The Quality Improvement paradigm has been applied to a wide spectrum of settings and patient populations. There has been an exponential rise in QI publications over the recent decades.1 In this new HiQuiPs Series we explore the QI paradigm applied to different medical specialties and settings. We start with an example of an outpatient nephrology setting. Quality Improvement (QI) in nephrology for patients with kidney disease takes on many different forms depending on …
Initiation of Congestive Heart Failure Action Plan in the Emergency Department
A 72-year-old English-speaking male with a history of congestive heart failure (CHF) withreduced ejection fraction (EF) presented to the emergency department (ED) with acutedecompensated CHF. He had a two-year history of progressive dyspnea and exercise intolerance.Other comorbidities included coronary artery disease, hypertension, dyslipidemia, cardioembolicstroke, and gastroesophageal reflux disease. His medications included furosemide, apixaban,atorvastatin, carvedilol, and fosinopril. His furosemide was reduced from 40 mg to 20 mg daily by hisfamily physician five months prior …
An Approach to Adult Burns in the Emergency Department
Case: You are working as a 3rd year clerk in the ED and your staff has asked you to see Kathy, a 24 year old female caught in a house fire presenting with burns in multiple areas and difficulties breathing. Burn injuries result in the partial or complete destruction of the skin and can affect any of its three layers: the epidermis, dermis, or subcutaneous tissue.1 In this article, we will explore a …
Clinical Question: How do I measure frailty in the Emergency Department?
Mrs. Vivianne Dubois is an 84-year-old female presenting to your Emergency Department with her daughter. She tells you that she is here because she has been feeling weak and has had a fall. You speak to her daughter and find out that in the past year since her husband’s death, Vivienne has been struggling to take care of herself, requiring assistance with bathing and cooking. Recently, she has had several falls, and her …
Opioid Use Disorder Treatment: Opioid Agonist Therapy Induction
Venus is a 29-year-old female who presents to the ED with tremor and diaphoresis. You learn that she has presented to the ED with similar symptoms before, and has a 5yr history OUD, using about 5 points (0.5 g) a day. She has no other medical conditions and blood work is within normal limits. Venus is tachycardic at 105 bpm, with dilated pupils, piloerection, slight tremors, and flushed face. You remember a previous …
Approach to Unhoused Patients Presenting to the Emergency Department with a History of Opioid Use Disorder
Editor’s Note: This is part 2 of a 2-part series on homelessness. Check out Part I about the Ottawa Inner City Health Initiative. ‘Ken’ is a 47-year-old unhoused man presenting to the Emergency Department (ED) with severe opioid withdrawal symptoms. After taking his history, you learn that he has been unhoused for the past 2 years and using non-prescribed fentanyl for the past 8 months. His last dose was 28 hours ago. You …