Emergency Medicine Journal最新文献

{"title":"In adult patients presenting to ED with severe acute pain, is intranasal ketamine as effective as intravenous opiates for pain reduction?","authors":"Khilan Santilal, Rhea Saldanha","doi":"10.1136/emermed-2025-215080","DOIUrl":"10.1136/emermed-2025-215080","url":null,"abstract":"<p><p>This systematic review assessed whether intranasal (IN) ketamine is as effective as intravenous (IV) opiates for adults presenting to the ED with acute severe pain. EMBASE and Medline were searched, using relevant search terms, identifying four studies relevant to our three-part question. Key findings, as well as study weaknesses, were presented in a table. In summary, our results indicate that IN ketamine provides pain relief comparable to IV morphine in this patient cohort, with a similar side effect profile. However, the generalisability of these findings is limited owing to the lack of uniformity in study methodologies, short-term follow-up, broad exclusion criteria, sampling techniques and small sample sizes. Further studies regarding the role of IN ketamine in this setting would be worthwhile.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"683-685"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186772","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":"Streaming and redirection of lower acuity adult patients attending the ED: patient and staff experience.","authors":"Emily Louise Phillpotts, Jessica Coggins, Laura Goodwin, Sarah Voss, Edward Carlton, Rebecca Hoskins, Cathy Liddiard, Karen Butler, Laura Wilkinson, Grace Blows, Lisa Evans, Rebecca Macfarlane, Jonathan Benger","doi":"10.1136/emermed-2024-214767","DOIUrl":"10.1136/emermed-2024-214767","url":null,"abstract":"<p><strong>Background: </strong>Streaming and redirection in the ED involves the assessment, triage and prioritisation of patients. Lower acuity patients can be streamed to alternative services within the hospital or redirected to off-site services with the aim of alleviating ED clinical pressures. This study aimed to understand staff, patient, family members and carers' experiences of streaming and redirection, including patients and staff who used an NHS web-based application.</p><p><strong>Methods: </strong>A semistructured interview study with staff working in the ED involved in streaming delivery and adult patients and family members who had attended the ED for conditions that could be safely managed in lower acuity settings. Participants were recruited from two NHS Hospital sites in England, one using a web-based NHS urgent care self-service product (digital tool) and one using a nurse-led streaming model. Recruitment took place between August and December 2023.</p><p><strong>Results: </strong>28 interviews were completed. Participants across both sites commented on the challenges of streaming and redirection and confusion around where patients needed to go for what conditions. Patients and staff felt that the lack of capacity in alternative services limited the effectiveness of streaming and redirection. Three themes developed: 'it's too muddy': disruption to the flow of care, balancing privacy and efficiency in streaming and redirection, pressures in the wider healthcare system beyond the ED.</p><p><strong>Conclusions: </strong>This research has implications for understanding patient and staff experiences of streaming and redirection approaches, and the need for clear communication and navigation when utilising digital technologies in the ED.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"629-635"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505131","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":"10.1136/emermed-2025-215102","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"691"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","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":"Rapid cycle QI methods ensure prompt paediatric emergency care during 2022 respiratory surge.","authors":"Alexandria Wiersma, Anthony Watkins, Traci Ertle, Bernadette Johnson, Sandra Spencer","doi":"10.1136/emermed-2024-214180","DOIUrl":"10.1136/emermed-2024-214180","url":null,"abstract":"<p><strong>Objectives: </strong>In fall 2022, paediatric EDs (PEDs) and urgent cares (PUCs) cared for an unprecedented number of children, leading to long waits and boarding patients. This surge mimicked the adult ED/UC COVID-19 pandemic experience. Learning from published data and surge response plans, we adapted our response using rapid cycle quality improvement methodology.</p><p><strong>Methods: </strong>A multidisciplinary PUC/PED team met to determine the current state and create interventions. After the standard seasonal surge response did not have a significant impact, we further expanded inpatient capacity, created new physical PUC space, started provider intake and transitioned PED beds to inpatient.</p><p><strong>Results: </strong>Statistical control charts were used to monitor metrics from 4 weeks prior to the surge to when volumes returned to baseline, but improvement was seen prior to this. Our primary outcome measure, left without being seen (LWBS) rates, decreased from a peak of 40% to <5% and PUC door-to-provider time (process measure) decreased from 158 min to 106 min before the surge was over. These metrics also dropped below the prior baseline after volumes returned to normal. PED door-to-provider time (process measure) and PUC lengths of stay (LOS) (balancing measure) were maintained throughout.</p><p><strong>Conclusions: </strong>Using rapid cycle methodology, we responded quickly to an unprecedented patient volume by innovatively increasing staffing and space. We improved LWBS rates and PUC door-to-provider time despite high volumes and large numbers of boarding patients. We created efficiencies that allowed us to maintain PUC LOS and PED door-to-provider times during the surge. This resulted in sustained improvement, and we now operate with shorter LOS and door-to-provider times than historically achieved.