2047 The impact of patient-to-staff incivility in the emergency department: a qualitative study
Conclusion
15 participants were recruited. Four main themes emerged in analysis of transcripts: ‘Training and Coping Strategies’, ‘Environmental Accentuation and the related Impact’, ‘Power Dynamics and Latent Factors’, and ‘Implications on Staff Resilience and Wellbeing’.
Conclusions
This study confirms that patient-to-staff incivility exists in EDs and has negative implications on patient care and staff wellbeing. Findings included: Staff reduced the impact of patient-to-staff incivility on patient safety by relating incivil incidents to patients clinical conditions; Staf...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Pow, E. A., Skinner, J. Tags: RCEM Lightning Papers Source Type: research
2033 Results of the cessation of smoking trial in the emergency department (COSTED)
Conclusion
Of 2,888 screened, 1,327 were eligible and 972 were randomised (488 control and 484 intervention). The mean age was 40, 62% were male and 72% were White British. By the time of the conference we will be able to report biochemically verified quit rates between groups (primary outcome), self-reported point prevalence by group and changes to number of cigarettes per day between the groups. The results of the economic evaluation will also be presented in terms of cost per QALY and cost per quitter.
It is feasible to implement a smoking cessation intervention in EDs with dedicated staff time to deliver the intervent...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Pope, I., Notley, C., Boyle, A. Tags: RCEM Lightning Papers Source Type: research
2348 Modelling 111 demand for primary care services using discrete event simulation
Conclusion
The simulation of the current system estimated that there would be 39,485 (95%CI 39,437—39,534) primary care contacts, 2,059 (95%CI 2,050—2,068) 999 calls and 1,137 (95%CI 1,129—1,145) avoidable ED attendances. Modifying the model to ensure a timely primary care response resulted in a mean increase in primary care contacts of 37,755 (95%CI 37,675—37,835), a mean reduction in 999 calls of 443 (95%CI 430–456) and a mean reduction in avoidable ED attendance of 39 (95%CI 29–49).
The model suggests that timely contact with a primary care service reduces 999 calls, but has minimal i...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Pilbery, R., Smith, M., Green, J., Chalk, D., OKeeffe, C. Tags: RCEM Lightning Papers Source Type: research
2351 Multicentre randomised controlled trial to assess the impact of online training on CT head interpretation performance: the simulation training for emergency department imaging 2 (STEDI2) trial
Conclusion
Results
A total of 206 participants took part in the study. The online phase showed a significant increase in pooled sensitivity (73.3% to 83%) and specificity (65.8% to 89.1%) in detecting acute abnormalities. Similar improvements were observed across all pathology subgroups. At six months post training, overall diagnostic performance remained elevated (sensitivity 80.6%, specificity 79.1%). In the prospective phase, 4,815 CT Head interpretations with linked radiology reports were recorded, and data analysis is ongoing.
Discussion and Conclusion
Dedicated training significantly improved the interpretation accu...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Novak, A., Ather, S., Martinez, J., Baron, T., Triscott, S., Davies, M., Gulati, D., Shashikala, R., Wilson, S., Keating, L. Tags: RCEM Lightning Papers Source Type: research
2046 'Call before Convey - Delivering urgent care for patients in the right place with the right clinician, first time
Conclusion
Across the pilots, 32-38% were given an alternative to ED attendance or admission. 24% avoided hospital entirely. We reduced ambulance lost minutes by 84-87 hours compared to the previous 3 week average.
Streamlining access to urgent care pathways with a single point of access benefits these patients but also those who do attend by reducing harm from overcrowding through better ED and hospital flow by offering alternatives to ED attendance and admission.
