Conference Proceedings
McGill Emergency Medicine Conference (MEMC), First Edition | October 19, 2024
McGill Emergency Medicine Conference (MEMC)
Published online: October 19, 2024
Emergency Department wait times to an inpatient bed: Comparing mental health and non-mental health patients
Cassandra Chisholm 1, Xiaoming Wang, Conné Lategan, Zoe Hsu, Amelia Ridout, Eddy Lang
1University of Alberta, Edmonton, Alberta, Canada
University of Calgary, Calgary, Alberta, Canada
Abstract
Introduction:
Emergency department (ED) boarding is a threat to timely and safe delivery of care.
Addressing it requires an in-depth understanding of which patients are specifically and
adversely impacted to inform policy and advocacy. Our primary objective was to examine ED
median boarding time for addiction and mental health (AMH) compared to non-addiction and
mental health (NAMH) patients, accounting for the impact of COVID-19 on boarding trends.
Method:
We conducted a retrospective observational study of 96 EDs in Alberta, Canada using National
Ambulatory Care Reporting System data. Patients were classified as AMH or NAMH using
International Statistical Classification of Diseases and Related Health Problems—10th
Revision codes. Boarding time was defined as the interval between decision to admit and ED
departure. Descriptive statistics summarized visits and median (IQR) boarding time.
Interrupted time series analysis compared pre-pandemic (09/2018–02/2020) and post-pandemic
(02/2022–09/2022) AMH and NAMH boarding trends.
Results:
During the study period, 887,494 patients were admitted from an ED with AMH (113,209; 13%)
or NAMH (774,285; 87%) diagnoses. Pre-pandemic median (IQR) boarding time for AMH patients
was 2.2× longer than for NAMH: 264 (70, 1148) minutes vs 120 (108, 151) minutes. During the
pandemic, median boarding time decreased for AMH to 213 (77, 907) minutes, yet remained
higher than NAMH at 121 (59, 323) minutes; both groups improved early in the pandemic.
Post-pandemic, AMH median boarding time increased by 273% to 434 (102, 1312) minutes versus
NAMH at 159 (65, 592) minutes—i.e., 1 in 4 AMH patients waited over 21 hours for an
inpatient bed. Post-pandemic AMH boarding increased by 164% compared to pre-pandemic levels,
and AMH boarded three times longer than NAMH.
Conclusion:
To our knowledge, this is the largest Canadian study comparing AMH and NAMH boarding. AMH
patients experienced substantially longer ED boarding times before the pandemic, which
worsened post-pandemic relative to NAMH. Findings suggest structural inequity in resourcing
acute care inpatient beds for AMH patients and can inform policies and advocacy aimed at
reducing boarding for AMH patients in crowded EDs and improving patient flow.
The Impact of Different Learner Arrangements on Modern-Day Emergency Department Staff Productivity
Jessica Maher 1, Jeff Landreville 1, Julien Turk 1, Scott Odorizzi 1, Meng 1
1University of Ottawa, Ottawa, ON, Canada
Abstract
Introduction:
Emergency departments (EDs) across Canada are experiencing unprecedented wait times and
staffing challenges1. However, the impact of learners on staff physician
productivity in modern-day EDs—particularly considering recent increases in patient
complexity and the use of electronic medical records—remains underexplored. This study aimed
to evaluate how different learner arrangements affect staff physician productivity.
Methods:
A retrospective cohort study was conducted using all ED shifts at The Ottawa Hospital Civic
and General campuses between April 2022 and March 2023. Each staff physician shift was
categorized by shift type (ambulatory or non-ambulatory), learner arrangement, and number of
patients seen per hour (PPH). Relationships between learner arrangements and PPH were
analyzed using two-sample, two-tailed t-tests and descriptive statistics.
Results:
A total of 8,161 shifts were analyzed (5,233 ambulatory; 2,928 non-ambulatory). In
ambulatory care, average PPH was 2.09 when working alone, compared to 1.81 with a medical
student (p<0.001), 1.79 with a junior resident (p<0.001), 2.05 with a senior resident
(p=0.05), 1.76 with a junior resident and medical student (p<0.001), and 2.01 with a
senior resident and medical student (p=0.004). In non-ambulatory care, PPH was 1.40 when
working alone, 1.42 with a medical student (p=0.63), 1.48 with a junior resident (p=0.02),
1.75 with a senior resident (p<0.001), 1.56 with a junior resident and medical student
(p<0.001), and 1.77 with a senior resident and medical student (p<0.001).
