Emergency medicine journal : EMJ
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To review clinical indications and demographics of transfusion and the patterns of blood component ordering, transfusion, wastage and traceability, before (2007) and after (2011) implementation of simple improvement strategies. ⋯ Blood component ordering, usage and traceability within the ED have improved significantly since 2007 following implementation of simple strategies. The age of ED transfusion recipients is increasing.
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Minor head injuries account for a significant number of paediatric presentations to the Emergency Department. In 2007 NICE produced national guidelines to improve and standardise practice across the UK. One indication for CT head scanning is vomiting ≥3 times, even in the absence of any other risk factors. In this study we reviewed CT outcomes with specific focus on children with isolated vomiting. ⋯ This study looks at practice in our unit over a 6 year period, starting 6 months after the 2007 NICE guidelines were introduced. This clearly shows that a large percentage of CTs are being performed on children following minor head injury on the basis of vomiting alone (20.2%). The yield of this is however extremely low with only 0.96% of the patients scanned having an abnormality. There are other clinical decision making algorithms in use internationally which do not have isolated vomiting as an indicator. We believe the current NICE guideline is exposing children's' heads to unnecessary ionising radiation.
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Appropriate activation of multi-disciplinary trauma teams improves outcome for severely injured patients, but can disrupt normal service in the rest of the hospital. Derriford Hospital uses a two-tiered trauma team activation system. The emergency department (ED) trauma team is activated in response to a significant traumatic mechanism; the hospital trauma team is activated when this mechanism co-exists with physiological abnormality or specific anatomical injury. The aim of this study was to compare characteristics, process measures and outcomes between patients treated by ED or hospital trauma teams to evaluate the approach in a UK setting and to estimate any cost savings involved. Figure 1 outlines the composition and activation criteria of the teams. Abstract 014 Figure 1(a) ED trauma team activation and (b) Hospital trauma team activation. ⋯ A two-tiered trauma team activation system is an efficient, safe and cost-effective way of dealing with trauma patients presenting to a Major Trauma Centre in the UK.
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Increasing ambulatory care is a goal of the College of Emergency Medicine. It reduces burden on inpatient wards, and is well received by patients and parents. Ambulatory care of children with periorbital cellulitis is not universally accepted, and warrants evaluation. ⋯ Ambulatory care of periorbital cellulitis is safe and cost effective, with very low rate of complication. We postulate that the availability of ambulatory intravenous antibiotics may be affecting clinical decision making, resulting in more children with mild periorbital cellulitis receiving intravenous rather than oral antibiotics. We suggest there is a role for developing a periorbital cellulitis scoring system to assess severity and guide treatment. Abstract 031 Figure 1Periorbital Cellulitis. Abstract 032 Figure 1Street Doctors.
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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.