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Characteristics of patients who leave emergency departments without being seen.

https://arctichealth.org/en/permalink/ahliterature169464
Source
Acad Emerg Med. 2006 Aug;13(8):848-52
Publication Type
Article
Date
Aug-2006
Author
Brian H Rowe
Peter Channan
Michael Bullard
Sandra Blitz
L Duncan Saunders
Rhonda J Rosychuk
Harris Lari
William R Craig
Brian R Holroyd
Author Affiliation
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. brian.rowe@ualberta.ca
Source
Acad Emerg Med. 2006 Aug;13(8):848-52
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Alberta
Child
Child, Preschool
Emergency Service, Hospital - utilization
Female
Follow-Up Studies
Hospitals, Pediatric - utilization
Humans
Length of Stay
Male
Middle Aged
Patient Acceptance of Health Care - statistics & numerical data
Patient Admission - statistics & numerical data
Primary Health Care - utilization
Prospective Studies
Sex Distribution
Treatment Refusal - statistics & numerical data
Waiting Lists
Abstract
Patients leaving the emergency department (ED) without being seen (LWBS) by a physician have become a growing concern in overcrowded EDs. The purpose of this study was to determine the acuity level, reasons, and outcomes of LWBS cases.
LWBS patients (or their guardians) from two linked Canadian EDs (one adult, one pediatric), identified during 11 sampling periods of seven days' duration each, were contacted by telephone. Descriptive statistics are provided.
A total of 711 (4.5%) of 15,660 registered emergency patients left without being seen (50% male; median age, 33 years). Triage-matched controls waited a median of 87 minutes before seeing a physician. Of the 711 LWBS cases, 512 (72%) were contacted and 498 agreed to participate. The most common major reason for leaving was "fed up with waiting" (44.8%). Overall, 60% of LWBS cases sought medical attention within one week; 14 patients were hospitalized, and one required urgent surgery. Triage level was not associated with the probability of subsequently seeking medical attention (61%, 61%, and 60% in triage levels 3, 4, and 5, respectively). Of the 198 (39%) who did not subsequently seek medical attention, 50 patients (26%) had been triaged as urgent and one patient died six days after ED registration.
The most common reason for LWBS is impatience during peak ED periods. Many of these patients seek medical care within one week. Complications occurred rarely; however, "high-risk" patients who leave without being seen do experience adverse health outcomes. Further research is required to examine ways to reduce LWBS cases.
PubMed ID
16670258 View in PubMed
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Consultation outcomes in the emergency department: exploring rates and complexity.

https://arctichealth.org/en/permalink/ahliterature159120
Source
CJEM. 2008 Jan;10(1):25-31
Publication Type
Article
Date
Jan-2008
Author
Robert A Woods
Renee Lee
Maria B Ospina
Sandra Blitz
Harris Lari
Michael J Bullard
Brian H Rowe
Author Affiliation
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
Source
CJEM. 2008 Jan;10(1):25-31
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Emergency Medicine
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Patient Admission - statistics & numerical data
Referral and Consultation - statistics & numerical data
Abstract
Consultation is a common and important aspect of emergency department (ED) care. We prospectively examined the consultation rates, the admission rates of consulted patients, the emergency physician (EP) disposition prediction of consulted patients and the difficult consultations rates in 2 tertiary care hospitals.
Attending EPs recorded consultations during 5 randomly selected shifts over an 8-week period using standardized forms. Subsequent computer outcome data were extracted for each patient encounter, as well as demographic data from the ED during days in which there was a study shift.
During 105 clinical shifts, 1930 patients were managed by 21 EPs (median 17 patients per shift; interquartile range 14-23). Overall, at least 1 consultation was requested in 38% of patients. More than one-half of the patients (54.3%) who received a consultation were admitted to the hospital. Consultation proportions were similar between males and females (51% v. 49%, p=0.03). Consultations occurred more frequently for patients who were older, had higher acuity presentations, arrived during daytime hours or arrived by ambulance. The proportion of agreement between the EP's and consultant's opinion on the need for admission was 89% (kappa=0.77, 95% confidence interval 0.72-0.83). Overall, 92% of patents received 1 consultation. Six percent of the consultations were perceived as "difficult" by the EPs (defined as the EP's subjective impression of difficulties with consultation times, accessibility and availability of consultants, and the interaction with consultants or disposition issues).
Consultation is a common process in the ED. It often results in admission and is predictable based on simple patient factors. Because of perceived difficulty with consultations, strategies to improve the EP consultation process in the ED seem warranted.
PubMed ID
18226315 View in PubMed
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A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture.

