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Introduction : De nombreux facteurs peuvent contribuer à la qualité des soins. La présence d'un transfert interétablissements peut affecter la qualité des soins en induisant une fragmentation du parcours de soins qui peut entraîner des effets indésirables. De plus, la pandémie de SRAS-CoV-2 a entraîné des retards massifs et des annulations dans les chirurgies électives. Nous avons ainsi documenté les changements dans les indicateurs de la qualité des soins, pour les patients attendant une chirurgie élective en orthopédie pédiatrique pour les profils visés, entre les périodes pré et perpandémie et identifié les facteurs associés aux délais chirurgicaux. Méthode : Une analyse rétrospective des cas pédiatriques subissant des interventions orthopédiques électives dans les trois hôpitaux pédiatriques de Montréal a été réalisée. Trois profils de patients ont été sélectionnés: chirurgie du rachis, radicellectomie et chirurgie des membres chez des patients présentant une déficience motrice. Nous avons enregistré le taux de réadmission, le nombre d'incidents, de plaintes et le volume chirurgical. Nous avons ensuite comparé entre les périodes (septembre 2019-février 2020 vs septembre 2020-février 2021), les changements dans le nombre d'annulations chirurgicales, dans la mortalité, la duplication d'examens, la durée de séjour et les délais chirurgicaux à l'aide de tests du chi carré ou Mann-Whitney. Finalement, nous avons déterminé les facteurs associés aux délais à l’aide d’un modèle de régression de Cox multivariable. Résultats : 94 patients ont été inclus (47 pour chaque période). Aucune différence significative n’a été trouvée pour le nombre de réadmissions, le nombre d’incidents/plaintes, le nombre de décès, le nombre d’annulations chirurgicales, la duplication de tests et la durée de séjour entre les périodes prépandémie et perpandémie. Cependant, les délais chirurgicaux étaient plus longs en 2020- 2021 qu’en 2019-2020 avec des médianes respectives de 149 [ÉIQ=283] et 12, Introduction: Many factors can contribute to the quality of care. The presence of an inter- establishment transfer can affect the quality of care by inducing fragmentation of the care pathway, which can lead to adverse effects. Another contributor is the presence of the SARS- CoV-2 pandemic which cause massive delays and elective surgery cancellations. As such, we sought to document the differences in specific indicators, for patients awaiting elective surgery in pediatric orthopedics for the targeted profiles, between pre- and peri-pandemic periods and to identify factors associated with surgical delays. Methods: A retrospective analysis of pediatric cases undergoing elective orthopedic procedures in three Montreal pediatric hospitals was performed. Three patient profiles were selected: spine surgery, rhizotomy, and limb surgery in patients with motor impairment. We recorded the readmission rate, number of incidents, complaints, and surgical volume. We then compared between periods (September 2019-February 2020 vs September 2020-February 2021) the changes in the number of surgical cancellations, in mortality, duplication of examinations, length of stay and surgical delays using chi-square test or Mann-Whitney tests. Finally, we identified the factors associated with surgical delays using a multivariable Cox regression model. Results: 94 patients were included (47 for each period). No statistically significant difference was found for in the readmission rate, number of incidents or complaints, mortality rate, number of surgical cancellations, duplication of tests, and the length of stay between the pre-pandemic and the peri-pandemic periods. However, surgical delays were longer in 2020-2021 than in 2019-2020 with respective medians of 149 [IQR=283] and 120 days [IQR=218] (p = 0.002). Factors associated with delays were a primary surgical diagnosis of scoliosis (p = 0.032), or of upper limb procedure (p = 0.021), associated conditions of dysplasia (p = 0.02

