Emergency Medicine Journal最新文献

{"title":"How do we avoid being accused of 'playing God'? Approaches to information provision for relatives in the era of emergency waiver of consent.","authors":"Ellen J Weber, Edward Carlton","doi":"10.1136/emermed-2025-215097","DOIUrl":"https://doi.org/10.1136/emermed-2025-215097","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute coronary syndrome rule-out strategies in the emergency department: an observational evaluation of clinical effectiveness and current UK practice.","authors":"","doi":"10.1136/emermed-2024-214616","DOIUrl":"https://doi.org/10.1136/emermed-2024-214616","url":null,"abstract":"<p><strong>Background: </strong>Numerous strategies have been developed to rapidly rule-out acute coronary syndrome (ACS) using high-sensitivity troponin. We aimed to establish their performance in terms of emergency care length of stay (LOS) in real-world practice.</p><p><strong>Methods: </strong>A multicentre observational cohort study in 94 UK sites between March and April 2023. Recruitment was preferably prospective, with retrospective recruitment also allowed. Adults presenting to the ED with chest pain triggering assessment for possible ACS were eligible. Primary outcome was emergency care LOS. Secondary outcomes were index rate of acute myocardial infarction (MI), time to be seen (TTBS), disposition and discharge diagnosis. Details of ACS rule-out strategies in use were collected from local guidelines. Mixed effects linear regression models tested the association between rule-out strategy and LOS.</p><p><strong>Results: </strong>8563 eligible patients were recruited, representing 5.3% of all ED attendances. Median LOS for all patients was 333 min (IQR 225, 510.5), for admitted patients was 460 min (IQR 239.75, 776.25) and for discharged patients was 313 min (IQR 221, 451). Heterogeneity was seen in the rule-out strategies with regard to recommended troponin timing. There was no significant difference in LOS in discharged patients between rule-out strategies defined by single and serial troponin timing (p=0.23 and p=0.41). The index rate of acute MI was 15.2% (1301/8563). Median TTBS was 120 min (IQR 57, 212). 24.4% (2087/8563) of patients were partly managed in a same day emergency care unit and 70% (5934/8563) of patients were discharged from emergency care.</p><p><strong>Conclusion: </strong>Despite heterogeneity in the ACS rule-out strategies in use and widespread adoption of rapid rule-out approaches, this study saw little effect on LOS in real-world practice. Suspected cardiac chest pain still accounts for a significant proportion of UK ED attendances. ED system pressures are likely to be explanatory, but further research is needed to understand the reasons for the unrealised potential of these strategies.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing door-in-door-out time in a rural primary stroke centre using a large vessel occlusion alert: a quality improvement project.","authors":"Austin Cannoy, Brittany Liberati, Christopher Berry","doi":"10.1136/emermed-2024-214263","DOIUrl":"https://doi.org/10.1136/emermed-2024-214263","url":null,"abstract":"<p><strong>Background: </strong>Thrombectomy is the primary treatment in the management of acute large vessel occlusions (LVO) strokes; however, many rural hospitals are not able to perform this procedure and must transfer patients to thrombectomy-capable centres expeditiously. This quality improvement initiative was aimed at optimising the door-in-door-out (DIDO) time for patients with stroke at a rural primary stroke centre in the USA, with a specific goal of DIDO time of <90 min, 50% of the time and <120 min, 75% of the time.</p><p><strong>Methods: </strong>System inefficiencies in serial event processing, radiology interpretation, teleneurology application and activation of transferring emergency medical services were identified. We implemented several system changes using multiple plan-do-study-act (PDSA) cycles. The final implementation was an LVO-Alert process, which incorporated prehospital alert based on an LVO scale, parallel event processing of emergency medicine, teleneurology and radiology activities, as well as early dispatch of Emergency Medical Services transfer resources. Two years premetrics and 1 year postmetrics were compared.</p><p><strong>Results: </strong>We saw change on the fifth PDSA cycle, in which we implemented the LVO-Alert. For all LVO transfers, the group for whom the LVO-Alert was used (n=21) demonstrated decreased mean DIDO times compared with the no LVO-Alert group (n=20): 103.7 min, SD=49.6 vs 167.9 min, SD=64. Pre-LVO-Alert implementation, 20% of LVO patients had DIDO times <120 min and 5% had times <90 min. Post-LVO-Alert, 76% of LVO patients had DIDO times <120 min and 52% had times <90 min.