Emergency medicine journal : EMJ
-
To investigate the performance characteristics in children with moderate and minor injuries of prehospital paediatric triage tools currently in use in England for identifying seriously injured children. ⋯ Three tools (East Midlands, North West and Northern) demonstrated acceptable over- and under-triage rates in this population of minor and moderately injured children. All tools reached recommended standards for over-triage, but the majority favoured under-triage.
-
Patients with chronic conditions account for a third of emergency hospital admissions, many of which are not life-threatening and result in unnecessary hospital stays. Focussed primary and community care could prevent one-in-five emergency admissions, improving health outcomes and saving money. Predictive risk models which use routine data to identify at risk populations for targeted care aim to reduce emergency admissions but we do not know how GPs react to their introduction. The Prism tool predicts likelihood of patient's emergency admission to hospital and divides the entire practice population into risk categories low to high. Swansea University is leading the PRISMATIC trial, evaluating the introduction of Prism into 32 Welsh GP practices. Prism, and other similar tools, effectively predict admissions but questions remain over their adoption. We asked potential users of Prism how they expect its introduction to affect patient care and emergency admissions. ⋯ Risk predictions tools like Prism effectively predict hospital emergency admissions and are increasingly being introduced. Without sufficient evidence about how practitioners perceive and use these tools, their introduction is unlikely to make a difference to patients-nor have the desired effect on resources. PRISMATIC will provide evidence about how context and expectations can affect implementation.
-
Barnsley Emergency Department, which recruited patients into the RATPAC trial, initiated a POC pathway for low-risk chest pain patients from December 2011. A preceding audit estimated that 50% of chest pain patients may be suitable for discharge from the ED. ⋯ Our pilot work would suggest that the use of POC cardiac markers in chest pain can facilitate discharge of low risk patients from the Emergency Department without a significant re-attendance rate or impacting on the 4-hour access standard.
-
If package counts on abdominal CTs of body-packers were known to be accurate, follow-up CTs could be avoided. The objective was to determine the accuracy of CT for the number of concealed packages in body-packers, and the reliability of package counts reported by body-packers who admit to concealing drugs. ⋯ The accuracy of CT for determining the number of concealed packages is poor, although when applied to patients with few concealed packages accuracy is high and is useful as a rule-out test. Among patients who have admitted to drug concealment, the number of packages reported to be concealed is reliable.
-
We noticed that COPD patients travelling long distances to our rural ED arrived in a worse condition than those living nearby. We suspected this might be due to oxygen-driven nebulisers en route: high-flow oxygen during transfer is known to increase COPD mortality. ⋯ These results support our observation that COPD patients living a long way from hospital are sicker on arrival in ED: but they are sicker to start with. Almost everyone arrives at hospital approximately as sick as they were on ambulance arrival, the exception being a small subgroup living furthest from the hospital (35-40 miles). Our data are retrospective and preliminary: numbers are too small for statistical analysis. However, they suggest that COPD patients in rural areas are already sicker-possibly seeking help later-than those living nearby. A larger study is needed to confirm these results and investigate why: is it rural GPs, their patients, or both, who have a higher threshold for hospital admission than those living closer? Rural PHEM service planners should consider that paramedics in rural areas not only have longer transport times to hospital, but may also be caring for sicker patients than their urban counterparts.