Objectifs : Cette étude s'inscrit dans une initiative d’intégration des services péri-chirurgicaux interétablissements, pour les troubles musculosquelettiques pédiatriques complexes. Ses objectifs étaient : 1) Explorer les perceptions sur la collaboration interprofessionnelle (CIP) du personnel de santé impliqué dans la gestion des transferts interétablissements. 2) Identifier les facteurs facilitants et contraignants à la CIP. Méthodes : Une analyse qualitative descriptive interprétative transversale a été utilisée. Trois groupes de discussion et trois entretiens individuels ont été effectués avec 18 participants impliqués dans les transferts de jeunes patients entre quatre institutions participantes à Montréal. Le guide d’entretien et l’analyse sont fondées sur le cadre de la collaboration interprofessionnelle et inter-organisationnelle de D'Amour et collaborateurs, 2008. Résultats : Le rôle des coordonnatrices trajectoires interétablissements (CTI) a été nommé comme pilier central dans la coordination, la connectivité entre les lieux de soins, la confiance et le leadership. D’autres thèmes évoqués sont l’importance des moyens de communication entre les partenaires et le besoin de standardisation des procédures. Les facteurs facilitants à la CIP étaient : la proximité physique et organisationnelle entre deux établissements, l'autonomie des professionnels dans les tâches quotidiennes et disponibilité/accessibilité de la CTI en soutien aux équipes. Les facteurs contraignants identifiés incluaient : l’incapacité d’accéder au dossier médical à distance, l’absence d’un dossier harmonisé informatisé, les rares espaces d’échanges informels et la compréhension limitée des rôles/responsabilités des autres. Conclusion : La situation actuelle de la CIP dans le contexte étudié s’illustre particulièrement autour du besoin de formalisation des outils et des processus, ainsi que de la connaissance mutuelle limitée. En comprenant les facteurs qui facilitent ou entravent la CIP, t, Aims: This study is part of an initiative to integrate inter-establishment peri-surgical services for complex pediatric musculoskeletal disorders. Its objectives were: 1) To explore the perceptions of interprofessional collaboration (IPC) of healthcare personnel involved in the management of inter-establishment transfers. 2) Identify facilitating and constraining factors to IPC. Methods: A cross-sectional interpretative descriptive qualitative analysis was used. Three focus groups and three individual interviews were conducted with 18 participants involved in transfers of young patients between the four participating sites in Montreal. The interview guide and analysis are based on D'Amour's 2008 interprofessional and interorganizational collaboration framework. Results: The role of inter-establishment navigators (IEN) was identified as a central pillar in coordination, connectivity between care sites, trust and leadership. Other topics raised are the importance of means of communication between partners and the need for standardization of procedures. The facilitating factors of ICP were the physical and organizational proximity between two establishments, the autonomy of the professionals in daily tasks and the availability/accessibility of the IEN in support of the teams. The constraining factors identified included: the inability to access the medical file remotely, the absence of a harmonized electronic medical record, the rare spaces for informal exchanges and the limited understanding of the roles/responsibilities of others. Conclusion: The current situation of IPC in our context is particularly illustrated around the need for formalization of tools and processes, as well as limited mutual acquaintance. This study identified the factors that facilitate or hinder IPC that have generated leads for improvement in the next stages of the process of implementing trajectory innovations. The study also emphasized the importance of involving the stakeholders i

Objective: Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods: We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results: Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (n = 11), occupational therapy (n = 2), prosthetics (n = 1), exercise physiology (n = 1) and multidisciplinary (n = 4) services. The methodological quality varied (n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions: This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.

Introduction -- Lateral head impact occurs in motor vehicles roll-over crashes [1]. Roberts et al [1] have reproduced rollover crashes on post-mortem human surrogates and dummies and have noted that the Nij is ineffective to assess neck injury. Moreover, most previous experimental studies on neck injury have focused on axial compression or sled impact and the cervical spine kinematics during a lateral head impact have not yet been described nor associated with the risk of neck injury. This experimental study objective was to evaluate head kinematics and cervical spine injuries from a lateral head impact on human cadavers.

Flexion-distraction injuries frequently cause traumatic cervical spinal cord injury (SCI). Post-traumatic instability can cause aggravation of the secondary SCI during patient care. However, there is little information on how the pattern of disco-ligamentous injury affects the SCI severity and mechanism. This study objective was to analyze how posterior disco-ligamentous injuries affect spinal cord compression and stress and strain patterns in the spinal cord during post-traumatic flexion and extension. A cervical spine finite element model including the spinal cord was used and different combinations of partial or complete intervertebral disc (IVD) rupture and disruption of various posterior ligaments were modeled at C4–C5, C5–C6, or C6–C7. In flexion, complete IVD rupture combined with posterior ligamentous complex rupture was the most severe injury leading to the highest von Mises stress (47–66 kPa), principal strains p1 (0.32–0.41 in white matter) and p3 (−0.78 to −0.96 in white matter) in the spinal cord and the highest spinal cord compression (35–48%). The main post-trauma SCI mechanism was identified as the compression of the anterior white matter at the injured level combined with distraction of the posterior spinal cord during flexion. There was also a concentration of the maximum stresses in the gray matter during post-traumatic flexion. Finally, in extension, the injuries tested had little impact on the spinal cord. The capsular ligament was the most important structure to protect the spinal cord. Its status should be carefully examined during the patient's management.