Conclusion:
Staff emergency physicians were more productive when working with residents compared to
working alone, with greater productivity associated with resident seniority. The presence of
medical students had mixed effects—no significant change in non-ambulatory settings but
reduced productivity in ambulatory care. These findings may inform academic ED scheduling
and staff coverage optimization by clarifying how learners can be effectively integrated
into staff workflows.
Reference:
1. Varner C. Emergency departments are in crisis now and for the foreseeable future.
CMAJ. 2023;195(24):E851–E852. https://doi.org/10.1503/cmaj.230719
Comparing 21-Hour and Open-Ended N-Acetylcysteine Infusion Protocols in Acetaminophen Toxicity at an Academic Tertiary Care Hospital – A Retrospective Chart Review
J. Wen 1, J. Wang 1, K. Van Aarsen 1, A. Dong 1
1London Health Sciences Centre, London, ON, Canada
Abstract
Introduction:
Intravenous N-acetylcysteine (NAC) for acetaminophen (APAP) toxicity is commonly delivered
via a 21-hour, three-bag protocol. In 2020, our centre implemented an open-ended protocol
(OP) where discontinuation is based on normalization of transaminases and APAP levels. We
compared hospitalization duration between the 21-hour protocol and OP.
Methods:
Retrospective cohort of adults admitted with APAP overdose at LHSC (Jan 2018–Jul 2022).
Exclusions: NAC regimens not matching either protocol; toxic co-ingestions requiring
additional management. Outcomes: mean length of stay (LOS) and peak ALT/AST. Mann–Whitney U
tests were used.
Results:
Final samples: 21-hour (n=30) and OP (n=40). Mean LOS: 75.87 h (21-hour) vs 80.03 h (OP),
p=0.393. No significant differences in peak transaminases (ALT p=0.643; AST p=0.913).
Conclusion:
Hospitalization duration did not differ after adopting OP. Given the triphasic 21-hour
regimen spans multiple handovers and may increase error risk, OP’s streamlined delivery may
reduce resource use and opportunities for error; broader adoption should be considered.
Multivariate Analysis of Risk Factors Predicting 28-Day Mortality Among Adult Patients Presenting with Bacteremia in the Emergency Department
Noémie Laurier 1,3,5, Angela Karellis 1,5, Xiaoqing Xue 2, Marc Afilalo 2,3, Karl Weiss 1,3,4,5
1Jewish General Hospital, Division of Infectious Diseases & Microbiology, Montreal,
QC, Canada
2Jewish General Hospital, Emergency Department, Montreal, QC, Canada
3McGill University, Montreal, QC, Canada
4Université de Montréal, Montreal, QC, Canada
5Centre of Excellence in Infectious Diseases / Lady Davis Institute, Montreal, QC,
Canada
Abstract
Objectives:
To identify predictors of 28-day mortality among adults presenting to the ED with
bacteremia.
Methods:
Retrospective chart review of ED patients with positive blood cultures (2019 & 2022) at
Quebec’s busiest ED. Exclusions: contaminants; palliative discharge. Descriptive analyses
were followed by univariate and multivariate logistic regression (α=0.05).
Results:
N=433 (mean age 74.1±15.2; 49.9% female). 28-day mortality: 15.2% (n=66). In multivariate
analysis, independent predictors were ICU admission (OR 6.0, 95% CI 3.08–11.8), pneumonia
source (4.9, 2.62–9.32), age ≥70 (3.2, 1.39–7.17), hypotension at admission (2.1,
1.02–4.40), and absence of infectious diseases consultation (2.0, 1.08–3.78). Rapid
first-dose antibiotics, initial regimen appropriateness, and Gram status were not
significant.
Conclusions:
Several clinical factors predict 28-day mortality in ED bacteremia. Notably, requesting ID
consultation emerged as a modifiable factor associated with improved outcomes.
Evaluating the Diagnostic Accuracy of Telesonography for Acute Cholecystitis in Emergency Medicine: Preliminary Findings from a Prospective Study
T. Toor 1, A. Kapur 1, E. Nzekwu 1, C. Dusdal 1, B. Salamati 1, A. Clay 1, M. Butz 1
1University of Saskatchewan, Saskatoon, SK, Canada
Abstract
Introduction:
Telesonography may expand diagnostic ultrasound access by pairing bedside scanning with
real-time radiologist guidance.
