Emergency medicine journal : EMJ
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Paediatric gynaecology can provide challenging and varied consultations in the emergency department setting. Although the first international journal and society were established in the late 1980's, no specific UK guidelines have been published for the care of children and teenagers in this specialty. Moreover, limited published data is available regarding the types of cases presenting at the "front door". This study aimed to investigate the scope of paediatric and adolescent gynaecological problems presenting to the emergency department of a UK children's hospital. ⋯ The study demonstrates the wide variety of paediatric gynaecology cases that present to the emergency department, nearly two thirds of which require ongoing care. This exhibits a need for both national guidance and appropriate training for front line medical staff covering the common gynaecological problems found in children.
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Demonstrating educational interventions improve patient care can been difficult. This study aimed to perform an extensive assessment of a bespoke e-learning package on the NICE Feverish illness in Children Guideline to aid the development of an evaluation model. ⋯ It is important any educational intervention is thoroughly examined as positive findings in respect of satisfaction or knowledge gain may not equate to behaviour change. The continued poor assessment of educational interventions results in potentially continued poor practice or educational technique. A new framework for evaluation (the 7Is) will be presented as a solution.
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Emergency Departments (ED) typically offer walk-in services for minor injuries, and patients arriving at peak times may experience delays. Other NHS services (e.g. GP, dentists and GUM) utilise booked appointments even for urgent problems.We wished to ascertain whether patients attending our ED (a DGH with a very large rural catchment area) with minor injuries would find an appointment system accessed via phone/internet acceptable, and also their views on perhaps being asked to return for an appointment later the same (or following) day, should they arrive when waiting times are unacceptably long. ⋯ This study confirms acceptance of the concept of ED offering appointments to minor injury patients. Participants would prefer pre-booked appointments over being asked to return later or next day, but they would accept either in preference to enduring excessive delays.
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To determine whether the Emergency Department (ED) could effectively identify patients with suspected cauda equina or cord compression who warranted further investigation with MRI, and thus request MRI without prior review from neurosurgeons. ⋯ There was good correlation between ED and NS opinion on the need for MRI. Detection rate for cauda equina/severe stenosis (20.6%) was in keeping with other studies in the literature. There is significant time delay in the current referral process which can delay emergency treatment and may adversely affect patient outcome, and one patient was missed despite the proforma recommending MRI. ED doctors should request MRIs directly in the case of suspected cauda equina/cord compression . emermed;31/9/782-a/EMERMED2014204221F8F1EMERMED2014204221F8 Patient outcomes at each stage. emermed;31/9/782-a/EMERMED2014204221F9F2EMERMED2014204221F9 Outcome of MRI including detection rate of cauda equina or severe spinal stenosis. emermed;31/9/782-a/EMERMED2014204221F10F3EMERMED2014204221F10 Times between being seen by ED doctor, NS referral and MRI in all patients and patients subsequently requiring an emergency operation.
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SIGN guideline 111 makes recommendations on the optimal management of patients with a hip fracture.(1) It is clear from the use of care bundles in other conditions, eg sepsis, that these perform very well in time-critical settings and ensure that all necessary actions for person-centred care are achieved timeously. Given the success of our Emergency Department (ED) compliance with the Sepsis 6 bundle (100%-unpublished data) the principal author (JK) rationalised that a bundle applied to the SIGN hip fracture recommendations would ensure that all actions were achieved in a timely manner. ⋯ Although fractures of the neck of femur do not necessarily result in the physiological derangement associated with sepsis, it is evident that the use of a bundle of care will ensure that hip fracture patients are managed in a timely, person-centred and safe fashion as recommended in SIGN 111. Future work will concentrate on improving compliance with all seven actions within one hour of patient attendance.