Emergency Department Management of Heart Failure and COPD: A National Survey of Attitudes and Practice

Abstract

Objectives: The Ottawa Heart Failure Risk Scale (OHFRS) and the Ottawa COPD Risk Scale (OCRS) were developed in order to estimate medical risk and to help guide disposition decisions for patients presenting to the ED with acute exacerbations of heart failure (HF) and COPD. We sought to determine physician attitudes towards these two new risk scales and to identify potential barriers to their ED implementation. Methods: Two self-administered online surveys were distributed to the Canadian Association of Emergency Physicians. The surveys each consisted of 16 questions relating to the OHFRS and OCRS. The primary outcome measures were the overall physician rating of the two risk scales. Secondary outcome measures assessed the likelihood of risk scale implementation into Canadian EDs, as well as the perceived barriers to such implementation. Descriptive statistics were used. Results: For the OHFRS survey, we received responses from 195 emergency physicians (35.7%). Overall, 74.4% approved of the risk scale based on a Likert rating of 4 or 5 and 66.7% believed that the risk scale would be implemented at their hospital. For the OCRS survey, we received responses from 208 emergency physicians (38.1%). Overall, 76.9% approved of the risk scale based on a Likert rating of 4 or 5 and 70.2% believed that the risk scale would be implemented at their hospital. Conclusions: Canadian emergency physicians are very supportive of the new OHFRS and OCRS. We believe these risk scales will assist physicians with making safe and efficient disposition decisions and improve outcomes for patients suffering from HF and COPD. RÉSUMÉObjectifs: L'échelle Ottawa Heart Failure Risk Scale (OHFRS) et l'échelle Ottawa COPD Risk Scale (OCRS) ont toutes deux été élaborées dans le but de faciliter l'évaluation du risque médical et les prises de décision quant aux suites à donner chez les patients atteints d'insuffisance cardiaque (IC) aiguë et d'une exacerbation de bronchopneumopathie chronique obstructive (BPCO). L'étude visait donc à déterminer les attitudes des médecins à l'égard de ces deux nouvelles échelles de risque et à cerner les obstacles possibles à leur mise en oeuvre au service des urgences (SU).

Current State of Point-of-care Ultrasound Usage in Canadian Emergency Departments

“…However, the response rate is consistent with those observed in other surveys of physicians [24-25]. It is also similar to previously reported CAEP response rates for similar studies [26-27]. It is also important to note that our survey was not formally validated and since it involved retrospective self-reporting some respondents may, in fact, respond differently than how they actually practice.…”

Clinical validation of a risk scale for serious outcomes among patients with chronic obstructive pulmonary disease managed in the emergency department

“…Many nonmedical factors are important in the decision to admit a patient, such as support at home or availability of early followup. 31 We see OCRS as an important tool to help physicians gauge the medical risk for their patients with COPD, while they determine the need for admission or early follow-up.…”

Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, With and Without Use of Quantitative NT‐proBNP

“…In 2014 we completed an online survey of 195 randomly selected members of the Canadian Association of Emergency Physicians regarding the revised OHFRS. We found very good overall acceptance with only 7.7% indicating OHFRS was “not useful.”…”