Emergency medicine journal : EMJ
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The NICE head injury guidelines recommend a different approach in the management of head injury patients. It suggests that CT head scan should replace skull x ray (SXR) and observation/admission as the first investigation. We wished to determine the impact of NICE on SXR, CT scan, and admission on all patients with head injury presenting to the ED setting and estimate the cost effectiveness of these guidelines, which has not been quantified to date. ⋯ The implementation of the NICE guidelines led to a two to fivefold increase in the CT head scan rate depending on the cases and baseline departmental practice. However, the reduction in SXR and admission appears to more than offset these costs without compromising patient outcomes.
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Multicenter Study
Emergency department organisation of critical care transfers in the UK.
Transport of the critically ill patient to or from the emergency department (ED) is a frequent occurrence. This study was designed to determine whether UK EDs currently have appropriate equipment, monitoring, staff training systems, and processes of care for transportation of the critically ill patient. ⋯ This study highlights inadequacies in provision of equipment and monitoring during interhospital transfer from the ED. Training and processes of care for transport of the critically ill are also suboptimum. Many departments are currently reviewing these processes to formalize and improve transfer training procedures and protocols.
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Multicenter Study
Application of variable life adjusted display (VLAD) in early detection of deficiency in trauma care.
Early detection of deficient care is an increasingly important element of trauma audit. We aimed to assess the feasibility and demonstrate the use of a variable life adjusted display (VLAD) in trauma audit. Data from the Trauma Audit and Research Network database of Sheffield Teaching Hospitals NHS Trust were used to create a VLAD. ⋯ The first 2 months of this period were characterised by a downward trend in the line, which may indicate suboptimum performance and provides an example of a trend that would prompt detailed review. The VLAD chart is a potentially useful "early warning" system for poor performance in trauma care. Further work should to be carried out to evaluate VLAD prospectively as an audit tool, perhaps involving comparison of VLAD charts from different institutions.
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Multicenter Study
Reliability of ophthalmic accident and emergency referrals: a new role for the emergency nurse practitioner?
Annual attendances at the accident and emergency (A&E) department of St Bartholomew's and The Royal London NHS Trust exceed 100,000 people of which 6% are ophthalmic. This study evaluated the accuracy of eye referrals from A&E senior house officers (SHOs) and emergency nurse practitioners (ENPs) and the impact any inaccuracies may have had on out of hours work. ⋯ This study found ENPs to be more accurate than A&E SHOs in history taking, recording visual acuity, describing ocular anatomy, and making provisional diagnoses. A significant reduction in out of hours ophthalmic workload may be achieved in the authors' unit if ENPs were to see all eye emergencies.
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Multicenter Study
Targets and moving goal posts: changes in waiting times in a UK emergency department.
To describe changes in the case mix, demographics, waiting times (WTs; time from arrival in the emergency department (ED) until seen by a clinician) and treatment times (TTs; time from seeing a clinician until leaving the ED) of adult patients presenting to the EDs in Sheffield, UK, between 1993 and 2003. ⋯ The demographics, case mix, and waiting times of patients presenting to EDs in Sheffield changed considerably over an 11 year period. There is evidence that the service for minor case patients improved slightly at the end of the period studied, but this is possibly at the expense of a deteriorating experience for major case patients.