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Emergency Medicine

Emergency medicine research involves the study of services, innovations, and clinical management related to illness or injuries that require immediate medical attention.

The Emergency Medicine Program at CHÉOS conducts research in resuscitation, clinical prediction rules, cardiovascular emergencies, patient safety, infectious diseases, mental health care, and addictions/substance use, with care and research goals that are aligned with the needs of local patients and that aim to support patients and physicians across British Columbia.

Program Head: Dr. Frank Scheuermeyer

The St. Paul’s Emergency Research Group was founded by Dr. Jim Christenson in 1994, and under his leadership became one of the pre-eminent emergency research groups in Canada, with an annual output of over 30 peer-reviewed publications. Now a CHÉOS research program, this group of investigators works in close collaboration to develop study protocols, analyze data, and disseminate results through publication and other platforms. The emergency department (ED) at St. Paul’s Hospital has nearly 90,000 annual visits and serves many patients who have complex health and social needs.

All researchers in the program are CHÉOS Scientists and are involved with the British Columbia Emergency Medicine Network, a multi-platform knowledge exchange and translation network that provides 1,400 B.C. emergency practitioners with evidence-based information to improve patient care.

The primary research & methodology areas the Emergency Medicine Program undertakes are:

Cardiac Arrest and Resuscitation

Dr. Jim Christenson has been the Principal Investigator for the BC Resuscitation Research Unit since its inception in 2000. The unit was one of the 10 academic prehospital/emergency Resuscitation Outcomes Consortium (ROC) centers across North America, funded by the US National Heart, Lung and Blood Institute, the Canadian Institute for Circulatory and Respiratory Health and the Heart and Stroke Foundation of Canada. The ROC published numerous observational and interventional studies in out-of-hospital cardiac arrest and trauma, in addition to maintaining a North American cardiac arrest and major trauma registry.

In 2016 the unit transitioned to participation within the newly formed Canadian Resuscitation Outcomes Consortium (CanROC) that continues with the same mandate in Canada, in partnership with all other provinces. As a result of an active focus on the quality of resuscitation and other aspects of prehospital care, the chance of survival in B.C. from an out-of-hospital cardiac arrest has  doubled over the past decade. Along with Dr. Christenson, Dr. Brian Grunau is a leading researcher in this area.

Cardiovascular Emergencies

Two of the most common cardiovascular emergencies are chest pain and arrthymias. Chest pain accounts for nearly one million ED visits annually in Canada, and distinguishing serious heart problems from trivial diagnoses can be a challenging process. Atrial fibrillation and flutter are the most common arrhythmias (irregular heart rhythms) seen and treated in the ED.

As a cardiac referral center, St. Paul’s Hospital manages many of these patients and a number of studies have been conducted in chest pain and arrthymias. This research emphasizes safe, rapid discharge of patients who may have previously been admitted to hospital. The research team, led by Dr. Frank Scheuermeyer, has demonstrated that many tests that were traditionally conducted in hospital can be deferred to outpatient environments, decreasing ED resource use while maintaining safety.

Other areas of research in cardiovascular emergencies undertaken by the Program include:

  • using cardiac computed tomography (CT), a new technology, in diagnosing heart disease;
  • demonstrating stroke prevention as an important part of ED care;
  • identifying vulnerable patients with atrial fibrillation and flutter who may be unexpectedly critically ill and who may not benefit from traditional care; and
  • writing evidence-based guidelines for ED treatment of cardiovascular emergencies.

Sepsis and Infections

St. Paul’s Hospital sees a disproportionally high number of patients with infections, sepsis, and septic shock. Dr. Rob Stenstrom has been leading the infections and sepsis research program in at St. Paul’s for over 10 years. St. Paul’s has been an innovator in sepsis diagnosis and treatment in the ED, and was awarded the Canadian College of Health Care3M Canadian Health Team Award for the development and implementation of the Providence Health Care Emergency Department Sepsis Protocol. Dr. Stenstrom has been involved with the development of the Canadian Association of Emergency Physicians (CAEP) guidelines for ED sepsis management with three iterations over the past decade.

Current sepsis studies include:

  • characterizing the role of biomarkers for identifying patients at risk for bacteremia;
  • a multi-center randomized controlled trial of the use of point-of-care C-reactive protein to decrease the use of blood cultures in patients with sepsis; and
  • a multi-center trial of the utility of blood cultures obtained after the administration of antibiotics to patients with severe sepsis or septic shock.

Other areas of research include non-targeted HIV point of care testing in the emergency department, prevalence of HIV infection, HIV prophylaxis, methicillin resistant staphylococcus aureus (MRSA) infections, skin and soft tissue infections, and novel antibiotics.

Mental Health and Substance Use

The ED also serves a patient population with an unusually high prevalence of addictions and mental health, including high-risk opioid use, as seen across North America. Building on SPH’s expertise in harm reduction, the CHÉOS Emergency Medicine Program, in collaboration with the City of Vancouver and provincial public health officials, implements and studies novel approaches to deliver care to vulnerable populations. The aim of the Program is not only to improve patient care, but also to contribute evidence that will help patients beyond SPH. Research in mental health and substance use at the SPH ED is led by Drs. David Barbic and Andrew Kestler.

Current projects include:

  • examining ED physician attitudes on initiating buprenorphine/naloxone for patients with opioid use disorder;
  • characterizing the general public’s attitudes on responding to overdoses in the community; and
  • evaluating a novel program combining low-barrier distribution of buprenorphine/naloxone in the ED with close follow-up in the community.

Previous work focused on safe ED discharge of patients with presumed fentanyl overdose, as well as pioneering ED implementation of take-home naloxone programs for lay-person, out-of-hospital response to opioid overdose.

Patient Safety and Resilient System Performance

Patient safety is a complex and wicked problem, and patient harm remains a pervasive global healthcare issue. The ED is a crowded and often high-hazard unit that exposes patients to risk of harm. Mismatch between demand and capacity contributes to adverse patient outcomes, including death and hospital admission. This research program, led by Dr. Garth Hunte, builds on and advances work to implement a proactive and productive safety strategy in urban emergency care.

Current work includes:

  • development of proactive system responses guided by operational thresholds;
  • calibration of predictive analytics forecasting model for capacity and demand; and
  • prospective evaluation of the National Early Warning Score at triage.

Previous work included an ethnographic analysis of how emergency care providers create safety for patients in everyday practice, implementation of a framework based on resilience engineering principles in the context of emergency care, and retrospective evaluation of the effect of structured clinical assessment to risk stratify patients with a higher likelihood of admission.

Health research in the heart of Vancouver