Edmund Kwok
@eddeestyle
Emergency Medicine. Quality Improvement. Patient Safety. Change Management. Opinions are my own.
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Have you ever wondered how to improve inter-shift handover communication in your emergency department? Check out our ED-VITALS framework as a starting point to consider: bmjopenquality.bmj.com/content/9/1/e0… @emergmedottawa @CAEP_Docs @dr_lisa_lcalder
I'm an emergency physician. I've seen what a functioning health care system needs and it's not more downloading to pharmacies thestar.com/opinion/contri… via @torontostar
I mean what can you possibly say? 2.2 million Ontarians without a family physician. Rural ERs closing every damned day. Wait times for some specialties routinely over 18 months Aging physician workforce retiring in droves. And the Ontario government isn't concerned.
NEW: Recruitment and retention of doctors in Ontario is “not a major concern,” the Ministry of Health suggests as it argues with the Ontario Medical Association over physician compensation. Via @allisonjones_cp globalnews.ca/news/10481990/… #onpoli
It’s finally out. Please stop giving Paxlovid to vaccinated people. nejm.org/doi/full/10.10…
“Across the country, 252 family medicine positions went “unmatched,” according to the Canadian Resident Matching Service. In Ontario alone, there were 108 unfilled family medicine spots — meaning those positions were available but no one wanted them”
When trying to find adverse events in healthcare, we know trigger tools are better than spotty manual review. Leveraging EMRs we’ve validated an electronic emergency department trigger tool (EDTT) across multiple sites! onlinelibrary.wiley.com/doi/10.1111/ac…
“In Ontario, more than 2.2 million people are currently without a family doctor. Another 1.7 million are looked after by a doctor who is 65 or older. The Ontario College of Family Physicians predicts more than four million Ontarians will be without a family doctor by 2026…”
What exactly is the point of walk-in clinic / urgent care clinics in Ontario? They are run by primary care trained physicians, but they don’t seem to want to do primary care stuff…(eg won’t follow ADHD pts or refill their meds, then advise them to go to the ER instead!)
“..current understanding that individuals with new episode of low back pain get better within 2 weeks may need reconsideration... our updated meta-analysis shows that many continue to experience ongoing pain and disability.“ @emergmedottawa
Casual reminder that we have yet to see RCT evidence showing that Paxlovid benefits people who've been vaccinated against COVID or recovered from it, which is now pretty much everyone.
Paxlovid evidence: still very little reason to prescribe #FOAMed first10em.com/paxlovid-evide…
'Am I going to die?' We fled to the U.S. after long waits, misdiagnosis in Canada nationalpost.com/feature/long-w…
"Do not go to the ER. Call your pharmacist." With these words, Christian Dube has demonstrated that he is unfit to be Quebec's Health Minister.
Regarding the recent tragic losses in Quebec & the worsening conditions throughout the country. @EShouldice @Kapur_AK @HowardOvens @docstemp @bernarddho @TrevorJain @emjayhermano @SKEMCollective @lisaesther6 @DrCarolynSnider @alandrummond2 @Avis_Favaro @HasanMSheikh @BrittJEllis
Study finds lower health-care costs among Ontario patients who had female surgeons cp24.com/mobile/news/st…
"As eight-, 10-, 12-hour waits become the standard, I find myself apologizing 20 times per shift, 15 shifts a month, likely thousands of times per year for something that is not my fault" -- ER doc @Wall_BF #CanadaWAITS
This is the reason your ER doctors are leaving. You don’t have a family doctor, and you can’t get an admission bed. So you end up waiting and waiting in the ER for a physician who might not be able to help much, by @Wall_BF thestar.com/opinion/this-i… @TorontoStar @raghu_venugopal
Our abstract showing that NSTEMI with OMI have very high mortality and very long time to reperfusion. Abstract now published in November issue of Eur Ht J. Full paper will be published as soon as we calculate GRACE scores for all patients. @RobertHermanMD @PendellM…
“…findings suggest that older patients, particularly those with limited autonomy, who spend the night in the ED awaiting hospital admission may have a higher risk of in-hospital mortality and morbidity” jamanetwork.com/journals/jamai…
I was taught this too, and later taught it myself. It's only after reflecting on their pharmacology that you land where Josh has: opioids work best with intermittent, short-term dosing.
in med school I was taught that scheduling opioids was clever, to "get ahead" of the pain but... continuous opioid exposure *rapidly* causes tolerance & dependence (in as little as 3 days) a PRN bolus strategy may allow opioids to maintain efficacy for longer (less = more)
Your patient is in cardiac arrest. You are giving epinephrine every 3 minutes. Is that based on any evidence? Not really. This study in Resuscitation actually measured the epinephrine level every minute after a bolus during cardiac arrest in humans. The half-time was 2.6…
The Ottawa Hospital asks people to avoid General campus after transformer fire cbc.ca/news/canada/ot…
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