Emergency medicine journal : EMJ
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Differentiating between cardiac and obstructive causes for dyspnoea is essential for proper management, but is difficult in the prehospital setting. ⋯ Lower levels of ETCO2 were associated with CHF, and may serve as an objective diagnostic adjunct to predict this cause of dyspnoea in the prehospital setting.
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Pressure on emergency departments (EDs) sometimes results in handover delays for patients who arrive in ambulances, leading to operational disruption to the ambulance service and ED, and poorer patient experience. Some EDs have adopted models of care to provide rapid access for emergency patients to senior clinical staff. ⋯ The review suggests that rapid access models in the ED may have benefits for patients, though evidence is still limited.
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Improving sustained ROSC rates following out-of-hospital cardiac arrest is a key focus for ambulance services. Accordingly, a Quality Improvement (QI) project was initiated whereby an Intensive Care Society post-resuscitation care bundle of evidence-based interventions was adapted for use by pre-hospital clinicians. The objective was to introduce and embed this care bundle, in order to increase its delivery. emermed;32/6/e18-b/EMERMED2015204980TB1T1EMERMED2015204980TB1 Apr & May 2012 Apr & May 2013 Apr & May 2014 No. of patients 96 106 97 Complete Care Bundle 8.3% 32.1% 35.1% 12-Lead ECG 60% 71.7% 81.4% Blood Sugar 43% 94.3% 95.9% Cooling Started 49% 69.8% 62.9% Ventilatory Support 53% 52.8% 73.2% Haemodynamic Support 74% 82.1% 82.5% ⋯ The care bundle model, alongside targeted QI activities, has proved successful in ensuring best-practice care is more routinely provided. These methods promote clinician co-production of practice development, and are adaptive to evolving clinical evidence.
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A shortcut review was carried out to establish whether a procalcitonin-guided algorithm could safely reduce antibiotic consumption for patients with an exacerbation of chronic obstructive pulmonary disease attending the emergency department. Four randomised controlled trials were found directly relevant to the three-part question, combined within a later systematic review and meta-analysis. ⋯ The clinical bottom line is that a procalcitonin algorithm appears to be a useful strategy to guide initiation and duration of antibiotics and can reduce consumption without conferring additional risk. However, no cost effectiveness data are available as yet and further validation studies are required prior to widespread recommendation.
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The PhOEBE (Pre-Hospital Outcomes for Evidence Based Evaluation) research programme aims to develop new ways of measuring how well ambulance services meet the needs of the patients who call them and the quality of the care they provide. Measuring how services are performing is important as it allows us to monitor if standards are being maintained, assess what works well and identify problems early so improvements can be made. The first stages of our programme have focused on identifying the range of possible measures and from these narrowing it down to a small number that we will then develop in more detail. ⋯ This event not only provided the project with valuable information about which of our potential measures are considered important but also demonstrated that a PPI led initiative can enhance a lay audience's understanding of ambulance service performance issues. Despite some challenges in communication the event proved the PPI ref group as valued research collaborators. We continue to develop a more proactive PPI-led model of involvement capable of meeting the needs of the PhOEBE programme.