scholarly journals A Collaborative Quality Improvement Model and Electronic Community of Practice to Support Sepsis Management in Emergency Departments: Investigating Care Harmonization for Provincial Knowledge Translation

2012 ◽  
Vol 1 (2) ◽  
pp. e6 ◽  
Author(s):  
Kendall Ho ◽  
Julian Marsden ◽  
Sandra Jarvis-Selinger ◽  
Helen Novak Lauscher ◽  
Noreen Kamal ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Knowledge Translation ◽  
Community Of Practice ◽  
Emergency Departments ◽  
Sepsis Management ◽  
Electronic Community

A Community of Practice for Knowledge Translation Trainees: An Innovative Approach for Learning and Collaboration

2013 ◽  
Vol 33 (4) ◽  
pp. 274-281 ◽  
Author(s):  
Robin Urquhart ◽  
Evelyn Cornelissen ◽  
Shalini Lal ◽  
Heather Colquhoun ◽  
Gail Klein ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Community Of Practice ◽  
Innovative Approach ◽  
Learning And Collaboration

Abstract P131: What Drives Greater Assimilation of Telestroke in Emergency Departments?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Lori Uscher-Pines ◽  
Jessica Sousa ◽  
Kori S Zachrison ◽  
Amy K Guzik ◽  
Lee H Schwamm ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Emergency Departments ◽  
Positive Deviance ◽  
Matrix Analysis ◽  
Structured Interviews ◽  
Leadership Support ◽  
Diversity Sampling ◽  
Ongoing Evaluation

Objective: Although many emergency departments (EDs) have telestroke capacity, it is unclear why some EDs consistently use telestroke and others do not. We compared the characteristics and practices of EDs with robust and low assimilation of telestroke. Methods: We conducted semi-structured interviews with representatives of EDs that received telestroke services from 10 different networks and had used telestroke for a minimum of two years. We used maximum diversity sampling to select EDs for inclusion and applied a positive deviance approach, comparing programs with robust and low assimilation. Data collection was informed by the Consolidated Framework for Implementation Research. For the qualitative analysis, we created site summaries and conducted a supplemental matrix analysis to identify themes. Results: Representatives from 21 EDs with telestroke, including 11 with robust assimilation and 10 with low assimilation, participated. In EDs with robust assimilation, telestroke workflow was highly protocolized, programs had the support of leadership, telestroke use and outcomes were measured, and individual providers received feedback about their telestroke use. In EDs with low assimilation, telestroke was perceived to increase complexity, and ED physicians felt telestroke did not add value or had little value beyond a telephone consult. EDs with robust assimilation identified four sets of strategies to improve assimilation: strengthening relationships between stroke experts and ED providers, improving and standardizing processes, addressing resistant providers, and expanding the goals and role of the program. Conclusion: Greater assimilation is associated with standardized workflow, leadership support, ongoing evaluation and quality improvement efforts, and mechanisms to address resistant ED providers.

scholarly journals COVID-19 screening of asymptomatic patients admitted through emergency departments in Alberta: a prospective quality-improvement study

CMAJ Open ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. E887-E894
Author(s):  
Pietro Ravani ◽  
Lynora Saxinger ◽  
Uma Chandran ◽  
Kevin Fonseca ◽  
Stephanie Murphy ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Emergency Departments ◽  
Asymptomatic Patients

scholarly journals LO35: A province-wide quality improvement collaborative for treatment of children's pain in Alberta's emergency departments

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S19-S19
Author(s):  
J. Thull-Freedman ◽  
E. Pols ◽  
A. McFetridge ◽  
S. Libbey ◽  
K. Lonergan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Pain Score ◽  
Emergency Departments ◽  
Control Charts ◽  
Interrupted Time Series ◽  
Quality Improvement Collaborative ◽  
Topical Anesthetic ◽  
Children's Pain ◽  
Underlying Trend

Background: Pediatric pain is often under-treated in emergency departments (EDs), causing short and long-term harm. In Alberta EDs, children's pain outcomes were unknown. A recent quality improvement collaborative (QIC) led by our team improved children's pain care in 4 urban EDs. We then spread to all EDs in Alberta using the Institute for Healthcare Improvement Framework for Going to Full Scale. Aim Statement: To increase the proportion of children <12 years who receive topical anesthetic before needle procedures from 11% to 50%; and for children <17 years with fractures: to 1) increase the proportion receiving analgesia from 31% to 50%; 2) increase the proportion with pain score documentation from 24% to 50%, and 3) reduce time to analgesia from 60 to 30 minutes, within 1 year. Measures & Design: All 97 EDs in Alberta that treat children were invited. Each was asked to form a project team, attend webinars, develop key driver diagrams and perform PDSA tests of change. Sites were given a monthly list of randomly selected charts for audit and entered data in REDCap for upload to a provincial run chart dashboard. Baseline performance measurement informed aims. Measures included proportion of children <12 years undergoing a lab test who received topical anesthetic, and for children <17 years with fracture, the proportion with a pain score, proportion receiving analgesia and median minutes to analgesia. Length of stay and use of opioids were balancing measures. Control charts were used to detect special cause. Interrupted time series (ITS) was performed to assess significance and trends. Evaluation/Results: 36 sites (37%) participated, including rural and urban sites from all regions. 8417 visits were audited. 23/36 sites completed audits before and after tests of change and were analyzed. Special cause occurred for all aims. The proportion receiving topical anesthetic increased from 11% to 30% (ITS p < 0. 001). For children with fractures, the proportion with pain scores increased from 24% to 34% (ITS p = 0.21, underlying trend present), proportion receiving analgesic medication increased from 31% to 39% (ITS p = 0.41, underlying trend present) and minutes to analgesia decreased from 60 to 28 (ITS p < 0. 01). There was no increase in length of stay or use of opioid medications. Discussion/Impact: A pragmatic approach encouraging locally led change was well-received and key to success. The QIC method shows promise for improving outcomes in diverse EDs across large geographic areas. Next steps include further spread and sustainability measurement.