https://arctichealth.org/en/permalink/ahliterature178523
Source
Ann Intern Med. 2004 Sep 7;141(5):366-73
Publication Type
Article
Date
Sep-7-2004
Author
Sumit R Majumdar
Brian H Rowe
Deb Folk
Jeffrey A Johnson
Brian H Holroyd
Donald W Morrish
Walter P Maksymowych
Ivan P Steiner
Charles H Harley
Brian J Wirzba
David A Hanley
Sandra Blitz
Anthony S Russell
Author Affiliation
Department of Medicine, University of Alberta, 2E3.07 Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440 112th Street, Edmonton, Alberta T6G 2B7, Canada. me2.majumdar@ualberta.ca
Source
Ann Intern Med. 2004 Sep 7;141(5):366-73
Date
Sep-7-2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Algorithms
Bone Density
Canada
Female
Fractures, Bone - etiology
Humans
Male
Middle Aged
Osteoporosis - complications - diagnosis - drug therapy
Outcome Assessment (Health Care)
Patient Education as Topic
Patient satisfaction
Practice Guidelines as Topic
Prospective Studies
Quality of Life
Reminder Systems
Wrist Injuries - etiology
Abstract
Despite the high risk for future fractures and the availability of effective treatments, fewer than 10% to 20% of patients who sustain a fragility fracture are tested or treated for osteoporosis.
To improve rates of testing and treatment for osteoporosis in patients with wrist fractures who are seen in the emergency department.
Nonrandomized, controlled trial with blinded ascertainment of outcomes.
Emergency departments in Edmonton, Alberta, Canada.
Persons 50 years of age or older who were treated for a wrist fracture and their physicians. Patients admitted to the hospital or treated for osteoporosis were excluded. Overall, 572 consecutive patients with fractures were screened, and 102 patients (55 intervention, 47 control) and 101 physicians were studied.
The primary end point was the prescription of osteoporosis treatment 6 months after fracture. Secondary end points included rates of testing for bone mineral density and patients' knowledge, satisfaction, and quality of life.
Faxed physician reminders that contained osteoporosis treatment guidelines endorsed by local opinion leaders and patient education. Control patients received usual care and information about falls and home safety.
The median patient age was 66 years. Most patients were female (78%) and white (79%); 70% of patients reported a previous fracture, and 22% had a fall with injury in the previous year. The intervention increased the rates of testing for bone mineral density to 62% (vs. 17% for controls; adjusted relative increase, 3.6 [P
Notes
Comment In: Ann Intern Med. 2004 Sep 7;141(5):I5415353445
PubMed ID
15353428 View in PubMed
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Data collection on patients in emergency departments in Canada.

https://arctichealth.org/en/permalink/ahliterature165762
Source
CJEM. 2006 Nov;8(6):417-24
Publication Type
Article
Date
Nov-2006
Author
Brian H Rowe
Kenneth Bond
Maria B Ospina
Sandra Blitz
Michael Schull
Douglas Sinclair
Michael Bullard
Author Affiliation
Department of Emergency Medicine, University of Alberta, 8440 112th Street, Edmonton, AB.
Source
CJEM. 2006 Nov;8(6):417-24
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Canada
Health Care Surveys
Hospitals - manpower
Humans
Medical Records Systems, Computerized - utilization
Abstract
Relatively little is known about the ability of Canadian emergency departments (EDs) and the federal, provincial and territorial governments to quantify ED activity. The objectives of this study were to determine the use of electronic patient data in Canadian EDs, the accessibility of provincial data on ED visits, and to identify the data elements and current methods of ED information system (EDIS) data collection nationally.
Surveys were conducted of the following 3 groups: 1) all ED directors of Canadian hospitals located in communities of >10,000 people, 2) all electronic EDIS vendors, and 3) representatives from the ministries of health from 13 provincial and territorial jurisdictions who had knowledge of ED data collection.
Of the 243 ED directors contacted, 158 completed the survey (65% response rate) and 39% of those reported using an electronic EDIS. All 11 EDIS vendor representatives responded. Most of the vendors provide a similar package of basic EDIS options, with add-on features. All 13 provincial or territorial government representatives completed the survey. Nine (69%) provinces and territories collect ED data, however the source of this information varies. Five provinces and territories collect triage data, and 3 have a comprehensive, jurisdiction-wide, population-based ED database. Thirty-nine percent of EDs in larger Canadian communities track patients using electronic methods. A variety of EDIS vendor options are available and used in Canada.
The wide variation in methods and in data collected presents serious barriers to meaningful comparison of ED services across the country. It is little wonder that the majority of information regarding ED overcrowding in Canada is anecdotal, when the collection of this critical health information is so variable. There is an urgent need to place the collection of ED information on the provincial and national agenda and to ensure that the collection of this information consistent, comprehensive and mandatory.
PubMed ID
17209491 View in PubMed
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The effect of current management on morbidity and mortality in hospitalised adults with funguria.

