Canadian Hospitals Research Articles

Mortality and hospitalizations fully attributable to alcohol use before versus during the COVID-19 pandemic in Canada.

The COVID-19 pandemic period was associated with increased alcohol consumption. We sought to estimate excess mortality and hospitalizations attributable to alcohol use in Canada between April 2020 and December 2022. Using data from the Canadian Vital Statistics Database and hospital Discharge Abstract Database (Jan. 2016 to Dec. 2022), we analyzed monthly mortality and hospitalization rates for conditions fully attributable to alcohol use in people in Canada aged 15 years and older. We estimated excess rates during the study period of April 2020 to December 2022 by comparing observed rates to expected rates, modelled using the autoregressive integrated moving average method, accounting for trends, seasonality, autocorrelation, and pandemic waves. Between April 2020 and December 2022, mortality fully attributable to alcohol in Canada increased by 17.6% (1600 excess deaths), and hospitalizations fully attributable to alcohol rose by 8.1% (7142 excess hospitalizations). Most increases occurred in the first 2 years, with deaths up about 24% and hospitalizations about 14%. Mortality rose by 55.4% in adults aged 25-44 years, 19.1% in those aged 45-64 years, and 2.6% in those aged 65 years and older, with similar increases among males (17.0%) and females (17.8%). Deaths rose by 11.7% in the highest income quintile, as compared with 17.0%-21.5% in the other quintiles. Excess hospitalizations were highest among people aged 15-24 years (20.3%) and 25-44 years (13.1%) and increased more for females (15.6%) than for males (5.7%). Regionally, mortality increased most in the Prairie provinces (Manitoba, Saskatchewan, and Alberta; 28.1%) and British Columbia (24.2%), whereas hospitalizations increased the most in the territories (Northwest Territories, Nunavut, and Yukon; 27.3%) and the Prairie provinces (14.6%). Alcoholic liver disease was the leading cause of excess mortality and hospitalizations, which increased by 22% and 23%, respectively. Mortality and hospitalizations fully attributable to alcohol increased substantially across different demographics and regions in Canada during the April 2020 to December 2022 period of the COVID-19 pandemic. A comprehensive approach to preventing and managing high-risk drinking, alcohol use disorder, and alcoholic liver disease in the aftermath of the pandemic should comprise both public health and clinical management interventions.

PyDeid: an improved, fast, flexible, and generalizable rule-based approach for deidentification of free-text medical records.

Deidentification of personally identifiable information in free-text clinical data is fundamental to making these data broadly available for research. However, there exist gaps in the deidentification landscape with regard to the functionality and flexibility of extant tools, as well as suboptimal tradeoffs between deidentification accuracy and speed. To address these gaps and tradeoffs, we develop a new Python-based deidentification software, pyDeid. pyDeid uses a combination of regular expression-based rules, fixed exclusion lists and inclusion lists to deidentify free-text data. Additional configurations of pyDeid include optional named entity recognition and custom name lists. We measure its deidentification performance and speed on 700 admission notes from a Canadian hospital, the publicly available n2c2 benchmark dataset of American discharge notes, as well as a synthetic dataset of artificial intelligence (AI) generated admission notes. We also compare its performance with the Physionet De-identification Software and the popular open-source Philter tool. Different configurations of pyDeid outperformed other tools on various metrics, with a "best" accuracy value of 0.988, best precision of 0.889, best recall of 0.950, and best F1 score of 0.904. All configurations of pyDeid were significantly faster than Philter and Physionet De-identification Software, with the fastest deidentification speed of 0.48s per note. pyDeid allows the flexibility to prioritize between performance and speed, as well as precision and recall, while addressing some of the gaps in functionality left by other tools. pyDeid is also generalizable to domains outside of clinical data and can be further customized for specific contexts or for particular workflows.

It is Time to Address Fear of Cancer Recurrence in Family Caregivers: Feasibility and Acceptability of a Randomized Pilot Study of the Family Caregiver Version of the Fear of Recurrence Therapy (FC-FORT).

