Trevor Strome

Bio: Trevor Strome is an academic researcher from University of Manitoba. The author has contributed to research in topics: Emergency department & Poison control. The author has an hindex of 12, co-authored 22 publications receiving 386 citations. Previous affiliations of Trevor Strome include Winnipeg Regional Health Authority.

Evaluation of fast track strategies using agent-based simulation modeling to reduce waiting time in a hospital emergency department

Abstract: Different strategies have been proposed to reduce patient waiting time in hospitals. Previous investigations indicate that up to 50% or more patients can be treated in a “fast track” process compared to the standard procedure in some emergency departments. However most studies on emergency department (ED) fast tracks were based on evidence without using an efficient decision tool to show applicability of the results. An agent-based simulation tool is proposed in this research to evaluate fast track treatment (FTT) in an ED. The tool can study the behavior change of entities and resources in a complex ED system. Static and dynamic FTT processes are evaluated. The static process uses a fixed duration in the daily ED operation. In the dynamic process, FTT is triggered based on the current patient waiting time and the state of ED operations. The simulation results provide details and information for the process of the FTT implementation at the ED to reduce patient waiting time.

"Google flu trends" and emergency department triage data predicted the 2009 pandemic H1N1 waves in Manitoba.

Abstract: Objectives: We assessed the performance of syndromic indicators based on Google Flu Trends (GFT) and emergency department (ED) data for the early detection and monitoring of the 2009 H1N1 pandemic waves in Manitoba. Methods: Time-series curves for the weekly counts of laboratory-confirmed H1N1 cases in Manitoba during the 2009 pandemic were plotted against the three syndromic indicators: 1) GFT data, based on flu-related Internet search queries, 2) weekly count of all ED visits triaged as influenza-like illness (ED ILI volume), and 3) percentage of all ED visits that were triaged as an ILI (ED ILI percent). A linear regression model was fitted separately for each indicator and correlations with weekly virologic data were calculated for different lag periods for each pandemic wave. Results: All three indicators peaked 1-2 weeks earlier than the epidemic curve of laboratory-confirmed cases. For GFT data, the best-fitting model had about a 2-week lag period in relation to the epidemic curve. Similarly, the best-fitting models for both ED indicators were observed for a time lag of 1-2 weeks. All three indicators performed better as predictors of the virologic time trends during the second wave as compared to the first. There was strong congruence between the time series of the GFT and both the ED ILI volume and the ED ILI percent indicators. Conclusion: During an influenza season characterized by high levels of disease activity, GFT and ED indicators provided a good indication of weekly counts of laboratory-confirmed influenza cases in Manitoba 1-2 weeks in advance. Key words: Epidemiology; influenza A virus, H1N1 subtype; public health surveillance

The impact of abdominal computed tomography in a tertiary referral centre emergency department on the management of patients with inflammatory bowel disease

Abstract: Summary Background Although exposure to diagnostic radiation may be associated with increased risk of malignancy, the use of abdominal CT (ACT) in the last decade has increased for patients in the emergency department (ED) Aim To examine the impact of ACT ordered in the ED on management of patients with inflammatory bowel diseases (IBD), as well as to quantify the cumulative effective dose (CED) of radiation received by these patients Methods A total of 152 patients with Crohn's disease (CD) and 130 patients with ulcerative colitis (UC) that presented to the ED in a tertiary centre between 2009 and 2011 were identified For patients that had an ACT, chart review assessed if the ACT findings changed clinical management CED of diagnostic radiation (DR) was calculated for all imaging studies between 1 January 2006 and 30 August 2012 Results Abdominal CT use was 49% for CD and 19% for UC ACTs with findings of penetrating/obstructive disease were 35% for CD Urgent non-IBD-related diagnoses were found in 13% for CD and 28% for UC (P < 005) ACT caused a change in management in 81% of CD and 69% of UC patients Mean CED from DR was 774 ± 630 mSv (median 53 mSv) for CD and 672 ± 510 mSv (median 56 mSv) for UC (P = 047) The CED for the 80-month period exceeded 75 mSv in 35% and 36% respectively (P = 099) Conclusions Although abdominal CT often changes management of IBD patients in the emergency department, this population carries a very high-risk of radiation exposure Efforts should be made to decrease this risk by development of low-radiation protocols, and wider use of MRI/ultrasound

Patients presenting to the emergency department: the use of other health care services and reasons for presentation.