https://arctichealth.org/en/permalink/ahliterature178613
Source
J Infect. 2004 Oct;49(3):248-52
Publication Type
Article
Date
Oct-2004
Author
Christine Simpson
Sandra Blitz
Stephen D Shafran
Author Affiliation
Department of Medicine, University of Alberta, 2F1.13 Walter C. Mackenzie Health Sciences Centre, 8440-112 Street, Edmonton, Alta., Canada T6G 2R7.
Source
J Infect. 2004 Oct;49(3):248-52
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
Amphotericin B - therapeutic use
Antifungal Agents - therapeutic use
Female
Hospitalization
Humans
Incidence
Male
Middle Aged
Mycoses - drug therapy - epidemiology - mortality
Retrospective Studies
Risk factors
Urinary Catheterization - adverse effects
Abstract
To compare morbidity and mortality in inpatients with asymptomatic funguria between those treated and those observed for funguria.
Retrospective analyses were performed in 149 consecutive adult tertiary care inpatients with asymptomatic funguria. The primary endpoints were death, length of hospitalisation and progression to invasive fungal infection (IFI).
Of the 149 subjects, 70% were female, 55% were >65 years, recent antibiotic and urinary catheter use occurred in >70%, diabetes in 32%, recent ICU admission in 29%, and concomitant bacteriuria in 28%. Forty-seven percent did not receive active intervention. Of the remainder, 46% were managed by controlling or eliminating risk factors for funguria or progression to IFI; fluconazole or amphotericin B were used to treat the other 54%. Fourteen percent died and 2.7 % progressed to IFI, with no significant difference between the treated versus observed groups for either endpoint (p>0.2). Median length of hospitalisation was significantly greater in the treated group (p
PubMed ID
15337343 View in PubMed
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Effect of gender and calendar year on time to and duration of virologic suppression among antiretroviral-naïve HIV-infected individuals initiating combination antiretroviral therapy.

https://arctichealth.org/en/permalink/ahliterature137878
Source
HIV Clin Trials. 2010 Nov-Dec;11(6):340-50
Publication Type
Article
Author
Janet Raboud
Sandra Blitz
Sharon Walmsley
Courtney Thompson
Sean B Rourke
Mona R Loutfy
Author Affiliation
University Health Network, Toronto, Ontario, Canada. raboud@lunenfeld.ca
Source
HIV Clin Trials. 2010 Nov-Dec;11(6):340-50
Language
English
Publication Type
Article
Keywords
Adult
Anti-Retroviral Agents - pharmacology - therapeutic use
Cohort Studies
Drug Therapy, Combination
Female
HIV Infections - drug therapy - virology
Humans
Male
Middle Aged
Ontario
Pregnancy
Pregnancy Complications, Infectious - drug therapy - virology
Proportional Hazards Models
Risk factors
Seasons
Sex Factors
Time Factors
Viral Load - drug effects
Abstract
To determine the effects of gender and calendar year on time to and duration of virologic suppression among HIV-infected antiretroviral-naïve individuals initiating combination antiretroviral therapy (cART).
Ontario Cohort Study antiretroviral-naïve participants who initiated cART after December 31, 1998, and who had =2 follow-up viral loads were included. Multivariable Cox proportional hazard models were used to estimate the effects of gender and calendar year on times to virologic suppression and rebound.
Of the 840 patients, 81% were male (median age 40 years; interquartile range [IQR], 34-46). Time to virologic suppression was shorter among women (hazard ratio [HR]=1.27, P=.01) and in more recent calendar time periods (2002-2004: HR, 1.04, P=.67; 2005-2006: HR, 1.22, P=.06; 2007-2008: HR, 1.36, P=.004) compared to 1999-2001 after adjusting for age and type of cART regimens. Women had shorter times to virologic rebound (HR, 1.57; P
PubMed ID
21239362 View in PubMed
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The effect of training on nurse agreement using an electronic triage system.

