Emergency medicine journal : EMJ
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Patient surveys and research have shown that Emergency Department attendees do not receive adequate analgesia. Pain monitoring has not been automated and usually involves a member of staff asking the patient to rate their score with no continuous record, often no specific place to record it and no automated alarm system for scores outside accepted parameters. Few patients have regular monitoring of their pain and our own preliminary research showed that over one week only 58% of patients with moderate to severe pain had a second or subsequent score recorded. ⋯ We aim to recruit 200 patients (100 per arm) from the emergency department at Leicester Royal Infirmary. All patients will use the display. This is a parallel group, two arm superiority trial with a 1:1 allocation ratio. Patients will be randomised to have their pain score on display (intervention) or hidden (control). Blinding is not possible. The display beeps every 15 min to remind patients to enter their pain score. Treatment will not be constrained by study protocol and will depend on the judgment of the treating clinician. The study will continue for up to 6 hours to allow time for the first dose of analgesia to wear off. Data collection will cease when the patient leaves the department. Questionnaires will be given to participants and the staff nursing them.
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For a significant number of patients suffering out-of-hospital cardiac arrest (OHCA) cardiopulmonary resuscitation (CPR) is likely to be futile and attempting it may be the wrong thing to do. Anticipatory care plans with do-not-attempt cardiopulmonary resuscitation (DNACPR) instructions exist to prevent this. Anecdotally we felt that many patients present to our Emergency Department (ED) with ongoing resuscitation which was not in their best interests. The aim of this study was to establish the proportion of patients arriving in our ED with ongoing CPR who had low, intermediate or high risk of futility. ⋯ Our results suggest that community DNACPR implementation in Edinburgh is suboptimal, with many patients resuscitated and transported to the ED with ongoing resuscitation despite a high likelihood of futility. It is unclear what is required to improve this situation. Possible avenues for improvement may be more anticipatory care planning in the community, better recording of the outcomes of key conversations with patients and carers, or more consistent implementation of these plans by Ambulance Service responders. We plan further work to establish how this system can be changed to serve patients and their families better.
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An NHS England review recognised that demand for Urgent and Emergency Care is unsustainable. Health practitioners and policy makers are interested in understanding the reasons why patients with low acuity problems attend the Emergency Department (ED). This should, in turn, assist the development of interventions to reduce demand.We aimed to gain an understanding about the reasons for rising ED demand and to identify possible solutions. ⋯ We found evidence of a rise in patients being referred to the ED by other healthcare services. This may be a reflection of the wider healthcare system under strain, thereby causing overspill into EDs. Future research is needed to design and test interventions that can lead to improvements in the system that are acceptable to patients, do not lead to increased demand, are cost-effective and lead to more sustainable working environments.
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ED crowding is associated with increased mortality, poor staff and patient experience, an increased inpatient length of stay and poor compliance with the four-hour emergency access standard.1 Where crowding is caused by exit block, the focus needs to be on whole system patient management, reducing the temporal mismatch between admissions and discharges since at times of peak demand hospitals may become gridlocked until patients are discharged.In an attempt to tackle exit block, the Scottish Government Unscheduled Care Team have implemented the Daily Dynamic Discharge (DDD) approach, which aims to increase the number of inpatient discharges by 12 pm, thus enabling more timeous flow through the ED. ⋯ Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust2006;184(5):213-216.
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The quality of cardiopulmonary resuscitation (CPR) has been shown to affect the survival of out-of-hospital cardiac arrest cases (OHCA). There are various individual factors that can affect the quality of chest compression. We aimed to determine if age, gender and physical attributes (height, weight and BMI) affected the quality of chest compressions administered by laypersons during training. ⋯ Overall, at least 1 parameter of chest compression quality decreased with age, and was better in males than females. A possible application of these results is to have differences in training methods for different ages and sexes, targeting parameters that they are weaker at.