Emergency Medicine Journal最新文献

{"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}

{"title":"Poetry: the art of expression.","authors":"Mary Dawood","doi":"10.1136/emermed-2025-215127","DOIUrl":"https://doi.org/10.1136/emermed-2025-215127","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":"144247002","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":"Assessing urgent care centres as alternatives to emergency departments for paramedic transported non-emergent patients: implications for length of stay.","authors":"Ryan Peter Strum, Brent McLeod, Andrew Costa, Shawn E Mondoux","doi":"10.1136/emermed-2024-214592","DOIUrl":"https://doi.org/10.1136/emermed-2024-214592","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224751","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":"Choice at the end of life is a privilege.","authors":"Cliona Ni Cheallaigh, Rosa McNamara","doi":"10.1136/emermed-2025-215030","DOIUrl":"https://doi.org/10.1136/emermed-2025-215030","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224752","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 affecting diagnostic imaging decision-making in the emergency department during day and night shifts.","authors":"Robert Peter Klein, Gary Velan, Husna Razee, Andrew Coggins, Kevin Lai, Amith Shetty, Noel Young, Michelle Moscova","doi":"10.1136/emermed-2024-214416","DOIUrl":"https://doi.org/10.1136/emermed-2024-214416","url":null,"abstract":"<p><strong>Background: </strong>Medical imaging use has increased progressively, prompting discussions about its clinical impact. Interventions to reduce low-value imaging have had varying success, as they generally do not consider the influence of the clinical environment on decision-making. Factors affecting imaging ordering decisions by Emergency Department (ED) medical officers (MOs) and how these factors differ between day and night shifts are poorly understood.</p><p><strong>Methodology: </strong>This mixed methods study was conducted in 2021 at a major tertiary hospital in Western Sydney. Observations and interviews with ED MOs for 20 day-shift and 26 night-shift clinical encounters were analysed to understand how and why imaging decisions were made, along with usage of imaging guidelines. Demographic and clinical patient data (including patient disposition) were obtained retrospectively from medical records to assess the impact of imaging.</p><p><strong>Results: </strong>During night shifts, 18 of the 26 observed clinical encounters used diagnostic imaging, compared with 12 of the 20 observed clinical encounters during day shifts. Factors affecting decision-making during night shifts included limited resources, fatigue, reduced support for junior ED MOs and higher patient load. Interviews suggested CT was more likely to be used during night shifts as a screening tool to expedite decisions and as a substitute for unavailable imaging modalities. In contrast, imaging decisions by day shift junior MOs were influenced by the need to justify their decisions to senior MOs, prompting them to research presenting complaints and imaging indications. Generally, there was minimal reference to imaging decision-making guidelines across both shifts.</p><p><strong>Conclusion: </strong>Differing factors impact imaging decisions by ED MOs during day and night shifts. This needs consideration when designing and implementing targeted physician support strategies and interventions to reduce low-value imaging. Limited resources and MO fatigue should be considered when modifying guidelines/strategies aiming to support MOs during ED night shifts.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224753","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":"Continuous erector spinae plane block for abdominal visceral cancer analgesia in the emergency department: the case for catheters.","authors":"Matthew Townsend Reeves, Michael Shalaby","doi":"10.1136/emermed-2024-214815","DOIUrl":"https://doi.org/10.1136/emermed-2024-214815","url":null,"abstract":"<p><p>Abdominal visceral cancer pain is a challenging oncology presentation to treat in the ED. Current emergency oncologic pain management strategies focus largely on parenteral opioid administration, although ultrasound-guided regional anaesthesia has the potential to provide more targeted, superior and long-lasting analgesia without comparable adverse side effects. In particular, a continuous erector spinae plane block (ESPB) performed between T6 and L2 represents a promising analgesic tool in this patient population. Anterior spread of local anaesthetic from the erector spinae plane to the paravertebral space may anaesthetise abdominal visceral sensory afferents travelling centrally within the thoracolumbar spinal nerves and the sympathetic chain at this level, thereby directly blocking pain conduction stemming from the gastrointestinal tract. While emergency physicians are becoming well versed in single-shot nerve blocks, continuous nerve blockade with catheter placement has yet to be readily adopted. The continuous ESPB for malignancy-related abdominal pain has the potential to not only reshape established oncologic pain management paradigms but also serve as the stepping stone for emergency physician adoption of continuous nerve blocks.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215289","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}