Abstract: OBJECTIVE: Some low-acuity emergency department (ED) presentations are considered convenience visits and potentially avoidable with improved access to primary care services. This study assessed the frequency and determinants of patients' efforts to access alternative care before ED presentation. METHODS: Patients aged 17 years and older were randomly selected from 2 urban ED sites in Edmonton. Survey data were collected on use and characteristics of alternative care before the ED visit. Information was also collected on patient demographics and factors influencing their perception of whether the ED was the best care option. RESULTS: Of the 1389 patients approached, 905 (65%) completed the survey and data from 894 participants were analyzed. Sixty-one percent reported that they sought alternative care before visiting the ED. Eighty-nine of the patients who attempted alternative access before the ED visit felt that the ED was their best care option. Results of the multivariate logistic regression analysis showed that injury presentation, living arrangements, smoking status and whether or not patients had a family practitioner were predictors for seeking alternative care before visiting the ED. CONCLUSION: Most ambulatory patients attempt to look for other sources of care before presenting to the ED. Despite this attempted access to alternative care, while patients wait for ED care, they perceive that the ED is their best care option at that point in time. Language: en

Predictors of Emergency Department Use by Persons with Inflammatory Bowel Diseases: A Population-based Study.

Abstract: BACKGROUND To describe the patterns and predictors of emergency department (ED) attendance and post-ED hospitalization by persons with inflammatory bowel disease (IBD). METHODS We linked the University of Manitoba IBD Epidemiology Database with the Emergency Department Information System of the Winnipeg Regional Health Authority to determine the rates of presentation to the ED by persons with IBD from January 01, 2009 to March 31, 2012. Incident cases were diagnosed during the study period and all others were considered prevalent cases. Multivariate logistic regression was used to determine predictors of attendance in the ED and for hospitalization within 2 days of ED attendance. RESULTS The study population included 300 incident and 3394 prevalent IBD cases, of whom 76% and 49%, respectively, attended the ED at least once during the study period. Incident cases with Crohn's disease or with a history of opioid use were more likely to attend the ED. Those who had seen a gastroenterologist within the year before diagnosis were less likely to visit the ED. Among prevalent cases, higher comorbidity, opioid or corticosteroid use, and recent hospital admission were predictive of ED attendance and those who saw only 1 physician in the preceding year had lower ED attendance. Presenting to the ED with a primary gastrointestinal complaint was the strongest predictor of subsequent hospital admission. CONCLUSIONS ED attendance by both incident and prevalent cases of IBD is high. Identified predictors of ED attendance and post-ED hospitalization could guide the optimization of outpatient IBD care to limit ED attendance and potentially post-ED hospitalization.

Quality of care.

Abstract: Editor – I am moved by Professor Allan's elegy to bygone NHS virtues of ‘calm caring and gentle pace of clinical life… and all the time in the world to deliver compassionate care' ( Clin Med October 2009 p 407). One's immediate instinct would be to say ‘Ah, but times have changed' – only

Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines.

