IntroductionSocial Work (SW) referrals made in the emergency department (ED) highlight the weaknesses in the existing support system for vulnerable and disadvantaged patients. SW personnel play a pivotal role in some EDs but are not integrated into the team in several jurisdictions. Our objective was to provide a detailed description of the need for SW support in the ED setting by describing SW consultation patterns in an urban ED location.MethodsA three-year analysis of ED SW referrals made through a network of four acute care hospitals serving a city population of 1.2 million inhabitants where social workers operate from 8 a.m. to 10 p.m. The study design was descriptive reporting proportions. The descriptors of interest were the types of ED patients receiving SW consultations and the reasons for patient referral to the SW Department.ResultsDuring the study period, there were 46,970 SW consultations, representing 8.02% of the 572,804 patients who visited the ED across Calgary, yielding 42.9 referrals per day to social workers through the ED. Consultations for domestic violence were three times more prevalent for women (6% of referrals). However, domestic violence consultations were still an active issue for men (1.9%). Comparisons by age group yielded illness adjustments (15.3%), discharge planning (31.2%), and legal decision making (23.9%) as the most common reasons for referral of patients over 75 years old; 92.8% of patients over 75 years were admitted following the SW consultation. Reasons for deferral of patients under 30 years of age were illness adjustments (12.2%), discharge planning (16.4 %), and legal decision making (1.4%); 57.3% of patients under 30 years were admitted following the consultation. Addiction/drug use and homelessness were more common in those under the age of 30, comprising 24.1% and 15.4% of the SW referrals, respectively, compared to 1.6% and 0.4% of referrals for those over age 75, respectively.ConclusionsThe demand for SW support is significant and complex in these large urban EDs. However, the impact on patient care and resource use is substantial, and the data indicates that SW integration may be of universal benefit to EDs. Further studies are warranted to accurately characterize the amount and type of SW necessary for optimal patient outcomes and hospital resource use.

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Background: Nepal continues to struggle to increase its population access to healthcare, especially in rural and isolated villages where primary healthcare is offered through local health outposts. However, people often prefer to consult initially with traditional healers for minor issues as this is more aligned with their cultural beliefs and practices. Knowing that Nepal is undergoing healthcare reform, it would be timely to explore perceptions of health and care-seeking behaviors amongst patients living in high-altitude communities in rural Nepal for consideration in future planning and policy; which is the purpose of this qualitative study. Methods: In-person, semi-structured interviews were conducted, with the use of a translator, with 17 participants, living in two rural villages. After transcribing the interviews, themes were identified using thematic analysis. Results: People expressed the belief that they hold expertise in sustaining health due to their naturalistic lifestyle and community-focus developed within the context of a unique local culture and environment. When faced with a health problem, villagers are compelled to seek treatment from available healthcare offerings. Their care-seeking behavior and their eventual choice between Modern and Belief-based medicine is filtered through a number of considerations: the ease of its accessibility, the cost of services, their prior knowledge related to the illness, their belief system, and the severity of the medical situation. Conclusion: This study indicates that better understanding of the perceptions of the rural Nepali is crucial in advocating for sustainable and culturally-sensitive delivery of healthcare. Tweetable Abstract: Rural Nepali’s care-seeking behavior, rooted in naturalistic lifestyle and community-focus; however, contextual considerations oblige them to make choices between Modern and Belief-based medicine.

Objectives: We examined the effect of a full bladder on proportions of diagnostic ultrasound (US) studies in children with suspected appendicitis. We also examined the effect of a full bladder on proportions of fully visualized ovaries on US in children with suspected appendicitis. Methods: We conducted a retrospective health record review of children aged 2-17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis who had an ultrasound performed. We compared proportions of diagnostic US studies in children with full and sub-optimally filled bladders. We also compared proportions of ovarian visualization in females with full and sub-optimally filled bladders. Results: 678 children were included in our final analysis. The proportion of diagnostic US studies did not vary significantly between groups with a full (132/283, 47%, 95% confidence interval [CI] 38%-56%) or sub-optimally filled bladder (205/ 395, 52%, 95% CI 47%-57%) (p = 0.17). Rates of ovarian visualization were higher in females with a full bladder (196/ 205, 96%, 95% CI 93%-99%) compared to those with a suboptimally filled bladder (180/223, 81%, 95% CI 76%-86%) (p < 0.01). Conclusions: Administrators and clinical decision makers should consider removing routine bladder filling practice from current pediatric appendicitis protocols in males and in pre-pubertal females where ovarian pathology is not suspected. Selective bladder filling prior to US should be performed in females when ovarian pathology is suspected. Conclusions: Les gestionnaires et les décideurs en matière de pratiques cliniques devraient envisager le retrait du remplissage systématique de la vessie, des protocoles actuels de traitement de l'appendicite, chez les garçons et chez les filles prépubères ainsi que chez les filles chez qui tout doute d'affection des ovaires est écarté. Par contre, on devrait procéder à un remplissage sélectif de la vessie avant une échographie chez les filles chez qui il y a des doutes quant à l'existence d'une affection des ovaires.