Emergency Care

Transfer Team PRH ED: Safe and Timely Urgent and Emergency Care Campaign (2026)

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Type of publication:

Service improvement case study

Author(s):

*Deb Archer, *Laura Wild

Citation:

SaTH Improvement Hub, April 2026

SMART Aim:

To transfer 100% of patients out of the Emergency Department within 30 minutes of bed being declared during March 2026. Mean ambulance handover <2 hours during March 2026.

Link to PDF poster

Improvement in the Time to Analgesia in Suspected Long Bone Fractures in the Emergency Department (ED) (2026)

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Type of publication:

Service improvement case study

Author(s):

*Dr S.Arshad, *Dr A.Sullivan Supervised by Dr A.Yasin

Citation:

SaTH Improvement Hub, April 2026

SMART Aim:

Achieve a reduction in the time from registration to analgesics being administered within a 30-minute target in ED over 6 weeks. This will improve pain scores whilst waiting to see a clinician to review their pain and escalate according to the analgesic ladder

Link to PDF poster

Safe and Timely Urgent and Emergency Care Campaign - SAU Extension of Hours (2026)

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Type of publication:

Service improvement case study

Author(s):

*Nick Jones, *Kelly Toothill

Citation:

SaTH Improvement Hub, April 2026

SMART Aim:

For the month of March as part of the UEC improvement campaign. LOS in ED < 24 hours. Time in ED for patients that move to SAU

Link to PDF poster

ReSPECT Documentation (2026)

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Type of publication:

Service improvement case study

Author(s):

*Dr Sultan Ahmed

Citation:

SaTH Improvement Hub, March 2026

SMART Aim:

To increase the proportion of A&E patients with a documented ReSPECT form at initial triage or early assessment from 10 % to 0-60 % by 31/12/2026) using a nursing-led, triage-focused intervention.

Link to PDF poster

Arteriolar Collapse and Haemodynamic Incoherence in Shock: Rethinking Critical Closing Pressure (2026)

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Type of publication:

Journal article

Author(s):

*Miller, Ashley; Rola, Philippe; Spiegel, Rory; Haycock, Korbin.

Citation:

Journal of Personalized Medicine. 16(2), 2026 Feb 01.

Abstract:

Critical closing pressure (CCP) and the vascular waterfall have long been used to explain perfusion failure in shock, yet their physiological meaning has been inconsistently interpreted. CCP is frequently treated as a continuous downstream pressure and inserted into formulas such as mean arterial pressure (MAP) – CCP, implying that a collapse threshold behaves like an opposing pressure even when vessels remain open. Drawing on classical vascular mechanics, whole-bed flow studies, microvascular models, and contemporary clinical physiology, we show that this interpretation is incorrect. Tone-dependent arteriolar collapse does not behave as a Starling resistor: CCP is a threshold at which smooth-muscle tension exceeds intraluminal pressure and vessels close, not a pressure governing flow in patent vessels. Perfusion becomes heterogeneous because different vascular beds reach their collapse thresholds at different pressures (via excessive tone, extrinsic compression, or profound hypotension), disconnecting macro-haemodynamics from microcirculatory flow. This explains why systemic variables such as MAP and systemic vascular resistance (SVR) may appear adequate even while tissues are under-perfused, a phenomenon now termed haemodynamic incoherence. Reframing CCP as a binary collapse threshold resolves longstanding contradictions in the literature, clarifies why MAP-centred targets often fail, and unifies the behaviour of shock states within a four-interface model of circulatory coupling. Therapeutically, the aim is not to "restore a waterfall" but to reopen closed vascular territories by lowering excessive tone, relieving external pressure, or raising truly low arterial inflow. This mechanistic reinterpretation provides a more coherent, physiologically grounded approach to personalised perfusion management in critical illness.

DOI: 10.3390/jpm16020078

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Evaluation of the Impact of an Emergency Focused Ophthalmology Teaching Course on the Confidence of Emergency Doctors (2024)

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Type of publication:

Conference abstract

Author(s):

*Mahon E.J.E.; *Ahnood D.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2024. Belfast United Kingdom. 38 (pp 142), 2024. Date of Publication: 01 Nov 2024.

Abstract:

Introduction: It has been established that doctors in Accident and Emergency (A&E) departments have minimal confidence in managing ophthalmic presentations (Murray, P., et al. Eye 2016; https://doi.org/10.1038/eye.2016.99). The lack of confidence to accurately assess and manage patients presenting to A&E will likely have an impact on the quality of patient management and the quality of referrals made to eye casualties. We hypothesize that a teaching course covering core emergency ophthalmic examination and management skills will improve attendees' confidence in these areas. Method(s): Doctors currently or potentially working in A&E were invited to attend a teaching session where they would rotate between three stations which included slit lamp examination, simulation of foreign body removal and managing chemical eye injury. Teaching was delivered in small groups, with experienced staff leading the sessions. Pre-and post-course questionnaires included a 1-5 Likert scale self-assessment confidence rating on the three areas of teaching and overall confidence. Result(s): The course was attended by 13 doctors, with 46% of attendees being junior emergency specialty trainees or trainee equivalents, 38% were foundation doctors and 15% were A&E staff grade doctors equivalent to registrar. 92% of those who attended reported less than one hour of slit lamp examination time. Overall, the attendees' overall confidence went from 1.9 to 4.2 on the Likert scale. Conclusion(s): Our findings demonstrate a lack of confidence from the A&E doctors in assessing patients presenting with ophthalmic issues, with an overall confidence score of

DOI: 10.1038/s41433-024-03254-3

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Emergency hospital admissions while on an elective waiting list in England: an observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

James, Anthony P; Gray, William K; *Cheetham, Mark J; Eardley, Ian; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

INTRODUCTION: Patients awaiting elective procedures often have conditions that carry a risk of medical emergencies. This study quantifies the extent and variation of emergency hospital admissions during the waiting period across selected specialties and procedures.

METHODS: Data from the NHS England Waiting List Minimum Dataset linked to the Secondary Uses Service hospital admissions data set from 1 January 2022 to 31 December 2023 was analysed. Emergency admissions occurring while patients awaited treatment were identified and categorized from 'very likely' related to the index condition or its recognized co-morbid risks-and potentially avoidable through definitive treatment-through to 'unrelated'.

RESULTS: In 2023 some 2 093 789 waits (both incomplete and complete) were recorded across 41 selected procedures spanning 11 specialties. Over a combined waiting time of 33 832 790 days, 69 322 emergency admissions occurred, accounting for 535 806 bed days. The highest emergency admission rates per 52 weeks waiting were observed for urinary stent procedures (0.71), endoscopic retrograde cholangiopancreatography (0.63), and urinary catheter care (0.55). Nine procedures had more emergency bed days during the wait than elective bed days post-treatment, with the highest emergency/elective bed day ratios for ureteric stones (4.59), colonoscopy (2.80), and ablation/cardioversion (2.05).

CONCLUSION: A substantial number of patients on elective waiting lists are being admitted as emergencies during their wait, placing a burden on emergency care that would be avoided through more timely treatment. The variation in risk between specialties and pathways requires further prioritization strategies that mitigate patients' risk of associated harm, acting both within and across waiting lists, specialties, and organizations.

DOI: 10.1093/bjs/znaf292