Abstract 2046 Figure 1
Abstract 2046 Figure 2
Abstract 2046 Figure 3 (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Noble, S., Flattery, P., Stonehouse, W., Barkham, A., Bates, D., Kelly, D., Storrar, W., Cruttenden-Wood, D., Housley, R., Shire, L. Tags: RCEM Lightning Papers Source Type: research
2331 A novel approach to research delivery in the emergency department
Conclusion
A three month pilot from January 2022-March 2022. One research naive ED Health Care Assistant was appointed to the role of ED Research Practitioner. Training was performed by the ED Consultant Lead for Research, which included gaining GCP certification, NIHR consent modules, and a two week period of shadowing and sign off prior to working independently. Weekly meetings were held to trouble shoot.
Over a period of 5 weeks at average 37.5hrs a week of independent practice, the ED Research Practitioner screened and recruited a total of 180 patients into 5 ED studies. None of the studies were using Investigative Med...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Messahel, S. Tags: RCEM Lightning Papers Source Type: research
2347 Traumatic brain injury coagulopathy is associated with raised intracranial pressure, 7-day progression of haemorrhage and mortality
Conclusion
237 patients had a severe ITBI. At least one coagulation abnormality was present in 66% of individuals EXTEM CA5<40mm (45%), EXTEM ML<5% (44%), d-dimer>30,000 (38%), fibrinogen<2g/L (38%) and EXTEM CT>80s (29%), aPTT (7%). Coagulation abnormalities were more common in those with more severe injuries, head AIS 5 versus AIS 3 (70% vs 62%) and BCC (81% vs 64%). The presence of any abnormality was associated with BCC (35% vs 18%), 7-day PICH (67% vs 51%) and higher 7-day mortality (21% vs 7.5%). Several admission tests were good or excellent predictors of BCC (d-dimer AUROC 0.832, fibrinogen AUROC 0.7...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Lindsay, C., Davenport, R., Brohi, K. Tags: RCEM Lightning Papers Source Type: research
2219 A prospective multi-center observational study of chest drain insertion and associated complications in Irish emergency departments
Conclusion
Data was obtained from 10 sites resulting in 133 drain insertions for 107 patients. The median age was 48 years (IQR 32,69, Range 15-90) and 74.8% (n=80) of patients were male.
On average, 1 drain was inserted per patient (IQR 1,1, Range 1-3).
The indications for drain insertion was spontaneous pneumothorax (n=60), traumatic causes (n=44), pleural effusion (n=2) and iatrogenic pneumothorax (n=1).
The overall rate of successful first attempt at drain insertion was 82.2%.
The immediate complication rate was 32%, the delayed complication rate was 41%. No association was found between drain type, indication or opera...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Legge, J., Foley, J., Umana, E., Jee, M. Tags: RCEM Lightning Papers Source Type: research
1995 Fat intravasation, fat emboli and fat embolism syndrome in adult major trauma patients with intraosseous catheters; a systematic review
Conclusion
In total, twenty-seven abstracts were identified and n=7 met full inclusion criteria (table 1). All papers were large animal translational studies. The overall risk of bias was high. Fat intravasation and fat embolisation were observed to be near-universal following IO infusion, but of uncertain clinical significance. In one study, high infusion pressures were associated with immediate cardiovascular instability which was attributed to FES. The initial IO flush appeared to be the procedure with the highest intramedullary pressure. No conclusions could be made on FES from the study methodologies.
