Emergency Care

Unscheduled Emergency Department Revisits in a Tertiary Care Hospital – A Quality Improvement Study (2020)

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Type of publication:
Journal article

Author(s):
Mohammed Nazim Kt, Nithyanand M, *Dodiy Herman, Sourabh M Prakash, Shahana Sherin, *Benita Florence

Citation:
Indian Journal of Clinical Practice, Vol. 30, No. 10, p. 931-933, March 2020

Abstract:
Patients who revisit the emergency department (ED) within 72 hours constitute an integral key performance indicator of quality emergency care. The number of patient footfalls to the ED in a tertiary care hospital in a rural area of a district in India from December 1, 2018 to May 31, 2019 was 7,808 and the average re-attendances recorded during that period was 0.32%. With increase in the number of healthcare setups, rising standards of the healthcare industry and increase in the expectations of the population visiting hospitals, ED re-attendance within 72 hours has been considered as an important key performance indicator of emergency patient care. The early ED revisit rate at this tertiary care hospital for 6 months was found to be only 0.32% (at an average of 4 cases per month). This is less when compared to many other international hospitals where it ranges from 1.5% to 2.5%. Since readmissions cause unnecessary overcrowding in ED, it would be best if each hospital evaluated their rate of readmission and its causes, and then tried to address the problems found. This can be effective in better management of ED, reduction of treatment costs, increasing patient satisfaction and prevention of ED overcrowding.

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Comprehensive geriatric assessment in the emergency department (2020)

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Type of publication:
Journal article

Author(s):
*Harding, Siobhan

Citation:
Age & Ageing; Nov 2020; vol. 49 (no. 6); p. 936-938

Abstract:
Completing comprehensive geriatric assessments (CGA) for frail patients admitted to acute hospitals has well-established benefits and is advocated by national guidelines. There is high-quality evidence demonstrating an association between inpatient CGAs and the patient being alive and community-dwelling at 12-month follow-up. However, less well-known is the effectiveness of CGAs conducted within the emergency department (ED), with the primary purpose of facilitating admission avoidance, on reducing 30-day reattendance or readmission. This commentary provides an overview of five studies that measure the impact of conducting an ED-CGA on subsequent secondary care attendance. Two randomised-controlled trials, one case-matched cohort study and two quasi-experimental pre- and post-intervention studies were reviewed. The studies reported variable success in preventing subsequent secondary care use. No studies meeting the criteria had been conducted within the UK, affecting generalisability of the findings. There is no clear evidence that conducting a CGA within ED reduced reattendances or admissions 30 days post-discharge. The existing evidence base is methodologically and clinically heterogeneous and is vulnerable to multiple sources of bias. Further research is needed to understand whether screening to identify target populations or whether increased intensity of interventions delivered improves outcomes. ED-CGA may not have a beneficial effect on cost improvement or service delivery metrics, but it may have positive outcomes that are of high importance to the patients. This warrants further study.

Human factors: role of cognitive and social skills in clinical practice (2017)

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Type of publication:
Journal article

Author(s):
*Thomas Wood

Citation:
Emergency Nurse; Mar 2017; vol. 24 (no. 10); p. 18-19

Abstract:
Last September, a team from our trust was chosen by the Resuscitation Council UK (RCUK) to represent the UK in a simulation-based cardiopulmonary resuscitation (CPR) competition at the annual European Resuscitation Congress, in Iceland.

Improving Oxygen Delivery on Wards (2017)

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Type of publication:
Post on the Academy of Fab NHS Stuff website

Author(s):
*Nawaid Ahmad

Full text:
Oxygen (O2) is a drug and should be prescribed if administered to a patient. The British Thoracic Society has published guidelines on emergency oxygen delivery and a recent audit showed that out of 100 patients on O2, 42 did not have a written order.

Cycle 1: 2 FY1s collected data on O2 prescription and delivery on the respiratory ward at the Princess Royal Hospital, a part of the Shrewsbury and Telford Hospital NHS trust. At our trust, O2 is prescribed on the patient’s drug chart and saturation targets are mentioned on the prescription. 61% patients on O2 had a written order and 58% had the target mentioned along with the prescription.

 

Cycle 2: After the data collection, we started doing face to face education about O2 prescription in the acute medical unit and the respiratory ward. We targeted the Drs, nurses and the health care assistants. This was done for a week. A prompt card was developed (Pic 1) which was attached next to the O2 delivery system on the wall to prompt nurses to get the O2 prescribed. A card mentioning O2 targets was attached to the board above the patients bed. Another data collection was done a month later which showed that O2 prescription rates had gone up to 79% and 77% had a target mentioned.

Cycle 3: This involved forming an O2 team comprising the 2FY1s, one staff nurse and one healthcare assistant from the ward. They are called ‘O2 Ninjas’ and wear a badge (Pic 2). Their main role now will be to continue the education of all staff, each at their own level. We plan to roll out an educational programme through the trust staff education department and teach using scenarios. The idea is to spread this process to other specialties within the trust. Work is on going.

Our Motto: “ An idea needs to become a movement, for change to happen”

Link to more details or full-text: http://fabnhsstuff.net/2017/05/27/improving-oxygen-delivery-wards/

Complications of airway management and how to avoid them (2014)

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Type of publication:
Journal article

Author(s):
*Chandra P., Frerk C.