</p><p><strong>Conclusion: </strong>The application of a parallel process bundle of care model, with early activation from a prehospital positive LVO scale, improved DIDO time in this patient population.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing approaches to code status conversations between Thai and American emergency clinicians: a survey study.","authors":"Thidathit Prachanukool, Pongsakorn Atiksawedparit, Suthasinee Senasu, Thapanawong Mitsungnern, Thavinee Trinarongsakul, Suwarat Wongjittraporn, Hannah Oelschlager, Sarayut Kahapana, Kei Ouchi","doi":"10.1136/emermed-2024-213883","DOIUrl":"https://doi.org/10.1136/emermed-2024-213883","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency clinicians conduct code status conversations as part of shared decision-making regarding the management of patients with serious life-limiting illnesses. Given that varying sociocultural norms and healthcare systems affect communication, we hypothesised that American and Thai emergency clinicians report different approaches to code status conversations.</p><p><strong>Methods: </strong>A cross-sectional survey study was conducted in one US hospital and four Thai hospitals from December 2021 to November 2022. Using a 5-point Likert Scale, the survey questions focused on clinical practice for procedure-based and value-based components of code status conversations. We developed the survey from a medical communication expert team and then reviewed, refined and validated the questions. Multiple logistic regression analysis was used to compare the asking in code status conversation among American and Thai emergency clinicians and controlled for potential confounding variables.</p><p><strong>Results: </strong>We received responses from 84 American and 81 Thai emergency clinicians (74% and 70%, respectively). Most of the participants had 6-10 years of clinical experience (n=71, 43%), had code status conversations more than twice each month (n=63, 38%), and had prior palliative care training (n=141, 86%). Over 50% of all emergency clinicians responded 'very likely' or 'somewhat likely' to incorporate all six procedure-based components but only one of the six value-based components. Compared with Thai emergency clinicians, American emergency clinicians were significantly more likely to ask one procedure-based component (restarting the patient's heart, adjusted OR (aOR) =9.3 (95% CI 3.2 to 26.8)), while less likely to ask another procedure-based component (the patient's preference for vasopressors, aOR=0.3 (95% CI 0.1 to 0.7)), and two value-based components (providing a recommendation, aOR=0.2 (95% CI 0.1 to 0.5), assessing the patient's baseline activity, aOR=0.2 (95% CI 0.1 to 0.4)).</p><p><strong>Conclusion: </strong>In the approaches to code status conversations, American and Thai emergency clinicians collectively report asking about procedures rather than personal values, while specific distinctions exist and potentially reflect different cultural approaches.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we be advising patients to use topical silicone gel for wound care following facial laceration suturing in the emergency department ?","authors":"Marc Kendrick, Afrose Dor","doi":"10.1136/emermed-2025-215094","DOIUrl":"https://doi.org/10.1136/emermed-2025-215094","url":null,"abstract":"<p><p>A short systematic review was undertaken to assess whether silicone gel improves cosmetic and symptomatic outcomes of scars following the suturing of traumatic facial lacerations in ED. A systematic keyword search of EMBASE, MEDLINE, Cochrane and Google Scholar databases returned two papers. The author, year, country, patient characteristics, study type, key outcomes and weaknesses were tabulated. The results indicate that silicone gel improves cosmetic and symptomatic outcomes when used for at least one month. However, the limited patient characteristics and short follow-up period indicate that larger studies are needed to provide further recommendations.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Care with the First measurement of high-sensitivity troponin T (ICare-FirsT) to enable early rule out and reduce length of stay: a diagnostic and observational study.","authors":"John W Pickering, Laura Joyce, Gerard Devlin, Chris Pemberton, Richard Troughton, A Mark Richards, Martin P Than","doi":"10.1136/emermed-2024-214754","DOIUrl":"https://doi.org/10.1136/emermed-2024-214754","url":null,"abstract":"<p><strong>Background: </strong>Pathways incorporating clinical risk assessment, ECG and serial troponin measurements for the assessment of patients with possible myocardial infarction (MI) in the ED are standard practice. Incorporating a single troponin test to stratify to low risk of MI using a baseline measurement of cardiac troponin (cTn) with a high-sensitivity T assay (hs-cTnT) is recommended. We aimed to implement a pathway incorporating a single-test component and measure the impact on length of stay (LOS).