Department of Emergency Medicine Faculty Publications

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    Keeping up with the literature: A current practice survey and qualitative needs assessment among emergency physicians
    (Wiley, 2022-05-05) Colmers-Gray, Isabelle; Solis Aguilar, Leandro; Gauri, Aliyah; Ha, David J.; Stauffer, Brandy A.
    Purpose Physicians face the challenge of staying current with a rapidly growing body of evidence and applying it to their practice. How emergency physicians (EPs) do so is unknown. The authors sought to describe and assess needs around EP patterns of evidence based medicine (EBM) and continuing medical education (CME) resource use. Methods The authors conducted a multi-centre, cross-sectional study in 2019 across 12 tertiary care, community and suburban emergency department (ED) sites in the greater area of Edmonton. Information on EBM/CME resource use along with barriers and facilitators to staying current was gathered using a rigorously-developed survey tool, distributed electronically and by mail. Responses were tabulated and subgroups analyzed using MANOVA and ANOVA tests. Thematic analysis of comments used a phenomenological lens. Results One-hundred-eighteen EPs (40.1%) completed the survey. Listening to podcasts, attending EM conferences, and subscription-based resources were preferred for staying current. Resource use differed by years in practice but not by age, sex, training background or site type. EBM had an important impact on respondents’ practice (average rating 3.8 out of 5, with 5 indicating ‘practice changing’). Time was an important barrier. Most (62.7%) felt they did not spend enough time, despite spending a median of four to five hours monthly on EBM. Facilitators (including journal club summaries or lists of practice-relevant papers) had only moderate impacts. Thematic analysis found three themes (importance of EBM, implementation challenges and dissemination of EBM) and 13 subthemes. Conclusion EPs preferentially choose podcasts, conferences and subscription-based resources to stay current with EBM; time is the biggest barrier. These findings help ED leads and educators tailor CME to physician learning preferences, to maximize application of EBM to clinical practice. Next steps include developing/curating resources and disseminating the survey on a larger scale to identify opportunities for shared virtual resources.
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    Patient and hospital factors predict use of coronary angiography in out-of-hospital cardiac arrest patients
    (2019-05-01) Hanuschak, Tasha A.; Peng, Yingwei; Day, Andrew; Morrison, Laurie J.; Zhan, Cathy C.; Brooks, Steven C.
    Aim To describe the association between patient- and hospital-level factors and coronary angiography among patients who suffer out-of-hospital cardiac arrest (OHCA). Methods A population-based retrospective cohort study using data from 28 hospitals in Southern Ontario between March 1, 2010 and December 31, 2014. We included consecutive adult patients with atraumatic, OHCA, who achieved return of spontaneous circulation, and were alive at least six hours after hospital arrival. Multilevel logistic regression was used to measure the relationship between patient- and hospital-level covariates and receipt of coronary angiography. Results Among 2578 consecutive patients, the mean age was 67(±15), 69% were male, 49% had a shockable initial cardiac arrest rhythm and 84% were comatose at hospital admission. Overall, 33% of the study population received coronary angiography. This varied markedly by hospital of first assessment (13%–70%). Factors associated with receiving coronary angiography included ST-segment elevation (OR = 21.30, CI95 16.17–28.04), a shockable initial cardiac rhythm (OR = 5.00, CI95 3.70–6.75), bystander AED use (OR = 2.51, CI95 1.49–4.23), EMS-witnessed arrest (OR = 2.49, CI95 1.62–3.81), initial admission to a PCI center (OR = 2.94, CI95 1.66–5.21), age (OR = 1.04, CI95 1.02–1.07 for age <55, OR = 0.91, CI95 0.88−0.94 for age ≥55), and pre-hospital ROSC (OR = 1.59, CI95 1.06–2.39). Conclusion We identified patient- and hospital-level factors that explain some of the variability in the use of coronary angiography for OHCA. Future work should determine which post arrest patients will benefit most from urgent coronary angiography and evaluate knowledge translation strategies to ensure consistent delivery of best practices.