, 93.3% of nurses indicated time and workload as barriers to providing ED cessation support during the survey. Conclusion: Although the ED is a critical location for providing cessation support, the proposed interventions were viewed as a low priority task outside the scope of the ED. Previous literature has demonstrated that multifaceted ED interventions using counselling, handouts, and referrals are more efficacious than a singular approach. While introduction of a referral program has some merit, having professionals dedicated to ED cessation support would be most effective. At minimum, staff education regarding importance of providing smoking cessation therapy, and simple ways to incorporate smoking cessation counselling into routine nursing care could be beneficial.

scholarly journals LO091: Non-urgent presentations to the emergency department: patients’ reasons for presentation

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S61-S61
Author(s):  
L. Krebs ◽  
R. Chetram ◽  
S.W. Kirkland ◽  
T. Nikel ◽  
B. Voaklander ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Professionals ◽  
Access To Health Care ◽  
Health Concern ◽  
Patient Centeredness ◽  
Care Needs ◽  
Appropriateness Of Care ◽  
Access To Health ◽  
Access To Primary Care ◽  
Emergency Department Patients

Introduction: Some low acuity Emergency Department (ED) presentations are considered non-urgent or convenience visits and potentially avoidable with improved access to primary care. This study explored self-reported reasons why non-urgent patients presented to the ED. Methods: Patients, 17 years and older, were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada during weekdays (0700 to 1900). A 47-item questionnaire was completed by each consenting patient, which included items on whether the patient believed the ED was their best care option and the rationale supporting their response. A thematic content analysis was performed on the responses, using previous experience and review of the literature to identify themes. Results: Of the 2144 eligible patients, 1408 (65.7%) questionnaires were returned, and 1402 (65.4%) were analyzed. For patients who felt the ED was their best option (n = 1234, 89.3%), rationales included: safety concerns (n = 309), effectiveness of ED care (n = 284), patient-centeredness of ED (n = 277), and access to health care professionals in the ED (n = 204). For patients who felt the ED was not their best care option (n = 148, 10.7%), rationales included a perception that: access to health professionals outside the ED was preferable (n = 39), patient-centeredness (particularly timeliness) was lacking in the ED (n = 26), and their health concern was not important enough to require ED care (n = 18). Conclusion: Even during times when alternative care options are available, the majority of non-urgent patients perceived the ED to be the most appropriate location for care. These results highlight that simple triage scores do not accurately reflect the appropriateness of care and that understanding the diverse and multi-faceted reasons for ED presentation are necessary to implement strategies to support non-urgent, low acuity care needs.

scholarly journals Prevalence of Cigarette Smoking Among Adult Emergency Department Patients in Canada

2020 ◽  
Vol 21 (6) ◽  
Author(s):  
Andrew Tolmie ◽  
Rebecca Erker ◽  
Taofiq Oyedokun ◽  
Emily Sullivan ◽  
Thomas Graham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cigarette Smoking ◽  
Emergency Department Patients

scholarly journals Characteristics and outcomes of older emergency department patients assigned a low acuity triage score

CJEM ◽  
2018 ◽  
Vol 20 (5) ◽  
pp. 762-769 ◽  
Author(s):  
Ariel Hendin ◽  
Debra Eagles ◽  
Victoria Myers ◽  
Ian G. Stiell
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Admission Rate ◽  
High Risk Population ◽  
Chi Square ◽  
Patients Âgés ◽  
Patient Demographics ◽  
Included Patient ◽  
Emergency Department Patients ◽  
Stratified Analysis