</p><p><strong>Methods: </strong>There were two study phases: (1) Development and performance assessment of a novel pathway incorporating a single-test hs-cTnT stratification using high-fidelity research data, (2) An audit of the implementation of a single-test Roche hs-cTnT strategy within multiple EDs. The low-risk threshold used for hs-cTnT was 5 ng/L. The safety metric was MI or death not known to be non-cardiac within 30 days (MACE30).</p><p><strong>Results: </strong>Phase I: The derived pathway had 16.3% low risk after one blood draw ≥3 hours from symptom onset with hs-cTnT <5 ng/L, non-ischaemic ECG and ED Assessment of Chest pain Score <21.</p><p><strong>Phase ii: </strong>In six hospitals, there were 10 912 patients in the control arm and 13 997 after implementation of single-test hs-cTnT. The unadjusted estimated mean reduction in LOS after intervention was 1.6% (95% CI 0.4% to 2.9%). After adjustment accounting for increased presentations, this was 8.5% (95% CI 7.7% to 9.3%).</p><p><strong>Conclusions: </strong>Within clinical pathways, a single test with a result from an hs-cTnT of <5 ng/L as a component resulted in a small, but meaningful, reduction in mean ED LOS.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vapocoolant spray for intravenous cannulation.","authors":"Caglar Kuas, Mustafa Emin Canakci","doi":"10.1136/emermed-2025-215060","DOIUrl":"https://doi.org/10.1136/emermed-2025-215060","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing benchmarking indicators for Australian virtual emergency departments: a Delphi study.","authors":"Timothy J Schultz, Andrew Partington, Pamela Everingham, Mark Morphett, Jackie Davidson, Suzanne M Miller, Kim Hansen, Nicole Mitchell, Ian Dey, Jon Karnon","doi":"10.1136/emermed-2025-214904","DOIUrl":"https://doi.org/10.1136/emermed-2025-214904","url":null,"abstract":"<p><strong>Introduction: </strong>There is a lack of indicators to guide quality improvement activities in virtual emergency medicine internationally. We developed quality indicators for use across a collaboration of four metropolitan virtual ED (VED) settings in four Australian states. The services deliver ED care directly to patients, in consultation with paramedics, and as virtual care coordination.</p><p><strong>Methods: </strong>The model of care and use of potential indicators at each site were described using interviews and combined with literature review to develop a set of 27 candidate benchmarking indicators. These were refined using a three-stage Delphi study conducted between November 2022 and May 2023. The first stage used a survey to assess the indicators' feasibility and importance, synonyms and draft definitions. These results were fed back to participants for refinement during discussions and written review of revised indicators and definitions across two subsequent stages.</p><p><strong>Results: </strong>A definition for VED care was proposed: 'An episode of care between patients and/or care providers, occurring remotely, using any form of communication or information technologies, for conditions that would otherwise result in a physical presentation for emergency care.' Across Delphi rounds 1 and 2, some proposed indicators were removed, and new types of indicators were added. In rounds 2 and 3, 24 and 23 indicators, respectively, were reviewed, and the final indicator set comprised 16 indicators. The majority (15) were readily mapped to the six Institute of Medicine Domains of Quality (efficient (n=2), effective (n=5), equitable (n=2), patient centred (n=2), safe (n=2) and timely (n=2)) and all 16 mapped to the National Quality Forum's telehealth quality indicators (access to care (n=2), effectiveness (n=8), experience (n=4), financial impact/cost (n=2)).</p><p><strong>Conclusion: </strong>There is enthusiasm for a national benchmarking collaborative across four Australian VED services and states. An identified set of 16 indicators and definitions can be further validated with consumers and piloted.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Correspondence on 'Comparison of the effects of vapocoolant spray and topical anaesthetic cream (lidocaine-prilocaine) on pain of intravenous cannulation: a randomised controlled trial' by Akhgar <i>et al</i>.","authors":"Atousa Akhgar, Hamideh Akbari, Mohammad Jalili, Hadi Mirfazaelian","doi":"10.1136/emermed-2025-215102","DOIUrl":"https://doi.org/10.1136/emermed-2025-215102","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whose turn is it?","authors":"Jeffrey P Louie, Mary Ryan","doi":"10.1136/emermed-2025-214879","DOIUrl":"https://doi.org/10.1136/emermed-2025-214879","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}