Most respondents perform CT angiography in pregnant patients suspected of having pulmonary embolism, but their policies and practices vary considerably.

Objectives: Fast tracks are one approach to reduce emergency department (ED) crowding. No studies have assessed the use of fast tracks in smaller hospitals with single physician coverage. Our study objective was to determine if implementation of an ED fast track in a single physician coverage setting would improve wait times for low-acuity patients without negatively impacting those of higher acuity. Methods: A daytime fast track opened in 2010 at Strathroy Middlesex General Hospital, a southwestern Ontario community hospital. Before and after intervention groups comprised of ED visits in 2009 and 2011 were compared. Pooled comparison of all Canadian Triage and Acuity Scale (CTAS) patients in each period, and between subgroups CTAS 2-5 comparisons were performed for: wait time (WT), length of stay (LOS), WTs that met national CTAS time guidelines (MNCTG), and proportion of patients that left without being seen (LWBS). Results: WT and LOS were six minutes (88 min to 82 min, p = 0.002) and 15 minutes (158 min to 143 min, p < 0.001) lower, respectively, in the post-intervention period. Subgroup analysis showed CTAS 4 had the most pre-to postintervention decrease in WT, of 13 minutes (98 min to 85 min, p < 0.001). There was statistical improvement in MNCTG in the post-intervention period. No differences were found in outcome measures for higher-acuity patients or LWBS rates. Conclusions: Implementation of a fast track in a mediumvolume community hospital with single physician coverage can improve patient throughput by decreasing WT and LOS without negatively impacting high-acuity patients. This may be clinically relevant, particularly for hospital administrators, given the improvement in meeting national WT standards we found post-intervention. RÉSUMÉObjectif: Le traitement accéléré des patients est un moyen de réduire l'encombrement des services des urgences (SU). Toutefois, aucune étude n'a porté sur le traitement accéléré des patients dans les petits hôpitaux où un seul médecin est de garde. L'étude visait à déterminer si la mise en oeuvre du traitement accéléré des patients dans un SU où un seul médecin est de garde diminuerait les délais d'attente pour les patients souffrant de troubles peu graves, sans toutefois se répercuter défavorablement sur les patients se trouvant dans un état grave. Méthode: Un processus de traitement accéléré des patients a été mis en oeuvre, le jour, en 2010, au Strathroy Middlesex General Hospital, un hôpital communautaire situé dans le sud-ouest de l'Ontario. Il y a eu comparaison des groupes de patients qui ont consulté au SU, en 2009 et en 2011, soit avant et après la mise en oeuvre du traitement accéléré. Les auteurs ont procédé à des comparaisons globales de tous les patients, selon l'Échelle canadienne de triage et de gravité (ECTG) pour chaque période, ainsi qu'à des comparaisons partielles entre des sous-groupes de patients du 2 e au 5 e degré de priorité selon l'ECTG, en ce qui concerne les délais d'attente (DA), la durée de séjour (DS), le respect des lignes directr...

Objective To examine the frequency, natural history, and outcomes of 3 subtypes of abdominal pain (general abdominal pain, epigastric pain, localized abdominal pain) among patients visiting Canadian family practices.Design Retrospective cohort study with a 4-year longitudinal analysis. Setting Southwestern Ontario.Participants A total of 1790 eligible patients with International Classification of Primary Care codes for abdominal pain from 18 family physicians in 8 group practices. Main outcome measuresThe symptom pathways, the length of an episode, and the number of visits. ResultsAbdominal pain accounted for 2.4% of the 15,149 patient visits and involved 14.0% of the 1790 eligible patients. The frequencies of each of the 3 subtypes were as follows: localized abdominal pain, 89 patients, 1.0% of visits, and 5.0% of patients; general abdominal pain, 79 patients, 0.8% of visits, and 4.4% of patients; and epigastric pain, 65 patients, 0.7% of visits, and 3.6% of patients. Those with epigastric pain received more medications, and patients with localized abdominal pain underwent more investigations. Three longitudinal outcome pathways were identified. Pathway 1, in which the symptom remains at the end of the visit with no diagnosis, was the most common among patients with all subtypes of abdominal symptoms at 52.8%, 54.4%, and 50.8% for localized, general, and epigastric pain, respectively, and the symptom episodes were relatively short. Less than 15% of patients followed pathway 2, in which a diagnosis is made and the symptom persists, and yet the episodes were long with 8.75 to 16.80 months' mean duration and 2.70 to 4.00 mean number of visits. Pathway 3, in which a diagnosis is made and there are no further visits for that symptom, occurred approximately one-third of the time, with about 1 visit over about 2 months. Prior chronic conditions were common across all 3 subtypes of abdominal pain ranging from 72.2% to 80.0%. Psychological symptoms consistently occurred at a rate of approximately one-third. ConclusionThe 3 subtypes of abdominal pain differed in clinically important ways. The most frequent pathway was that the symptom remained with no diagnosis, suggesting a need for clinical approaches and education programs for care of symptoms themselves, not merely in the service of coming to a diagnosis. The importance of prior chronic conditions and psychological conditions was highlighted by the results. This article has been peer reviewed. Cet article a fait l'objet d'une révision par des pairs.

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