Emergency medicine journal : EMJ
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55 'Mini Sim' - innovative bite sized simulation teaching in a busy children's emergency department.
: Emergency Medicine requires a highly skilled workforce who are passionate about delivering excellent patient care. Shift patterns linked with the ever increasing numbers of patients who attend Emergency Departments puts strain on educating the workforce and fostering team togetherness. Our objective in devising and instigating the 'Mini Sim' programme was to embed regular in-situ simulation training to enhance the learning of all staff within our Emergency Department team, building a highly trained workforce to deliver excellent care within the remit of our busy department. ⋯ After the simulation a debrief is held and any additional teaching is carried out to embed learning. Each medical participant is then offered the opportunity to complete a work place based assessment on the 'Mini Sim' for their e-portfolio.emermed;34/12/A899-a/F1F1F1Figure 1Evaluation of impact of 'mini sim'The work flow of the department has been unaffected and we have received excellent written feedback from participants about the educational quality of the programme which has also shown improvements in staff confidence in dealing with a variety of emergency situations. We would suggest this model could be used in other departments for similar gain.emermed;34/12/A899-a/F2F2F2Figure 2.
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Multicenter Study
17 Exploring ambulance conveyances to the emergency department: a descriptive analysis of non-urgent transports.
An NHS England report highlighted key issues in how patients were initially navigating access to healthcare. This has manifested in increased pressure on ambulance services and emergency departments (EDs) to provide high quality, safe and efficient services to manage this demand. This study aims to identify non-urgent conveyances by ambulance services to the ED that would be suitable for care at scene or an alternative response. ⋯ 16% of ambulance conveyances to ED in 2014 were non-urgent with around 1 in 3 patients under the age of 34 conveyed with non-urgent complaints. 1 in 5 patients had a non-urgent conveyance out of hours. AMPDS analysis identified target areas for intervention including referrals from other healthcare providers. Final ED diagnosis identified specific patient target areas including minor illness and alcohol intoxication.emermed;34/12/A872-a/F2F2F2Figure 2emermed;34/12/A872-a/F3F3F3Figure 3Age of patients taken to ED by ambulance (avoidable).
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In February 2012, the Commission on Human Medicines recommended lowering the paracetamol toxicity treatment threshold for all patients. Children between one month and six years of age are physiologically distinct and metabolise paracetamol differently, making them less prone to toxicity. Furthermore, overdose in early childhood is almost exclusively accidental, as opposed to predominately deliberate self harm seen in adults and adolescents. As a result, the use of the new 75 mg/kg ingestion threshold for young children would appear to be of unproven benefit, and is substantially lower than the threshold used in other countries. ⋯ This retrospective study supports the hypothesis that accidental paracetamol ingestions less than 150 mg/kg, in children one month to six years of age, can be safely managed without investigation or treatment, in accordance with other international guidance. The use of 150 mg/kg threshold would reduce testing in over a third of attendances in our cohort. Study limitations include retrospective bias and the predominate use of serum paracetamol levels to determine toxicity.
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Multicenter Study
50 How can informal support impact child PTSD symptoms following a psychological trauma?
An estimated 20% of children who present to hospital emergency departments following potentially traumatic events (e.g., serious injuries, road traffic accidents, assaults) will develop post-traumatic stress disorder as a consequence. The development of PTSD can have a substantial impact on a child's developmental trajectory, including their emotional, social and educational wellbeing. Despite this, only a small proportion will access mental health services, with the majority relying on informal sources of support. Parents, in particular, are often the primary source of support. However, it remains unclear what types of parental responses may be effective, and parents themselves report experiencing uncertainty about the best approach. To address this gap in knowledge, we examined the capacity for specific aspects of parental responding in the aftermath of child trauma to facilitate or hinder children's psychological recovery. ⋯ Findings indicate that children's social support can influence their post-trauma psychological outcomes. That parenting was associated with 6 month PTSD, even after controlling for the child's initial symptoms, suggests that parenting responses in the posttrauma period actively influence the child's poorer longer-term adjustment, rather than simply being a response to the child's initial distress. The results suggest that helping parents to provide fewer negative appraisals about the trauma/their child's response, and to encourage more adaptive coping styles, could be effective in improving child psychological outcomes. As emergency departments provide primary care and support for families affected by trauma, they could play an important role in making this advice available to parents.
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The assessment of pain in the emergency department (ED) is difficult but important for appropriate management of pain. Guidelines for the management of acute pain in the ED worldwide advocate using numeric rating scales such as the 0-10 pain score as tools to ensure consistency of documenting patient's pain, and this is mandated at initial assessment in many EDs. Studies of interventions to improve pain management in the ED indicate that whilst the inclusion of mandatory pain scoring within interventions may improve documentation of pain, there was mixed evidence as to whether this resulted in improvements in provision of analgesia. As part of a wider study looking at barriers and enablers to pain management in the ED, we explored how pain scoring was used in the ED. ⋯ The pain score appeared to have parallel but misaligned roles: to assess patient pain and ED staff practice. ED staff faced conflict between the need to record pain to ensure accountability of pain management, and recording pain to reflect the patient's report. The role of the pain score needs to be reviewed in order for pain scoring to improve the patient experience of pain management in the ED.