Fear of cancer recurrence (FCR) is common, persistent, and associated with lower quality of life, impaired functioning, and psychological distress in family caregivers (FC) of individuals with a cancer diagnosis. Interventions are needed to specifically target FCR in FC. This study aimed to pilot test the adapted Family Caregiver-Fear Of Recurrence Therapy (FC-FORT) to establish its feasibility, acceptability, and clinical significance. This pilot study used a mixed-method, parallel, two-group randomized control trial (FC-FORT vs. waitlist control group) design. Women FC were recruited through Canadian hospitals, community partners, and social media. FC in the intervention group completed 7 weekly sessions of virtual group therapy (FC-FORT) and an exit interview. All participants completed questionnaires at baseline, post-intervention, and 3-month follow-up. Feasibility (e.g., recruitment, allocation, fidelity), acceptability (e.g., dropout, completion, satisfaction) and clinical significance of secondary outcomes were evaluated. Descriptive statistics, mixed ANOVAs, and conventional content analyses were used. Regarding feasibility, 22 FC were recruited, 18 were randomized and therapist fidelity was 87%. As to acceptability, 67% of participants completed 5 sessions (33% dropout). Questionnaire completion rate was 92%. FC satisfaction was 80%. Analyses did not reveal any significant differences on the secondary outcomes between groups. Qualitative analyses revealed high importance, helpfulness, satisfaction, and group cohesion. Suggestions were made by FC for improvements. This is one of the first interventions to address FCR in FC. While acceptability of FC-FORT was good, important feasibility issues need to be addressed before moving forward with a larger randomized control trial. NCT, NCT05441384. Registered July 1st, 2022, https://classic. gov/ct2/show/NCT05441384.

P-1816. Stepwise Implementation of an Antimicrobial Stewardship Prospective Audit and Feedback Intervention at a Large Academic Center in Canada

Abstract Background Effective implementation strategies for establishing antimicrobial stewardship (AMS) program inpatient interventions are not well described. We describe a methodology for prospective audit and feedback (PAF) implementation at a large Canadian hospital and report its outcomes. Methods A PAF intervention targeting restricted antibiotics (carbapenems, daptomycin, linezolid, and tigecycline) was launched in March 2018. Stepwise implementation by inpatient programs was prioritized by collaboration readiness as immediate site-wide implementation was deemed unfeasible. New prescriptions were assessed by the antimicrobial stewardship team. Prescription, prescriber, intervention type, and acceptance data were collected through March 2024. Results Over a 2-year period, site wide stepwise implementation occurred in 16 discrete phases. Over the study period, 5185 prescriptions were evaluated; 3789 (73%) were empiric, and 1396 (27%) culture directed from which 3604 (70%) were optimally prescribed (evaluated by agent, regimen, and duration). Of empiric prescriptions, 636 (17%) were not guideline-concordant by indication, 1102 (29%) did not follow guidelines but was reasonable by expert opinion, and 2051 (54%) were guideline-concordant. ASP recommendations included: 3604 no change (70%), 864 change agent (17%), 535 change regimen (10%), 172 discontinue antibiotic (3%), and 10 other (0.2%). The recommendation acceptance rate was 91% (1581 cases evaluable). Infectious diseases (ID) were involved in 1466 (28%) prescriptions. With ID involvement, higher guideline-concordant empiric prescribing (64% vs 51%, p< 0.001) and regimen appropriateness (85% vs 65%, p< 0.001) was observed. ASP suggested no changes more often with ID involvement (84% versus 62%, p< 0.001). Conclusion Stepwise implementation allowed evolution and implementation of ASP processes and workflow. 30% of prescriptions audited resulted in intervention, suggesting a possible role for further education, guidelines, or restriction. ID involvement was associated with more optimal prescribing. A stepwise implementation of an antimicrobial stewardship PAF intervention is a viable strategy. Disclosures All Authors: No reported disclosures

Investigating the implementation of a Trial of Labour After Caesarean (TOLAC) delivery bundle with respect to decreasing caesarean delivery rates: a multisite quality improvement initiative

ObjectivesTo study the effect of implementing a Trial of Labour After Caesarean (TOLAC) delivery bundle with respect to decreasing caesarean delivery rates across five hospitals.DesignProspective quality improvement study.SettingFive Canadian hospital...

