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To explore the impact of a physician non-accompanying pediatric critical care transport program, and to identify factors associated with the selection of specific transport team compositions.

Objectives:Patients leaving the emergency department (ED) without being seen (LWBS) by a physician have become a growing concern in overcrowded EDs. The purpose of this study was to determine the acuity level, reasons, and outcomes of LWBS cases.

Implementation of the International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system presents challenges for using administrative data. Recognizing this, we conducted a multistep process to develop ICD-10 coding algorithms to define Charlson and Elixhauser comorbidities in administrative data and assess the performance of the resulting algorithms.

The objectives of this study were to describe the utilization of emergency departments in the Capital Health region, Alberta, between 1998 and 2000, and temporal variations in emergency department utilization by month, day of week, and time of day in 2000. Between 1998 and 2000, the annual number of visits to emergency departments in the region increased by six percent. The mean length of stay, median length of stay and the number of patients who left without being seen increased by six minutes, eight minutes, and 4,442 patients respectively. Variations in the number of visits, mean and median lengths of stay, and numbers of patients who left without being seen by month, day of week, and time of day were modest except for patients who left without being seen. Service pressures in Capital Health emergency departments continue to exist. Temporal variations in service pressures were small. Causes of emergency department pressures are multiple and interrelated. Therefore, system-wide changes should be considered in addressing emergency department pressures.

The objectives of this study were to describe the utilization of emergency departments in the Capital Health region, Alberta, between 1998 and 2000, and temporal variations in emergency department utilization by month, day of week, and time of day in 2000. Between 1998 and 2000, the annual number of visits to emergency departments in the region increased by six percent. The mean length of stay, median length of stay and the number of patients who left without being seen increased by six minutes, eight minutes, and 4,442 patients respectively. Variations in the number of visits, mean and median lengths of stay, and numbers of patients who left without being seen by month, day of week, and time of day were modest except for patients who left without being seen. Service pressures in Capital Health emergency departments continue to exist. Temporal variations in service pressures were small. Causes of emergency department pressures are multiple and interrelated. Therefore, system-wide changes should be considered in addressing emergency department pressures.

This article is an historical case study of the effects of consolidating surgical services in Alberta's Capital Health Authority from 1994 to 2001. The consolidation resulted in the region's two largest hospitals offering primarily high intensity inpatient surgical care, while three other hospitals offered low-intensity day surgery and short-stay procedures only. Over time, refinements of the initial model were required. Lessons learned from the initiative are also presented.

This article is an historical case study of the effects of consolidating surgical services in Alberta's Capital Health Authority from 1994 to 2001. The consolidation resulted in the region's two largest hospitals offering primarily high intensity inpatient surgical care, while three other hospitals offered low-intensity day surgery and short-stay procedures only. Over time, refinements of the initial model were required. Lessons learned from the initiative are also presented.

ABSTRACTObjectives:To determine the perceptions of health care professionals and service providers with regard to emergency department (ED) overcrowding, including definitions of overcrowding, characteristics of an overcrowded ED, and causes of overcrowding, and secondarily to solicit potential solutions to the problem.Methods:Focus groups were conducted with front-line staff, physicians and managers from 7 EDs within an integrated health region. Participants received questions before the sessions, and an experienced moderator conducted the sessions and prepared transcripts from audio tapes. Analyses included identification of key themes and the interrelationships between those themes.Results:Focus group participants defined service pressures that result in overcrowding as “anything that impedes the flow of patients through the ED, affects the quality of care delivered or results in patient frustration and stress to staff.” Overcrowding, which can occur at any time of the day, was perceived to have many causes, including some seasonal factors. Two key problems were identified as causing many spin-off pressures: inefficient access to ED beds (stretchers) because of slow throughput of patients and staff shortages. Other perceived causes included the changing role and use of EDs and limited access to services such as home care, diagnostic imaging, laboratory services, social services and specialist care. Participants generally believed that the characteristics and causes of overcrowding could not be viewed independently; rather, in the search for remedies, they should be considered as interrelated variables.Conclusion:Qualitative studies of this complex issue can identify and describe complex interactions in real-world settings. The findings of such studies can lead to quantitative studies involving objective measurement.

Objectives:To determine variations in the rate of inpatient and outpatient dilatation and curettage (D&C), for the treatment of early pregnancy loss and for the diagnosis of abnormal uterine bleeding, in 17 health regions across a Canadian province.

The primary objective of this study was to examine trends in rates and outcomes of coronary artery bypass graft (CABG) surgery across the 3 Canadian provinces of Alberta, Manitoba, and Nova Scotia, during fiscal years 1991-1995. Annual age-standardized CABG surgery rates were calculated by sex for each province. Province-specific average length of stay (ALOS) and postsurgical complication rates were calculated using ICD-9 codes. Rates of CABG were higher among men compared with women in all 3 provinces. Whereas ALOS, complication rates, and mortality rates decreased in all provinces over the study period, there was considerable variation in province-specific rates.

Study 1 To determine the interrater agreement on the Multiattribute Health Status Classification (MAHSC) for brain-injured children. Study 2 To determine the outcome of severe childhood traumatic brain injury (TBI) by comparing three measures MAHSC, Functional Independence Measures (FIM/WeeFIM), and the Glasgow Outcome Scale.

