Evaluating a new emergency department avoidance service for older people: patient and relative experiences
Conclusion
Our findings suggest that ED admission avoidance programmes may be an acceptable alternative treatment for older people requiring urgent care, potentially benefiting both public health systems and user experience. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Greene, L., Lane, R., Crotty, M., Whitehead, C., Potter, E., Bierer, P., Laver, K. Tags: Open access Original research Source Type: research
Emergency department staff views of NHS 111 First: qualitative interview study in England
Discussion
While remote preassessment of patients before they present at ED is attractive, existing triage and streaming systems based on acuity, and staff views about the superiority of clinical acumen, are likely to remain barriers to the effective use of 111 First as a demand management strategy. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: MacLellan, J., Turnbull, J., Prichard, J., Pope, C. Tags: Open access Original research Source Type: research
Laceration just proximal to the proximal nail fold of the great toe
Clinical introduction An 11-year-old boy lying in bed caught his right great toe nail on the blanket as the blanket was pulled away, forcing plantar flexion and traction injury to the toe, resulting in a dorsal transverse laceration just proximal to the proximal nail fold, exposing the proximal end of the nail plate (figure 1A). There was no deformity of the great toe. Radiographs of the great toes were taken (figure 1B). Question How would you manage this injury? Wound care by daily dressing and oral antibiotics Suturing of the laceration and oral antibiotics Closed reduction of the fracture and K-wire fixation Wound expl...
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Lui, T. H., Ng, J. P., Pan, X. Tags: EMJ Image Challenge Source Type: research
Effect of removing the 4-hour access standard in the ED: a retrospective observational study
Conclusion
Lifting the 4-hour access standard reporting was associated with a drop in short-stay admissions to the hospital. However, it was also associated with an increase in the average length of stay in the ED. Our study also suggests that the removal of the 4-hour standard does not impact all patients equally. While certain patient groups such as those Majors (Ambulant) patients with less severe issues might have benefited from the removal of the 4-hour access standard by avoiding short-stay hospital admissions, the average length of stay in the ED seemed to have increased across all groups, particularly for older and...
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Momesso, T., Gokpinar, B., Ibrahim, R., Boyle, A. A. Tags: Original research Source Type: research
"You may think that the consultants are great, and they know everything, but they dont": exploring how new emergency medicine consultants experience uncertainty
Conclusion
This study highlights the need for new consultants to have psychologically safe, reflective spaces to think through uncertainties with others. This appears to reduce uncertainty, and also act as a source of feedback. The study adds to the existing calls to address uncertainty more explicitly in training, and challenge the expectations of certainty that exist within medicine. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Collini, A., Alstead, E., Knight, A., Page, M. Tags: Editor's choice Original research Source Type: research
Stuck in the middle: the liminal experiences of entering practice
Most physicians can recall the palpable stresses of entering practice, from the pressures of figuring out new systems, to worries of how others will view their expertise, to experiencing the weight of responsibility for important clinical decisions. Recent work by Collini et al1 nicely illustrates these experiences among new emergency medicine consultants, framing the transition from training to practice as a liminal period. Liminal experiences such as these give individuals opportunities to construct and reconstruct how they view themselves as professionals through an interplay between the identities they seek to present,...
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Watsjold, B. K., Griffith, M., Ilgen, J. S. Tags: Commentary Source Type: research
Primary survey: Highlights from this issue
Welcome to the September 2023 issue of the Emergency Medicine Journal. This month we have a trio of papers on health services: a qualitative study exploring views of NHS 111 from the perspective of the Emergency Department (ED); a retrospective study looking at the impact scrapping the UK 4 hour process target; and an evaluation of an innovative service to try and avoid ED attendances for older adults. We also cover a range of topics from the experience of feeling uncertain as a consultant to fluid biomarkers of traumatic brain injury, a look at the use of isopropyl alcohol as an anti-emetic and a survey of current practic...
