Emergency medicine journal : EMJ
-
ANPs are autonomous practitioners and form a core part of many Emergency Departments (EDs). However, there is little data on their role in major trauma and deployment within MTTs. The project aimed to explore clinicians' views on the role of ANPs within MTTs in Major Trauma Centres (MTCs). ⋯ The project data shows that, although ANPs are now part of many ED teams and are increasingly taking on extended autonomous ED roles, there is still a level of uncertainty and lack of clarity on their role as part of an MTT. There needs to be a national policy outlining and standardising ANP training, qualification and utilisation within the ED as well as a robust programme to promote their education, training and skills, to optimise their deployment.
-
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.
-
EM and Paediatrics are specialties at the forefront of the move towards 24/7 consultant delivered care. This shift has been partly driven in EM by trauma pathways, as well as aiming to provide better patient care, and to support training.Chelsea and Westminster Paediatric ED sees around 34,000 children a year. It is not a major trauma centre. In May 2013, 6 consultant paediatricians were appointed to be resident in PED at night. This study evaluates the PED team's perceptions of the impact of this change on the quality of clinical care, training and job satisfaction, and of trainee's views of undertaking a similar role in the future. ⋯ PED staff at C&W have welcomed the move to 24/7 consultant delivered care. The core aims - to improve the efficiency and proficiency of patient care, and to better utilise out of hours working as a training opportunity - are being achieved. Concerns remain about disempowerment of senior trainees and the perceived impact of night shifts in a consultant role on work-life balance. To sustain this model, trainees must be convinced of the benefits of becoming a resident consultant upon their own career.
-
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.
-
Circulating leucine-rich α-2-glycoprotein-1 (LRG1) protein has been found in the plasma and urine of patients with acute appendicitis (AA) and may be useful for diagnosis. The present study aimed to investigate whether circulating LRGI mRNA levels also improve the early diagnosis of AA. ⋯ This research study was supported by a Direct Grant for Research from the Chinese University of Hong Kong (reference no.: 2041642) (HK$18000).