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Biomedical subjects

Alison Macpherson

Publications and source records attributed to Alison Macpherson.

8 recordsLinked to original sources
PubMed2006

The effect of a short tutorial on the incidence of prescribing errors in pediatric emergency care.

BACKGROUND: In the paediatric emergency department (ED) trainees are more likely to commit prescribing errors. OBJECTIVE: To determine whether a short educational intervention reduces the incidence of prescribing errors among trainees in a pediatric ED. METHODS: A prospective cohort study at the ED of a tertiary paediatric hospital. All fellows and residents arriving at the ED at the beginning of the academic year were invited to participate in a 30-minute tutorial focusing on appropriate methods for prescribing medications, followed by a written test. Eighteen days were selected randomly during July 2001. All the charts from these days were reviewed for medication errors. Two reviewers, blinded to whether or not a particular physician attended the tutorial, independently decided whether or not an error had occurred. The main outcome measure was the number of prescribing errors. RESULTS: Twenty-two trainees worked in the ED during July 2001. Of these, 13 trainees attended the tutorial. Eight hundred and ninety nine orders given by trainees were evaluated. We identified 66 (12.4%) errors in 533 orders given by those who attended tutorial, and 46 (12.7%) errors in 363 orders given by those who did not attend tutorial. The adjusted odds of a medication error was not significantly different between those who did not attend the tutorial and those who did (OR: 1.07 95% CI: 0.66-1.70). CONCLUSIONS: A short tutorial, followed by a written test, administered to trainees before entering their rotation in the paediatric ED, did not appear to reduce prescribing errors.

Clinical Competence↗
PubMed2006

Language and length of stay in the pediatric emergency department.

BACKGROUND: Quality and accessibility of care for patients presenting to the emergency department (ED) can be limited if they cannot communicate in the same language as their health care provider. STUDY OBJECTIVES: We aimed to determine if children whose parents speak a primary language other than English have a longer length of stay (LOS) in the ED compared with English-speaking families. METHODS: We reviewed computerized ED records of age-matched English and 4 most common non-English languages in a tertiary pediatric hospital in Toronto, Canada. We randomly chose English-speaking families in a 3:1 ratio with non-English. We performed bivariate analyses and a multivariable linear regression to test the relationship between language, triage score, age, gender, day of the week, and diagnostic grouping. RESULTS: Out of 48,497 visits for 1 year, we included 6051 English-, 628 Spanish-, 486 Cantonese-, 486 Mandarin-, and 417 Tamil-speaking families. The average LOS was 3.86 and 3.95 hours for English and non-English-speaking patients, respectively (P > 0.05). Non-English speakers had lower acuity more frequently (P = 0.004) and arrived more over weekdays (P = 0.02). In the multivariate regression model, language, triage score, age, and gender were all significantly associated with LOS. Only 6% of the variance in LOS was explained by the regression model. CONCLUSIONS: Language, triage score, patient age, and gender are significantly associated with LOS in the ED. Among other interventions, securing ways to accommodate non-English-speaking health providers in the ED can possibly shorten the LOS and reduce nonacute visits to the ED.

Child, Preschool↗
PubMed2006

Unscheduled return visits to the pediatric emergency department-one-year experience.

OBJECTIVES: Patients returning to the emergency department (ED) within 72 hours of their visit may contribute to crowding and might indicate failure to give a proper assessment, treatment, or follow-up instructions. The aim of this study was to describe the rate of return visits in a tertiary care pediatric ED (PED) and find characteristics of children who return to the ED. METHODS: We retrospectively reviewed all records of patients visiting our PED in Toronto during 2003. We collected demographic data, time of visit(s), and acuity. We excluded patients who left without being seen, left against medical advice, or were admitted to the hospital. We conducted univariate and multivariate analyses to determine odds ratio of variables associated with returning. RESULTS: Of 37,725 eligible children, 1990(5.2%) returned within 72 hours. One hundred fifty-six returned for a third visit, and 10 returned for a fourth visit. A quarter of the children who returned were younger than 1 year, and the younger the child, the higher the likelihood of returning; the higher the acuity of the first (index) visit, the higher the likelihood that a patient will return. Patients coming during the busiest hours, between 8 pm and midnight, were more likely to return. We found no significant seasonal differences in univariate or multivariate analysis. CONCLUSIONS: Five percent of our PED visits are return visits of children seen in the 72 hours before the visit. Younger children, with high acuity who come to the ED in the late evening hours, are most likely to return to the ED.

