EMOttawa - Emergency Medicine Ottawa

What is Quality Improvement (QI)? You have all heard the latest buzzword in healthcare: “quality improvement”, or QI. Yet many healthcare professionals still only have a vague idea of what that truly means, and likely an even poorer understanding of how it might apply to their frontline practice. Conceptually, QI can be defined as the “combined and unceasing efforts of everyone - healthcare professionals, patients and their families, researchers, payers, planners and educators - to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)”1. 

Journal Club Summary Methodology Score:4/5 Usefulness Score:4/5 Stanley AJ, et al. BMJ. 2017 Jan 4;356:i6432. Full Article This multicentre, multinational study assessed the ability of five upper gastrointestinal bleeding scores to predict outcomes including death, re-bleeding, need for endoscopy, transfusion, surgery or interventional radiology, and length of hospital stay, finding that the Glasgow Blatchford score is best at predicting the composite outcome of intervention or death, although AIMS65 was best at predicting mortality. While applying the scores as recommended may result in missing a small number of significant outcomes, they are easy to apply and can help expedite disposition planning, whether outpatient management or hospital-based intervention. By: Dr. Daniel James
Epi lessonComposite OutcomesIt is not unusual for studies to select a composite outcome as their primary outcome measure. The necessity to do so is often justified by the rare occurrence of the primary outcome of t…

Journal Club Summary
Methodology Score: 3/5                    Usefulness Score:  3.5/5 NijssenEC, et al Lancet.2017Feb 20. [Epub ahead of print] Abstract Link

The Zika Virus exploded onto the international health scene in the last several months. It was first discovered in humans in 1951 and remained limited to Africa and Asia until the first major outbreak in Micronesia in 2007. Since then the virus has continued to evolve and spread from the Pacific Islands and French Polynesia to the main major outbreak in South America in early 2015 and finally to the US in January 2016.

Journal Club SummaryMethodology Score: 4/5                    Usefulness Score:  3/5
Lascarrou JB, et al. JAMA. 2017 Feb 7;317(5):483-493. Abstract Link

Journal Club SummaryMethodology Score: 4/5                    Usefulness Score: 3.5/5
Hinson JS, et al. Ann Emerg Med. 2017 Jan 19 [Epub ahead of print] Full Article

Pediatric endotracheal intubation is an uncommon procedure in the Emergency Department (ED); even in high volume tertiary pediatric centres the incidence has been reported at 8-10/10,000 patients. While infrequent, pediatric airway management is an essential and life-saving skill that all ER physicians must be prepared for.  Much of the knowledge and skill set from the adult world is applicable here, however there are several important differences that are unique to the pediatric population.

SummaryMethodology Score: 4/5
Usefulness Score: 3.5/5

Patel BK, et al. JAMA. 2016 Jun 14;315(22):2435-41
Full Article

Editorial: Unmasking a Role for Noninvasive Ventilation in Early Acute Respiratory Distress Syndrome. Beitler JR, et al. JAMA. 2016 Jun 14;315(22):2401-3.

This single-centre, non-blinded RCT of ICU ARDS patients, found that NIV delivered by a novel helmet, as compared to a standard NIV facemask, reduced intubations (18.2% vs. 61.5%; P <0.001) and hospital mortality (27.3% vs. 48.7%; P= 0.04). Despite its few methodological flaws, this study supports the existing literature on the advantage of oxygen delivered via helmet over facemask in avoiding intubation in ARDS, and future studies should focus on its impact in heart failure or hypercapneic respiratory failure.
By: Dr. Shannon Fernando 
Epi lesson:
Interim Analyses and Stopping Rules
In clinical trials, an interim analysis is one that is conducted before data collection has been completed to determin…

A male in his 60’s presents with progressive dyspnea on exertion x 1 month starting while he was swimming in the ocean. He had not been diving.  He has no significant medical history and takes no medications.