Impact of microgeography on communication dynamics in a healthcare environment

BackgroundFor growing healthcare organisations, anchored resources—assets that are not easily movable—may complicate expansion and distort workflow patterns. We examine work patterns at a radiation oncology department of a major Canadian...

Improving healthcare value: Choosing wisely canada's hospital designation program.

Improving healthcare value: Choosing wisely canada's hospital designation program.

Burden of disease of respiratory syncytial virus in older adults and adults considered at high risk of severe infection.

Availability of new vaccines for adults has increased interest in understanding Canada's respiratory syncytial virus (RSV) burden in older adults and adults considered at high risk of severe infection. To characterize the burden of RSV disease in Canada by joint analysis of the published literature and hospitalization data from a healthcare administrative database. Electronic databases of published literature were searched to identify studies and systematic reviews reporting data on outpatient visits, hospitalizations, intensive care unit (ICU) admissions and deaths associated with RSV infection in adults. For the hospitalization data analysis, hospital discharge records were extracted from the Canadian Institute of Health Information Discharge Abstract Database for all patients admitted to an acute care facility for RSV infection defined by ICD-10 codes from 2010 to 2020 and 2021 to 2023. Overall, 26 studies, including seven systematic reviews, were identified and summarized. Evidence suggests that medically attended RSV respiratory tract infections (RTI) are frequently causing 4.7%-7.8% of symptomatic RTI in adults 60 years of age and older. Incidence of RSV RTI increases with age and presence of underlying medical conditions. This trend was consistently observed across all RSV clinical outcomes of interest. Patients who reside in long-term care or other chronic care facilities have a higher likelihood of severe clinical outcomes compared to patients with other living situations upon hospital admission. Approximately 10% of older adults hospitalized with RSV infection require ICU admission. Although data are limited, the case fatality ratio (CFR) among those admitted to hospital varies between 5% and 10%. Some evidence suggests that RSV burden may be close to the influenza burden in older adults. In general, the results from the Canadian hospitalization data support the rapid review findings. Rates of hospitalization, ICU admission and death associated with RSV all increased with age, with 16% of hospitalizations resulting in ICU admission and with an in-hospital CFR of 9%. In adults, the burden of severe RSV outcomes in general increases with age and presence of comorbidities.

2747 The impact of specialised geriatric 5 M education on mobilisation of older adult patients in acute care in five Canadian hospitals

2747 The impact of specialised geriatric 5 M education on mobilisation of older adult patients in acute care in five Canadian hospitals

A conceptual framework for identifying and managing system vulnerabilities for diversion of controlled substances in healthcare.

Diversion or theft of controlled substances is a recognized problem affecting healthcare systems globally. The purpose of this study was to develop a framework for identifying and characterizing system factors leading to vulnerabilities for diversion within hospitals. We applied a qualitative framework method, which involved 1) compiling a list of critical diversion vulnerabilities through observations and proactive risk analyses in the inpatient pharmacy, emergency department and intensive care unit of two Canadian hospitals; 2) coding the vulnerabilities into deductively and inductively derived themes and subthemes; and 3) building a conceptual framework. Our framework for diversion demonstrates how mitigating downstream diversion outcomes (e.g., harms to patients, healthcare workers, and institutions) requires the redesign of upstream system factors associated with pilfering and forgery processes. We identified 20 subthemes associated with the following five overarching themes of system factors contributing to diversion risk: task (e.g., variation in how work was done or lack of verification), person (e.g., use of insider knowledge or collaboration among staff), tools/technologies (e.g., limitations of electronic systems to identify discrepancies), organization (e.g., cultural/behavioural norms or hospital policies for controlled substance management), and internal environment (e.g., layout of the space). The Diversion Framework is a conceptual model developed for use by practitioners, researchers, and policy makers to identify system factors and analyze medication-use processes that may be vulnerable to diversion. This in turn can inform safeguards to prevent harm to patients, healthcare workers and the institution.