Appointments and Schedules↗
PubMed2006

Determinants of sufficient daily activity in Australian primary school children.

AIMS: Australian guidelines recommend that children participate in at least one hour of physical activity every day. We aimed to measure physical activity participation in a random sample of Australian primary school children and to determine the biological, behavioural, environmental and social influences associated with insufficient daily activity. METHOD: We analysed the following cross-section data from a randomly selected sample of children (N=518) aged 5 to 12 years: age, gender, socioeconmic status (SES) indicators, family size, home play equipment availability, transport method to school, and estimated time per week in physical and sedentary activity. Logistic regression analysis was performed to determine variables that were associated with insufficient (<60 minutes) daily activity. RESULTS: Seventy-six children (15% of the cohort) failed to meet the minimum activity recommendations of 60 minutes of daily activity. These children were significantly less likely to walk or cycle to school (adjusted odds ratio (OR) 0.43; 95% CI=0.24-0.77) or participate in organised sports or activity (OR 0.42; 95% CI=0.28-0.64) and were more likely to spend in excess of 2 hours a day watching television of using a computer for entertainment (OR 2.10 (1.16-3.78). Age, gender, SES and family size were not significantly associated with insufficient activity. CONCLUSION: There exists a significant proportion of the paediatric population who are insufficiently active. Interventions to encourage increased activity in this sub-group may be successful if they seek to alter sedentary behaviour (namely television use) and method of transportation to and from school.

Australia↗
PubMed2006

Body-checking rules and childhood injuries in ice hockey.

BACKGROUND: Body checking is the predominant mechanism of youth ice hockey injuries. The Canadian Hockey Association has allowed body checking from ages 12 to 13 (peewee level) and up. One Canadian province (Ontario) introduced body checking at ages 10 to 11 (atom level) in the competitive leagues, whereas in Quebec body checking has only been allowed at ages 14 to 15 (bantam Level). The purpose of this study was to compare body-checking injuries, fractures, and concussions in boys' minor hockey between jurisdictions in which checking is allowed and jurisdictions in which body checking is not allowed. METHODS: Data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were used to characterize children's ice hockey injuries from September 1995 to the end of August 2002. Children treated at CHIRPP hospitals in areas in which checking was allowed were compared with children in areas in which checking was not allowed. RESULTS: Of the 4736 hockey injuries, 3006 (63%) were in Ontario and 1730 (37%) were in Quebec. Most of the injuries occurred in areas in which checking was allowed (3618 [76.4%]) [corrected] At ages 10 to 13, players had significantly greater odds of suffering a checking injury where checking was allowed (odds ratio [OR]: 2.65 [corrected]; 95% confidence interval [CI]: 2.21[corrected]-3.18 [corrected]). Players in this age group were also more likely to suffer a concussion (OR: 1.53 [corrected]; 95% CI: 0.93 [corrected]-2.52 [corrected]) or fracture (OR: 1.20 [corrected]; 95% CI: 1.00 [corrected]-1.47) where checking was allowed. Among older players, when checking was allowed in both provinces, there were higher odds (OR: 1.1 [corrected]; 95% CI: 0.94 [corrected]-1.33 [corrected]) of receiving a checking injury in the province that had introduced checking at a younger age, suggesting that there is no protective effect from learning to check earlier. CONCLUSIONS: Increased injuries attributable to checking were observed where checking was allowed. This study supports policies that disallow body checking to reduce ice hockey injuries in children.

