CanadiEM: Accessing a Virtual Community of Practice to Create a Canadian National Medical Education Institution

Background: The rise of free open-access medical education (FOAM) has led to a wide range of online resources in emergency medicine. Canadian physicians have been active contributors to FOAM. Objectives: We aimed to create a virtual community of practice that would serve as a national platform for collaboration, learning, and knowledge dissemination. Methods: CanadiEM was formed in 2016 from the merger of two Canadian websites and a podcast. Using a community-of-practice model, we introduced two training programs to support junior community members in becoming core editorial team members and employed asynchronous Web technologies to facilitate collaboration. We also introduced a coached peer review process and formed strategic alliances that aim to ensure a high quality of publication. Results: CanadiEM has become a portal for readers to access a broad range of FOAM content. The website has published 782 articles. Of these, 71 have undergone a coached peer review process. The website has received over 2.5 million page views from 217 countries, and the associated CRACKCast podcast has been downloaded over 750,000 times. Conclusions: CanadiEM has succeeded in building a national multi-interface dissemination network that fosters collaboration and knowledge sharing in emergency medicine while fostering junior digital scholars. The construction of a community of practice has been facilitated by quality assurance, training programs, and the use of asynchronous Web technologies. Ongoing challenges in sustainability include a volunteer workforce with high turnover

The Impact of COVID-19 Pandemic on Emergency Department Visits at a Canadian Academic Tertiary Care Center

Introduction: Public health response to the coronavirus 2019 (COVID-19) pandemic has emphasized social distancing and stay-at-home policies. Reports of decreased emergency department (ED) visits in non-epicenters of the outbreak have raised concerns that patients with non-COVID-19 emergencies are delaying or avoiding seeking care. We evaluated the impact of the pandemic on ED visits at an academic tertiary care center. Methods: We conducted an observational health records review between January 1–April 22, 2020, comparing characteristics of all ED visits between pre- and post-pandemic declaration by the World Health Organization. Measures included triage acuity, presenting complaints, final diagnoses, disposition, and mortality. We further examined three time-sensitive final diagnoses: stroke; sepsis; and acute coronary syndrome (ACS). Results: In this analysis, we included 44,497 ED visits. Average daily ED visits declined from 458.1 to 289.0 patients/day (-36.9%). For the highest acuity triaged patients there was a drop of 1.1 patients/day (-24.9%). Daily ED visits related to respiratory complaints increased post-pandemic (+14.1%) while ED visits for many other complaints decreased, with the greatest decline in musculoskeletal (-52.5%) and trauma (-53.6%). On average there was a drop of 1.0 patient/day diagnosed with stroke (-17.6%); a drop of 1.6 patients/day diagnosed with ACS (-49.9%); and no change in patients diagnosed with sepsis (pre = 2.8 patients/day; post = 2.9 patients/day).  Conclusion: Significant decline in ED visits was observed immediately following formal declaration of the COVID-19 pandemic, with potential for delayed/missed presentations of time-sensitive emergencies. Future research is needed to better examine long-term clinical outcomes of the decline in ED visits during pandemics

Characterizing Highly Frequent Users of a Large Canadian Urban Emergency Department

Introduction: Highly frequent users (HFU) of the emergency department (ED) are a poorly defined population. This study describes patient and visit characteristics for Canadian ED HFU and patient subgroups with mental illness, substance misuse, or ≥ 30 yearly ED visits. Methods: We reviewed health records from a random selection of adult patients whose visit frequency comprised the 99th percentile of yearly ED visits to The Ottawa Hospital. We excluded scheduled repeat ED assessments. We collected the following: 1) patient characteristics – age, sex, and comorbidities; and 2) ED visit characteristics – diagnosis category, length of stay, presentation time, consultation services, and final disposition. Two reviewers collected data, and we performed an inter-rater review to measure agreement. Results: We analyzed 3,164 ED visits for 261 patients in all subgroups overall. Within the HFU random selection, mean age was 53.4 ± 1.3, and 55.6% were female. Most patients had a fixed address (88.9%), and family physician (87.2%). Top ED diagnoses included musculoskeletal pain (9.6%), alcohol intoxication (8.5%), and abdominal pain (8.4%). Allied health (social work, geriatric emergency medicine, or community care access centre) was consulted for 5.9% of visits. In 52.7% of these cases, allied health services were not available at the time of presentation. Conclusion: HFU are a complex population who represent a marked proportion of annual ED visits. Our data indicate that there are opportunities to improve the current approaches to care. Future work examining ED-based screening and multi-disciplinary approaches for HFU may help reduce frequent ED presentations, and better serve this vulnerable population