Dr Lisa Calder Emergency Research Group

Research Activities

 

Current Studies

A Multicenter Prospective Cohort STudy of Adverse Events among Patients Discharged with Sentinel Cardiovascular Emergency Department Diagnoses (CarE)

Almost a million Canadians visit emergency departments every year seeking healthcare due to heart-related problems. When complications are related to healthcare, the consequences can be serious and devastating. Common heart-related reasons for patients coming to the emergency department include those who have fluid in the lungs (heart failure), heart rhythm problems (atrial fibrillation) and fainting (syncope). Researchers have discovered that a high proportion of these healthcare related complications (called adverse events) are preventable. Understanding the cause of these healthcare related complications will better enable solutions to prevent future unintended harm to Canadians.The overall goal of this study is to investigate adverse events and preventable adverse events within14 days among ED discharged patients with: acute heart failure, recent onset atrial fibrillation and syncope. We will prospectively and systematically identify adverse events with a standardized and widely accepted adverse event classification. We believe identifying adverse events causes will allow the development of high yield interventions which will improve the safety of Canadian ED patients.

Principal Investigator
: Dr. Lisa Calder  
Co-Investigators
: Dr. Jeff Perry, Dr. Venkatesh Thiruganasamandamoorthy, Dr. Monica Taljaard, Dr. Alan Forster, Dr. George Wells, Dr. Ian Stiell, Dr. Eddy Lang, Dr. Andrew McRae, Dr. Bjug Borgundvaag, Dr. Marco Sivilotti, and Dr. Marcel Émond
Sites:
The Ottawa Hospital Civic and General Campuses, Ottawa ON; Foothills Medical Center, Calgary AB; Mount Sinai Hospital,  Toronto ON; Kingston General Hospital & Hotel Dieu Hospital, Kingston ON; and Hopital l'Enfant-Jesu, Quebec City QC.
Funding Partner: Canadian Institutes of Health Research


Improving the Safety of Patients who Present to the Emergency Department with Respiratory Distress: an Analysis of Adverse Events

This partner study with Dr. Stiell’s initiative to develop a decision rule for the admission and discharge of acute heart failure and COPD patients aims to determine patient safety outcomes for those who present to the ED with acute exacerbations of these conditions. We will analyse adverse events, i.e. undesired outcomes related to healthcare received in the ED, for discharged patients. This will help plan future interventions for these vulnerable populations.

Principal Investigator: Dr. Lisa Calder
Co-Investigators: Dr. Alan Forster, and Dr. Ian Stiell
Students: Sarah Tierney, Austin Gagne, Yue Jiang, Sarina Scaffidi Argentina, Shannon Pretty
Sites: The Ottawa Hospital, Kingston General Hospital, Mount Sinai Hospital, University of Alberta Hospital
Funding Partners: Canadian Institutes of Health Research, Physician Services Incorporated, and the University of Ottawa Department of Emergency Medicine

To read a related publication to this study, click HERE.


Recently Completed

Implementation of A Structured Emergency Medicine Mortality and Morbidity Rounds Model – an Interventional Study

This multi-pronged interventional before and after study aims to enhance the quality of Mortality and Morbidity Rounds. We aimed to improve inter-professional and multidisciplinary participation as well as enrich the discussion to include system and cognitive issues. By creating an administrative pathway to handle identified issues, we hoped to increase the number of M&M rounds which have real impact in the ED.

Principal Investigator: Dr. Lisa Calder
Co-Principal Investigator: Dr. Edmund Kwok
Co-Investigators: Dr. Jason Frank, Dr. Andrew Seeley, Dr. James Worthington, and Dr. Adam Cwinn
Study Dates: August 2011- July 2015
Sites: The Ottawa Hospital
Funding Partners: University of Ottawa Department of Emergency Medicine and The Ottawa Hospital Academic Medical Organization (TOHAMO) Innovation Fund

To read the related publication to this study, click HERE.



The Efficacy of Phone Follow-up in Reducing Adverse Events in the Emergency Department: A Pilot Project

Return emergency department (ED) visits are frequent (20% of high acuity patients) and may be due to adverse events (AEs), adverse outcomes related to healthcare received. This study's objective was to determine the feasibility of an interactive voice response system (IVRS) for telephone follow-up of discharged high acuity ED patients to detect AEs. Using a before-and-after study design, we assessed consecutive high acuity (triaged to monitor or stretcher) patients discharged from a tertiary care academic ED for AEs for two weeks pre-IVRS and post-IVRS. We searched health records for flagged outcomes: deaths, admissions to hospital, return ED visits. Three trained emergency physicians independently determined AE occurrence. We then analyzed outcomes using descriptive statistics.