Aims:
To compare telesonography by trained emergency physicians (with radiologist guidance)
against formal radiology-performed ultrasound for acute cholecystitis.
Materials & Methods:
Prospective study using Butterfly iQ at two Regina sites. Diagnostic criteria: gallstones
plus ≥2 of wall thickening (>3 mm), pericholecystic fluid, or positive sonographic
Murphy’s sign. Findings were recorded dichotomously and compared with formal ultrasound.
Results:
N=11 (5 male, 6 female). Agreement with formal ultrasound was observed in 9/11 for
gallstones, 11/11 for wall thickening, 10/11 for pericholecystic fluid, and 10/11 for
Murphy’s sign. Overall diagnosis concurred in all but one case.
Discussion & Conclusion:
Preliminary data suggest telesonography yields diagnostic accuracy comparable to formal
ultrasound for acute cholecystitis and may be valuable where radiology access is limited.
Enrollment is ongoing.
Identifying Patient Characteristics and Reasons for Frequent Emergency Department Visits Among Adult Patients in Canadian Hospitals: A Scoping Review
Min Joon Lee 1,2, James Bunker 3, Carolyn Ziegler 4, Yusef Yusuf 1,2, Natascha Crispino 1,2
1Department of Family & Community Medicine, University of Toronto, Toronto, ON,
Canada
2St. Joseph’s Urban Academic Family Health Team, Toronto, ON, Canada
3Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
4Library Services, Unity Health Toronto, Toronto, ON, Canada
Abstract
Introduction:
ED overcrowding in Canada is multifactorial; frequent users represent a key subgroup. No
Canadian-focused synthesis has summarized characteristics of frequent adult ED users.
Methods:
Scoping review of MEDLINE, Embase, SCOPUS, CINAHL, and Cochrane Library. Dual independent
screening and extraction; descriptive and quantitative summaries emphasized frequent-use
definitions, demographics, primary-care involvement, and health characteristics.
Results:
Thirteen Canadian studies met criteria, spanning six provinces. Definitions varied; ≥4 ED
visits/year was most common. Frequent users tended to be older (>75), of lower
socioeconomic status, and to have higher chronic disease burden; mental health and
substance-use conditions were common. Frequent users also had more family physician
encounters.
Conclusions:
Frequent ED use in Canada reflects complex medical and social needs and heterogeneous
definitions. Tailored, community-specific strategies are required to address local
contributors to ED crowding.
Enhancing Learner Ultrasound-Guided Procedural Skills: Development and Use of an Inexpensive Pericardiocentesis Phantom
Jake Rose 1*, Omar Idrissi 1*, Saad Razzaq 1,2, Eadan Farber 1
1Faculty of Medicine, McGill University, Montreal, QC, Canada
2Faculty of Education, McGill University, Montreal, QC, Canada
*Contributors listed as co-first authors.
Abstract
Introduction, Aims, & Innovation Concept:
Emergency pericardiocentesis is critical yet rarely performed. To expand training access
beyond costly commercial models, we developed a simple, ultrasound-amenable
pericardiocentesis task trainer and delivered a hands-on workshop for medical students.
Methods:
The trainer used inexpensive materials (e.g., water-filled ping-pong ball for right
ventricle, saline bag for effusion) embedded in an ultrasound-compatible gelatin matrix with
a cost-free 3D-printed rib cage. The workshop comprised teaching on indications and
technique, supervised scanning on volunteers to learn cardiac views and tamponade signs, and
practice of ultrasound-guided pericardiocentesis on the phantom. Post-workshop surveys
(5-point Likert) assessed impact.
Results/Evaluation:
Nine students participated (1 first-year, 7 second-year, 1 third-year). All agreed or
strongly agreed the model improved ultrasound fundamentals, ultrasound-guided procedural
skills, ability to perform ultrasound-guided pericardiocentesis, and overall preparedness.
All reported being “very much satisfied.”
Conclusion:
Low-cost phantom simulators can substantially enhance learner training in ultrasound-guided
procedures, broadening access to essential hands-on experience and improving competence and
confidence.
