Emergency Medicine Journal最新文献

{"title":"Practitioner experiences of developing and implementing two UK ED-based hospital violence intervention programmes: a process evaluation.","authors":"Simon Moore, Jordan Van Godwin, Graham Moore, Megan Hamilton, David O'Reilly","doi":"10.1136/emermed-2024-214333","DOIUrl":"https://doi.org/10.1136/emermed-2024-214333","url":null,"abstract":"<p><strong>Background: </strong>EDs can address modifiable risks of patients attending due to violence. Hospital-based violence intervention programmes (HVIPs) can reduce patients' exposure to violence but can place additional burdens on staff. We explored practitioners' views on two nurse-led HVIPs' design and delivery, response to patient need, engagement with ED health professionals, adaptation to local context and analysed documents relevant to these objectives.</p><p><strong>Methods: </strong>This was a qualitative process evaluation, from January to September 2023, of two nurse-led HVIPs implemented in a major trauma centre and a large urban hospital in the UK. Interview participants (N=49) were involved with the commission and implementation of the HVIPs, or worked within the broader violence-prevention ecology. We gathered perspectives on intervention implementation and undertook documentary analysis on local and national policies, and guidance relating to HVIPs development, implementation and delivery (N=46). Documentary data were subject to thematic and content analyses, interview data to thematic analysis.</p><p><strong>Results: </strong>HVIPs were developed in response to a perceived under-provision of services for patients attending EDs due to violence. The HVIP nurses had access to clinical records facilitating the identification of eligible patients. They provided patient-centred care, addressing needs through referrals into health and community-based services. Over 60% of eligible patients engaged. The nurses were seen as credible champions working towards a minimally burdensome service that supported and trained ED staff. Embedding HVIPs into usual care took time and was limited by the perceived short-term nature of the intervention.</p><p><strong>Conclusion: </strong>The implementation of nurse-led HVIPs enables access to clinical records, facilitating patient engagement, and can provide an additional service aligned to usual emergency care, supporting both patients and ED staff.</p><p><strong>Pre-registration: </strong>The protocol was pre-registered (ISRCTN 15286575; March 13, 2023) and published before data collection was complete.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413638","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":"Multicentre cross-sectional study to assess nursing workload in Belgian emergency departments.","authors":"Thomas Ganty, Julien Szecel, Anh Diep, Alexandre Ghuysen, Méryl Paquay","doi":"10.1136/emermed-2024-214334","DOIUrl":"https://doi.org/10.1136/emermed-2024-214334","url":null,"abstract":"<p><strong>Background: </strong>Excessive workload in emergency departments (ED) negatively affects patient safety, often leading to missed critical tasks due to time constraints. The Workload Assessment of Nurses on Emergency (WANE) scale developed in Belgium offers a detailed measurement of nursing workload, but its complexity makes it hard to use in practice. Our study aims to find a simpler method for assessing nursing workload in EDs.</p><p><strong>Methods: </strong>A multicentre cross-sectional study was performed in four Belgian EDs between September 2022 and March 2023. Nursing workload was assessed using the WANE scale in each hospital, during 4-hour time periods. The associations between WANE scores, and nurses' subjective workload assessment, number of patients, patient triage levels, post-triage destination area and the Jones Dependency Tool Score were examined employing multiple linear regression models.</p><p><strong>Results: </strong>161 nurses, caring for 591 patients, were included. 67% of the variation in 'direct' care time could be explained with a model based on triage level and two items of the Jones Dependency Tool (ABC perturbation and mobility). The number of new patients admitted and nurses' perceived workload were also highly associated with the total nursing care time TNCT. The actual number of patients in the ED at any time explained 78% of the variation in TNCT. Each additional patient increases the TNTC by 45.22 min.</p><p><strong>Conclusions: </strong>Simple indicators might be used to evaluate the nursing care time in Belgian EDs. A retrospective method is suggested, using the total number of patients over a defined period of time. This study reveals a path to a predictive method to calculate the direct care time for each patient with three simple indicators, available from nursing triage stage.