Discharged Emergency Department (ED) patients should receive instructions about their condition, including self-care and return-to-care guidance, while satisfying medicolegal requirements. Verbal instructions are forgotten or poorly understood. Written instructions are best practice, but usage barriers include multifactorial inefficiencies getting them to the patient and patient challenges finding them later when needed. In this feasibility and uptake study, we sought to address these barriers by developing a website that enables physicians to send condition-specific discharge instructions by text message. We recruited from the approximately 60 physicians working in the Saskatoon, Canada adult EDs, which serve > 140,000 patients/year. The physician visits our website, enters the patient’s phone number, selects a condition, and taps “send.” The patient receives a text message with a link to condition-specific discharge instructions. We analyzed link access data and surveyed physician feedback. Over a 2-month study period, 115 discharge instructions were texted (< 1

In Canada, emergency departments have a large number of patients with mental health and substance use concerns passing through their doors. Our research aim was to assess the impact that therapy dog visits may have for patients presenting with mental health and/or substance use concerns to an emergency department based in Saskatoon, Saskatchewan. Working alongside an active patient advisory group and community-based therapy dog program volunteers, our mixed method approach utilizing ethnography, surveys, and interviews showed that therapy dog visitation had a beneficial impact on both patients and staff, thus improving the overall patient experience. Our study displays how the patient experience was enhanced via improved patient communication; a decrease in agitation or distress; providing a sense of connection from perceived non-judgemental support; an increase in hope and optimism; and a welcomed, calming distraction from local stressors. Further, staff also received benefit in their working conditions where they considered the therapy dog a member of the care team. This paper outlines how including therapy dog visits as a complementary aide in existing provisional care settings provides a more holistic and empathetic approach to mental health and substance use responses in the Canadian context, which is particularly relevant in busy, high-stress emergency departments.

The shortage of after-hours ultrasound (US) imaging in the ED puts considerable strain on the patient and the already scant resources in the ED. Implementing an alternate clinical pathway that guides ED physicians to utilize the US imaging centers in the community for non-emergent scans may help alleviate some of these stressors. We aimed to reduce the number of patients returning to the ED for US by 50

Insufficient evidence-based recommendations to guide care for patients with devastating brain injuries (DBIs) leave patients vulnerable to inconsistent practice at the emergency department (ED) and intensive care unit (ICU) interface. We sought to characterize the beliefs of Canadian emergency medicine (EM) and critical care medicine (CCM) physician site directors regarding current management practices for patients with DBI.

The Canadian Association of Emergency Physicians' (CAEP) Global Emergency Medicine committee presents a four-part series that builds upon the Academic Symposium recommendations from the CAEP 2018 meeting (Collier et al. in CJEM 21(5):600-606, 2019). This series presents best practices and offers practical tools for the development and practice of Global EM. This is the first paper of the series which provides an overview of current Global EM systems and development. The breadth and scope of the field is described, and key definitions are outlined. International efforts, initiatives, and organizations relating to public health and humanitarian response are introduced. Other key aspects of Global EM are explored in papers 2-4 including: developing partnerships, supporting centers of research and practice, and education and training.

The Canadian Association of Emergency Physicians’ (CAEP) Global Emergency Medicine committee presents a four-part series that builds upon the Academic Symposium recommendations from the CAEP 2018 meeting (Collier et al. in CJEM 21(5):600–606, 2019). This series presents best practices and offers practical tools for the development and practice of Global EM. This is the first paper of the series which provides an overview of current Global EM systems and development. The breadth and scope of the field is described, and key definitions are outlined. International efforts, initiatives, and organizations relating to public health and humanitarian response are introduced. Other key aspects of Global EM are explored in papers 2–4 including: developing partnerships, supporting centers of research and practice, and education and training.

Introduction Canadian patients presenting to the emergency department (ED) typically undergo a triage process where they are assessed by a specially trained nurse and assigned a Canadian Triage and Acuity Scale (CTAS) score, indicating their level of acuity and urgency of assessment. We sought to assess the ability of patients to self-triage themselves through use of one of two of our proprietary self-triage tools, and how this would compare with the standard nurse-driven triage process. Methods We enrolled a convenience sample of ambulatory ED patients aged 17 years or older who presented with chief complaints of chest pain, abdominal pain, breathing problems, or musculoskeletal pain. Participants completed one, or both, of an algorithm generated self-triage (AGST) survey, or visual acuity scale (VAS) based self-triage tool which subsequently generated a CTAS score. Our primary outcome was to assess the accuracy of these tools to the CTAS score generated through the nurse-driven triage process. Results A total of 223 patients were included in our analysis. Of these, 32 (14.3%) presented with chest pain, 25 (11.2%) with shortness of breath, 75 (33.6%) with abdominal pain, and 91 (40.8%) with musculoskeletal pain. Of the total number of patients, 142 (47.2%) completed the AGST tool, 159 (52.8%) completed the VAS tool and 78 (25.9%) completed both tools. When compared to the nurse-driven triage standard, both the AGST and VAS tools had poor levels of agreement for each of the four presenting complaints. Conclusions Self-triage through use of an AGST or VAS tool is inaccurate compared to the established standard of nurse-driven triage. Although existing literature exists which suggests that self-triage tools developed for specific subsets of complaints may be feasible, our results would suggest that adopting the self-triage approach on a broader scale for all-comers to the ED does not appear to be a viable option to enhance the current triage process. Further study is required to show if self-triage can be used in the ED to optimize the triage process.

