Identifying Gender Barriers for Colorectal Cancer Screening and Assessing the Need for a Multigender Endoscopy Team: A Prospective Multicenter Study.

INTRODUCTION: Gender preferences have been reported as a barrier to colorectal cancer screening, particularly among women. We aim to identify the role of patients' gender preferences for endoscopists and endoscopy team members, with the effect of age-related and regional differences. METHODS: We conducted an anonymous, voluntary survey of all adult outpatients presenting at our endoscopy centers before their procedures. RESULTS: We received 2,138 (1,207 women, 905 men, and 26 undisclosed; 50% urban and 50% rural) completed surveys. The majority of the patients (89%) did not have an endoscopist gender preference, while 8% preferred a same-gender endoscopist, and 2% preferred an opposite gender endoscopist. Among patients who expressed a gender preference, men more commonly preferred a same-gender endoscopist than women (91% vs 67%, P < 0.05). More patients preferred a same-gender endoscopy team member than a same-gender endoscopist (17% vs 8%, P < 0.05), and women more commonly preferred a same-gender endoscopy team member than men (26% vs 6%, P < 0.05). Most patients who expressed same-gender endoscopist preference were between the ages of 50-69 years as compared to other age groups (P < 0.05). Of the urban patients, 9% expressed a same-gender endoscopist preference and 3% expressed an opposite gender preference, compared with 7% and 2% of rural patients (P < 0.05). Among patients with any endoscopist gender preference, rural patients were more willing to wait longer (41% vs 21%, P < 0.05), whereas urban patients were willing to pay more (64% vs 14%, P < 0.05) to have their preferences met. DISCUSSION: Contrary to previous studies, most patients did not have an endoscopist gender preference. Interestingly, men had more same-gender endoscopist preference, whereas women had more same-gender endoscopy team member preference. Age-related and regional differences exist among patients' gender preferences for their endoscopist and endoscopy team member, and addressing these preferences while creating an environment of a multigender endoscopy team may be beneficial in improving colorectal cancer screening.

Are emergency medical services offload delay patients at increased risk of adverse outcomes?

OBJECTIVE: Emergency department (ED) and hospital overcrowding cause offload delays that remove emergency medical services (EMS) crews from service and compromise care delivery. Prolonged ED boarding and delays to inpatient care are associated with increased hospital length of stay (LOS) and patient mortality, but the effects of EMS offload delays have not been well studied. METHODS: We used administrative data to study all high-acuity Canadian Triage Acuity Scale 2-3 EMS arrivals to Calgary adult EDs from July 2013 to June 2016. Patients offloaded to a care space within 15 minutes were considered controls, whereas those delayed ≥ 60 minutes were considered "delayed." Propensity matching was used to create comparable control and delayed cohorts. The primary outcome was 7-day mortality. Secondary outcomes included hospital LOS and 30-day mortality. RESULTS: Of 162,002 high-acuity arrivals, 70,711 had offload delays 60 minutes. Delayed patients were more likely to be female, older, to have lower triage acuity, to live in dependent living situations, and to arrive on weekdays and day or evening hours. Delayed patients less often required admission and, when admitted, were more likely to go to the hospitalist service. Main outcomes were similar for propensity-matched control and delayed cohorts, although delayed patients experienced longer ED LOS and slightly lower 7-day mortality rates. CONCLUSION: In this setting, high-acuity EMS arrivals exposed to offload delays did not have prolonged hospital LOS or higher mortality than comparable patients who received timely access.

