Emergency medicine journal : EMJ
-
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.
-
Existing practice in emergency departments (ED) in the UK for managing anticoagulated patients after blunt head trauma is variable and based on limited evidence. We aimed to determine the head injury complication rate within this group of patients and identify risk factors associated with a poor outcome. ⋯ This is the largest cohort of anticoagulated head injury patients ever reported. The head injury complication rate was 6.1% which correlates well with previous findings. INR was not found to be associated with a poor outcome however GCS <13, vomiting and loss of consciousness were identified as significant risk factors for an adverse outcome in anticoagulated patients with a head injury.
-
Transfusion thresholds for upper gastrointestinal bleeding (UGIB) are controversial. Observational studies suggest associations between liberal red blood cell (RBC) transfusion and adverse outcome. A recent trial reported increased mortality following liberal transfusion. We delivered a cluster randomised trial to evaluate the feasibility and safety of implementing a restrictive (transfusion when haemoglobin (Hb) <8 g dL) vs liberal (transfusion when Hb <10 g/dL) RBC transfusion policy for UGIB. ⋯ Adherence to both policies was high, resulting in a reduction in RBC transfusion and separation in the degree of anaemia and RBC exposure. There was a trend towards improved safety in the restrictive policy. We have demonstrated that a large-scale cluster randomised trial is feasible and is now warranted to determine the effectiveness of implementing restrictive RBC transfusion for all patients with AUGIB.
-
The continuing shortfall of organs for transplantation has led to interest in Maastricht Category II (uncontrolled) Donation after Circulatory Death (DCD) organ donation. As preparation for a proposed pilot, this study aimed to explore the potential of uncontrolled DCD organ donation from patients presenting in cardiac arrest to the emergency department (ED) who are unsuccessfully resuscitated. ⋯ Identifying potential organ donors in the ED who are unsuccessfully resuscitated from cardiac arrest may contribute to reducing the shortfall of organs for transplantation, although numbers are likely to be small. If such a programme was to be introduced during weekday working hours, there may be around four donors a year. However, even one additional donor per year from hospitals across the UK with an ED and a transplantation service would add considerably to the overall organ donation rate.
-
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.