Principal Investigator: Dr. Lisa Calder
Co-Investigators: Dr. Adam Cwinn, Dr. Ian Stiell, and Dr. Alan Forster
Site: The Ottawa Hospital - Civic Campus
Funding Partner: Canadian Medical Protective Association (CMPA)


A Visual Enhancement of Emergency Department Team Communication: Development of an ED Team Situational Display – Phase II: Optimizing Emergency Department Resuscitations Using a Technological Cognitive Aid – the Situational Awareness Display

A recurring theme among ED morbidity and mortality rounds is the need to improve team communication. If we establish that a visual Situational Awareness display improves team communication and situational awareness, this will have direct implications for improved resuscitation of ED patients. Once deployed, all team members will be able to, at a glance, be up to date on a patient’s status and be able to effectively participate in improving the patient’s outcome either by noticing a task that needs to happen or make a key decision that is required in that moment. Teams often pause to reflect on a patient’s current status and this tool will place key information at their immediate disposal. We envision greater dialogue among team members and clearer direction for the team with the use of this tool. If successful, the SA display could be easily implemented in any ED across the country. Potentially, this tool could be used in any North American setting where patients are resuscitated. This is a non-randomized prospective controlled trial of a cognitive aid using health care providers as participants and psychometric tools as measures of improved communication and situational awareness.

Principal Investigator: Dr. Lisa Calder
Co-Investigators: Dr. Avi Parush, Dr. Stanley Hamstra, Dr. Ben Sohmer, Dr. Adam Cwinn, Dr. Brian Weitzman, Dr. Kathryn Momtahan, Dr. George Mastoras, and Kathy Day
Study Dates: September 2014 - August 2015
Funding Partners: The Ottawa Hospital Academic Medical Organization (TOHAMO) Innovation Fund


Handover in the Emergency Department: Assessment and Implementation of Standardized Tool


Patient handover during shift change in the emergency department (ED) is a potentially high risk period for medical error, and handover procedures have not been well described. This study examined current handover procedures and effectiveness in the ED.This resident research project aims to examine current physician to physician practices of handover communication at shift change in the ED using interviews, focus groups and direct observations.
Principal Investigator:
Dr. Alexis Haligua – Resident Research Project
Primary Supervisor: Dr. Lisa Calder
Co-Investigators: Dr. Christa Dakin, Dr. Stephen Choi and Dr. Jason Frank
Study Dates: February 2011-September 2012
Sites: The Ottawa Hospital
Funding Partners: Physician Services Incorporated and the Academic Health Science Center Alternate Funding Plan Innovation Fund


Disposition Decision Making Study Phase 1-3

Phase 1: How do Emergency Physicians Make Discharge Decisions?


This real-time interview of emergency physicians aimed to determine how they make discharge decisions for high acuity patients and whether the rationale for these decisions was associated with the occurrence of adverse events.

Principal Investigator: Dr. Lisa Calder
Co-Investigators: Dr. Alan Forster, Dr. Jeffrey Perry, Dr. Christian Vaillancourt, Dr. Ian Stiell
Student: Trevor Arnason
Study Dates: June 2008 - September 2010
Site: The Ottawa Hospital
Funding Partners: Emergency Medicine Patient Safety Foundation and Society for Academic Emergency Medicine

To read the related publication to this study, click HERE.

Phase 2: Experiential and Rational Decision Making: A Survey to Determine How Emergency Physicians Make Clinical Decisions


This provincial survey of emergency physicians aimed to determine whether this population endorsed a particular decision making style using a validated psychometric tool, called the Rational Experiential Inventory.

Principal Investigator: Dr. Lisa Calder
Co-Investigators: Dr. Alan Forster, Dr. Jeffrey Perry, Dr. Christian Vaillancourt, Dr. Jamie Brehaut, Dr. Ian Stiell, Ms. Laura Carr, Dr. Patrick Croskerry
Study Dates: September 2009 - September 2010
Site: The Ottawa Hospital
Funding Partners: Emergency Medicine Patient Safety Foundation and Society for Academic Emergency Medicine

To access the related publication to this study, click HERE.


Phase 3: Mapping Out the Disposition Decision for High Acuity Emergency Patients


This series of focus groups asked stakeholders in the ED disposition decision to map out the decision using a process map. Focus group members further highlighted error prone areas on the map which allowed prioritization of future research.

Principal Investigator: Dr. Lisa Calder
Co-Investigators: Dr. Alan Forster, Dr. Jeffrey Perry, Dr. Christian Vaillancourt, Dr. Jamie Brehaut, Ms. Laura Carr, Dr. Ian Stiell
Study Dates: September 2009 - May 2011
Site: The Ottawa Hospital
Funding Partners: Emergency Medicine Patient Safety Foundation and Society for Academic Emergency Medicine

To access the related publication to this study, click HERE.