Canadian Trends in Estimated Drug Purchases and Projections: 2024 and 2025

What Is the issue? Data on trends in the pharmaceutical market remain limited. We offer an annual update on estimated drug purchases in Canada and highlight key factors that could impact future spending. What Did We do? We conducted a retrospective time-series analysis of annual estimated drug purchases across Canada between 2001 and 2023 using IQVIA’s Canadian Drugstore and Hospital Purchases Audit. We calculated total estimated drug purchases and relative percentage change annually, stratified by sector (retail and hospital), and forecast annual spending to 2025. What Did We Find? Total estimated drug purchases for 2023 were approximately $43.5 billion, 13.7% higher than in 2022. Overall, expenditure on the top 25 high-cost drugs accounted for 32.5% and 53.3% of total spending in the retail and hospital sectors, respectively. Pharmaceutical spending has grown over the past 2 decades, with an annual average growth of 5.8% and 8.2% in the retail and hospital sectors, respectively. Drug expenditure in the retail sector is expected to increase annually by 10.9% to 10.1% and spending within the hospital sector is expected to increase by 14.6% to 12.9% for 2024 and 2025, respectively. What Does This Mean? The accelerated growth in overall estimated drug purchases is likely driven by the increasing use of new diabetes and obesity treatments. Continued growth in drug purchases is projected across the Canadian market, which will be influenced by new approvals of specialty and oncology drugs, as well as generic and biosimilar versions of the top 25 drugs. Without measures to address this ongoing increase in pharmaceutical spending, there may be a need to reallocate funds from other public sectors or shift costs to private industry and patients.

External Validation of Brief Resolved Unexplained Events Prediction Rules for Serious Underlying Diagnosis

The American Academy of Pediatrics (AAP) higher-risk criteria for brief resolved unexplained events (BRUE) have a low positive predictive value (4.8%) and misclassify most infants as higher risk (>90%). New BRUE prediction rules from a US cohort of 3283 infants showed improved discrimination; however, these rules have not been validated in an external cohort. To externally validate new BRUE prediction rules and compare them with the AAP higher-risk criteria. This was a retrospective multicenter cohort study conducted from 2017 to 2021 and monitored for 90 days after index presentation. The setting included infants younger than 1 year with a BRUE identified through retrospective chart review from 11 Canadian hospitals. Study data were analyzed from March 2022 to March 2024. The BRUE prediction rules. The primary outcome was a serious underlying diagnosis, defined as conditions where a delay in diagnosis could lead to increased morbidity or mortality. Of 1042 patients (median [IQR] age, 41 [13-84] days; 529 female [50.8%]), 977 (93.8%) were classified as higher risk by the AAP criteria. A total of 79 patients (7.6%) had a serious underlying diagnosis. For this outcome, the AAP criteria demonstrated a sensitivity of 100.0% (95% CI, 95.4%-100.0%), a specificity of 6.7% (95% CI, 5.2%-8.5%), a positive likelihood ratio (LR+) of 1.07 (95% CI, 1.05-1.09), and an AUC of 0.53 (95% CI, 0.53-0.54). The BRUE prediction rule for discerning serious diagnoses displayed an AUC of 0.60 (95% CI, 0.54-0.67; calibration intercept: 0.60), which improved to an AUC of 0.71 (95% CI, 0.65-0.76; P < .001; calibration intercept: 0.00) after model revision. Event recurrence was noted in 163 patients (15.6%). For this outcome, the AAP criteria yielded a sensitivity of 99.4% (95% CI, 96.6%-100.0%), a specificity of 7.3% (95% CI, 5.7%-9.2%), an LR+ of 1.07 (95% CI, 1.05-1.10), and an AUC of 0.58 (95% CI, 0.56-0.58). The AUC of the prediction rule stood at 0.67 (95% CI, 0.62-0.72; calibration intercept: 0.15). Results of this multicenter cohort study show that the BRUE prediction rules outperformed the AAP higher-risk criteria on external geographical validation, and performance improved after recalibration. These rules provide clinicians and families with a more precise tool to support decision-making, grounded in individual risk tolerance.

Distinct journeys and unique stories: how individuals from multiple professions cultivate careers in healthcare leadership

IntroductionStrong hospital leadership is critical to navigating the challenges of the Canadian healthcare system. Currently, physicians and nurses tend to be selected to fulfil hospital executive roles. To date, we...

