Emergency medicine journal : EMJ
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Emergency department crowding is recognised as a major public health problem. While there is agreement that emergency department crowding harms patients, there is less agreement about the best way to measure emergency department crowding. We have previously derived an eight point measure of emergency department crowding by a formal consensus process, the International Crowding Measure in Emergency Departments (ICMED). We aimed to test the feasibility of collecting this measure in real time, and to partially validate this measure. ⋯ We obtained 84 measurements, spread evenly across the four emergency departments. The measure was feasible to collect in real time, except for the 'Left Before Being Seen' variable. Increasing numbers of violations of the measure were associated with increasing clinician concerns. The Area under the Receiving Operator Curve was 0.80 (95% CI 0.72-0.90) for predicting crowding and 0.74 (95% CI 0.60-0.89) for predicting danger. The optimal number of violations for predicting crowding was three, with a sensitivity of 91.2 (95% CI 85.1-97.2) and a specificity of 100.0 (92.9-100). The measure predicted clinician concerns better than individual variables such as occupancy. Abstract 007 Table 1BeforeAfterResearch 'hotline'2 (3%)0Verbal10 (15%)3 (3%)Notes label21 (32%)14 (14%)iPad030 (30%)Not notified32 (49%)52 (52%)Total6599 CONCLUSION: The ICMED is easily to collect in multiple emergency departments with different IT systems. The ICMED seems to predict clinician's concerns about crowding and safety well, but future work is required to validate this before it can be advocated for widespread use.
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WHO ETAT training courses provide comprehensive training in paediatric emergency care over 3.5-5 days and have been shown to improve outcome in resource-limited settings. However, the logistics, cost and impact on local service delivery of a five-day course may limit training opportunities in some settings. In this context, we aimed to determine whether a shorter, more focused course would be feasible. ⋯ 'Essential ETAT' was well received by participants and improvements in post-course test scores compared well to results from standard ETAT courses. Further evaluation is required to indicate whether knowledge is retained and changes clinical practice. Focused, short duration resuscitation training may offer a pragmatic and potentially cost-effective alternative to standard courses.
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There is currently little evidence defining the clinical importance of detecting and treating isolated distal deep vein thrombosis (IDDVT). Contemporary international guidelines vary regarding diagnostic and therapeutic advice. The potential benefits of anticoagulation remain poorly defined. We sought to evaluate the feasibility of a randomised controlled trial within a modern emergency department cohort. ⋯ We have established feasibility for a definitive trial on the value of therapeutic anticoagulation for IDDVT. Our pilot study currently provides the largest prospective randomised clinical dataset on this topic and demonstrates a non-significant trend towards reduction in complications with anticoagulation.
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Clinical assessment can be used to identify which patients with acute asthma are at risk of unsuccessful initial treatment. We aimed to determine, using data from the 3MG trial, which elements of clinical assessment predict unsuccessful treatment, defined as needing critical care or any unplanned additional treatment. ⋯ PEFR, heart rate and other serious illness are the best predictors of unsuccessful treatment, but models based on these variables provide only modest predictive value.