Citation:
Trends in Anaesthesia and Critical Care, December 2014, vol./is. 4/6(195-199)

Abstract:
Major complications of airway management are rare, but complications causing minor patient harm are common. Our aim should be to manage our patients airways without causing any injury. Complications arise from technique failure, direct and indirect trauma and as a consequence of cardiovascular instability associated with our airway management techniques. Avoiding complications depends on planning (choosing the lowest risk procedure & having a well thought through strategy), providing optimal conditions, using the best available equipment and using the optimum technique for all practical procedures. This review provides an overview of the technical and non-technical aspects of airway management to help minimise the incidence of complications.

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Extrication time prediction tool (2015)

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Type of publication:
Journal article

Author(s):
Nutbeam, Tim, *Fenwick, Rob , Hobson, Charles, Holland, Vikki, Palmer, Michael

Citation:
Emergency medicine journal : EMJ, May 2015, vol. 32, no. 5, p. 401-403 (May 2015)

Abstract:
Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for extrication or the factors which affect this time. To derive a tool to predict the time taken to extricate patients from MVCs. A prospective, observational derivation study was carried out in the West Midland Fire Service's metropolitan area. An expert group identified factors that may predict extrication time-the presence and absence of these factors was prospectively recorded at eligible extrications for the study period. A step-down multiple regression method was used to identify important contributing factors. Factors that increased extrication times by a statistically significant extent were: a physical obstruction (10 min), patients medically trapped (10 min per patient) and any patient physically trapped (7 min). Factors that shortened extrication time were rapid access (-7 min) and the car being on its roof (-12 min). All these times were calculated from an arbitrary time (which assumes zero patients) of 8 min. This paper describes the development of a tool to predict extrication time for a trapped patient. A number of factors were identified which significantly contributed to the overall extrication time.

Link to full-text: http://emj.bmj.com/content/32/5/401.abstract

The stages of extrication: A prospective study (2014)

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Type of publication:
Journal article

Author(s):
Nutbeam T., *Fenwick R. , Hobson C., Holland V., Palmer M.

Citation:
Emergency Medicine Journal, December 2014, vol./is. 31/12(1006-1008), 1472-0205;1472-0213 (01 Dec 2014)

Abstract:
Background: Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for the various stages of extrication. Objective: To report the time taken for the various stages of extrication. Methods: A prospective, observational study carried out in the West Midland Fire Service’s metropolitan area. Time points related to extrication were collected ’live’ by two-way radio broadcast. Any missing data were actively gathered by fire control within 1 h of completion of extrication. This paper reports an interim analysis conducted after 1 year of data collection following a 3-month run-in and training period: data were analysed from 1 January 2011 to 31 December 2011 inclusive. Results: During the study period 228 incidents were identified. Seventy-nine were excluded as they met the predetermined exclusion criteria or had incomplete data collection. This left 158 extrications that were suitable for analysis. The median time for extrication was 30 min, IQR 24-38 min. Conclusions: In patients requiring extrication following an MVC a median time of 8 min is typically required before initial limited patient assessment and intervention. A further 22 min is typically required before full extrication. Prehospital personnel should be aware of these times when planning their approach to a trapped patient.

Link to more details or full-text: http://emj.bmj.com/content/31/12/1006.abstract

 

Minimising negative ankle and foot X-rays in the Emergency Department-Are the Ottawa ankle rules good enough? (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, *Leaman A, *Phung W

Citation:
Injury, 12 2014, vol./is. 45/12(2002-4), 0020-1383;1879-0267 (2014 Dec)

Abstract:
OBJECTIVES: To review fracture rates in patients who had X-rays of either the ankle or foot or both in the Emergency Department of a district hospital.METHOD: A retrospective review of 2589 Emergency Department patients who had X-rays of the ankle or foot or both over a 12-month period.RESULTS: There were 1199 ankle X-rays taken of which 193 (16%) showed a significant fracture. There were 1081 patients who had a foot X-rayed of which 165 (15%) showed a significant fracture. Younger patients had more X-rays but older patients were more likely to have a fracture. There were 309 patients who had an ipsilateral ankle and foot X-rayed at the same time, and of these 42 (14%) showed one fracture and just two (0.6%) showed a significant fracture of both ankle and foot.CONCLUSIONS: The approach to X-raying ankle and feet in this study is probably widespread, and Ottawa Ankle Rules still seem to be of limited use in diagnosing fractures. This low yield of positive X-ray could be accepted or a more sophisticated ankle rule introduced. Copyright 2014 Elsevier Ltd. All rights reserved.

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The use of a remifentanil infusion and elective tracheostomy to avoid ventilation in a patient with tetanus (2014)

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Type of publication:
Journal article

Author(s):
*Redshaw C., *Slater R.

Citation:
Journal of the Intensive Care Society, April 2014, vol./is. 15/2(161-163), 1751-1437

Abstract:
Tetanus is very rare in developed countries but the mortality is still high in the elderly population despite access to intensive care medicine. Death can frequently occur from secondary complications due to the need to sedate, paralyse and ventilate patients in an effort to control spasms. We describe the case of a 77-year-old man with tetanus in whom we successfully controlled tetanic spasms with a remifentanil infusion where conventional treatment failed, thus preventing the need for mechanical ventilation. We also describe the use of an elective percutaneous tracheostomy which was performed for airway protection. This prevented him from developing pneumonia from aspirating the excess secretions caused by the autonomic features of tetanus.