AbstractObjectiveAlthough older patients are a high-risk population in the emergency department (ED), little is known about those identified as “less acute” at triage. We aimed to describe the outcomes of patients ages 65 years and older who receive low acuity triage scores.MethodsThis health records review assessed ED patients who were ages 65 years and above or ages 40 to 55 years (controls) who received a Canadian Triage Acuity Scale score of 4 or 5. Data collected included patient demographics, ED management, disposition, and a return visit or hospital admission at 14 days. Data were analysed descriptively and chi-square testing performed. A pre-planned stratified analysis of patients ages 65 to 74, 75 to 84, and 85 and older was conducted.ResultsThree hundred fifty older patients with a mean age of 76.5 years and 150 control patients were included. Most patients presented with musculoskeletal or skin complaints and were triaged to the ambulatory care area. Older patients were significantly more likely than controls to be admitted on the index visit (5.0% v. 0.3%, p=0.016) and on re-presentation (4.0% v. 0.7%, p=0.045). In a subgroup analysis, patients ages 85 years and above were most likely to be admitted (8.9%, p=0.003).ConclusionsOlder patients who present to the ED with issues labelled as “less acute” at triage are 16 times more likely to be admitted than younger controls. Patients ages 85 years and up are the primary drivers of this higher admission rate. Our study indicates that even “low acuity” elders presenting to the ED are at risk for re-presentation and admission within 14 days.

scholarly journals Assessing improvements in emergency department referrals to a hospital-based violence intervention program

2021 ◽  
Vol 8 (S1) ◽  
Author(s):  
Jayda Watkins ◽  
Na’il Scoggins ◽  
Brooke M. Cheaton ◽  
Mark Nimmer ◽  
Michael N. Levas ◽  
...  
Keyword(s):  
Emergency Department ◽  
Interpersonal Violence ◽  
Intervention Program ◽  
The United States ◽  
Referral Rate ◽  
Health Concern ◽  
Improvement Project ◽  
Violence Intervention ◽  
Patient Consent ◽  
Eligibility Requirements

Abstract Background Youth violence is a major public health concern in the United States. Hospital-based Violence Intervention Programs (HVIPs) are integral in connecting youth sustaining interpersonal violence-related injuries to medical, mental health, and social services. At our pediatric emergency department, our baseline referral rate to the established HVIP was 32.5%. From November 2018–2019, we aimed to increase the percent of eligible patients referred to our HVIP from 32.5 to 70% for patients aged 7–18 years who present to our Level 1 emergency department/trauma center with a violent injury. Methods For this quality improvement project, we recorded key aspects of the referral process, such as patient eligibility, who placed referrals, and when referrals were placed in relation to the ED admission. Key stakeholders were interviewed to identify specific interventions. Our key interventions were: 1. Educating providers on eligibility requirements. 2. Encouraging nurses to enter consults at the time of admission. 3. Publishing information about program referrals in the weekly nursing newsletter. 4. Updating social workers on eligibility requirements for the HVIP. We used PDSA cycles to inform our project. Our primary outcome measure was the number of eligible patients referred to our HVIP and measures were analyzed using statistical process control charts. Results The HVIP-eligible population had the following demographics: 31.1% female and a mean age 14.3 ± 2.7, 82.6% assaults and 17.4% gunshot wounds. From 11/2018 to 11/2019, there were 78 referrals to the HVIP, out of 167 eligible patients. The referral rate improved from 32.5% pre-interventions to 61.1% post-interventions, showing an 88% increase. Conclusion(s) We noted an increase in referrals to our HVIP following our interventions that centered on educating, advertising, and encouraging. Future studies will focus on analyzing other aspects of the enrollment process, such as obtaining patient consent.

scholarly journals LO09: Assessing the ability of emergency department patients to self-triage by using an electronic questionnaire: a pilot study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S30
Author(s):  
S. Trivedi ◽  
J. Littmann ◽  
P. Kapur ◽  
M. Betz ◽  
J. Stempien
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Prospective Observational Study ◽  
Convenience Sample ◽  
Survey Tool ◽  
Electronic Questionnaire ◽  
Ambulatory Patients ◽  
Chief Complaints ◽  
The Mean ◽  
Emergency Department Patients