EE216 Potential Budget Impact of Using a Cyanoacrylate Polymer Barrier Film Compared to Traditional Methods for the Prevention and Management of Incontinence-Associated Dermatitis in a Canadian Hospital Setting

EE216 Potential Budget Impact of Using a Cyanoacrylate Polymer Barrier Film Compared to Traditional Methods for the Prevention and Management of Incontinence-Associated Dermatitis in a Canadian Hospital Setting

Community versus academic hospital community-acquired pneumonia patients: a nested cohort study

BackgroundMost Canadians receive their care in community hospitals, yet most clinical research is conducted in academic hospitals. This study aims to compare patients with community acquired pneumonia (CAP) treated in academic and community hospitals with respect to their demographics, clinical characteristics, treatments and outcomes.MethodsThis nested observational cohort substudy of the Community Acquired Pneumonia: Toward InnoVAtive Treatment (CAPTIVATE) trial included 1,329 hospitalized adults with CAP recruited between March 1st, 2018 and September 31st, 2023 from 15 Canadian hospitals. Unadjusted and adjusted analyses for age, sex and co-morbidities using logistic, Cox and censored quantile regressions were conducted.ResultsPatients in community hospitals were older (mean [SD] 75.0 [15.7] years vs. 68.3 [16.2] years; p < 0.001), were more likely to be female (49.7% vs. 41.0%, p = 0.002), and had more comorbidities (75.9% vs. 64.8%, p < 0.001). More patients in community hospitals received corticosteroids (49.2% vs. 37.4%, p < 0.001). Community hospital patients had a higher likelihood of developing acute respiratory distress syndrome (OR 3.13, 95% CI: 1.87, 5.24, p = < 0.001), and acute cardiac injury (OR 2.53, 95% CI: 1.33, 4.83, p = 0.005). In unadjusted and adjusted analyses, 28-day mortality difference did not meet statistical significance (OR 1.43, 95% CI: 0.98, 20.7, p = 0.062 and OR 1.23, 95% CI: 0.81, 1.87, p = 0.332, respective).ConclusionPatients with CAP in Canadian community and academic hospitals differed with respect to their age, clinical characteristics, treatments and outcomes, emphasizing the importance of including more community hospitals in clinical research studies to ensure the generalizability of results.

Teleworking by hospital pharmacists: Another step to achieve decarbonization of the healthcare system.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The healthcare sector contributes approximately 4% to 5% of global greenhouse gas (GHG) emissions, thereby impacting climate change. Various initiatives, including teleworking, have been considered to mitigate GHG emissions, but their environmental impact remains poorly defined in the healthcare sector. This study aims to evaluate the impact of teleworking by hospital pharmacists on GHG emissions reduction by comparing the actual situation at one Canadian hospital, which includes teleworking shifts from home, to a scenario where all working shifts necessitate travel to the hospital. The study was conducted at the pharmacy department of an academic hospital with 86 pharmacists (75 pharmacist full-time equivalents), between June 1, 2020, and May 31, 2023. Two different online carbon footprint calculators, one developed by the Centres de Gestion des Déplacements (CGD) and one available at the website of Carbon Footprint Ltd., were employed to measure mean GHG emissions in kilograms of carbon dioxide equivalents (CO2eq) for individuals based on their modes of transport and distances traveled between home and work. During the study period, teleworking resulted in a significant reduction of mean GHG emissions per pharmacist relative to the scenario of all on-site shifts, with a reduction of 134kg CO2eq (1,160 CO2eq vs 1,026 CO2eq; t = 3.32; P = 0.0007) estimated with the CGD calculator and a reduction of 135kg CO2eq (1,117 CO2eq vs 982 CO2eq; t = 4.31; P < 0.0001) estimated with the Carbon Footprint calculator. Those figures correspond to a reduction of 11.5% (11,249kg CO2eq) to 12.1% (11,315kg CO2eq) of the total quantity of emissions associated with commuting for the 84 pharmacists over 3 years. The median distance from home to the hospital was 10.0 (8.1) km, with nearly three-quarters of pharmacists commuting by public or active transport. Teleworking has a positive environmental impact and could be implemented in other pharmacy departments. The implemented teleworking approach represents an encouraging initial step toward reducing the GHG emissions associated with the travel of employees.