Adolescent↗
PubMed2005

Patients who leave the pediatric emergency department without being seen: a case-control study.

BACKGROUND: Children who visit pediatric emergency departments (EDs) and leave before being seen by a physician may present with particular health problems and may be at risk for preventable health outcomes. We compared children who left without being seen with those who stayed and were seen by a pediatrician, and followed all of the study subjects after they left the ED. METHODS: We asked all parents of children who visited the ED between July 1 and Oct. 31, 2002, to participate. Parents were interviewed by a trained ED research assistant. We abstracted data from the ED medical records. We used the Canadian Emergency Department Triage and Acuity Scale (CTAS) to measure the acuity of the illness or injury. Each child who left without being seen was matched with 2 children who had been seen by selecting the next patients on an alphabetical list by day, sex and age (within 1 year). We did follow-up interviews with parents within 96 hours of the visit to determine the reason for leaving and any treatment and diagnoses received subsequent to the ED visit. RESULTS: Of the 11 087 children seen in the ED during the study period, 289 (3%) left without being seen. Of the 289, the families of 158 (56%) consented to participate in the study and met the study criteria. The case and control groups thus consisted of 158 and 316 children respectively. Of the children who left without being seen, 24 (15%) were triaged as "urgent," and none had a CTAS score of less than 3. A total of 99 children (63%) who left were taken by their families elsewhere for further medical care, compared with 89 (28%) of those who stayed. Waiting too long and resolution of symptoms accounted for 92 (58%) and 59 (37%) of the premature departures respectively. One child who left without being seen was subsequently admitted to hospital. Multivariate analysis showed that, after adjustment for time of arrival and time to reach the ED, children who left without being seen had lower acuity than those who stayed (odds ratio [OR] 4.0, 95% confidence interval [CI] 2.2-7.2) and were more likely to register in the ED between midnight and 4 am (OR 5.9, 95% CI 2.8- 12.5). Children in the premature departure group were also more likely to be taken elsewhere for follow-up care (unadjusted OR 4.3, 95% CI 2.9-6.4). INTERPRETATION: Children who left the ED without being seen had lower acuity levels and were more likely to be taken elsewhere for follow-up care than children who stayed. Most of those who left did so because the wait was too long or their symptoms resolved.

Case-Control Studies↗
PubMed2002

Variables associated with medication errors in pediatric emergency medicine.

OBJECTIVE: Medication errors are a common cause of iatrogenic morbidity and mortality. The incidence of medication errors in pediatric emergency departments (EDs) has not been described. The objective of this study was to describe the incidence and type of drug errors in a pediatric ED and determine factors associated with risk of errors. METHODS: A retrospective cohort study was conducted of the charts of 1532 children who were treated in the ED of a pediatric tertiary care hospital during 12 randomly selected days from the summer of 2000. Two pediatricians, blinded to other study variables, independently decided whether a medication error occurred and ranked it according to a severity score. Disagreement was resolved by consensus. RESULTS: Prescribing errors were identified in 10.1% of the charts. The following variables were associated in univariate analysis with an increased proportion of errors: patients seen between 4 AM and 8 AM (odds ratio [OR]: 2.45; 95% confidence interval [CI]: 1.10-5.50), patients with severe disease (OR: 2.53; 95% CI: 1.18-5.41), medication ordered by a trainee (OR: 1.48; 95% CI: 1.03-2.11), and patients seen during weekends (OR: 1.48; 95% CI: 1.04-2.11). Among trainees, there was a higher rate of errors at the beginning of the academic year (OR: 1.67; 95% CI: 1.06-2.64). Logistic regression revealed increased risk for errors when a medication was ordered by a trainee (OR: 1.64; 95% CI: 1.06-2.52) and in seriously ill patients (OR: 1.55; 95% CI: 1.06-2.26). CONCLUSIONS: In the pediatric ED, trainees are more likely to commit prescribing errors, and the most seriously ill patients are more likely to be subjected to prescribing errors.

Child↗