Source: Emergency Medicine Journal - August 23, 2023 Category: Emergency Medicine Authors: Body, R. Tags: Highlights from this issue Source Type: research
Flow
A newspaper on my neighbour’s stoop declares a Historic Drought in New England, but in my hospital’s basement, water leaks from the ceiling. A yellow sign warns of the "Wet Floor" with a cartoon man in free fall, seconds away from his own trip to the ED. In our triage area, a pool of patients stretches out on beds that extend down the hallway. Beyond them, in the collective treatment area, is a flood. My attending likes to start shifts by asking about our daily goals. An intern says he wants to complete sepsis bundles; a second-year is shooting for more bedside ultrasounds. As the senior resident, I say I&rsquo...
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Lalley, A. Tags: The view from here Source Type: research
Abstracts from international emergency medicine journals
Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Production, E. Tags: Global emergency highlights Source Type: research
Journal update monthly top five
This month’s update is by a team from Emergency Medicine Research in Oxford (EMROx). We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as: Worth a peek—interesting, but not yet ready for prime time. Head turner—new concepts. Game changer—this paper could/should change practice. Door-to-furosemide time and clinical outcomes in acute heart fa...
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Glover, S. J., Metcalfe, D., Erasu, V., Panduro, T., Gibbs, W., Paul, I., Novak, A., Shanahan, T. A. G. Tags: Journal update Source Type: research
Why is pain management so difficult in the Emergency Department? A systematic mixed studies review and thematic synthesis of staff perceptions of enablers and barriers to pain management within the Emergency Department
Conclusions
Overly focusing on environmental barriers as principal barriers to pain management may mask underlying beliefs that hinder improvements. Improving feedback on performance and addressing these beliefs may enable staff to understand how to prioritise pain management. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Sampson, F. C., Johnson, M. Tags: Systematic review Source Type: research
Sudden-onset flank pain
Clinical Introduction A 36-year-old woman presented to the ED with sudden-onset right flank and iliac fossa pain that began 3 hours prior to arrival, associated with vomiting and diarrhoea. She denied dysuria or fever. Her observations were within normal range. Examination of her abdomen revealed right flank tenderness (figure 1). A point-of-care ultrasound was obtained. Question What is the likely diagnosis? Ruptured ectopic pregnancy. Renal haematoma. Ruptured ureteral calyx. Ruptured appendix. Answer: C The ultrasound shows moderate hydronephrosis with right upper quadrant free fluid (figure 2). This is suspicious of ur...
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Chopra, K., Adams, T., Matthies, A. Tags: EMJ Image Challenge Source Type: research
Patient and public involvement in emergency care research: a scoping review of the literature
Conclusion
Relatively few emergency care studies comprehensively describe PPI. Opportunity exists to improve the consistency and quality of reporting of PPI in emergency care research. Further research is required to better understand the specific challenges for implementing PPI in emergency care research, and to determine whether emergency care researchers have adequate resources, education and funding to undertake and report involvement. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Muir, R., Carlini, J., Crilly, J., Ranse, J. Tags: Systematic review Source Type: research
Factors associated with persistent multiyear frequent emergency department use
Conclusion
Differences exist between persistent and non-persistent frequent ED users that should be considered when implementing interventions designed to improve health outcomes and curtail healthcare expenditures generated by the broad population of frequent ED users. (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Giannouchos, T., Pirrallo, R., Ukert, B. Tags: Original research Source Type: research
Feasibility of using a community pharmacist within a Childrens Emergency Department
Given increasing demand and constraints in ED staffing, pharmacists are a potential resource to expand the Children’s Emergency Department (CED) workforce. We determined whether a pharmacist in the CED could independently safely discharge eligible patients and whether the role would be acceptable to families. A single community non-prescribing pharmacist was recruited to participate in CED care during weekdays (10:00–18:00) over a 12-week period (17 November 2021 to 11 February 2022, excluding bank holidays). A set of criteria for referral to a non-prescribing pharmacist were determined based on existing criter...
Source: Emergency Medicine Journal - July 24, 2023 Category: Emergency Medicine Authors: Patel, S., Khiroya, M., Roland, D. Tags: Research letter Source Type: research
