Emergency medicine journal : EMJ
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ED crowding is associated with increased mortality, poor staff and patient experience, an increased inpatient length of stay and poor compliance with the four-hour emergency access standard.1 Where crowding is caused by exit block, the focus needs to be on whole system patient management, reducing the temporal mismatch between admissions and discharges since at times of peak demand hospitals may become gridlocked until patients are discharged.In an attempt to tackle exit block, the Scottish Government Unscheduled Care Team have implemented the Daily Dynamic Discharge (DDD) approach, which aims to increase the number of inpatient discharges by 12 pm, thus enabling more timeous flow through the ED. ⋯ Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust2006;184(5):213-216.
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Sudden cardiac death is one of the leading causes of mortality in the UK. The incidence of out-of-hospital cardiac arrest (OHCA) in the UK is approximately 30 000. The initial cardiac rhythm in these cases is often a ventricular tachyarrhythmia which requires electrical defibrillation. The efficacy of defibrillation is dependent on its timely use, with the odds of survival decreasing by up to 10% for every minute of delay. The use of AEDs has been shown to significantly improve neurologically intact survival in OHCA. Significant progress has been made regarding the provision of AEDs in public places but it is questioned whether sufficient public education has been undertaken in order to support this strategy. This study aims to explore the attitudes of the general public in order to inform public education strategies, increase AED use and ultimately improve survival of OHCA. ⋯ The level of knowledge of AEDs is low amongst the general public. Majority of the study population who knew about AEDs had some degree of resuscitation training. Further research is required to ascertain how to translate knowledge into optimal use of AEDs in practice.
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: In recent years the RVH Emergency Department (ED) had been under intense pressure and public scrutiny. This led to a demoralised workforce who had become disengaged with quality improvement (QI). QI projects had become an exercise in data collection with little focus on improving care for patients. ⋯ We have also increased efficiency with senior review for Ambulance patients and subsequent significant decrease in waiting times. A recent project targeting the waste associated with unnessecary triage blood tests is showing promising early results.emermed;34/12/A880-a/F2F2F2Figure 2The ED improvement team have endeavoured to improve the environment for staff by developing a 'Grrr to Great' board, through which staff are empowered to highlight problems but are also tasked with developing solutions. We have also increased accessibility of QI data by producing a QI update board and displaying data openly and transparently in the department.emermed;34/12/A880-a/F3F3F3Figure 3.
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Forearm fractures are the most common paediatric injury presenting to A+E.1,2 Literature supports safe and effective treatment of these injuries in A+E using a variety of sedation methods, including ketamine.3,4 The Paediatric Orthopaedic Trauma Snapshot (POTS) study showed that only 35% of A+Es nationally allow manipulation of these injuries in the department. ⋯ With adequate and appropriate training, the majority of simple radius and ulna fractures can be reduced and definitively treated safely and effectively using Es-ketamine in the emergency department. This technique has significant benefits in terms of resource management and finance whilst maintaining optimum patient care.
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The number of ventricular assist devices (VADs) being implanted for terminal heart failure is rising at an exponential rate. These implanted patients have a decreased mortality, but still have significant morbidities, as the prevalence of these patients increases in the community. When VAD patients are discharged to home, they will very likely require emergency medical services (EMSs) and emergency medical doctors (EDs) with their future care. ⋯ The cardiovascular treatment of VAD patients in the field can pose different challenges typically encountered including difficulties measuring a pulse and sometimes undetectable BP. Despite these unique challenges, official guidelines or even standard operating procedures regarding the emergency treatment of VAD patients are still lacking. We present a basic overview of the most commonly used left VAD systems and propose guidelines that should be followed in the event of an emergency with a VAD patient out of hospital.