Emergency medicine journal : EMJ
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Handover in emergency care is an important patient safety issue and has particular problems due to different environmental, professional, organisational and cultural backgrounds. Previous work as focussed on the standardisation of handover content (including use of checklists), relatively little is known about the verbal behaviours that shape handover conversations. This study looks at both the content of the handover and the verbal behaviours during different types of handovers around the emergency department. ⋯ Handover may entail both descriptive (aimed at information transfer) and collaborative (aimed at joint decision-making) elements. Standardisation of handover needs to accommodate collaborative aspects with their greater variability according to the individual situation, and should incorporate communication of information relevant to the patient's social and psychological needs to establish appropriate care arrangements at the earliest opportunity.
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Widespread conservative management of low-risk chest pain has motivated the development of a rapid triage strategy based on CT coronary angiography (CTCA) in the Emergency Department (ED). Recently, three prominent trials using this technology in the ED setting have presented results in support of its routine use. However, these studies fail to show the incremental prognostic value of CTCA over clinical and biomarker-based risk-stratification strategies, demonstrate additional downstream costs and interventions, and result in multiple harms associated with radio-contrast and radiation exposure. Observing the widespread overdiagnosis of pulmonary embolism following availability of CT pulmonary angiogram as a practice pattern parallel, CTCA use for low-risk chest pain in the ED should be advanced only with caution.
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Computed tomography (CT) is becoming increasingly popular as a primary imaging modality in adult trauma patients. This study aims to examine the added value of thoracic CT (TCT) in the context of paediatric trauma. ⋯ This study indicates a need for a comprehensive guideline for imaging in paediatric trauma, where the use of TCT is limited to specific patients, especially in view of the health implications that CT poses and source of financial burden for the NHS.
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The London Trauma Network was launched in April 2010 in order to centralise trauma care in the capital city. The consultation and resourcing of the four new major trauma centres (MTC) was adult focused. The objective of this study was to assess the impact that adult MTC status has on paediatric trauma workload. ⋯ Major adult trauma centre status has a significant effect on paediatric trauma workload and hence resources. When reconfiguration of trauma services are being considered it is essential to take into account the impact on paediatric services alongside those of the adult population.
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Redbridge Tackling Knife Crime Programme was an initiative run between Redbridge Safer Communities Partnership, a London-based police force and Barking, Havering and Redbridge University Hospital Trust. It comprised of data collection resulting in the analysis of types of assault, locations, demographics of both assailant and victim and were police informed. Domestic violence (DV) was identified as a category of assault. The inspiration came from the 1996 'Cardiff-model'-the Violence Prevention Group shared ED assault data with its police force. The outcome led to enhanced effectiveness of the police in managing alcohol-related violence. The TKAP aim is it identify DV locations and patterns, otherwise unknown to police by improved intelligence gathered through ED data. As a result police deployment can reflect areas of need and allow police to compare their own figures allowing a more informed service for DV victims. ⋯ will be used to implement police enforcement activities and prevention work, hence improving safe-guarding.