Emergency medicine journal : EMJ
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Unplanned emergency re-attendance within seven days is a national quality indicator set at 1-5% by the Department of Health. Newham University Hospital (NUH), one of three hospitals forming Barts Health NHS Trust, recorded rates exceeded this target in October 2012, with a spike at 10% in April 2013 prompting investigation of the root cause. A review was carried out to determine the potential causes and provide solutions. ⋯ We discovered that different definitions across the three Barts Health ED sites were being applied. Following presentation of results a unified definition was drawn up. Coding error was the main reason for our blip of 10% in April 2013 and was rectified by education of reception staff. We have now instigated bimonthly review of 'frequent fliers' so that case-management plans can be implemented with relevant Trust and community teams. This review has highlighted several issues contributing to inaccurate figures which are likely to apply to many emergency departments and has shown how useful it is to qualify as well as quantify unplanned returns.
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Pain is the commonest reason that patients present to an Emergency Department (ED), but is often not treated effectively. Patient controlled analgesia (PCA) is used in other hospital settings but there is little evidence to support its use in emergency patients. This study (one of two parallel trials) aimed to assess the effectiveness and cost-effectiveness of PCA in emergency patients with traumatic injuries. ⋯ Provisional results indicate that there is no statistically significant reduction in pain using PCA compared to routine care for emergency department patients with traumatic injuries. Further analyses are in progress, in particular, of total morphine consumption and cost-effectiveness.
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ANPs are autonomous practitioners and form a core part of many Emergency Departments (EDs). However, there is little data on their role in major trauma and deployment within MTTs. The project aimed to explore clinicians' views on the role of ANPs within MTTs in Major Trauma Centres (MTCs). ⋯ The project data shows that, although ANPs are now part of many ED teams and are increasingly taking on extended autonomous ED roles, there is still a level of uncertainty and lack of clarity on their role as part of an MTT. There needs to be a national policy outlining and standardising ANP training, qualification and utilisation within the ED as well as a robust programme to promote their education, training and skills, to optimise their deployment.
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Until January 2014, The National Institute of Clinical Excellence (NICE) Head Injury Guidelines (CG56) issued to clinicians advised anticoagulated patients with a head injury should only receive CT imaging if loss of consciousness or amnesia was experienced. These guidelines have recently been updated to advise CT imaging for all anticoagulated patients. We aimed to investigate how closely the 2007 guidelines were followed and whether the guideline update will mean considerable changes to existing practice. ⋯ The majority of patients that fulfilled the NICE 2007 criteria did have CT imaging performed (82%). However, a significant number of patients not fulfilling the criteria also had CT imagining performed. Overall, 60% of the anticoagulated patient cohort had CT imaging, this will need to increase considerably to follow the updated NICE 2014 guidelines of CT imaging for all patients.
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Pulmonary Embolism (PE) in pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high quality evidence resulting in a lack of consensus in managing this group of patients. The aim of the study was to address the diagnostic utility of D dimer for suspected PE in pregnant and postpartum patients, and to identify any clinical presentation variables that are predictors of PE in this group of patients. ⋯ According to our study, there is supportive evidence that a negative D-dimer result is useful as a means of ruling out PE in pregnant and post-partum patients. However, we need a larger prospective observational study to collaborate the findings.