Emergency medicine journal : EMJ
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Crowding in the Emergency Department is internationally recognised as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of crowding, including increased length of stay, mortality and cost per admission. Crowding is typically a manifestation of a hospital at full capacity and its main contributor is the practice of boarding patients in the ED. Therefore, a functioning flow system is advised to ease the burden. Different predictive tools/algorithms assess the degree of crowding. The National Emergency Department Overcrowding Scale (NEDOCS) is used effectively in other countries but has not been validated in Ireland. ⋯ We plan to validate the NEDOCS score in an Irish Emergency Department. Crowding is a significant issue in the Irish Healthcare setting. The '40% of inpatient beds by 11 am' needs to be adopted by our hospital. Our study suggests that our emergency staff accept the dysfunctional as the norm.
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Multicenter Study Observational Study
5 A study analysing the diagnostic performance of ECG interpretation for 30-day major cardiac events in the emergency department.
This study evaluates the diagnostic accuracy of an Emergency Medicine (EM) clinician at identifying ischaemia on an ECG using 30-day major adverse cardiac events (MACE) as the primary outcome. ⋯ This is the first prospective, multi-centre cohort study, that assess the diagnostic performance of EM clinician's ECG interpretation, with 30-day MACE as the primary outcome. The findings are highly relevant to EM as they represent the ECG terms used by popular acute coronary syndrome clinical decision rules. In this study a clinician's overall judgement of ischaemia has a better diagnostic performance compared to simple STD and ATWI. This may be due to an appreciation of morphology and the amount of deviation; future work should explore the effect of measuring deviation and analysing morphology.
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There is no consensus on the management of low back pain in the ED and evidence suggests that these patients are likely to receive unwarranted imaging and inappropriate opioid prescription.The purpose of this study is to review the available literature pertaining to the clinical management of acute low back pain in the ED. ⋯ More high quality trials are needed to determine an evidence-based management protocol for the treatment of acute low back pain in the ED.
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Multicenter Study
20 Risk factors for admission at three, urban emergency departments in england: a cross-sectional analysis of attendances over one month.
To investigate factors associated with unscheduled admission following presentation to Emergency Departments (EDs) at three hospitals in England. ⋯ This study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED- and clinician-level behaviour relating to admission decisions. The four-hour target is a strong driver for emergency admission.
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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).