Abstract: The Canadian Emergency Department Triage and Acuity Scale (CTAS) has been widely adopted in emergency departments (EDs) across Canada and abroad since its initial publication in 1999. CTAS continues to be revised and updated on a continuing basis. In 2001, a paediatric version of the CTAS implementation guidelines was developed and published. With the ongoing improvements in computer technology, the increasing demands for clinical and administrative data and the wider application of information technology in EDs, the Canadian Emergency Department Information Systems (CEDIS) committee published a standardized presenting complaint list in 2003. In 2004, a revision of the adult CTAS guidelines that incorporated the CEDIS complaint list and introduced the concept of modifiers to assist nurses in the assignment of the appropriate acuity level was published. Modifiers were divided into 2 types: first order and second order. First order modifiers are defined as modifiers that are broadly applicable to a wide number of different complaints. These include vital sign modifiers (e.g., respiratory distress, hemodynamic stability, level of consciousness and fever), pain severity (e.g., central v. peripheral and acute v. chronic) and mechanism of injury. Second order modifiers are specific to a limited number of complaints. One example of a second order modifier is low blood sugar (BS) (e.g., “BS < 3 mmol/L and/or symptomatic” is a modifier for 3 complaints, including altered level of consciousness, confusion and hypoglycemia; while “BS < 3 mmol/L and asymptomatic” modifies only 1 complaint: hypoglycemia). A CTAS revisions supplement that displayed the entire CEDIS complaint list and the relevant first and second order modifiers was published (in portable document format [PDF] and Microsoft Excel format). A more sophisticated Excel application, Complaint Oriented Triage (COT) was designed (by B.U. and M.B.) in 2007. COT, along with all CTAS publications and supplementary documents, is accessible online at www.caep.ca/template .asp?id=B795164082374289BBD9C1C2BF4B8D32. In December 2006, a new combined adult and paediatric CTAS educational package was made available to certified instructors and their students. The package is maintained on a password-protected website. Research regarding CTAS continues to be published. Studies looking at reliability and validity of CTAS using computerized decision support systems have been generally

Lean interventions in healthcare: do they actually work? A systematic literature review.

Abstract: Purpose: Lean is a widely used quality improvement methodology initially developed and used in the automotive and manufacturing industries but recently expanded to the healthcare sector. This systematic literature review seeks to independently assess the effect of Lean or Lean interventions on worker and patient satisfaction, health and process outcomes, and financial costs. Data sources: We conducted a systematic literature review of Medline, PubMed, Cochrane Library, CINAHL, Web of Science, ABI/Inform, ERIC, EMBASE and SCOPUS. Study selection: Peer reviewed articles were included if they examined a Lean intervention and included quantitative data. Methodological quality was assessed using validated critical appraisal checklists. Publically available data collected by the Saskatchewan Health Quality Council and the Saskatchewan Union of Nurses were also analysed and reported separately. Data extraction: Data on design, methods, interventions and key outcomes were extracted and collated. Results of data synthesis: Our electronic search identified 22 articles that passed methodological quality review. Among the accepted studies, 4 were exclusively concerned with health outcomes, 3 included both health and process outcomes and 15 included process outcomes. Our study found that Lean interventions have: (i) no statistically significant association with patient satisfaction and health outcomes; (ii) a negative association with financial costs and worker satisfaction and (iii) potential, yet inconsistent, benefits on process outcomes like patient flow and safety. Conclusion: While some may strongly believe that Lean interventions lead to quality improvements in healthcare, the evidence to date simply does not support this claim. More rigorous, higher quality and better conducted scientific research is required to definitively ascertain the impact and effectiveness of Lean in healthcare settings.

Internet-based surveillance systems for monitoring emerging infectious diseases

Abstract: Emerging infectious diseases present a complex challenge to public health officials and governments; these challenges have been compounded by rapidly shifting patterns of human behaviour and globalisation. The increase in emerging infectious diseases has led to calls for new technologies and approaches for detection, tracking, reporting, and response. Internet-based surveillance systems offer a novel and developing means of monitoring conditions of public health concern, including emerging infectious diseases. We review studies that have exploited internet use and search trends to monitor two such diseases: influenza and dengue. Internet-based surveillance systems have good congruence with traditional surveillance approaches. Additionally, internet-based approaches are logistically and economically appealing. However, they do not have the capacity to replace traditional surveillance systems; they should not be viewed as an alternative, but rather an extension. Future research should focus on using data generated through internet-based surveillance and response systems to bolster the capacity of traditional surveillance systems for emerging infectious diseases.