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413637","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":"Well-being interventions alone won't heal.","authors":"Zaid Al-Najjar","doi":"10.1136/emermed-2024-214755","DOIUrl":"https://doi.org/10.1136/emermed-2024-214755","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373842","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":"Identifying the walk-in wounded: paediatric major trauma patients self-presenting to a paediatric major trauma centre.","authors":"Robert Hirst, Ashwini Sridhar, Anne Frampton","doi":"10.1136/emermed-2024-214718","DOIUrl":"https://doi.org/10.1136/emermed-2024-214718","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364082","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":"Understanding cardiac arrest dispatch of physician-paramedic critical care prehospital teams: a survey-based evaluation.","authors":"Sarah Morton, Chris Eagle, Scott Wallman, Gaynor Wareham, Rob Major, Christopher Edmunds, Sarah McLachlan","doi":"10.1136/emermed-2024-214178","DOIUrl":"https://doi.org/10.1136/emermed-2024-214178","url":null,"abstract":"<p><strong>Background: </strong>Appropriate dispatch of critical care teams to out-of-hospital cardiac arrest (OHCA) has been identified as a research priority emergency care in the UK. The study aimed to understand the criteria informing the decision to dispatch a critical care physician-paramedic prehospital team to OHCA in one UK region.</p><p><strong>Methods: </strong>An invitation to participate in an anonymised online survey was sent by email to clinicians and non-clinicians working on the critical care (physician-paramedic) dispatch desk for the East of England Ambulance Service NHS Trust between June and July 2023. Demographic data relating to the experience of the dispatchers were collected alongside evaluating the effect of 15 predetermined criteria on OHCA dispatch (based on a pilot survey) on their decision to dispatch a physician-paramedic team. Responses to closed-end questions were calculated as percentages. A compulsory free text question on dispatching the physician-paramedic team was included. Free text data were interpreted by one author and the interpretation reviewed by all authors.</p><p><strong>Results: </strong>20 respondents (19 critical care paramedics and one non-clinical dispatcher) participated, yielding a 79% response rate for clinical and 17% for non-clinical dispatchers. 'Witnessed cardiac arrest' and return of spontaneous circulation achieved on scene were criteria used by 100% of respondents in informing dispatch of a physician-paramedic team to OHCA. 10 of the 15 preidentified criteria were considered important in their decision-making by at least 75% of respondents. 'Age' was considered as more than just a number, instead incorporating both the nuances of a paediatric cardiac arrest and the importance of physiological reserve and frailty.</p><p><strong>Conclusion: </strong>The only 100% agreement in dispatch criteria was 'witnessed arrest'. Otherwise, variation existed and additional information, like identification of frailty, was gathered to support nuanced decision-making. Wider research across the UK would help identify factors and commonalities in OHCA physician-paramedic dispatch to target improved survival rates.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364085","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":"Factors influencing paramedic conveyance decisions when attending children with minor head injury: a qualitative study.","authors":"Alyesha Proctor, Jedd Billing, Mark Lyttle, Sarah Voss, Jonathan Benger","doi":"10.1136/emermed-2024-214467","DOIUrl":"https://doi.org/10.1136/emermed-2024-214467","url":null,"abstract":"<p><strong>Introduction: </strong>Children with head injury are commonly transported to the ED by ambulance. However, most of those conveyed are deemed non-serious and are discharged at triage. Research is needed to explore the factors that influence paramedics when deciding to convey children with minor head injury to the ED, and to establish whether a clinical decision tool designed to support them would be beneficial.</p><p><strong>Methods: </strong>A generic qualitative approach, comprising semistructured interviews with front-line ambulance paramedics working in the UK. Interviews were audio-recorded and transcribed. Data were analysed using reflexive thematic analysis. Interviews aimed to explore the factors that influence paramedics when deciding to convey children with minor head injury to the ED.