The digital health landscape at children’s hospitals in Canada

ABSTRACT Objectives Canadian hospitals have historically lagged behind peer nations in terms of adoption of digital health tools. The aim of this study was to assess the current state of adoption of digital health tools at children’s hospitals in Canada. Methods We conducted an online survey of Canadian pediatric tertiary-care hospitals between January and July 2023. The 35-item questionnaire was administered in English and French. Hospital characteristics, informatics infrastructure data and electronic health record (EHR) functionality data were summarized using descriptive statistics. Results The survey was completed by 15 of the 17 (88.2%) pediatric hospitals in Canada. All institutions had an EHR with 10 (66.6%) being fully digitized and five (33.3%) being partially digitized. Funding and availability of clinicians with expertise in clinical informatics were cited as barriers to implementing digital health tools. The availability of core EHR functionalities ranged from 53.3% for medication to 100% for the presence of a laboratory and radiology information system. Only five (33.3%) institutions reported that they had a patient portal. Discussion While all hospitals in this study had an EHR, functionalities varied greatly between centers. Canada lags behind the United States in terms of adoption of digital health tools such as patient portals likely due to governmental mandates and incentives, and a focus on cultivating a physician informatics workforce. Conclusion Canadian pediatric hospitals lag behind peer institutions in digital maturity. This study highlights the perceived need from hospitals for policies, funding, and resources from the Canadian government to help increase the uptake of comprehensive EHRs.

STRIVE pilot trial: a protocol for a multicentre pragmatic internal pilot randomised controlled trial of Structured TRaining to Improve fitness in a Virtual Environment (STRIVE) before surgery

IntroductionHome-based, virtually-supported care models may represent the most efficient and scalable approach to delivering prehabilitation services. However, virtual approaches to prehabilitation are understudied. This manuscript describes the protocol for an...

Long-term clinical outcomes and healthcare resource utilization in male and female patients following hospitalization for heart failure.

Heart failure (HF) is a leading cause of hospitalization, and sex differences in care have been described. We assessed sex-specific clinical outcomes and healthcare resource utilization following hospitalization for HF. This was an exploratory analysis of patients hospitalized for HF across 10 Canadian hospitals in the Patient-Centered Care Transitions in HF (PACT-HF) cluster-randomized trial. The primary outcome was all-cause mortality. Secondary outcomes included all-cause readmissions, HF readmissions, emergency department (ED) visits, and healthcare resource utilization. Outcomes were obtained via linkages with administrative datasets. Among 4441 patients discharged alive, 50.7% were female. By 5 years, 63.6% and 65.5% of male and female patients, respectively, had died (p = 0.19); 85.4% and 84.4%, respectively, were readmitted (p = 0.35); and 72.2% and 70.9%, respectively, received ED care without hospitalization (p = 0.34). There were no sex differences in mean [SD] number of all-cause readmissions (males, 2.8 [7.8] and females, 3.0 [8.4], p = 0.54), HF readmissions (males, 0.9 [3.6] and females, 0.9 [4.5], p = 0.80), or ED visits (males, 1.8 [11.3] and females, 1.5 [6.0], p = 0.24) per person. There were no sex differences in mean [SD] annual direct healthcare cost per patient (males, $80 334 [116 762] versus females, $81 010 [112 625], p = 0.90), but males received more specialist, multidisciplinary HF clinic, haemodialysis, and day surgical care, and females received more home visits, continuing/convalescent care, and long-term care. Annualized clinical events were highest in first year following index discharge in both males and females. Among people discharged alive after hospitalization for HF, there were no sex differences in total and annual deaths, readmissions, and ED visits, or in total direct healthcare costs. Despite similar risk profiles, males received relatively more specialist care and day surgical procedures, and females received more supportive care. ClinicalTrials.gov NCT02112227.

The imperative to recruit and retain psychologists in Canadian hospitals: Challenges and proposed solutions.

The imperative to recruit and retain psychologists in Canadian hospitals: Challenges and proposed solutions.