Nova Scotia Hospital

Ambulance offload delay (AOD) occurs when incoming ambulance patients cannot be transferred promptly from paramedics to emergency department (ED) staff, usually due to ED and hospital congestion. This study empirically examines how AOD affects ambulance system efficiency in Nova Scotia, Canada. Using 12 months of call data from an integrated provincial EMS system and the electronic patient care reporting system, the analysis quantifies AOD impacts on the number of ambulances at EDs, turnaround time, total call time, response time, and ambulance availability across all regions. Findings show that AOD in the Central Region negatively affects all performance measures locally and in adjacent regions, prolonging turnaround and total call times, lengthening response times, and reducing ambulance availability where resources are shared. These results highlight the scale of AOD’s system-wide impact and provide a generalizable methodological framework that other EMS operators can adapt to assess and manage AOD in their specific operational contexts, recognizing that region-specific factors significantly influence outcomes.

Abstract Following the Dignity of Risk (DoR) adult participatory education workshops with healthcare staff, post workshop surveys were completed by over 200 participants (response rate ∼30%). The aims were: 1. To measure effectiveness of in person education with healthcare staff regarding the application of a DoR approach in the care of older adults living with frailty. 2. Use key findings and lessons learned to further inform education methods and implications to healthcare policy and quality improvement. Results showed an increase in staff confidence in applying DoR into practice and having DoR and risk management conversations with caregivers. Several main themes emerged as “takeaways”: staff perceived older adults often value autonomy over safety, risk can be included as a part of a supportive care plan, and the importance of a balanced, broadened and strength-based approach to risk management in care planning. Additionally, staff identified further learning needs to enhance skills in risk management care planning and conversations. There were notable lessons learned that continue to guide DoR initiatives, including an inpatientpilot with DoR/Frailty experts embedded onsite and supporting staff. Knowledge translation and staff behaviour change were measured via the Behaviour Change Wheel methods, and the Consolidated Framework for Implementation Research. In terms of behaviour change in practice that leads to measurable outcomes for older adults, engaged leadership (managers and team leads) is required to support and reinforce this culture shift. Additionally, enhanced interprofessional collaboration that focuses on a united approach to prioritize autonomy of the older adult first, followed closely by risk management. Policies (i.e. Falls Prevention) and guidelines need to incorporate human rights language and strength-based risk management considerations. Only when healthcare staff feel competent and empowered to support positive risk with older adults, will those older adults likely be able to return home from hospital or remain home longer despite living with frailty and changing abilities.

Background: Medical professionals experienced high rates of burnout and moral distress during the COVID-19 pandemic. In Canada, burnout has been linked to a growing number of family physicians (FPs) leaving the workforce, increasing the number of patients without access to a regular doctor. This study explores the different factors that impacted FPs’ experience with burnout and moral distress during the pandemic, with the goal of identifying system-based interventions aimed at supporting FP well-being and improving retention. Methods: We conducted semi-structured qualitative interviews with FPs across four health regions in Canada. Participants were asked about the roles they assumed during different stages of the pandemic, and they were also encouraged to describe their well-being, including relevant supports and barriers. We used thematic analysis to examine themes relating to FP mental health and well-being. Results: We interviewed 68 FPs across the four health regions. We identified two overarching themes related to moral distress and burnout: (1) inability to provide appropriate care, and (2) system-related stressors and buffers of burnout. FPs expressed concern about the quality of care their patients were able to receive during the pandemic, citing instances where pandemic restrictions limited their ability to access critical preventative and diagnostic services. Participants also described four factors that alleviated or exacerbated feelings of burnout, including: (1) workload, (2) payment model, (3) locum coverage, and (4) team and peer support. Conclusion: The COVID-19 pandemic limited FPs’ ability to provide quality care to patients, and contributed to increased moral distress and burnout. These findings highlight the importance of implementing system-wide interventions to improve FP well-being during public health emergencies. These could include the expansion of interprofessional team-based models of care, alternate remuneration models for primary care (ie, non-fee-for-service), organized locum programs, and the availability of short-term insurance programs to cover fixed practice operating costs.

Including post-event support planning as part of crisis preparedness is necessary to meet the emotional and psychological needs of those most affected. This necessarily requires engagement with health and community organization leaders best positioned to provide immediate, short- and long-term post-event supports as part of the response planning for a crisis. Drawing on the findings of the Mass Casualty Commission, the public inquiry tasked with investigating Canada's worst mass shooting, the critical role of post-event supports is explored as a critical element of crisis preparedness.

BackgroundMedication prescribing is essential for the treatment, curing, maintenance, and/or prevention of an illness and disease, however, medication errors remain common. Common errors including prescribing and administration, pose significant risk to patients. Electronic prescribing (e-prescribing) is one intervention used to enhance the safety and quality of prescribing by decreasing medication errors and reducing harm. E-prescribing in community-based settings has not been extensively examined. ObjectiveTo map and characterize the current evidence on e-prescribing and medication safety in community pharmacy settings. MethodsWe conducted a rapid scoping review of quantitative, qualitative, and mixed methods studies reporting on e-prescribing and medication safety. MEDLINE All (OVID), Embase (Elsevier), CINAHL Full Text (EBSCOHost), and Scopus (Elsevier) databases were searched December 2022 using keywords and MeSH terms related to e-prescribing, medication safety, efficiency, and uptake. Articles were imported to Covidence and screened by two reviewers. Data were extracted by a single reviewer and verified by a second reviewer using a standardized data extraction form. Findings are reported in accordance with JBI Manual for Evidence Synthesis following thematic analysis to narratively describe results. ResultsThirty-five studies were included in this review. Most studies were quantitative (n = 22), non-experimental study designs (n = 16) and were conducted in the United States (n = 18). Half of included studies reported physicians as the prescriber (n = 18), while the remaining reported a mix of nurse practitioners, pharmacists, and physician assistants (n = 6). Studies reported on types of errors, including prescription errors (n = 20), medication safety errors (n = 9), dispensing errors (n = 2), and administration errors (n = 1). Few studies examined patient health outcomes, such as adverse drug events (n = 5). ConclusionsFindings indicate that most research is descriptive in nature and focused primarily on rates of prescription errors. Further research, such as experimental, implementation, and evaluation mixed-methods research, is needed to investigate the effects of e-prescribing on reducing error rates and improving patient and health system outcomes.