Prescribing cellular phones to patients helps emergency physicians and staff provide care

Background: Emergency Department (ED) patients experiencing disadvantage (e.g., homelessness, addictions) can have limited access to cellular phones. This barrier can affect access to follow-up health care, connecting with community resources, and communicating with friends and family. PHONE-CONNECT is an intervention providing free cellular phones and prepaid plans to patients who do not have them. This intervention allows ED-based health care workers, such as social workers, nurses and physicians, to facilitate follow-up care with patients in their transition from hospital to community. Objective: To explore how the intervention affects health care workers in the emergency department, including those facilitating implementation. Methods: We used valid and reliable implementation science outcome measures - Acceptability, Appropriateness, and Feasibility of Intervention Measures - informed by a Realist Evaluation approach to explore how, why, and for whom the intervention works best. Staff trained in data collection deployed anonymous in-person and online surveys across 3 academic ED's in Toronto, Ontario. Respondents were registered nurses, medical doctors, social workers, and peer-based staff. Survey questions focused on implementation, and perceived impact of the intervention. Questions were scored on a 5-point Likert scale ranging from Completely disagree [1] to Completely Agree [5]. Data were analyzed using descriptive statistics and aggregate scores were calculated in Microsoft Excel. Results: 142 survey responses were collected between August and September 2022. Respondents agree that the intervention is acceptable (84.5%), appropriate (83.9%), and feasible (80.4%). A subset of 46 respondents facilitating the intervention reported that it improves their ability to meet the health (92.9%) and social needs of patients (91.4%); facilitate follow-up care (91.9%) and disposition planning while in the ED (88.1%); and improves the quality of care provided (90.5%). Distributing phones was reported to be worth the cumulative time and effort (91.7%), and was felt to reduce experiences of moral distress (82.4%) and burnout (69%).  Conclusion:  PHONE-CONNECT is feasible, acceptable, and appropriate in the ED. It empowers physicians and health care workers to provide high quality care, while reducing moral distress and burnout. Novel ED-based interventions are efficacious ways to bridge gaps in care experienced by patients in their transition from hospital to community. Though challenging with this population, future work exploring patient experiences will help optimize outcomes and further streamline the process of phone delivery and utilization

Implementation of the YEARS algorithm to optimise pulmonary embolism diagnostic workup in the emergency department

Background Excessive use of CT pulmonary angiography (CTPA) to investigate pulmonary embolism (PE) in the emergency department (ED) contributes to adverse patient outcomes. Non-invasive D-dimer testing, in the context of a clinical algorithm, may help decrease unnecessary imaging but this has not been widely implemented in Canadian EDs.Aim To improve the diagnostic yield of CTPA for PE by 5% (absolute) within 12 months of implementing the YEARS algorithm.Measures and design Single centre study of all ED patients >18 years investigated for PE with D-dimer and/or CTPA between February 2021 and January 2022. Primary and secondary outcomes were the diagnostic yield of CTPA and frequency of CTPA ordered compared with baseline. Process measures included the percentage of D-dimer tests ordered with CTPA and CTPAs ordered with D-dimers <500 µg/L Fibrinogen Equivalent Units (FEU). The balancing measure was the number of PEs identified on CTPA within 30 days of index visit. Multidisciplinary stakeholders developed plan- do-study-act cycles based on the YEARS algorithm.Results Over 12 months, 2695 patients were investigated for PE, of which 942 had a CTPA. Compared with baseline, the CTPA yield increased by 2.9% (12.6% vs 15.5%, 95% CI −0.06% to 5.9%) and the proportion of patients that underwent CTPA decreased by 11.4% (46.4% vs 35%, 95% CI −14.1% to −8.8%). The percentage of CTPAs ordered with a D-dimer increased by 26.3% (30.7% vs 57%, 95% CI 22.2% 30.3%) and there were two missed PE (2/2695, 0.07%).Impact Implementing the YEARS criteria may safely improve the diagnostic yield of CTPAs and reduce the number of CTPAs completed without an associated increase in missed clinically significant PEs. This project provides a model for optimising the use of CTPA in the ED