Emergency medicine journal : EMJ
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To survey the attendance of patients presenting with a head injury (HI) at a UK emergency department (ED), identifying numbers, types of service and referral routes; to survey subsequent service use and to highlight the challenges in service planning and identifying which patients may potentially benefit from follow-up/rehabilitation input. ⋯ These study findings highlight the difficulties in identifying patients who would benefit from follow-up, in particular after mild HI. Our study findings will form the basis of a long-term follow-up study.
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To assess staff knowledge of Centers for Disease Control (CDC) guidelines, attitudes and barriers towards emergency department (ED) HIV testing before and after implementing an ED rapid HIV testing programme (EDRHTP). ⋯ Overall support for ED HIV testing increased after establishment of a rapid testing programme.
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Unplanned emergency re-attendance within seven days is a national quality indicator set at 1-5% by the Department of Health. Newham University Hospital (NUH), one of three hospitals forming Barts Health NHS Trust, recorded rates exceeded this target in October 2012, with a spike at 10% in April 2013 prompting investigation of the root cause. A review was carried out to determine the potential causes and provide solutions. ⋯ We discovered that different definitions across the three Barts Health ED sites were being applied. Following presentation of results a unified definition was drawn up. Coding error was the main reason for our blip of 10% in April 2013 and was rectified by education of reception staff. We have now instigated bimonthly review of 'frequent fliers' so that case-management plans can be implemented with relevant Trust and community teams. This review has highlighted several issues contributing to inaccurate figures which are likely to apply to many emergency departments and has shown how useful it is to qualify as well as quantify unplanned returns.
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Intraosseous (IO) access is becoming increasingly accepted in adult populations as an alternative to peripheral vascular access, however there is still insufficient evidence in large patient groups supporting its use. ⋯ Intraosseous access can be used for the infusion of a wide variety life saving medications, quickly, easily with low complication rates. This highlights its valuable role as an alternative method of obtaining vascular access, vital when resuscitating the critically injured trauma patient.
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Until January 2014, The National Institute of Clinical Excellence (NICE) Head Injury Guidelines (CG56) issued to clinicians advised anticoagulated patients with a head injury should only receive CT imaging if loss of consciousness or amnesia was experienced. These guidelines have recently been updated to advise CT imaging for all anticoagulated patients. We aimed to investigate how closely the 2007 guidelines were followed and whether the guideline update will mean considerable changes to existing practice. ⋯ The majority of patients that fulfilled the NICE 2007 criteria did have CT imaging performed (82%). However, a significant number of patients not fulfilling the criteria also had CT imagining performed. Overall, 60% of the anticoagulated patient cohort had CT imaging, this will need to increase considerably to follow the updated NICE 2014 guidelines of CT imaging for all patients.