OBJECTIVE:Studies have shown that Emergency Department physicians have little to no training in recognizing and supporting victims of human trafficking despite being uniquely situated to identify and intervene on behalf of these patients. We assessed if screening for human trafficking was being completed by emergency physicians in three Saskatoon emergency departments. METHODS:We performed a retrospective chart review of patients presenting to three Saskatoon emergency departments deemed to potentially be at risk of human trafficking, based on discharge diagnosis. Of the 223 included charts, data extracted included sex, age, ethnicity, chief complaint, diagnosis, disposition, HT Screening (Y/N), specific quotes relating to HT, time of visit, intimate partner violence (Y/N), and travel history. Both quantitative and qualitative thematic analyses were conducted on this data. RESULTS:None of the charts (0%) included in this study had any documentation around screening for human trafficking. Furthermore, 21.1% of the high-risk patient charts included in this study -- which included many patients with a discharge diagnosis of sexually transmitted disease or pelvic inflammatory disease -- did not contain a documented sexual history. Thematic analysis revealed that the patients included in this study frequently had challenges with sexual health, substance use, and houselessness. CONCLUSION:This study found that Emergency physicians in Saskatoon were not routinely screening for human trafficking. Implementation of further training is needed to help these physicians recognize and subsequently support potential victims of human trafficking.

Objective The significance of physician leadership to help transform the healthcare system has been increasingly discussed. This study looked at the qualities of emergency medicine (EM) physicians that support or inhibit their work as healthcare leaders. Methods Through an iterative process of semi-structured interviews and then focus groups, we examined why EM physicians pursue leadership roles, the strengths they bring and the frustrations they encounter. Thematic analysis identified factors that facilitate and inhibit the work of EM physicians as they enter leadership roles. Results These findings can be summarized in four key themes. (1) A desire to improve the wider health system was often a prime motivator for entering a leadership role. (2) EM physicians’ clinical skills such as confident decision-making, relationship building through communication, and comfort with uncertainty supported their successful transition to leadership. (3) EM physician leaders perceived shiftwork as both a potential benefit and a challenge in their leadership role and felt it needed to be carefully managed to ensure personal wellness and success. And (4) participants were not driven to take on leadership positions by financial remuneration but stated that the discrepancy between EM clinical and leadership compensation was a point of stress. Conclusion As physician leadership is explored as a mechanism to support the healthcare system’s success, this project provides insights into the realities experiences by EM physicians and considerations for healthcare professionals as they encourage physicians into leadership positions.

ObjectiveTo identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs.MethodsWe surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence.ResultsWe excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup.ConclusionsIndividual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD.

Insufficient evidence-based recommendations to guide care for patients with devastating brain injuries (DBIs) leave patients vulnerable to inconsistent practice at the emergency department (ED) and intensive care unit (ICU) interface. We sought to characterize the beliefs of Canadian emergency medicine (EM) and critical care medicine (CCM) physician site directors regarding current management practices for patients with DBI. We conducted a cross-sectional survey of EM and CCM physician directors of adult EDs and ICUs across Canada (December 2022 to March 2023). Our primary outcome was the proportion of respondents who manage (or consult on) patients with DBI in the ED. We conducted subgroup analyses to compare beliefs of EM and CCM physicians. Of 303 eligible respondents, we received 98 (32

In 2018, the Canadian Association of Emergency Physicians (CAEP) academic symposium included developing recommendations on supporting global emergency medicine (EM) in Canadian departments and divisions. Members of CAEP's Global EM committee created a four-part series to be published in CJEM that would build upon the symposium recommendations. The objective is to offer practical tools to EM physicians interested in becoming involved in Global EM, as well as provide departments with successful Canadian case examples that foster, facilitate, and grow Global EM efforts. This submission is the fourth paper of the series which focuses on education and continuing professional development for Global EM. It includes resources for resident global EM electives, fellowship training and ongoing or additional CPD training for practicing EM physicians. It also highlights the importance of pre-departure training and other required elements of engaging responsibly in Global EM work.