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"676-682"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779530","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":"\"How long until I am seen, doc?\" Modelling paediatric emergency department waiting times to make personalised predictions.","authors":"Sarah Rahayu Hogben, Robin Marlow","doi":"10.1136/emermed-2023-213718","DOIUrl":"10.1136/emermed-2023-213718","url":null,"abstract":"<p><strong>Background: </strong>ED patient wait times have been progressively increasing leading to patient dissatisfaction in ED. Managing patient expectations towards wait times in ED may be more effective at decreasing dissatisfaction than shortening actual wait times. Models for predicting wait times have been made for general EDs but not for solely paediatric departments. We aimed to create a model that could predict the personalised wait time of a child presenting to paediatric ED after triage.</p><p><strong>Methods: </strong>This was a single-centre retrospective study analysing all ED attendances to the Bristol Royal Hospital for Children between 1 January 2022 and 31 December 2022. From anonymised routinely collected administrative data, we created a multiple linear regression model to predict wait times. We developed the model by randomly assigning 80% of the data to a training set and used the remaining 20% as a validation set to assess the accuracy of our model. CIs were calculated using 500 bootstrap iterations sampled from the validation set. Understanding that patients are satisfied being seen sooner than their predicted wait time, we considered the result to be unsuccessful if their actual wait time was 30 min over their predicted wait time.</p><p><strong>Results: </strong>From 40 828 ED presentations, the median patient wait time was 65 min (IQR 34-122). Our model was able to predict wait times for 84.2% (95% CI 83.42% to 84.91%) of attendances successfully. Triage category, number of patients waiting, number of patients in the department, time of presentation, length of wait of last patient and day of week all had a significant impact on prediction of wait times (all p<0.001).</p><p><strong>Conclusion: </strong>Tailored models created using routine data can be used to give individualised predictions for wait times in paediatric ED, which could be given to patients with the aim of managing expectations and improving patient satisfaction.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"636-642"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971898","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":"Prognostic accuracy of end-tidal carbon dioxide in cardiac arrest: a systematic review and meta-analysis.","authors":"Yi-Chih Lee, Yu-Tai Lo, Chen-Bin Chen, Tzu-Heng Cheng, Chen-June Seak, Chieh-Ching Yen","doi":"10.1136/emermed-2025-214918","DOIUrl":"https://doi.org/10.1136/emermed-2025-214918","url":null,"abstract":"<p><strong>Background: </strong>Cardiac arrest, a critical emergency with high fatality rates, needs accurate early predictors of resuscitation outcomes. End-tidal carbon dioxide (ETCO₂) monitoring, reflecting tissue perfusion and metabolic activity, is highlighted in guidelines for predicting return of spontaneous circulation (ROSC). This systematic review and meta-analysis evaluates the prognostic accuracy of ETCO₂ at various time points and cut-offs to enhance clinical decision-making during cardiac arrest.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, Embase and the Cochrane Library identified relevant prognostic accuracy studies. Inclusion criteria were original articles reporting prognostic accuracy of ETCO₂ for ROSC prediction in adult cardiac arrest patients. Sensitivity, specificity and 95% CIs were calculated for ETCO₂ measurements at initial, 10 and 20 min using 2×2 contingency tables. A multiple thresholds model was used for meta-analysis, and the Median of Medians method analysed median ETCO2 values.</p><p><strong>Results: </strong>Fourteen studies with 3186 cardiac arrest patients were included. The optimal ETCO₂cut-off was 19.8 mm Hg at initial (sensitivity 0.75 (95% CI 0.60 to 0.85), specificity 0.53 (95% CI 0.40 to 0.65)), 15.7 mm Hg at 10 min (sensitivity 0.91 (95% CI 0.72 to 0.97), specificity 0.68 (95% CI 0.56 to 0.78)) and 8.5 mm Hg at 20 min (sensitivity 0.95 (95% CI 0.53 to 0.99), specificity 0.78 (95% CI 0.39 to 0.95)). The highest area under the curve (AUC) was 0.88 (95% CI 0.31 to 0.98) at 20 min, followed by 0.82 (95% CI 0.61 to 0.91) at 10 min and 0.67 (95% CI 0.57 to 0.75) initially.</p><p><strong>Conclusions: </strong>While initial ETCO₂ demonstrates limited prognostic accuracy for ROSC with a pooled AUC of only 0.67, ETCO₂ measurements taken at 10 and 20 min provide a negative predictive value exceeding 0.95 when using a cut-off of 10 mm Hg. However, to meet the stringent criteria for termination of resuscitation (TOR) decisions, a lower cut-off, such as 5 mm Hg, or the incorporation of additional prognostic indicators would be necessary. Serial ETCO₂ monitoring could also be considered as a potential adjunct in current TOR guidelines. Significant variability between studies necessitates cautious interpretation of these results.</p><p><strong>Prospero registration number: </strong>CRD42024527811.