BACKGROUND:Hyperkalemia can be deadly, yet clinical decision-making for outpatient management is unclear. We sought to determine whether an emergency department encounter within 24 hours of a severe outpatient hyperkalemia result was associated with lower rates of immediate and short-term all-cause death. METHODS:We conducted a retrospective population-based cohort study in Ontario, Canada, involving adults (age ≥18 yr) with an outpatient potassium result greater than 6.2 mmol/L from Jan. 1, 2007, to Dec. 24, 2021. Patients who presented to the emergency department were propensity matched (1:1) to patients who did not. We estimated risk ratios and risk differences for all-cause death within 1, 3, and 7 days after the encounter. We performed subgroup analyses based on kidney function, sex, diabetes, renin-angiotensin-aldosterone inhibitor use, potassium level, and ordering physician specialty. RESULTS:A total of 57 607 individuals had an outpatient potassium result greater than 6.2 mmol/L. Among these individuals, 7469 emergency department encounters occurred. After matching, 6557 patients had an emergency department encounter and 6557 did not. Within 7 days, a total of 209 deaths (1.6%) occurred. The risk of death was significantly lower among those with an emergency department encounter at 1 day (risk ratio [RR] 0.39, 95% confidence interval [CI] 0.24 to 0.65), 3 days (RR 0.47, 95% CI 0.32 to 0.67), and 7 days (RR 0.69, 95% CI 0.52 to 0.90). Subgroup analysis showed the greatest mortality reduction among patients with higher potassium levels (>6.6 mmol/L) and impaired kidney function (estimated glomerular filtration rate <30 mL/min/1.73 m2). INTERPRETATION:Presentation to the emergency department within 24 hours of a severe outpatient hyperkalemia result is associated with lower rates of immediate and short-term death. These findings support urgent emergency department referrals and underscore the need for standardized reporting and management guidelines.
BACKGROUND:Equitable access to care is a cornerstone of inclusive and fair societies, yet Deaf patients continue to encounter entrenched barriers in Canadian health care systems that compromise safety, trust, and health outcomes. We aimed to characterize the experiences of culturally Deaf community members with accessing and navigating health care, and to identify priorities for creating equitable and culturally safe care. METHODS:We conducted a qualitative co-design study grounded in a critical-interpretive paradigm in partnership with Deaf Services Canada, a nonprofit organization that provides services to members of the Deaf community. We recruited participants from multiple regions across Ontario, Canada, including urban centres, rural communities, and northern Ontario. We recruited Deaf adults, family members, interpreters, and advocates, and conducted 8 focus groups using American Sign Language (ASL)-English interpreters. We rooted reflexive thematic analysis in the sociocultural model of deafness. We carried out coding and theme development collaboratively through iterative discussions, ensuring that the analytic process reflected diverse perspectives, reinforced trustworthiness, and remained accountable to experiences of the Deaf community. RESULTS:We included 23 participants. A total of 14 identified as culturally Deaf and 9 identified as hearing, with overlapping roles as family members (n = 7), interpreters (n = 5), and advocates (n = 7). Five intersecting themes were generated: limited access to care is embedded in a system that privileges hearing and spoken language; structural barriers in appointment-booking processes reinforce exclusion; interpreting services are inconsistently valued and implemented, compromising communication; communication roadblocks within the medical team compromise equitable care; and agency and adaptive strategies persist despite systemic barriers. INTERPRETATION:Deaf community experiences highlight how the privileging of spoken language and hearing norms operates both structurally and interpersonally to shape and constrain health care access and navigation. Embedding Deaf cultural responsivity in health-professional education, standardizing provision of interpreting services, and integrating culturally safe communication pathways are critical first steps toward advancing health equity for this underrecognized group.