Background: Health literacy is increasingly recognized as a major determinant of health; however, our insights into the health literacy strengths and needs of adults living with serious or persistent mental illness remain limited by a notable lack of research in this area. Improving our understanding is important because people in this group are especially vulnerable to numerous negative health outcomes, many preventable. Objective: To assess the health literacy strengths and needs of people living with serious or persistent mental illness in terms of their ability to acquire, understand, and use information about their illness and the health services they require. Methods: A cross-sectional convergent mixed methods design guided by the Ophelia Access and Equity Framework. People diagnosed with serious or persistent mental illness were offered participation. Quantitative and qualitative data was collected using questionnaires (Health Literacy Questionnaire [HLQ], World Health Organization [WHO-5]) and semi-structured interviews. Hierarchical cluster analysis identified and grouped participants with similar health literacy scores into mutually exclusive groups, for the development of clinical vignettes. Key Results: Participants struggled most with the appraisal of health information (HLQ mean 2.72, standard deviation [ SD ] .63 [scale 1–4]) and navigating what they often perceived to be a confusing health care system (HLQ mean 3.29, SD .79 [scale 1–5]). On the other hand, most participants reported positive experiences with their health care providers (HLQ mean 3.19, SD .62 [scale 1–4]) and generally felt understood and supported. The cluster analysis suggests we should not assume people living with serious or persistent mental illness have homogeneous HL strengths and needs, meaning a one-size-fits-all solution for improving health literacy in this diverse group will likely not be a successful strategy. It will be important to explore solutions that embrace patient-centered care approaches. Conclusions: This study is one of only a handful assessing the health literacy strengths and needs of people living with serious or persistent mental illness. By collecting both quantitative and qualitative data, then analyzing the results using sophisticated cluster analysis methods, the authors were able to develop clinical vignettes per the Ophelia Framework that offer results in a practical way that can be readily understood and acted upon by stakeholders. We found that the HLQ is a measure of HL that is acceptable to mental health clients, and our findings provide preliminary data on the use of this instrument in the mental health population. [ HLRP: Health Literacy Research and Practice . 2023;7(1):e2–e13. ] Plain Language Summary: This study explored the health literacy strengths and needs of people living with serious or persistent mental illness. The results showed a mix of strengths and needs among our participants, though several consistent themes emerged. Most of our participants felt understood and supported by their health care providers, but many often struggle with judging the quality of health information and finding their way through the health care system.

Lengthy emergency department (ED) wait times caused by hospital access block is a growing concern for the Canadian health care system. Our objective was to quantify the impact of alternate-level-of-care on hospital access block and evaluate the likely effects of multiple interventions on ED wait times. Discrete-event simulation models were developed to simulate patient flows in EDs and acute care of six Canadian hospitals. The model was populated with administrative data from multiple sources (April 2017–March 2018). We simulated and assessed six different intervention scenarios' impact on three outcome measures: (1) time waiting for physician initial assessment, (2) time waiting for inpatient bed, and (3) patients who leave without being seen. We compared each scenario's outcome measures to the baseline scenario for each ED. Eliminating 30

Objective Communication during consultations between referring and consultant physicians is often cited as a source of adverse events, medical error and professional incivility. While existing literature focuses on the role of referring physicians, few studies acknowledge the role of consultant physicians in enhancing communication during consultations. This scoping review aims to identify and synthesise available recommendations to enhance the communication practices of consultants during real-time consultations.Design A scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.Data sources Medline, EMBASE and PsycINFO databases were searched from inception to August 2022.Eligibility criteria for selecting studies English-language publications which describe recommendations, strategies or frameworks to improve the communication practices of consultant physicians during real-time consultations with referring physicians.Data extraction and synthesis The search strategy included the following concepts: consultation, physician, communication, interprofessional relations and best practice. Two authors independently performed each phase of title and abstract screening, full-text review and data extraction. Discrepancies were resolved by a third author. Extracted data were iteratively analysed and summarised thematically.Results Sixteen publications met the inclusion criteria. Synthesis of available recommendations identified organisation, expertise and interpersonal skills as three overarching and interconnected dimensions of communication demonstrated by consultants during effective consultations. Twelve studies identified interpersonal skills as being critical in alleviating the widespread professional incivility that is reported during consultations. Existing recommendations to improve the communication practices of consultants are limited as they lack standardised interventions and fail to comprehensively address all three elements identified in this review.Conclusion This scoping review synthesises available recommendations to improve the communication practices of consultant physicians during real-time consultations. An opportunity exists to develop communication tools or educational interventions based on the findings of this review to enhance interphysician consultation encounters.