Magnetic resonance imaging (MRI) has excellent specificity and sensitivity for the diagnosis of internal derangement of the knee (IDK). The use of MRI to screen patients with suspected IDK could avoid unnecessary arthroscopies with a reduction in costs. The purpose of this study was to evaluate the use of arthroscopy among patients with IDK, and to estimate the potential cost-effectiveness of MRI in these patients to avoid unnecessary arthroscopies. The study was based on a retrospective cohort of all patients attending three orthopedic clinics between April and September 1993 with a new diagnosis of IDK. Charts were reviewed in 1994 to allow for a follow-up of more than 6 months. An economic evaluation was performed based on cost-effectiveness ratios (per averted arthroscopy), including direct and indirect costs. There were 241 patients with a new diagnosis of IDK (67% males, mean age 35 ± 12 years), and 110 (46%) underwent arthroscopy. The remaining patients received conservative therapy and were not scheduled for arthroscopy within the period of observation. Using a priori established criteria, 10% of the arthroscopies could be considered diagnostic only (e.g., normal knee) and 27% were of doubtful efficacy from a therapeutic perspective (e.g., debridement alone). Many of these arthroscopies could have been avoided by performing a prior MRI. Using these findings, we conducted decision tree analyses of the use of MRI among patients requiring arthroscopy of the knee. A sensitivity analysis was performed to evaluate the various model assumptions. In general, MRI appeared to be a cost-effective diagnostic procedure for patients with IDK requiring arthroscopy of the knee, and there were cost savings associated with it in some of the models tested.

Fiscal concerns have provided the impetus for wide-ranging attempts to reform the delivery of health care in Canada. Health reform has in turn stimulated great interest and activity in health service research. For health service research to be of maximum use in addressing current and future challenges to the health care system, closer liaison is needed between researchers and decision makers — the users of research. The purpose of this paper is to promote greater interaction between decision makers and researchers by proposing a framework for health predicated on types of information needed for decision-making rather than on study methodologies. We distinguish between decision makers at the societal, health system, program and service levels. Types of studies are classified by their purpose and by the phase of the management cycle for which they provide information for decision-making.

As population health programs, environmental health services differ fundamentally from other forms of health service delivery. At a time when the health sector is striving for integration, the incorporation of these unique services into the delivery system presents a unique challenge to policy makers and administrators across the country. The University of Alberta recently completed a comprehensive review and redesign of locally governed and delivered environmental health protection services in Alberta. This paper outlines the key issues and unique features surrounding the delivery of environmental health services and presents the study team's suggested approach to addressing these issues.

Tout comme les programmes de santé publique, les services d'hygiène du milieu diffèrent fondamentalement des autres formes de prestation de services de santé. À une époque où le secteur de la santé se bat pour intégrer ses disciplines, l'incorporation de ces services uniques au système de prestation présente un défi unique pour les décideurs et les administrateurs dans tous le pays. L'université de l'Alberta a récemment terminé une étude exhaustive des services de protection de l'hygiène du milieu gérés et offerts localement en Alberta, et en a proposé une nouvelle conception. Dans cet article, les auteurs décrivent brièvement les questions clés et les caractéristiques particulières à la prestation de services d'hygiène du milieu, et y présentent l'approche proposée par l'équipe de recherche albertaine pour aborder ces questions.

The objective of this research was to determine factors related to injury for adult recreational and old‐timer hockey players. Four hundred and thirty‐one players from 5 hockey leagues were followed during an entire hockey season. Risk factor regression equations for facial injury, body contact injury, sprain/strain injury, and all injuries were determined using multiple logistic regression analysis. A total of 151 injuries were reported. Thirty‐two facial injuries were suffered by players, 51 injuries were a result of intentional and unintentional body contact between players, and 59 injuries diagnosed as either sprains or strains. Facial injuries were statistically predicted by the interaction of shooting side with player position. The multivariable equation for body contact injury included player weight as well as the number of other fitness activities a player participated in. The multivariable equation for sprain/strain injuries included age, self‐reported skill, and previous injury history. The usefulness of dividing injury into major categories for risk factor identification was demonstrated.

As population health programs, environmental health services differ fundamentally from other forms of health service delivery. At a time when the health sector is striving for integration, the incorporation of these unique services into the delivery system presents a unique challenge to policy makers and administrators across the country. The University of Alberta recently completed a comprehensive review and redesign of locally governed and delivered environmental health protection services in Alberta. This paper outlines the key issues and unique features surrounding the delivery of environmental health services and presents the study team's suggested approach to addressing these issues.

Tout comme les programmes de santé publique, les services d'hygiène du milieu diffèrent fondamentalement des autres formes de prestation de services de santé. à une époque où le secteur de la santé se bat pour intégrer ses disciplines, l'incorporation de ces services uniques au système de prestation présente un défi unique pour les décideurs et les administrateurs dans tous le pays. L'université de l'Alberta a récemment terminé une étude exhaustive des services de protection de l'hygiène du milieu gérés et offerts localement en Alberta, et en a proposé une nouvelle conception. Dans cet article, les auteurs décrivent brièvement les questions clés et les caractéristiques particulières à la prestation de services d'hygiène du milieu, et y présentent l'approche proposée par l'équipe de recherche albertaine pour aborder ces questions.

Fiscal concerns have provided the impetus for wide-ranging attempts to reform the delivery of health care in Canada. Health reform has in turn stimulated great interest and activity in health service research. For health service research to be of maximum use in addressing current and future challenges to the health care system, closer liaison is needed between researchers and decision makers - the users of research. The purpose of this paper is to promote greater interaction between decision makers and researchers by proposing a framework for health predicated on types of information needed for decision-making rather than on study methodologies. We distinguish between decision makers at the societal, health system, program and service levels. Types of studies are classified by their purpose and by the phase of the management cycle for which they provide information for decision-making.