Discharging patients directly home from the emergency room – Guidelines to standardize acute atrial fibrillation and flutter (AAFF) treatment across Canada 

CANet has helped Dr. Ian Steill share an important fact with hospitals across Canada – the majority of AAFF patients can be effectively and safely treated in the emergency room and then discharged to return home.
Steill, a CANet Investigator, clinical epidemiologist, and emergency medicine physician at The Ottawa Hospital Research Institute, received CANet’s Strategic Research Grant totaling $718,600 and $3 million in matching funds for his project, Decreasing Hospital Admissions from the Emergency Department for Acute Atrial Fibrillation.
The tour-de-force of Steill’s CANet-funded project – the first-of-its-kind collection of guidelines for emergency room (ER) physicians that standardizes AAFF treatment across Canada, and helps them provide a higher quality of care for AAFF patients.
Most emergency rooms in Canada treat AAFF – abnormally rapid heart rates that have been present for less than seven days and are often disabling to most patients – by using drugs or electricity to help return the heart to its normal ‘sinus’ rhythm.
The procedure is known as cardioversion. Patients are usually discharged soon thereafter.
“We have seen more and more Canadian ER physicians willing to cardiovert AAFF patients and then discharge them directly home from the ER,” Steill says.
In fact, Steill’s ER group at Ottawa hospital has “maintained a very low admission rate of less than 5% for many years, with an excellent safety profile, by discharging most patients home in sinus rhythm.”
Now, CANet is helping Steill take this success story Canada-wide.
“Our overall aim is to reduce the proportion of AAFF patients admitted to hospital from the ER from 30 per cent to 10 per cent of all visits across Canada,” he says – the 20 per cent reduction in AAFF hospital admissions is also part of CANet’s Strategic Research Plan goal.
Steill’s work with the guidelines will help ease the pressure from an already over-burdened Canadian health-care system and ERs.
In order to create them, Steill and his team conducted interviews with patients, ER physicians and cardiologists from rural, community, and academic centres to identify current practices, and perceived barriers for discharging AAFF patients home from the ER.
“We circulated the draft to approximately 300 emergency medicine and cardiology colleagues whose written feedback was further incorporated into the final version,” he says.
The Canadian Association of Emergency Physicians has endorsed the guidelines.
Steill is currently working on a two-year trial to evaluate their effectiveness in 10 Canadian ERs across hospitals in Nova Scotia, New Brunswick, Quebec, and Ontario.
“We will use hospital admission as the primary outcome and expect to enroll a total of 2,400 patients,” he says. “We want to encourage ER physicians working in small, medium and large hospitals across Canada to adopt the guidelines.”
CANet’s patient engagement strategy will be a critical component of Steill’s work.
“Patient partner experiences are a great asset within our research program,” he says.
Steill is working with a patient advisor who has been involved with the project since its inception.
“Our advisor is the project’s patient voice and provides invaluable patient perspective throughout the program,” Steill says.
The CANet project will train and mentor at least six Highly Qualified Personnel (HQP) including junior investigators, medical students, and research staff.
“Developing and training clinicians, scientists, and researchers is necessary for the continued production of world-class research,” Steill says.
He is working with CANet’s CHAT (CANet HQP Association for Trainees) program to train the next generation of world-class talent in arrhythmia research and patient engagement.
“The goal of all our studies is to always improve the care we provide for our patients,” Steill says. “I am excited for another opportunity to do so.”