Using Blood Wisely: lessons learnt in establishing a national implementation programme to reduce inappropriate red blood cell transfusion.

BACKGROUND: Up to 50% of blood is transfused inappropriately despite best evidence. In 2020, Choosing Wisely Canada launched a major national programme, 'Using Blood Wisely', the aim was to engage hospitals to audit their red blood cell transfusion use against national benchmarks and participate in a programme to decrease inappropriate use. STUDY DESIGN: Using Blood Wisely is a quality improvement programme including national benchmarks, an audit tool, recommended evidence-based effective interventions and a designation to reward success. Hospital engagement was measured using the number of hospitals signing up, performing a baseline audit, submitting the planning survey, entering two or more audits and achieving hospital designation. Barriers to implementation were collected. RESULTS: From 1 September 2020 to 31 December 2022, 229 individual hospitals signed up over time to participate. Their results are reported as 159 hospitals and hospital groups. Collectively, this accounts for 72% of the blood used in Canada. Overall, 147 (92%) performed a baseline audit, 10 (6%) submitted a planning survey and 130 (82%) entered two or more audits. At baseline (time of enrolment), 75 (51%) met both benchmarks. The designation was awarded to 62 (39%) hospital groups (a total of 105 individual hospitals) that met and sustained benchmarks. Barriers to implementation included human resource shortages, lack of local expertise to advise the team, need for more education of transfusion prescribers and competing priorities. CONCLUSION: In its initial phase, Using Blood Wisely engaged a substantial number of hospitals in transfusion quality improvement work and maintained that engagement. This large-scale engagement across a big country was more successful than anticipated. Additional efforts are needed to rigorously evaluate the programme's impact on utilisation.

An Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions.

Children and youth presenting to the emergency department with mental health concerns present a challenge for clinicians and system capacity. Addressing a significant system gap and sparse strategies in the literature, representative leaders from hospital and community agencies developed a novel pathway to guide efficient and doable risk assessment and ensure timely transition to appropriate community mental health services. This article describes and reflects on our innovative Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions that bridges traditional barriers between hospital and community settings to address mental health needs for this population.

Non-agricultural work injuries among youth: a systematic review.

BACKGROUND: To systematically review the quantitative literature on factors associated with youth non-agricultural work injury. METHODS: Seven electronic databases were searched for studies published between 1980 and 2005. In addition, reference lists from each potentially eligible study were checked and experts in the field contacted for additional studies. Studies had to meet relevance and quality appraisal criteria. RESULTS: Nine cross-sectional studies using multivariate analyses met the inclusion and quality appraisal criteria. This best evidence synthesis found that work injury varied significantly with job and workplace factors such as hazard exposure and perceived work overload. Visible minority status was also associated with likelihood of a work injury. The lack of youth work injury studies assessing the following factors was also identified: physical and cognitive development, safety training, supervision, social environment of the workplace, and intervention studies. CONCLUSIONS: This review has potential implications for prevention of work injuries. First, interventions need to target modifiable risk factors. This systematic review pointed to two job/workplace factors that are potentially modifiable: hazard exposure and work pace pressure. Second, the multiple determinants of work injury highlight the need to develop interventions and policies that focus on multiple factors rather than one-dimensional approaches that target a specific factor.

Simplified search strategies were effective in identifying clinical trials of pharmaceuticals and physical modalities.

BACKGROUND AND OBJECTIVES: Assess the efficacy of simplified search strategies and identify the best electronic bibliographic database for clinical trials in the field of musculoskeletal disorders and pain. METHODS: Clinical trials within selected reviews from the Cochrane Back, Musculoskeletal, and PaPaS Review Groups were searched using MEDLINE, EMBASE, CINAHL, and CENTRAL to identify which database included the highest percentage of trials. Simplified search strategies for each review were devised and compared to the original, more complex strategy for sensitivity, specificity and precision. RESULTS: Individually, MEDLINE, and EMBASE included 90 and 89% of the relevant studies respectively, and 94% when combined. CENTRAL contained 87% and CINAHL 31%. Generally, simplified search strategies (two to four lines) had higher specificity than the original strategies (approximately 27 lines). Sensitivity was also high, but varied according to intervention. Super simple search strategies (one to two lines) proved as sensitive, but were slightly less specific, depending on the intervention. Both simple and super simple search strategies were often more precise than the original. CONCLUSION: Simplified search strategies are an effective, efficient way to search for clinical trials. They work best when the intervention is a pharmaceutical or a well-defined physical treatment. Their sensitivity, however, is not adequate for conducting systematic reviews.