Choosing Wisely Canada's emergency medicine recommendations: Time for a revision.

Choosing Wisely Canada (CWC) is a national initiative designed to encourage patient-clinician discussions about the appropriate, evidence-based use of medical tests, procedures and treatments. The Canadian Association of Emergency Physicians' (CAEP) Choosing Wisely Canada (CWC) working group developed and released ten recommendations relevant to Emergency Medicine in June 2015 (items 1-5) and October 2016 (items 6-10). In November 2016, the CAEP CWC working group developed a process for updating the recommendations. This process involves: 1) Using GRADE to evaluate the quality of evidence, 2) reviewing relevant recommendations on an ad hoc basis as new evidence emerges, and 3) reviewing all recommendations every five years. While the full review of the CWC recommendations will be performed in 2020, a number of high-impact studies were published after our initial launch that prompted an ad hoc review of the relevant three of our ten recommendations prior to the full review in 2020. This paper describes the results of the CAEP CWC working group's ad hoc review of three of our ten recommendations in light of recent publications.

L'initiative nationale Choisir avec soin a été conçue pour favoriser les discussions entre patients et cliniciens sur l'utilisation appropriée et fondée sur des données probantes des examens médicaux, des interventions et des traitements. Le groupe de travail sur l'initiative, de l'Association canadienne des médecins d'urgence, a élaboré et diffusé dix recommandations relatives à la pratique de la médecine d'urgence, d'abord en juin 2015 (points 1-5), puis en octobre 2016 (points 6-10). En novembre 2016, le groupe de travail sur l'initiative s'est penché sur un processus de mise à jour des recommandations. Ce dernier comprend trois éléments : 1) l'application de l'instrument GRADE pour évaluer la qualité des données probantes; 2) une révision ponctuelle des recommandations pertinentes suivant la diffusion de nouvelles données; 3) un réexamen quinquennal de toutes les recommandations. La révision complète des recommandations présentées dans l'initiative est prévue en 2020; toutefois, un certain nombre d'études ayant une incidence importante ont déjà été publiées après le premier lancement des recommandations, ce qui a incité le groupe de travail à procéder à une révision ponctuelle de trois recommandations pertinentes sur les dix existantes, avant l'examen complet prévu en 2020. Il sera donc question, dans l'article, des résultats de la révision ponctuelle de ces trois recommandations, réalisée à la lumière des récentes publications, par le groupe de travail sur l'initiative.

Choosing Wisely Canada®: Five tests, procedures and treatments to question in Emergency Medicine.

OBJECTIVES: Choosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians' (CAEP) top five list of recommendations, and the process undertaken to generate them. METHODS: The CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned. This list was distributed to CAEP committee chairs, revised, and then divided and randomly allocated to 107 Canadian emergency physicians (EWG nominated) who voted on each item based on: action-ability, effectiveness, safety, economic burden, and frequency of use. The EWG discussed the items with the highest votes, and generated the recommendations by consensus. RESULTS: The top five CAEP CWC recommendations are: 1) Don't order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule); 2) Don't prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis; 3) Don't order lumbosacral spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators; 4) Don't order neck radiographs in patients who have a negative examination using the Canadian C-spine rules; and 5) Don't prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists. CONCLUSIONS: The CWC recommendations for emergency medicine were selected using a mixed methods approach. This top 5 list was released at the CAEP Conference in June 2015 and should form the basis for future implementation efforts.

CAEP position statement on cellphone use while driving.

Distracted driving caused by cellphone use is a significant source of needless injuries. These injuries place unnecessary financial burden, emotional stress and health care resource misuse on society. This paper states the Canadian Association of Emergency Physician's (CAEP's) position on cellphone use while driving. In recent years, numerous studies were conducted on the danger of cellphone use while driving. Research has shown that cellphone use while driving negatively impacts cognitive functions, visual fields, reaction time and overall driving performances. Some studies found that cellphone use is as dangerous as driving under the influence of alcohol. Moreover, vehicle crash rates were shown to be significantly higher when drivers used cellphones. Countermeasures have been implemented in recent years. Over 50 countries worldwide have laws limiting the use of cellphones while driving. Six Canadian provinces, Newfoundland and Labrador, Nova Scotia, Quebec, Ontario, British Columbia and Saskatchewan, currently have legislation prohibiting cellphone use. Other provinces are considering implementing similar bans. As emergency physicians, we must advocate for injury prevention. Cell phone related road traumas are avoidable. CAEP supports all measures to ban cellphone use while driving.

Public health considerations in knowledge translation in the emergency department.

Effective preventive and screening interventions have not been widely adopted in emergency departments (EDs). Barriers to knowledge translation of these initiatives include lack of knowledge of current evidence, perceived lack of efficacy, and resource availability. To address this challenge, the Academic Emergency Medicine 2007 Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake," convened a public health focus group. The question this group addressed was "What are the unique contextual elements that need to be addressed to bring proven preventive and other public health initiatives into the ED setting?" Public health experts communicated via the Internet beforehand and at a breakout session during the conference to reach consensus on this topic, using published evidence and expert opinion. Recommendations include 1) to integrate proven public health interventions into the emergency medicine core curriculum, 2) to configure clinical information systems to facilitate public health interventions, and 3) to use ancillary ED personnel to enhance delivery of public health interventions and to obtain successful funding for these initiatives. Because additional research in this area is needed, a research agenda for this important topic was also developed. The ED provides medical care to a unique population, many with increased needs for preventive care. Because these individuals may have limited access to screening and preventive interventions, wider adoption of these initiatives may improve the health of this vulnerable population.