Journal of accident & emergency medicine
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The objective of this study was to audit the initial management of patients with upper limb fractures, and to determine whether the accident and emergency (A&E) management of fractures is improved by using guidelines for treatment and referral. This was achieved by comparing the standard of treatment, as determined by fracture clinic doctors, before and after the introduction of fracture treatment guidelines in the A&E department of a London teaching hospital. A total of 326 patients seen in the department and referred to the fracture clinic over two 2-month periods were included in the audit. ⋯ After introducing the guidelines the total errors fell to 14/111 (12.6%) patients referred, of which only eight patients (7.2%) were at risk of increased morbidity. This represents an overall improvement of 19.5% [95% confidence interval (CI) 12.3 to 29.7%] and a 16.5% (95% CI 9.1 to 23.9%) reduction in the potentially more significant errors. Hence, the use of audit and implementation of simple guidelines for fracture management in an A&E department improves the standard of treatment.
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The nurse triage process in an accident and emergency (A&E) department was audited as part of the nursing quality assurance programme. It was found that in most cases documentation was adequate and guidelines had been adhered to. ⋯ Waiting time improvements were also seen. Triage audit was a useful tool in the continuous quality improvement effort.
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The management of 104 patients complaining of foreign body (FB) in the throat in an accident and emergency (A&E) department was analysed over a period of 7 months. The majority of these patients (88.4%), underwent a soft tissue radiograph of the neck. Less than 10% of the radiographs were thought to be abnormal by the A&E staff. ⋯ It is concluded that routine use of radiographs in the assessment of FB in the throat is inappropriate. By contrast thorough clinical examination and indirect laryngoscopy (IDL) have a high diagnostic yield. A protocol is suggested for managing the condition.
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Injured motorcyclists may have a damaged and unstable cervical spine (C-spine). This paper looks at whether a helmet can be safely removed, how and when should this be done? The literature is reviewed and the recommendations of the Trauma Working party of the Joint Colleges Ambulance Liaison Committee are presented.
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Comparative Study
Major incident planning in South East Thames Region: a survey of medical staff awareness and training.
In order to assess awareness and training of medical staff in major incident planning and disaster medicine, a telephone survey was conducted throughout South East Thames Region. Duty consultants and trainees in anaesthesia, general surgery and orthopaedic surgery from a total of 17 hospitals in the region were included. Accident and emergency (A&E) consultants were also interviewed in order to assess administrative aspects of major incident planning. ⋯ We conclude that major incident plans are in place and are updated in all the hospitals surveyed. However, all staff lack training in clinical and administrative aspects of major incident planning and disaster medicine. Recommendations to improve this situation are made.