</p><p><strong>Results: </strong>A total of 20 paramedics from several ambulance services participated in interviews. Three overarching themes were identified: 'we just take them in'; 'there are too many hurdles'; 'creating the right tool'. These were further categorised into subthemes. Paramedics do not feel confident when assessing and managing children with head injury, and convey children to hospital due to fear of consequences, despite knowing there will be no intervention in the ED. Further education, a prehospital paediatric clinical decision tool and greater support from Ambulance Trusts would be welcomed by paramedics. Criteria such as: parental anxiety; time; wound closure; policy and non-accidental injury need to be considered in a clinical decision tool designed to support paramedics' management of children with head injury.</p><p><strong>Conclusion: </strong>Paramedics generally feel a lack of confidence in assessing and managing children with head injury. A decision tool, coupled with training and useful feedback from EDs following conveyance, would be useful to help improve decision-making.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188484","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":"Outcomes from out-of-hospital cardiac arrest in nursing and care homes: a cohort study.","authors":"Ed Battin, Terry Brown, Keith Couper","doi":"10.1136/emermed-2024-214362","DOIUrl":"https://doi.org/10.1136/emermed-2024-214362","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) primarily affects older adults. Individuals in nursing homes are often elderly with significant comorbidities. Nursing homes are staffed by healthcare workers, able to respond immediately to cardiac arrest, including provision of bystander cardiopulmonary resuscitation (CPR). We aimed to describe the characteristics, treatments and outcome of individuals sustaining an OHCA in nursing and care home settings in England.</p><p><strong>Methods: </strong>Patients ≥18 years between 2015 and 2021 with a recorded location of either a nursing or care home from the 'Out-of-hospital Cardiac Arrest Outcomes' registry for England were included. We present descriptive statistics and compare groups, where appropriate, using a χ² test.</p><p><strong>Results: </strong>We included 4779 patients, of which 2474 (52.5%) were female and 3910 (81.8%) were aged ≥70. Cardiac arrest was witnessed by a bystander in 51.1% (n=2390) of cases. Overall, 80.2% (n=3698) of patients received bystander CPR and where an automated external defibrillator (AED) was available, 77.7% (n=331) were treated with an AED. Return of spontaneous circulation (ROSC) at any time was reported in 1614 (36.7%) and ROSC sustained to hospital handover in 1061 (22.3%) patients. Survival to hospital discharge or 30 days was observed in 97 (2.1%) patients. As age increased, there was a decrease in survival and ROSC sustained to hospital handover.</p><p><strong>Conclusion: </strong>Survival after OHCA in a nursing home setting was low, despite high rates of key interventions, such as bystander CPR. There may be an opportunity to optimise the availability of AEDs within nursing homes.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122455","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":"Knowledge of initial management of caustic ingestions: a national survey of emergency physicians in France.","authors":"Maurane Le Strat, Helene Corte, Benoit Plaud, François Dépret, Benjamin Deniau","doi":"10.1136/emermed-2024-214546","DOIUrl":"https://doi.org/10.1136/emermed-2024-214546","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074131","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":"Oral tranexamic acid for immediate use in major trauma: implications for mass casualty events.","authors":"Matthew Warner, Jonathon Lowe, Ed Benjamin Graham Barnard","doi":"10.1136/emermed-2024-214661","DOIUrl":"https://doi.org/10.1136/emermed-2024-214661","url":null,"abstract":"<p><p>The early administration of tranexamic acid is recognised as significantly reducing mortality in traumatically injured patients with major haemorrhage, typically given via intravenous or intramuscular routes. In the context of mass casualty events, there may exist multiple traumatically injured casualties that would benefit from tranexamic acid, however, it's administration may be delayed through the need to establish intravenous access. Additionally, if the initial assessment of the traumatically injured casualty is undertaken by an individual who cannot administer intravenous or intramuscular medications, time to administration will be further delayed. This concepts paper seeks to discuss the potential for utilising oral tranexamic acid, in the context of mass casualty events, as an alternative administration route.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064533","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":"They called it.","authors":"Jenn Reed","doi":"10.1136/emermed-2024-214749","DOIUrl":"https://doi.org/10.1136/emermed-2024-214749","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064535","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}