https://arctichealth.org/en/permalink/ahliterature162488
Source
CJEM. 2007 Jul;9(4):260-6
Publication Type
Article
Date
Jul-2007
Author
Sandy L Dong
Michael J Bullard
David P Meurer
Sandra Blitz
Brian R Holroyd
Brian H Rowe
Author Affiliation
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton.
Source
CJEM. 2007 Jul;9(4):260-6
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Chi-Square Distribution
Decision Making, Computer-Assisted
Emergency Nursing - education - instrumentation
Emergency Service, Hospital - utilization
Female
Humans
Inservice training
Male
Middle Aged
Prospective Studies
Reproducibility of Results
Severity of Illness Index
Triage - methods - standards
Abstract
Emergency department (ED) triage prioritizes patients based on urgency of care, and the Canadian Triage and Acuity Scale (CTAS) is the national standard. We describe the inter-rater agreement and manual overrides of nurses using a CTAS-compliant web-based triage tool (eTRIAGE) for 2 different intensities of staff training.
This prospective study was conducted in an urban tertiary care ED. In phase 1, eTRIAGE was deployed after a 3-hour training course for 24 triage nurses who were asked to share this knowledge during regular triage shifts with colleagues who had not received training (n = 77). In phase 2, a targeted group of 8 triage nurses underwent further training with eTRIAGE. In each phase, patients were assessed first by the duty triage nurse and then by a blinded independent study nurse, both using eTRIAGE. Inter-rater agreement was calculated using kappa (weighted kappa) statistics.
In phase 1, 569 patients were enrolled with 513 (90.2%) complete records; 577 patients were enrolled in phase 2 with 555 (96.2%) complete records. Inter-rater agreement during phase 1 was moderate (weighted kappa = 0.55; 95% confidence interval [CI] 0.49-0.62); agreement improved in phase 2 (weighted kappa = 0.65; 95% CI 0.60-0.70). Manual overrides of eTRIAGE scores were infrequent (approximately 10%) during both periods.
Agreement between study nurses and duty triage nurses, both using eTRIAGE, was moderate to good, with a trend toward improvement with additional training. Triage overrides were infrequent. Continued attempts to refine the triage process and training appear warranted.
PubMed ID
17626690 View in PubMed
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Emergency triage: comparing a novel computer triage program with standard triage.

https://arctichealth.org/en/permalink/ahliterature174488
Source
Acad Emerg Med. 2005 Jun;12(6):502-7
Publication Type
Article
Date
Jun-2005
Author
Sandy L Dong
Michael J Bullard
David P Meurer
Ian Colman
Sandra Blitz
Brian R Holroyd
Brian H Rowe
Author Affiliation
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Source
Acad Emerg Med. 2005 Jun;12(6):502-7
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Canada
Decision Making, Computer-Assisted
Emergency Nursing - instrumentation
Female
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Admission - statistics & numerical data
Prospective Studies
Severity of Illness Index
Single-Blind Method
Triage - methods - standards - statistics & numerical data
Abstract
Emergency department (ED) triage prioritizes patients based on urgency of care; however, little previous testing of triage tools in a live ED environment has been performed.
To determine the agreement between a computer decision tool and memory-based triage.
Consecutive patients presenting to a large, urban, tertiary care ED were assessed in the usual fashion and by a blinded study nurse using a computerized decision support tool. Triage score distribution and agreement between the two triage methods were reported. A random subset of patients was selected and reviewed by a blinded expert panel as a consensus standard.
Over five weeks, 722 ED patients were assessed; complete data were available from 693 (96%) score pairs. Agreement between the two methods was poor (kappa = 0.202; 95% confidence interval [95% CI] = 0.150 to 0.254); however, agreement improved when using weighted kappa (0.360; 95% CI = 0.305 to 0.415) or "within one" level kappa (0.732; 95% CI = 0.644 to 0.821). When compared with the expert panel, the nurse triage scores showed lower agreement (0.263; 95% CI = 0.133 to 0.394) than the tool (kappa = 0.426; 95% CI = 0.289 to 0.564). There was a significant down-triaging of patients when patients were triaged without the computerized tool. Admission rates also differed between the triage systems.
There was significant discrepancy by nurses using memory-based triage when compared with a computer tool. Triage decision support tools can mitigate this drift, which has administrative implications for EDs.
Notes
Comment In: Acad Emerg Med. 2005 Jun;12(6):533-515930405
PubMed ID
15930400 View in PubMed
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Evaluation of HIV and highly active antiretroviral therapy on the natural history of human papillomavirus infection and cervical cytopathologic findings in HIV-positive and high-risk HIV-negative women.

