Objectives Audit and feedback is widely used to improve physician performance. Many data metrics are being provided to physicians, yet most of these are driven by the regulatory environment. We sought to conduct a needs assessment of audit and feedback metrics that were most useful to clinicians within our health care region. Methods We conducted a Web-based survey of five clinical practice sites in our region and asked that physicians rank 49 clinical practice metrics. In addition, we assessed their readiness for audit and feedback and their preferences for data confidentiality. We collected data on duration of training, gender, and site of practice (academic v. community) allowing for comparison between groups. Results A total of 104 emergency medicine physicians participated in the survey (52.3% response rate). There was a significant readiness for participation in audit and feedback activities. Top ranked metrics were emergency department return rates and colleague's assessment of collegiality and quality of care, which were common across all sites. Small yet significant differences were noted between genders and academic v. community practitioners. Conclusion This study represents the first regional analysis of physician preferences for audit and feedback activities and implementation. It demonstrates that physicians are interested in audit and feedback activities and provides a roadmap for the development of a regional audit and feedback structure. It will also be used as a guiding document for regional change management.

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Background: Maintaining and enhancing competence in the breadth of emergency medicine (EM) is an ongoing challenge. In particular, resuscitative care in EM involves high-risk clinical encounters that demand strong procedural skills, effective team leadership, and up-to-date clinical knowledge. Simulation-based medical education is an effective modality for enhancing technical and nontechnical skills in crisis situations and has been effectively embedded in undergraduate and postgraduate medical curricula worldwide. To our knowledge, there are few existing systematic department-wide simulation programs to address continuing professional development (CPD) for practicing academic EM faculty.Development Process: We developed our novel, simulation-based CPD program following Kern's six-step model. Based on the results of a multimodal needs assessment, a longitudinal curriculum was mapped and tailored to the available resources. Institutional support was provided in the form of a departmental grant to fund a physician program lead, monthly session instructors, and operating costs.Outcomes: CPD simulation sessions commenced in January 2017. Our needs assessment identified two key types of educational needs: 1) crisis resource management skills and 2) frequent practice of high-stakes critical care procedures (e.g., surgical airways). Simulation sessions involve two high-fidelity simulated resuscitations and one skills lab per day. To date, 21 sessions have been delivered, reaching 161 practicing EPs. Feedback from our faculty has been positive.Reflective Discussion: We have successfully introduced a curriculum of monthly simulation-based CPD based on the educational needs of our EPs. Future work will include more detailed program evaluation linked to clinical outcomes and program expansion to support nearby institutions.

A 65-year-old male with ischemic cardiomyopathy, secondary prevention implantable cardioverter-defibrillator (ICD), diabetes, dyslipidemia and hypertension presents to your emergency department (ED). He reports 10 ICD shocks over the past 12 h. He reports palpitations and light-headedness preceding the ICD shocks. There was no loss of consciousness, chest pain, nor shortness of breath. His vital signs are stable and he is afebrile. His exam is unremarkable. Clinical questions What is the definition and clinical epidemiology of electrical storm?Electrical storm refers to the occurrence of three or more episodes of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) over a 24-h period. In patients with an ICD, the definition of electrical storm is accepted as three appropriate detections of ventricular arrhythmia that lead to ICD therapies (either anti-tachycardia pacing or shock) within 24 h. The incidence of electrical storm after ICD implantation ranges from 4% (primary prevention ICDs) [1] to 33.1% (secondary prevention ICDs) [2]. It is associated with high morbidity and mortality, with studies reporting a 5-to 18-fold increase in mortality in the first 3 months after diagnosis [1]. Monomorphic VT is by far the most common dysrhythmia encountered in electrical storm.