scholarly journals Management of Patients With Sepsis in Canadian Community Emergency Departments: A Retrospective Multicenter Observational Study

2020 ◽  
Vol 7 ◽  
pp. 233339282092008
Author(s):  
Victor C. K. Lo ◽  
Haitong Su ◽  
Yuet Ming Lam ◽  
Kathleen Willis ◽  
Virginia Pullar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Observational Study ◽  
Hospital Mortality ◽  
Emergency Departments ◽  
Lactate Concentration ◽  
Admission Rate ◽  
Multicenter Observational Study ◽  
Icu Admission ◽  
Physician Assessment ◽  
Assessment Time

Background: Sepsis is a life-threatening syndrome and a leading cause of morbidity and mortality representing significant financial burden on the health-care system. Early identification and intervention is crucial to maximizing positive outcomes. We studied a quality improvement initiative with the aim of reviewing the initial management of patients with sepsis in Canadian community emergency departments, to identify areas for improving the delivery of sepsis care. We present a retrospective, multicenter, observational study during 2011 to 2015 in the community setting. Methods: We collected data on baseline characteristics, clinical management metrics (triage-to-physician-assessment time, triage-to-lactate-drawn time, triage-to-antibiotic time, and volume of fluids administered within the first 6 hours of triage), and outcomes (intensive care unit [ICU] admission, in-hospital mortality) from a regional database. Results: A total of 2056 patients were analyzed. The median triage-to-physician-assessment time was 50 minutes (interquartile range [IQR]: 25-104), triage-to-lactate-drawn time was 50 minutes (IQR: 63-94), and triage-to-antibiotics time was 129 minutes (IQR: 70-221). The median total amount of fluid administered within 6 hours of triage was 2.0 L (IQR: 1.5-3.0). The ICU admission rate was 36% and in-hospital mortality was 25%. We also observed a higher ICU admission rate (51% vs 24%) and in-hospital mortality (44% vs 14%) in those with higher lactate concentration (≥4 vs ≤2 mmol/L), independent of other sepsis-related parameters. Conclusion: Time-to-physician-assessment, time-to-lactate-drawn, time-to-antibiotics, and fluid resuscitation in community emergency departments could be improved. Future quality improvement interventions are required to optimize management of patients with sepsis. Elevated lactate concentration was also independently associated with ICU admission rate and in-hospital mortality rate.

scholarly journals LO27: Relevance of Choosing Wisely Canada non-emergency medicine specialty lists to emergency medicine practice

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S16-S17
Author(s):  
S. Upadhye ◽  
C. Davies-Schinkel ◽  
S. Pilakka
Keyword(s):  
Emergency Medicine ◽  
Quality Improvement ◽  
Patient Care ◽  
Resource Use ◽  
Emergency Departments ◽  
Rating Scale ◽  
Likert Scale ◽  
Choosing Wisely ◽  
Low Back ◽  
Potential Impact

Introduction: The Choosing Wisely Canada (CWC) initiative is dedicated towards optimizing patient care and reduce unnecessary resource use. Different specialty organizations create recommendations lists towards these outcomes. The goal of this study was to examine the applicability of non-Emergency Medicine (EM) recommendations towards EM practice. Methods: The entire master recommendations listings spreadsheet was downloaded from the CWC website (March 2019; n = 333). The EM-specific items from the CAEP checklist were deliberately excluded (n = 10). Items were rated by Niagara community EM physicians (n = 7) using the previously validated Best Evidence in Emergency Medicine (BEEM) rating scale (7 point Likert scale) to determine potential impact on EM practice. Items rated “6 or 7/7” were determine as “high relevance.” Redundant items were consolidated. Results: From the retrieved CWC master list, a total of 102 “highly relevant” recommendations were identified (41 items scored 6/7 [12%], 61 scored 7/7 [18%]; total 31%). Redundant items consolidated included antimicrobial avoidance (n = 18), opioid avoidance for pain (n = 11), reduction of unnecessary imaging (n = 11), and avoidance of routine low back imaging (n = 7). Conclusion: There are a large number of non-EM specialty recommendations highly relevant to EM practice in the CWC database (31%). Quality improvement initiatives looking to operational CWC recommendations in Canadian Emergency Departments should be aware of these as a part of optimizing patient care.

scholarly journals Knowledge management mechanisms in e-learning environment: A conceptual model

2013 ◽  
pp. 468-491
Keyword(s):  
Knowledge Management ◽  
Learning Environment ◽  
Conceptual Framework ◽  
Community Of Practice ◽  
State Universities ◽  
Second Step ◽  
Management Mechanism ◽  
Virtual Universities ◽  
E Learning ◽  
Electronic Community

The purpose of this study is to design a conceptual framework for application of electronic mechanisms of knowledge management in e-learning environment. A three-step strategy has been adapted in this research. The first step deals with designing an initial framework for the research based on review and analysis of the related literature. The proposed conceptual framework has considered typology of knowledge including the knowledge “from”, “for” and “about” the learner to introduce electronic mechanisms of knowledge management. In the second step of research, validity of the suggested framework is evaluated by experts’ opinion. Totally, 37 knowledge management mechanisms were confirmed by the experts. Thereby, the most important electronic mechanisms for management of the three major types of learner knowledge were introduced as “electronic community of practice”, “learner complaining recording/satisfaction collecting system” and “web seminar”. Then, the extent of knowledge management mechanism utilization was explored in four Iranian virtual universities (two state universities and two non-governmental universities) using the conceptual framework of research.

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