CONTEXTE: L'engorgement des hôpitaux et des services des urgences (SU) entraîne des retards de déchargement des ambulances et une suspension des services médicaux d'urgence (SMU), en plus de porter atteinte à la prestation de soins. Les séjours prolongés au SU et les retards de prestation de soins aux patients hospitalisés sont associés à une prolongation de la durée de séjour (DS) à l'hôpital et à une augmentation de la mortalité, mais on ne connaît pas très bien les effets des retards de déchargement des ambulances pour cause d'engorgement. MÉTHODE: Pour ce faire, nous avons utilisé des données administratives pour examiner tous les cas très urgents dont le degré de gravité était de 2 ou 3 sur l'Échelle canadienne de triage et de gravité et qui ont été traités dans l'un des SU pour adultes de Calgary, de juillet 2013 à juin 2016. Les patients qui ont été conduits dans un lieu de prestation de soins en moins de 15 minutes étaient considérés comme des témoins, tandis que ceux qui ont attendu ≥ 60 minutes étaient considérés comme des « sujets en attente¼. Nous avons eu recours à l'appariement par score de propension pour former des cohortes comparables de témoins et de « sujets en attente ¼. Le principal critère d'évaluation était la mortalité au bout de 7 jours, et les critères d'évaluation secondaires comprenaient la DS à l'hôpital et la mortalité au bout de 30 jours. RÉSULTATS: Sur 162 002 cas très urgents, 70 711 ont connu une attente ≤ 15 minutes et 41 032, une attente > 60 minutes. Les personnes mises en attente étaient plus susceptibles d'être des femmes âgées, d'avoir un degré de gravité peu élevé au moment du triage, de vivre en état de dépendance et d'arriver les jours de semaine, de jour ou de soir. Les patients en attente avaient besoin moins souvent d'être hospitalisés et, le cas échéant, ils étaient plus susceptibles d'être mutés à l'étage. Les résultats du principal critère d'évaluation étaient comparables dans les deux cohortes; toutefois, les patients en attente ont connu une DS prolongée au SU, mais un taux de mortalité au bout de 7 jours légèrement inférieur à celui enregistré chez les autres patients. CONCLUSION: Dans le contexte étudié, les patients arrivés en grande urgence par ambulance et mis en attente n'ont pas connu de séjour plus long à l'hôpital ou un taux de mortalité plus élevé que les patients comparables, traités en temps opportun.

Development of a congestive heart failure protocol in a rehabilitation setting.

A number of patients in a rehabilitation setting were being transferred to acute-care facilities with a diagnosis of congestive heart failure (CHF). A transfer penalty was charged to the rehabilitation facility based on each patient's length of stay. A multidisciplinary team was assembled with physician support to address the problem. The team's goal was to develop a CHF protocol with guidelines that would allow for more frequent nursing assessments and reporting to physicians. The protocol interventions were initiated consistently and monitored on each shift. These interventions allowed for more timely assessment and treatment of patients with signs and symptoms of CHF. As a result, the number of patients being transferred to acute-care hospitals has decreased, allowing patients to complete their rehabilitation process without interruption. The decreased number of patients being transferred to the acute-care setting has resulted in fewer transfer penalties for the rehabilitation facility.

Corticosteroid use after hospital discharge among high-risk adults with asthma.

Despite the efficacy of corticosteroid therapy, patients hospitalized for asthma exacerbations are at high risk for re-exacerbation and death after discharge. The objective of this prospective cohort study was to evaluate adherence to inhaled corticosteroids (ICS) and oral corticosteroids (OCS) after discharge in adults hospitalized for asthma exacerbations. ICS and OCS were equipped with electronic medication monitors and were provided at discharge. Adherence (use/prescribed use x 100%) was measured by self-report and canister weight (ICS), pill count (OCS), and electronic medication monitors (both ICS and OCS) 2 weeks after discharge. Poor adherence was defined as adherence of less than 50%. The Asthma Control Questionnaire was used to assess symptom control. Sixty patients were enrolled (age 42.2 years, 98.3% African American, 65.0% female, 46.7% with history of near-fatal asthma). Electronically measured adherence to both corticosteroids dropped to approximately 50% within 7 days of discharge. Poor adherence to both corticosteroids predicted significantly worse symptom control (p = 0.04). Self-report, canister weight, and pill count all had low sensitivity (29.2%, 65.0%, and 7.7%, respectively) for detecting poor adherence. We conclude that adherence to ICS and OCS deteriorates within days of hospital discharge but may not be recognized in a substantial proportion of patients.