Associate Professor, Faculty of Medicine, McGill University
Director, Emergency Department and the Emergency Multidisciplinary Research Unit (EMRU), Jewish General Hospital
Dr. Marc Afilalo is Director of the Emergency Multidisciplinary Research Unit (EMRU), which is comprised of a highly dynamic group of researchers conducting health services and clinical research within the emergency department. The group consists of emergency physicians, epidemiologists, statisticians, psychologists, operation management experts, industrial engineers, nurses, and medical and graduate students. It has amassed expertise in a wide variety of research areas, most notably emergency department (ED) crowding, ED operations and management, clinical trials, knowledge translation, and medical errors.
Major Research Activities
Emergency Department Crowding, Operations and Management
Since 2003, EMRU has partnered with McGill’s Faculty of Management and, together, they have developed and conducted several projects and workshops. This fruitful collaboration has led to several FRSQ and CIHR research grants aimed at better understanding the underlying causes of ED crowding, as well as developing strategies geared towards curtailing and managing this ubiquitous health care problem. For example, CIHR funding was obtained in order to study the question, “What is Blocking Beds?” Two FRSQ grants have been awarded to: 1) develop a simulation-based computer model that can reliably mimic the daily operations of the ED; and 2) to understand why hospitalized patients occupy acute care beds for prolonged periods of time and develop strategies aimed at improving hospital bed management and facilitating accessibility to beds in the ED. Dr. Afilalo is also Co-Investigator of a CHSRF funded grant entitled, Waiting with an Emergency, the objective of which is to implement and evaluate interventions aimed at reducing ED length-of-stay and waiting times in Canadian hospitals. The team is currently working on another project, funded by the FRSQ, which is aimed at studying the process of hospital admission via the ED and designing strategies that improve such processes.
Dr. Afilalo is a strong supporter of knowledge translation (KT), which aims to bridge the gap between research and practice. In 2007, in collaboration with the Society of Academic Emergency Medicine in the United States, and with CIHR, AHRQ, and NIH funding, EMRU organized the first Consensus Conference on KT in emergency medicine entitled, Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake. Its primary goal was to stimulate the development of a research agenda and a coordinated initiative within the specialty of emergency medicine in order to find optimal routes into clinical practice for consistent and reliable implementation of evidence-based interventions. Dr. Afilalo served as a member of an International Expert Advisory Panel for this conference. The proceedings were published as 33 manuscripts in the November 2007 issue of the journal Academic Emergency Medicine.
Dr. Afilalo is currently co-investigator of two separately funded research grants aimed at improving emergency cardiac care treatment for ACS (particularly STEMI) in Quebec through implementing and evaluating a series of KT facilitators and strategies. A study funded by the CIHR, entitled AMI-QUEBEC 2: Knowledge Translation to Reduce Delays to Reperfusion Therapy by Primary PCI in Quebec will implement a regional system of STEMI care to expedite primary PCI, and evaluate the extent to which the proposed system of care will increase the proportion of timely reperfusion therapy. A second study funded by Sanofi, AMI-QUEBEC: Knowledge Translation to Promote Evidence-Based Medical Therapy in Acute Coronary Syndromes, aims to increase the prescription of evidence-based medical therapy in ACS (as recommended by ACC/AHA 2007 STEMI and NSTEMI guidelines) by implementing multi-faceted KT interventions at participating hospitals in Quebec.
Medical Errors, Patient and Healthcare Worker Safety in the Emergency Department
EMRU has been building expertise by conducting pioneering research in the area of medical errors and improving patient safety in the ED. In the last few years, EMRU has received substantial funding from the Canadian Patient Safety Institute and Canadian Medical Protective Association to conduct research in this field. In one study, entitled Investigation of Preventable Adverse Outcomes in the Emergency Department, a standard methodology was developed for investigating medical errors in the ED. Another study, Managing Patient Safety (MAPS I): Impact of Clinical, Organizational and Patient Factors on Medical Errors in the Delivery of Emergency Services, evaluated the impact of clinical practice, organizational and patient factors on medical errors and adverse events in the ED. During the 2009 H1N1 influenza pandemic, Dr. Afilalo spearheaded the development of a series of guidance statements aimed at protecting healthcare workers from influenza infection. These informal guideline recommendations were published and disseminated in a document entitled Healthcare Worker Protection in the Emergency Department During Pandemic Influenza: A Position Paper.
Unger B, Afilalo M, Boivin JF, Bullard M, Grafstein E, Schull M, Lang E, Colacone A, Soucy N, Xue X, Segal E. Development of the Canadian Emergency Department Diagnosis Shortlist. Canadian Journal of Emergency Medicine 2010; 12(4):311-9.
Stang A, McGillivray D, Bhatt M, Colacone A, Soucy N, Léger R, Afilalo M. Markers of Overcrowding in a Pediatric Emergency Department. Academic Emergency Medicine 2010; 17:151–156.
El-Rayes M, Schampaert E, Tardif JC, Eisenberg MJ, Afilalo M, Kouz S, Lauzon C, Harvey R, Nguyen M, Kouz R, Dery JP, Mansour S, Van Kieu AM, Rinfret S, and Huynh T. Safety and effectiveness of enoxaparin following fibrinolytic therapy: Results of the Acute Myocardial Infarction (AMI)-QUEBEC registry. Canadian Journal Cardiology, October 1, 2010; 26(8): 431-6.