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130354","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":"Assessment of vaping and substance use documentation in the emergency department and acute medical unit.","authors":"Lucy Tiffen, Lachlan John Sund, Callum Kennedy, Megan Hollands, Paul I Dargan, David M Wood","doi":"10.1136/emermed-2025-214920","DOIUrl":"https://doi.org/10.1136/emermed-2025-214920","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130314","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":"Implementing the WHO's Emergency Care Systems toolkit: a qualitative study for facilitators and barriers.","authors":"Kalkidan Tilahun Yegele, Alegnta Gebreyesus, Aman Safewo, Gelila Mengistu, Shama Patel, Menbeu Sultan, Tsion Firew","doi":"10.1136/emermed-2023-213652","DOIUrl":"https://doi.org/10.1136/emermed-2023-213652","url":null,"abstract":"<p><strong>Introduction: </strong>The emergency medical disease burden in low-income countries such as Ethiopia is four times that of high-income countries. It is estimated that more than half of all deaths occurring in low-and-middle-income countries each year could be prevented by organised Emergency Care System but the emergency care in these countries is fragmented and unstructured. The WHO's Emergency Care Systems (WHO-ECS) toolkit aims to systematise and structure emergency care in such countries.<b>Objectives</b>To identify and analyse key facilitators and barriers encountered during the implementation of the (WHO-ECS) toolkit in primary hospitals in Ethiopia, within the context of a national emergency care strengthening initiative.</p><p><strong>Methods: </strong>This was a qualitative research arm of a larger implementation study conducted within 10 primary hospitals in the Oromia region, Ethiopia for 14 months. Qualitative data were collected using focus group discussions with healthcare workers in target hospitals (Amaya, Arsi Kersa, Tulu Bolo and Robe Dida Hospitals) selected via lottery method and key-informant questionnaires among project coordinators from May 2021 to February 2022. Facilitators and barriers to the implementation process were identified using thematic data analysis.</p><p><strong>Results: </strong>There were 40 participants in four focus group discussions and four respondents to the key informant questionnaires. Facilitators of the toolkit included a supportive model of implementation, enthusiastic staff and the toolkit itself. Lack of medications and equipment, some components in the toolkit itself and lack of permanent staff in emergency departments were found to be barriers. Support from hospital administrators was a facilitator while lack thereof was a hurdle.</p><p><strong>Conclusion: </strong>This study has outlined the significant factors related to implementing the WHO-ECS toolkit in a low-income setting. Support from project implementers and hospital administrators as well as key stakeholder involvement facilitates success. Conversely, lack of support and resources as well as toolkits misaligned with context can hamper it. Comparable healthcare setups can use these lessons before and during implementation.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124428","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":"'Every day was a learning curve': implementing COVID-19 triage protocols in UK ambulance services-a qualitative study of staff experiences.","authors":"Alison Porter, Fiona Bell, Mike Brady, Shona Brown, Andrew Carson-Stevens, Timothy Driscoll, Bridie Angela Evans, Theresa Foster, John Gallanders, Imogen Gunson, Robert Harris-Mayes, Mark Kingston, Ronan Lyons, Elisha Miller, Andy Rosser, Aloysius Niroshan Siriwardena, Robert Spaight, Victoria Williams, Helen Snooks","doi":"10.1136/emermed-2024-214495","DOIUrl":"https://doi.org/10.1136/emermed-2024-214495","url":null,"abstract":"<p><strong>Background: </strong>TRIM (What TRIage model is safest and most effective for the Management of 999 callers with suspected COVID-19? A linked outcome study) was an evaluation of models used to triage and manage emergency ambulance service care for patients with suspected COVID-19. In an embedded qualitative component, we aimed to understand experiences and concerns of clinical and managerial staff about processes for responding to patients with suspected COVID-19, in the call centre and on scene.</p><p><strong>Methods: </strong>Research paramedics in four study sites across England interviewed purposively selected stakeholders from ambulance services (call handlers, clinical advisors in call centres, clinicians providing emergency response, managers) and emergency department clinical staff. Interviews (n=25) were conducted remotely, recorded and transcribed. Thematic analysis was conducted by a group of researchers and PPI (patient and public involvement) partners working together.</p><p><strong>Results: </strong>We present four themes, developed from the data. Services made efforts to target their response to those most in need, while trying to minimise infection risk; they reduced face-to-face contact where possible, dealing with more calls remotely. Adjustments by other providers in the wider healthcare system affected the flow of patients to and from ambulance services. There was substantial work and heavy cognitive load for staff at all levels in updating knowledge and repeatedly implementing changes. Staff working in the range of roles in ambulance services also carried a heavy emotional load.</p><p><strong>Conclusions: </strong>Services made flexible changes to triage processes using the best level of understanding available at the time, in a healthcare setting which always operates in high levels of uncertainty. Implementing triage protocols in response to the COVID-19 pandemic was a complex and fluid process which had to be actively managed by a range of front-line staff, dealing with external pressures and a heavy emotional load. Increased understanding of the way in which services and staff had to adapt, and the cognitive and emotional burden this entailed, may help in planning for future pandemics.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080043","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":"Austrian Emergency Day: a single-day audit of the call profiles of physician-staffed prehospital emergency medical services in Austria.","authors":"Helmut Trimmel, Christian Anzur, Stefan Dressler-Stross, Romana Erblich, Wolfgang G Voelckel, Martin Dünser","doi":"10.1136/emermed-2025-214968","DOIUrl":"https://doi.org/10.1136/emermed-2025-214968","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069207","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}