Introduction: The process of triage is used to prioritize the care of patients arriving in the emergency department (ED). To our knowledge, self-triage has not been previously studied in the general emergency department (ED) setting. In an attempt to test the feasibility of implementing this in the ED, we sought to assess the ability of ED patients to triage themselves using an electronic questionnaire. Methods: This was a prospective observational study. An iPad-based questionnaire was designed with a series of ‘yes’ or ‘no’ answers related to common chief complaints. A score corresponding to a Canadian Triage and Acuity Scale (CTAS) category was assigned based on their answers, without the knowledge of patients or ED staff. These scores were subsequently compared to the official CTAS score assigned by triage nurses. A convenience sample of ambulatory patients arriving at the ED were enrolled over a four week period. Patients arriving by ambulance were excluded. We also sought to assess patients’ ability to predict their ultimate disposition. Results: A total of 492 patients were enrolled. The mean age of enrolled patients was 43.9. Of enrolled patients, 56 (11.4%) were under 20 years old, 168 (34.1%) between ages 20-39, 116 (23.6%) between ages 40-59 and 152 (30.9%) older than 60 years. We had 245 (49.8%) patients identify as male. Patient-determined CTAS scores were as follows: 146 CTAS 1 (26.7%), 66 CTAS 2 (13.4%), 176 CTAS 3 (35.8%) and 104 CTAS 4 and 5 (21.1%). Formal triage CTAS scores were: 47 CTAS 2 (9.6%), 155 CTAS 3 (31.5%), and 290 CTAS 4 and 5 (59%). With our survey tool, 22.2% of patients matched their official triage scores. We found that that 69.9% of participants over-estimated their CTAS score while 7.9% underestimated it. Two hundred and three patients (41.3%) felt that they needed to be admitted. In fact, 73 patients (17.3%) were admitted to hospital. Conclusion: Using an electronic questionnaire, ambulatory patients frequently overestimated the acuity of their presenting complaint. Patients were also not unable to accurately predict their disposition. Further study of different approaches to self-triage is needed before possible implementation in EDs.

Abstract TP291: Swallow Screens: A Hard Act to Follow a Collaborative Effort Between the Stroke Program and the Emergency Department

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Laurie B Paletz ◽  
Gregory Eichelzer ◽  
Herbert Ip ◽  
Nili Steiner ◽  
Betty Robertson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Screening Tool ◽  
Medication Administration ◽  
Chi Square ◽  
Oral Medications ◽  
Increased Risk ◽  
Wide Range ◽  
Chief Complaints ◽  
Swallow Screening ◽  
Reliable Solution

Background: After stroke, up to 65 percent of stroke patients suffer dysphagia, with increased risk of aspiration pneumonia and disability. Aspiration risk is reduced by swallow assessment on every acute ischemic stroke (AIS) prior to medication or food intake. Annually, about 88,000 patients enter the Cedars-Sinai Emergency Department (ED). Although only 1% of these patients are AIS, 100% of these patients require a swallow screen. In busy EDs where stroke is infrequent, swallow screens are missed. Jointly with our ED Educator and our Electronic Information Systems (EIS) application specialist we created a user-friendly, reliable solution to improve swallow screen compliance in the ED. Purpose: To implement a valid swallow screening tool and optimize nurse awareness and compliance in a busy, urban ED. Method: We emphasized educating and listening to staff concerns and requests and collaboration with EIS. The Barnes Jewish Hospital stroke screening tool is a validated, evidence based screening tool for assessing swallowing. We defined “fall outs” as patients who received anything by mouth prior to a swallow assessment. EIS created an electronic alert linked to chief complaints that fired in response to a wide range of stroke symptoms. The alert was also linked to the medication administration record. Result: Prior to deployment, fall outs ranged from 40 to 65% of cases. Following deployment of the alert fall out numbers decreased (see graph) significantly (Chi-Square p<0.001 for trend), despite an overall increase in AIS volumes. While education was somewhat successful, linking the alert to the MAR prompted the nurse to complete the swallow screen prior to administering oral medications. Conclusion: We successfully improved ED compliance with swallow screening in a busy urban ED in which AIS represents less than 1% of the annual volume. A similar strategy should work well in a variety of other hospitals and medical centers.

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