Grant: Foundation Grant

Ottawa Hospital Research Institute

$2,093,538.00

Improving Care for Emergency Department and Pre-Hospital Patients with Acute and Life-Threatening Conditions

FY 2014-15

Summary

Vision and Goals I am very grateful for the opportunity to proceed to Stage 2 of the CIHR Foundation process after ranking 23rd of 1,366 applicants in Stage 1. I will step down as U Ottawa Chair of Emergency Medicine in June 2015 and devote the next 7 years or more to working as a fulltime clinician investigator. My vision is to improve the care and outcomes for emergency department (ED) and pre-hospital patients with acute and life-threatening conditions. I will create new evidence with my own projects (enrolling >9,000 patients in 6 prospective studies), improve Canadian emergency care research capacity, and ensure knowledge translation (KT) of new evidence to clinicians. Objectives and Expected Outputs 1. Conduct My Own Research I will build upon >20 years’ experience in conducting large clinical studies that created clinical decision rules and evaluated new therapies for cardiac arrest. a) Risk Scales. Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the most common causes of respiratory distress amongst adult ED patients. Unfortunately, there is little evidence to guide physicians in the critical decision of whether to admit or discharge these patients. I have recently completed 4 CIHR-funded studies to derive (Phase 1, N=1,500) and validate (Phase 2a, N=2,500) for the Ottawa HF (OHFRS) & COPD (OCRS) Risk Scales. Next I shall conduct 1) limited validation studies of the revised and concise scales; and 2) randomized implementation trials to demonstrate actual clinical impact. These scales will allow physicians to stratify the risk for serious adverse events. This should improve and standardize admission practices, diminishing both unnecessary admissions and unsafe discharge decisions. I will continue to work with colleagues to improve patient safety with risk scales for transient ischemic attack (TIA), subarachnoid hemorrhage (SAH), and syncope. b) Acute Cardiac Conditions. (i) Cardiac Arrest. Out-of-hospital cardiac arrest (OHCA) leads to an estimated 30,000 deaths per year in Canada and these initiatives could save thousands of Canadian lives. 1) Conduct a pilot RCT evaluating optimal CPR compression depth, building upon my analyses of 9,136 OHCA from the 10 U.S./Canadian sites in the Resuscitation Outcomes Consortium (ROC). 2) Create a Canadian version of ROC (CanROC) to conduct prehospital observational and interventional studies for OHCA. 3) Collaborate with colleagues to improve bystander CPR rates and use of automated external defibrillators by hospital ward nurses. (ii) Recent-onset Atrial Fibrillation (RAF). This is the most common arrhythmia treated in the ED but there is a lack of high-quality evidence to guide management. I lead a HSFC-funded pilot RCT to compare drug-first vs. shock-first strategies and plan to expand this to a full multicenter trial. 2. Improve Emergency Care Research Capacity a) Research Fellowship. With my colleague, Dr George Wells, I will expand our 2-year training program for ED physicians, which includes an MSc Epidemiology. b) Network of Emergency Care Researchers. Building upon existing linkages and with CAEP, I hope to create a new and unique Canada-wide network where researchers can collaborate to study adult ED patients. 3. Knowledge Translation (KT) Working with expert Dr Jeremy Grimshaw and national organizations, I plan to ensure rapid and broad uptake of Ottawa-created evidence by ED clinicians across Canada and elsewhere. We will use a variety of KT tools and strategies.