https://arctichealth.org/en/permalink/ahliterature114326
Source
J Infect Dis. 2013 Aug 1;208(3):454-62
Publication Type
Article
Date
Aug-1-2013
Author
Sandra Blitz
Joanna Baxter
Janet Raboud
Sharon Walmsley
Anita Rachlis
Fiona Smaill
Alex Ferenczy
François Coutlée
Catherine Hankins
Deborah Money
Author Affiliation
Toronto General Research Institute, University Health Network, Canada.
Source
J Infect Dis. 2013 Aug 1;208(3):454-62
Date
Aug-1-2013
Language
English
Publication Type
Article
Keywords
Adult
Antiretroviral Therapy, Highly Active - methods
Canada - epidemiology
Cervical Intraepithelial Neoplasia - epidemiology - pathology
Cervix Uteri - pathology - virology
Cohort Studies
Cytological Techniques
Female
HIV Infections - complications - drug therapy
Humans
Longitudinal Studies
Papillomavirus Infections - epidemiology - pathology
Prospective Studies
Uterine Cervical Neoplasms - epidemiology - pathology
Viral Load
Young Adult
Abstract
The Canadian Women's HIV Study (CWHS) enrolled human immunodeficiency virus (HIV)-positive and high-risk HIV-negative women in a longitudinal cohort. This analysis considered the effects of HIV and highly active antiretroviral therapy (HAART) on HPV persistence and cervical squamous intraepithelial lesions (SILs).
Longitudinal cytopathologic and HPV DNA results were analyzed using multistate models. States of cervical SIL were defined as absent, present, and treatment; HPV states were defined as negative or positive. Demographic variables and markers of sexual activity were considered predictors. Results were calculated on the basis of transition probabilities and reported as hazard ratios (HRs).
The CWHS followed 750 HIV-positive and 323 HIV-negative women during 1993-2002. A total of 467 and 456 women were included in the longitudinal cervical cytopathologic and HPV DNA analyses, respectively. HIV-positive women had increased prevalence (46.6% vs 28.7%; P
PubMed ID
23624362 View in PubMed
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Frequency, determinants and impact of overcrowding in emergency departments in Canada: a national survey.

https://arctichealth.org/en/permalink/ahliterature160289
Source
Healthc Q. 2007;10(4):32-40
Publication Type
Article
Date
2007
Author
Kenneth Bond
Maria B Ospina
Sandra Blitz
Marc Afilalo
Sam G Campbell
Michael Bullard
Grant Innes
Brian Holroyd
Gil Curry
Michael Schull
Brian H Rowe
Author Affiliation
Capital Health/University of Alberta Evidence-Based Practice Center, Edmonton.
Source
Healthc Q. 2007;10(4):32-40
Date
2007
Language
English
Publication Type
Article
Keywords
Canada
Crowding
Emergency Service, Hospital - organization & administration
Health Care Surveys
Humans
National Health Programs
Abstract
Several reports have documented the prevalence and severity of emergency department (ED) overcrowding at specific hospitals or cities in Canada; however, no study has examined the issue at a national level. A 54-item, self-administered, postal and web-based questionnaire was distributed to 243 ED directors in Canada to collect data on the frequency, impact and factors associated with ED overcrowding. The survey was completed by 158 (65% response rate) ED directors, 62% of whom reported overcrowding as a major or severe problem during the past year. Directors attributed overcrowding to a variety of issues including a lack of admitting beds (85%), lack of acute care beds (74%) and the increased length of stay of admitted patients in the ED (63%). They perceived ED overcrowding to have a major impact on increasing stress among nurses (82%), ED wait times (79%) and the boarding of admitted patients in the ED while waiting for beds (67%). Overcrowding is not limited to large urban centres; nor is it limited to academic and teaching hospitals. The perspective of ED directors reinforces the need for further examination of effective policies and interventions to reduce ED overcrowding.
PubMed ID
18019897 View in PubMed
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20 records – page 1 of 2.