Acute atrial fibrillation and flutter (AAFF) episodes are characterized by very rapid heart rates which have been present for less than seven days and are highly symptomatic, disabling most patients. It is the most common type of palpitation treated in the Emergency Department (ED). Some Canadian hospitals are able to discharge 95% of AAFF patients seen and treated in the ED whereas others admit up to 40% of similar patients. In this era of hospital and ED crowding, we believe that discharge home directly from the ED is an effective and safe strategy that reduces the burden on the patient and the health care system. Our overall aim is to improve the care of patients presenting to the ED with AAFF, while decreasing unnecessary hospitalizations across Canada by an absolute reduction of 20%. We cannot improve the ED discharge rate without a better understanding of what barriers there are at the local level. In our previous study (Project Ia), we conducted local in-depth interviews of emergency physicians, cardiologists, and AAFF patients. In Project 1b, we created the CAEP ED AAFF Guidelines Checklist to assist physicians across Canada manage AAFF more efficiently and safely. The Guidelines are comprised of two algorithms and four sets of checklists for ED assessment and management. They have been endorsed by the Canadian Association of Emergency Physicians and accepted for publication in the Canadian Journal of Emergency Medicine.
Building on Project 1, we are now planning Project 2 in which we will conduct a randomized trial at 10 large Canadian EDs and enroll 2,400 patients over a two-year period. Our goal is to introduce the new CAEP ED Guidelines into these hospitals to improve the care provided to AAFF patients. We hope to improve the safety and efficiency of AAFF management, leading to a significant decrease in hospital admissions. Central to our plans will be the engagement of our two patient partners. Our behaviorally optimized intervention will be developed using state-of-the-art implementation science approaches informed by the results of Project 1a. We will also undertake widespread within-project and end-of-project knowledge translation and implementation (KTI) strategies to facilitate scale up and roll out of our program to ED departments in small, medium, and large hospitals across Canada (future Project 3). Ultimately we expect to improve ED management practices and decrease AAFF admissions by at least 20%, without increasing ED visits.
Dr. Ian Steill MD, MSc, FRCPC
Senior Scientist, Clinical Epidemiology Program
The Ottawa Hospital Research Institute
Dr. Stiell is a clinical epidemiologist and an emergency medicine physician with a focus on health services research in emergency medicine. He is internationally recognized for his clinical research in emergency care. He has published 302 peer-reviewed papers in very high-impact journals, 19 of which he is listed as first author. He has won many international awards that include election into the U.S. Institute of Medicine.
Dr. Stiell has established the Emergency Research Group within the OHRI which is now comprised of 6 CIHR-funded clinician investigators, 5 international research fellows, and 30 staff. The group currently holds more than 12 million dollars in peer-reviewed funding from CIHR, HSFC, NIH, and others.
Two emergency medicine research networks have also been established under Dr. Stiell’s leadership. OPALS Pre-hospital Group consists of 12 Ontario cities that work together on large pre-hospital resuscitation studies which now works with the Canadian Resuscitation Outcomes Consortium (CanROC), and an informal network of 10 large Canadian teaching hospitals that collaborate on ED studies. Dr. Stiell’s tireless dedication to healthcare research has had a major impact on emergency care worldwide and hopes to continue to do so.