SREMI Research Chair | Dr. Lee
The SREMI Inaugural Research Chair in Geriatric Emergency Medicine Dr. Jacques Lee has continued to transition his existing geriatric-EM research program while maintaining forward momentum.
Emergency Department Use of Regional Anesthesia to Prevent Incident Delirium (EDU-RAPID)
Multiple systematic reviews have established that traditional narcotics provide sub-optimal analgesia for patients suffering a hip fracture. Regional anesthesia, also known as a nerve-block, provides more effective and faster pain relief, and is safer especially when guided by point-of-care ultrasound (POCUS).
Dr. Lee previously established that less than 5% of emergency physicians routinely performed nerve blocks for patients with a hip fracture. Over the past few years, Dr. Lee has been leading a national, CIHR-funded, multi-centred randomized clinical trial aimed to reduce delirium in older adults suffering from a hip fracture. The goal of the EDU-RAPID trial was to determine if teaching and encouraging emergency physicians to perform ultrasound guided hip nerve blocks could reduce delirium by improving pain without the need for sedating narcotics.
Over 200 emergency physicians have been successfully trained in the hip-block procedure and have completed over 840 nerve blocks for older patients presenting to the emergency department with a hip fracture. However, training a large cohort of emergency physicians has extended the impact of the research beyond the 840 trial participants. Improbably, one of the study’s own co-investigators, who was too young to participate in the trial, suffered a hip fracture in a cycling accident in November 2019. His significant pain was rapidly relieved after receiving a nerve-block from a 4th year resident who was trained and supervised by an EDU-RAPID trained physician.
Social isolation and loneliness
Social isolation and loneliness worsen older peoples’ quality of life, risk of dementia, and contributes to 45,000 deaths per year in Canada - as much as smoking. Of course with COVID-19, social isolation and loneliness has dramatically increased. In response, Dr. Lee pivoted his research program to address this challenging issue. He collaborated with the Dr. Judy Lowthian, an Australian developer of a telephone support program (HOW RU) shown to reduce social isolation and loneliness, and together with a team of scientists and clinicians have submitted multiple funding applications to support this important project. The goal of the study is to explore how older Canadians prefer to receive virtual support and determine if telephone and video delivery of care can reduce social isolation and loneliness.
In February 2020, Dr. Lee’s team established the feasibility of comparing urine metabolites collected from older people with hip fractures in the ED with their post-operative metabolite profile. The resulting pilot data has demonstrated a potentially novel pathophysiologic mechanism and a biomarker profile to better understand and identify delirium. This work, while preliminary, has great potential to improve the prediction, prevention, recognition and treatment of delirium in older patients.
Dr. Lee continues to mentor multiple medical students, residents and junior faculty and authored 7 peer-reviewed publications with multiple abstracts accepted at both CAEP and SAEM annual conferences. His h-index has increased from 15 to 26 since joining SREMI.