Department

Canadian Institutes of Health Research

Program

Foundation Grant

Recipient

Ottawa Hospital Research Institute

Location

Ontario, Canada

Recipient Type

Other

Type

Grant

Source

CIHR Funding Decisions Database

As published

313485

Name

Stiell Ian G

Region

Ontario

Country

Canada

Orgtype

Institution Paid; Research Institution

Instname2

Health Services and Policy Research

Theme2

Health systems / services

Prcname2

Foundation Grant

Projecttitle

Improving Care for Emergency Department and Pre-Hospital Patients with Acute and Life-Threatening Conditions

Programtype2

Operating Grants

Orgnameinp2

Ottawa Hospital Research Institute

Cihramount2

$2,093,538

Cihrequipment2

Programname2

Foundation Grant

Keyworddelim

Atrial Fibrillation; Cardiac Arrest; Chronic Obstructive Pulmonary Disease (Copd); Clinical Decision Rules; Clinical Trials; Emergency Medical Services; Emergency Medicine; Heart Failure; Knowledge Translation

Abstract

<html> <body> Vision and Goals   I am very grateful for the opportunity to proceed to Stage 2 of the CIHR Foundation process after ranking 23rd of 1,366 applicants in Stage 1. I will step down as U Ottawa Chair of Emergency Medicine in June 2015 and devote the next 7 years or more to working as a fulltime clinician investigator.   My vision is to improve the care and outcomes for emergency department (ED) and pre-hospital patients with acute and life-threatening conditions. I will create new evidence with my own projects (enrolling >9,000 patients in 6 prospective studies), improve Canadian emergency care research capacity, and ensure knowledge translation (KT) of new evidence to clinicians. Objectives and Expected Outputs 1. Conduct My Own Research I will build upon >20 years’ experience in conducting large clinical studies that created clinical decision rules and evaluated new therapies for cardiac arrest. a) Risk Scales. Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the most common causes of respiratory distress amongst adult ED patients. Unfortunately, there is little evidence to guide physicians in the critical decision of whether to admit or discharge these patients. I have recently completed 4 CIHR-funded studies to derive (Phase 1, N=1,500) and validate (Phase 2a, N=2,500) for the Ottawa HF (OHFRS) & COPD (OCRS) Risk Scales. Next I shall conduct 1) limited validation studies of the revised and concise scales; and 2) randomized implementation trials to demonstrate actual clinical impact. These scales will allow physicians to stratify the risk for serious adverse events. This should improve and standardize admission practices, diminishing both unnecessary admissions and unsafe discharge decisions. I will continue to work with colleagues to improve patient safety with risk scales for transient ischemic attack (TIA), subarachnoid hemorrhage (SAH), and syncope. b) Acute Cardiac Conditions. (i) Cardiac Arrest. Out-of-hospital cardiac arrest (OHCA) leads to an estimated 30,000 deaths per year in Canada and these initiatives could save thousands of Canadian lives. 1) Conduct a pilot RCT evaluating optimal CPR compression depth, building upon my analyses of 9,136 OHCA from the 10 U.S./Canadian sites in the Resuscitation Outcomes Consortium (ROC). 2) Create a Canadian version of ROC (CanROC) to conduct prehospital observational and interventional studies for OHCA. 3) Collaborate with colleagues to improve bystander CPR rates and use of automated external defibrillators by hospital ward nurses. (ii) Recent-onset Atrial Fibrillation (RAF). This is the most common arrhythmia treated in the ED but there is a lack of high-quality evidence to guide management. I lead a HSFC-funded pilot RCT to compare drug-first vs. shock-first strategies and plan to expand this to a full multicenter trial. 2. Improve Emergency Care Research Capacity a) Research Fellowship. With my colleague, Dr George Wells, I will expand our 2-year training program for ED physicians, which includes an MSc Epidemiology. b) Network of Emergency Care Researchers. Building upon existing linkages and with CAEP, I hope to create a new and unique Canada-wide network where researchers can collaborate to study adult ED patients. 3. Knowledge Translation (KT) Working with expert Dr Jeremy Grimshaw and national organizations, I plan to ensure rapid and broad uptake of Ottawa-created evidence by ED clinicians across Canada and elsewhere. We will use a variety of KT tools and strategies. </body> </html>

Competitiondate

201409

Approvedterm2

7 yrs 0 mth

Pinamesdelim

Stiell, Ian G

Approvedterm

7 ans 0 mois

Cihrcontribution2

~ $2,093,538~ $0~

View source data CIHR Funding Decisions Database (Canadian Institutes of Health Research)