Emergency medicine journal : EMJ
-
Many emergency medicine clinical trials have struggled to recruit to 'time and target' with investigators having to make a large additional effort or extend the time for recruitment. This study was performed to describe our experience in the use of a computer 'app' to facilitate the process of research subject identification and communication between the ED staff and the research team. Key questions were: 1) Does the introduction of an iPad 'app' result in a greater rate of patient notification to the research team? 2) Which type of notification method was most used? ⋯ There was a significant increase in the immediacy of communication after the introduction of the iPad app. This occurred without a large amount of input from the research team, and seemed to be due to the staff knowing a specific location for the system and the ease of use, with the whole process taking less than 20 seconds. ED staff seemed to prefer using the 'app', as after it was introduced there was very little use of the well publicised 'research hotline' phone number. Information and communications technology can aid in the timely identification of potential research subjects in emergency care.
-
Pre-hospital triage is becoming increasingly important as Regional Trauma Networks for children are implemented in England. The low incidence of trauma in children makes pre-hospital assessment of injury severity and where to send an injured child challenging. Currently there are few validated pre-hospital triage tools for children's trauma and no consensus on which to use. We investigate performance characteristics of pre-hospital paediatric triage tools currently in use in England for identifying injured children. ⋯ From TARN data, two triage tools demonstrated acceptable under-triage rates (3% and 4%) for severe injuries but unacceptable over-triage of moderate injuries (83% and 72%). Two tools demonstrated acceptable over-triage (7% and 16%) with unacceptable under-triage (61% and 63%). Four tools demonstrated unacceptable under- and over-triage. For moderate and minor injuries, three tools demonstrated acceptable under- and over-triage rates (all 0%). The other five tools had unacceptable under-triage rates (25-100%). All eight tools had acceptable over-triage rates (1%-21%). (See tables 1 and 2) Abstract 004 Table 1Performance characteristics of pre-hospital paediatric trauma triage tools-TARN/severe injuries ToolnISS>15Undertriage rate (%)Overtriage rate (%)East Midlands701230383London472North West780Northern977South West London; Surrey1259Wessex3923Paediatric Trauma Score617Paediatric Triage Tape283946316 Abstract 004 Table 2Performance characteristics of pre-hospital paediatric trauma triage tools-Moderate/minor injuries ToolnISS>15Undertriage (%)Overtriage (%)East Midlands29344018London2511North West021Northern019South West London; Surrey509Wessex507Paediatric Trauma Score1001Paediatric Triage Tape18114753 CONCLUSION: For severe injuries, none of the pre-hospital triage tools for injured children currently used in England meet recommended criteria for over- and under-triage rates. For moderate to minor injuries, all tools achieved acceptable over-triage rates but tended to under-triage. There is an urgent need for development of triage tools to accurately risk-stratify injured children in the pre-hospital setting.
-
Minor head injuries account for a significant number of paediatric presentations to the Emergency Department. In 2007 NICE produced national guidelines to improve and standardise practice across the UK. One indication for CT head scanning is vomiting ≥3 times, even in the absence of any other risk factors. In this study we reviewed CT outcomes with specific focus on children with isolated vomiting. ⋯ This study looks at practice in our unit over a 6 year period, starting 6 months after the 2007 NICE guidelines were introduced. This clearly shows that a large percentage of CTs are being performed on children following minor head injury on the basis of vomiting alone (20.2%). The yield of this is however extremely low with only 0.96% of the patients scanned having an abnormality. There are other clinical decision making algorithms in use internationally which do not have isolated vomiting as an indicator. We believe the current NICE guideline is exposing children's' heads to unnecessary ionising radiation.
-
Appropriate activation of multi-disciplinary trauma teams improves outcome for severely injured patients, but can disrupt normal service in the rest of the hospital. Derriford Hospital uses a two-tiered trauma team activation system. The emergency department (ED) trauma team is activated in response to a significant traumatic mechanism; the hospital trauma team is activated when this mechanism co-exists with physiological abnormality or specific anatomical injury. The aim of this study was to compare characteristics, process measures and outcomes between patients treated by ED or hospital trauma teams to evaluate the approach in a UK setting and to estimate any cost savings involved. Figure 1 outlines the composition and activation criteria of the teams. Abstract 014 Figure 1(a) ED trauma team activation and (b) Hospital trauma team activation. ⋯ A two-tiered trauma team activation system is an efficient, safe and cost-effective way of dealing with trauma patients presenting to a Major Trauma Centre in the UK.
-
Emergency department crowding is recognised as a major public health problem. While there is agreement that emergency department crowding harms patients, there is less agreement about the best way to measure emergency department crowding. We have previously derived an eight point measure of emergency department crowding by a formal consensus process, the International Crowding Measure in Emergency Departments (ICMED). We aimed to test the feasibility of collecting this measure in real time, and to partially validate this measure. ⋯ We obtained 84 measurements, spread evenly across the four emergency departments. The measure was feasible to collect in real time, except for the 'Left Before Being Seen' variable. Increasing numbers of violations of the measure were associated with increasing clinician concerns. The Area under the Receiving Operator Curve was 0.80 (95% CI 0.72-0.90) for predicting crowding and 0.74 (95% CI 0.60-0.89) for predicting danger. The optimal number of violations for predicting crowding was three, with a sensitivity of 91.2 (95% CI 85.1-97.2) and a specificity of 100.0 (92.9-100). The measure predicted clinician concerns better than individual variables such as occupancy. Abstract 007 Table 1BeforeAfterResearch 'hotline'2 (3%)0Verbal10 (15%)3 (3%)Notes label21 (32%)14 (14%)iPad030 (30%)Not notified32 (49%)52 (52%)Total6599 CONCLUSION: The ICMED is easily to collect in multiple emergency departments with different IT systems. The ICMED seems to predict clinician's concerns about crowding and safety well, but future work is required to validate this before it can be advocated for widespread use.