Intraosseous ca...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Hibberd, O., Ellington, M. Tags: RCEM Lightning Papers Source Type: research
2163 Enablers and barriers to the provision of end-of-life care in Irish emergency departments. A national survey
Conclusion
Of 694 potential respondents, 311 (44.8%) had completed surveys. The majority (62%) were between 25 – 35 years of age with 60% having < 5 years’ experience in EM. 55.8% were male. Clinicians with >10 years’ experience in EM had higher agreement regarding comfort discussing EOL with patients and families than those with <5 years’ experience (78% vs 39%) (p<0.001). Regarding clinical management, 31.9% were comfortable commencing subcutaneous medications. 23.5% agreed that appropriate rooms are allocated for EOL patients, with just 11.6% agreeing that the physical environment is ...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Foley, J., Umana, E., Mulcaire, J., Saeed, S., Browne, L., Keane, O., Jane O Leary, M., Deasy, C. Tags: RCEM Lightning Papers Source Type: research
2343 Towards a cost-effective repeatable training model for HALO procedures: a pilot study of low-fidelity, user-resettable peer-directed simulation for EM trainees
Conclusion
Thirteen ST3-ST6 EM trainees South-East Scotland participated in a one-day training course using simulation training tools prepared as outlined in table 1. Pre-course surveys showed most trainees had not practised most procedures in the preceding year and all trainees had at least one procedure that they had never seen or simulated. Across all procedures, the average confidence of trainees improved from 3.75 (pre-course) to 5.7 (post-course) on a 7-point Likert scale. Pre-course, all trainees reported at least two procedures where self-assessed confidence was 1 or 2, whereas after the course no procedures were r...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Day, D., Wood, J., Bonhomme, P., Forteath, J. Tags: RCEM Lightning Papers Source Type: research
2061 The EDUCATe study: a mixed method study investigating the effect that emergency department (ED) crowding has on training
Conclusion
Systematic Review: 22 papers were identified. None were UK based. Four semantic themes were identified: ‘More patients does not mean more procedures’, ‘Crowding leads to less feedback’, ‘Good training is more than the training environment’, ‘More efficient, means less education’.
Quantitative: There was a significant correlation between the percentage of waits under four hours and overall satisfaction (r=0.23, P<0.001), workload (r=0.24, P<0.001) and adequate experience scores (r=0.26, P<0.001).
Qualitative: We conducted 13 focus groups involving 67 EM tr...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Chatha, R., Roy, S., Reed, M. Tags: RCEM Lightning Papers Source Type: research
2152 Opt out blood borne virus (BBV) testing in emergency departments (EDs) in areas
Conclusion
By March 2023, 33 EDs had implemented HIV testing, 25 HCV and 19 HBV. From April 2022 through March 2023 in participating sites there were 1,384,378 ED attendances with blood tests. 853,015 HIV, 346,041 HBV and 452,284 HCV tests were performed. In March 2023, median test uptake was 62% (HIV), 57% (HBV) and 62% (HCV).
ED opt-out BBV testing identified 2002 people who were newly diagnosed (343 HIV, 1190 HBV, 484 HCV) and 473 who were previously diagnosed but not in care (HIV 209, HBV 156, HCV 108). Initial linkage to care was 339/552 (61%) for HIV (268/343 (78%) for new HIV diagnoses), 329/1346 (24%) for HBV and 2...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Hill-Tout, R., Hunter, L., Young, E., Mizzi, O., Sullivan, A., Waters, L., Mackie, N., Barber, T. J., McQuillan, O., Macdonald, D., Hindle, S. Tags: Emergency Medicine (General) Source Type: research
2039 'Its seriously affecting our mental health: the impact of emergency department crowding on the well-being of emergency medicine trainees
Conclusion
Between October 2022 and March 2023, we conducted 13 focus groups involving 67 EM Trainees in the United Kingdom. We identified three themes. The first, Risky Business, addresses trainees’ anxieties over patient safety and professional risk: ‘it [crowding] makes our department unsafe’; ‘[crowding] forcibly changes us to change our take on risk.’ The Pressure Cooker, considers how crowding feels in real time for trainees referring to both physical/sensory overload and daily frustration: ‘it feels out of control. Because you’ve got patients in, well, everywhere.’ Fin...
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Roy, S., Chatha, R. Tags: Emergency Medicine (General) Source Type: research
2106 Salbutamol for analgesia in renal colic
Conclusion
Formal statistical analysis of the results is pending, but provisional results suggest a trend towards benefit that does not reach the pre-determined levels of clinical or statistical significance. Full analysis will be available in time for the conference.
Abstract 2106 Figure 1 (Source: Emergency Medicine Journal)
Source: Emergency Medicine Journal - November 28, 2023 Category: Emergency Medicine Authors: Johnson, G., Tabner, A., Mason, S., Fakis, A., Game, F., Sherman, R. Tags: Emergency Medicine (General) Source Type: research
