cognitive decision making, diagnostic decision making, medical ethics
The question is: how do we best mentally and physically prepare for an ED shift? Dr. Rob Orman, master educator and fellow podcaster joins Anton to discuss a few options...
Howard Ovens, Grant Innes, Sam Campbell and Anton discuss the root causes, challenges and some of the solutions of one of the defining characteristics of emergency medicine in the 21st century - overcrowding. It is absolutely in the interest of every single ED provider to understand how this problem came to be, and what we can do about it. As citizens of the medical community, becoming aware of the issues that drive ED overcrowding will be a powerful asset in the drive for change. We hope to equip you with the knowledge and actionable moves to effect change on your next shift at the individual level, at the ED level, and even at the hospital and government levels…
Dr. Brindley explores ways in which physicians can find happiness and meaning in their work. A simple act of showing gratitude is just one of the tools in his toolbox for how to reduce burnout and promote resiliency...
I was taken aback when I came across the statistic that approximately every 6 days a woman in Canada is killed by her intimate partner. Victims of intimate partner violence and domestic violence that we see in the ED typically involve an abuse story of repeated escalating violence over time that ends up in a crisis situation. The woman is often financially dependent on her abuser and has no one to turn to for help. In one of her worst cases ever from Janus General, Dr. Meeta Patel and I discuss the notions that Emergency providers have a unique opportunity to identify patients who are victims of intimate partner violence; that we should begin by thinking of how we can screen every woman of childbearing age about intimate partner violence in a private, safe and respectful way. We describe the quick Partner Violence Screen and finally how to offer supportive, empowering statements and connect your patients with resources like assaulted women’s helpline and shelters in your community...
Dr. Sarah Gray tells us the story of her worst case ever and what she learned from it. About 50% of North American physicians involved in a serious medical error report increased anxiety for future errors, decreased confidence in their job, decreased job satisfaction, insomnia, PTSD, panic disorder – the list goes on. Dr. Gray shares how and why many of us react to medical error - the embarrassment, the shame, the guilt and sense of failure. She then explains the notion of acceptance that we all fail, that perfection is a myth, and how she learned that "failing up" after of the most difficult case of her career is the best choice after making a medical error...
Two classic EM Cases main episode podcasts, IV Iron for Anemia in EM with Jeannie Callum and Walter Himmel, and Emergency Management of Hyponatremia with Melanie Baimel and Ed Etchells are covered in the latest Rapid Reviews Videos by Taryn Lloyd and Nick Clarridge. Dr. Lloyd reviews how to avoid needless blood transfusions, the indications for IV iron and how to actually administer IV iron, while Dr. Clarridge reviews a novel approach, causes, complications and management of hyponatremia in the ED...
What does the evidence say about the true utility of physician performance feedback and scorecards? Do they meet a real need for information to guide self-improvement or just scratch our competitive itches? What do we know about the best way to provide feedback? In this month’s guest blog Dr. Amy Cheng, the Emergency Department Director of Quality Improvement at St. Michael’s Hospital in Toronto with an interest in physician performance feedback, reviews what’s known and comments on her own experiences...
Last month in introducing part one of our guest blog on quality assurance I told a story about a missed opportunity with follow-up care. This month I’d like to share a story with a happier ending. Recently, a patient presented at our emergency department (ED) with a non-specific fever. After discharge the patient’s blood cultures were reported positive, but attempts to reach this person over the ensuing 36 hours at the contact numbers provided were unsuccessful. An enterprising colleague googled the patient and found contact information online that eventually led to a call to the patient in a hotel room in another city, but when reached the patient was ill and confused...
I had the great pleasure of meeting Dr. Mike Winters on his first ever visit to Canada at North York General's Emergency Medicine Update Conference, where he gave two fantastic presentations. His credentials are impressive: He is the Medical Director of the Emergency Department, Associate Professor in both EM and IM, EM-IM-Critical Care Program co-director and Residency Program Director of EM-IM at the University of Maryland in Baltimore. Sometimes we are so caught up with the job we need to get done during cardiac arrest that we forget about the important and profound effect that this event has on patients' families. On this Best Case Ever Dr. Winters tells the story of witnessing his grandfather's cardiac arrest, being present in the ED during the resuscitation attempts, and how that experience has coloured his practice. We discuss some pearls on communication with patients' families after death, colour-coded cardiac arrest teams and how to integrate POCUS into cardiac arrest care while minimizing chest compressions.
Succeeding with the dirty task of hand hygiene promotion How many psychiatrists does it take to change a light bulb? The punch line to that old joke is, of course, “One—but the light bulb has to want to change.” But just as it’s tough to get patients to modify their behaviour (quit bad habits, take up good ones, comply with their meds, etc.), it’s also difficult for ED leaders to get their staff to alter their practices for the better. One example I find many EDs struggle with is improving hand hygiene. Despite what research has shown, some staff may believe they wash their hands plenty, thank you very much. Others may accept the evidence but struggle to remember to comply with hand hygiene guidelines, or competing priorities in a busy shift may get in the way of even the best of intentions. Access to a sink or supplies may be a problem when we provide care in hallways or waiting rooms; on the other hand, we may encounter patients stealing and drinking unsecured hand sanitizer. (Practice tip: If a patient becomes more intoxicated or less responsive after arrival in the ED, they may have consumed sanitizer.) In this month’s guest post, Dr. Mike Wansbrough, a colleague of mine at Mount Sinai Hospital in Toronto, Ontario, talks about his journey as our department’s “hand hygiene champion” (which means I was smart enough to delegate this thankless task to someone else—thanks, Mike!). Mike is a creative guy, so when he faced frustrations in trying to change the “light bulbs” that are my medical staff, he thought an online movie in this era of YouTube sensations might help. A link to the short film is provided below; the content has been researched and vetted by infection control experts and is only four minutes long. You are welcome to use it if it helps with your own hand hygiene efforts. I plan to make it mandatory viewing for our staff. Do you have other tips, suggestions, or resources on this issue to share? Please share them in our comments section so we can all learn from each other!