Emergency medicine journal : EMJ
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Getting staffing levels wrong in hospitals is linked to excess mortality and poor patient experiences but establishing the safe nurse staffing levels in the emergency department (ED) is challenging because patient demand is so variable. This paper reports a review conducted for the National Institute for Health and Care Excellence (NICE) which sought to identify the research evidence to inform UK nursing workforce planning. ⋯ The evidence is weak but indicates that levels of nurse staffing in the ED are associated with patients leaving without being seen, ED care time and patient satisfaction. Lower staffing is associated with worse outcomes. There remain significant gaps and in particular a lack of evidence on the impact of staffing on direct patient outcomes and adequate economic analyses to inform decisions about nurse staffing. Given that an association between nurse staffing levels and patient outcomes on inpatient wards has been demonstrated, this gap in the evidence about nurse staffing in EDs needs to be addressed.
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A short cut review was carried out to establish whether a normal CT scan within 6 h of onset of a severe, sudden onset headache can be used to rule out a subarachnoid haemorrhage. Four studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that a CT scan performed on a third generation scanner with thin slices, reported by a radiologist experienced in reporting CT brain scans, within 6 h of onset of the headache can be used to rule out a subarachnoid haemorrhage.
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A short cut review was carried out to establish whether Rivaroxaban is superior to warfarin in the management of pulmonary embolism. Three studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that Rivaroxaban is a promising alternative to warfarin in the management of pulmonary embolism.