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Improving emergency department flow by introducing a simple time out moment (The TRAFFIC LIGHT study). 通过引入一个简单的暂停时刻来改善急诊科的流程（TRAFFIC LIGHT 研究）。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0966
Audrey Jc Overgaauw, Marijn Ligthart, Kaoutar Azilji, Tanca C Minderhoud, Jonne J Sikkens, Tessa H Biesheuvel, Prabath Wb Nanayakkara
{"title":"Improving emergency department flow by introducing a simple time out moment (The TRAFFIC LIGHT study).","authors":"Audrey Jc Overgaauw, Marijn Ligthart, Kaoutar Azilji, Tanca C Minderhoud, Jonne J Sikkens, Tessa H Biesheuvel, Prabath Wb Nanayakkara","doi":"10.52964/AMJA.0966","DOIUrl":"https://doi.org/10.52964/AMJA.0966","url":null,"abstract":"<p><strong>Background and importance: </strong>Long waiting times in the emergency department (ED) is an increasing problem in the recent years and is expected to become an even bigger problem in the future Objective: We aimed to test the hypothesis whether increasing awareness of the time lapse with the treating physician, 2 hours after patient arrival, can reduce long patient turnaround time (TAT).</p><p><strong>Method: </strong>In this prospective single-center cohort study we compared and analyzed patient TAT in the ED before and after implementation of a so called 'traffic light' moment 2 hours after patient arrival. At this 'traffic light' moment a team member contacted the treating physician to increased awareness over the time lapse. Difference in percentage of patients who stayed more than 4 hours in the ED before and after intervention was the primary outcome Results: Between October 2nd 2021 and January 2nd,2022 1494 patients were included for primary outcome analysis. A total of 419 patients (n=740, 56.6%) had a TAT of less than 4 hour in the ED before intervention, compared to 497 (n=754, 65.9%) after intervention (p <0.001). Median time spent in de ED before intervention was 3:40 (IQR 2:24 - 5:04) compared to 3:15 (IQR 2:03 - 4:38) after intervention (p<0.001).</p><p><strong>Conclusion: </strong>This simple and low-cost intervention reduces the ED length of stay significantly. Although multiple interventions will be required to ensure less patients spending more than 4-hours in the ED, a 'traffic light' moment can be a simple and an effective tool.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Balancing acute medical management of acute kidney injury and hyperkalaemia versus medicines optimisation for long-term Cardio-Renal-Metabolic (CaReMe) diseases: a narrative review. 平衡急性肾损伤和高钾血症的急性药物治疗与长期心肾代谢疾病（CaReMe）的药物优化：叙述性综述。
Acute Medicine Pub Date : 2024-01-01
Benjamin David James, Mark Holland, Darren Green
{"title":"Balancing acute medical management of acute kidney injury and hyperkalaemia versus medicines optimisation for long-term Cardio-Renal-Metabolic (CaReMe) diseases: a narrative review.","authors":"Benjamin David James, Mark Holland, Darren Green","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cardio-Renal-Metabolic (CaReMe) diseases, in the form of heart failure, chronic kidney disease and diabetes mellitus, justify prescription of multiple prognostically beneficial medications, specifically renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter-2 inhibitors. Use of these medications is complicated by association with adverse effects, particularly acute kidney injury and hyperkalaemia. Balancing risk and benefit is a common dilemma in acute medicine, with increasingly frequent and complex treatment decisions. Physicians should contemplate adjustments to medications within the context of not just acute illness but also long-term benefit. In the setting of hyperkalaemia, potassium-binding medications can be utilised. At hospital discharge optimisation of therapy can be achieved through clear safety netting advice, scheduled biochemical follow-up, and planned clinical review.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Point of Care Ultrasound Bladder Volume Calculation on the Acute Medical Unit. 急诊科护理点超声膀胱容量计算。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0970
Joseph Nunan, Tom Lister, Harriet Howgill, Mia Marie Merced Parreno, Guy Brown, Andrew Walden
{"title":"Point of Care Ultrasound Bladder Volume Calculation on the Acute Medical Unit.","authors":"Joseph Nunan, Tom Lister, Harriet Howgill, Mia Marie Merced Parreno, Guy Brown, Andrew Walden","doi":"10.52964/AMJA.0970","DOIUrl":"https://doi.org/10.52964/AMJA.0970","url":null,"abstract":"<p><p>Nursing staff, healthcare assistants (HCAs) and other healthcare professionals on the Acute Medical Unit (AMU) at Royal Berkshire Hospital (RBH) were taught a Point of Care Ultrasound (POCUS) skill during a twenty minute session. Practitioners learned how to take bladder volume measurements with the Butterfly iQ, a portable ultrasound device which provides a visually-aided method of volume measurement. A Likert scale was used to measure the confidence that staff had in performing volume measurements with the AMU automated scanners, and with the semi-automated Butterfly iQ. After the teaching session, confidence reported by practitioners in using the semi-automated visual method was significantly higher than confidence reported in using the automated non-visual scanners (t < 0.001). Minimal time and expense was required to teach practitioners how to perform this skill. Training nurses in POCUS for bladder visualisation and bladder volume calculation is easy and practicable.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving Telemetry use in the Acute Assessment Unit. 改善急性评估病房遥测技术的使用。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0969
Patrick Timmons, Lindsay Reid, Kathleen Clare, Daniel Beckett, Tegan Thomson, Lisa Fabisiak
{"title":"Improving Telemetry use in the Acute Assessment Unit.","authors":"Patrick Timmons, Lindsay Reid, Kathleen Clare, Daniel Beckett, Tegan Thomson, Lisa Fabisiak","doi":"10.52964/AMJA.0969","DOIUrl":"https://doi.org/10.52964/AMJA.0969","url":null,"abstract":"<p><strong>Background and aims: </strong>Despite published guidelines, telemetry use is inappropriate in 25-43% of cases. This impacts patient safety and telemetry effectiveness. QI methodology was used to review telemetry in a hospital acute medical unit with the aim of reducing inappropriate use and addressing alarm fatigue.</p><p><strong>Methods: </strong>A 'Telemetry Indication Form' was created. Eight weeks of baseline data was collated before introducing the 'Indication Form'. Four plan-do-study-act cycles were conducted. At each cycle, data was analysed using statistical process control charts.</p><p><strong>Results: </strong>Inappropriate telemetry use significantly reduced from 32% to 4%. Total telemetry use also fell. Unfortunately, interventions to address alarm rates did not result in significant reduction in false alarms.</p><p><strong>Conclusions: </strong>A 'Telemetry Indication Form' has significant potential to improve patient safety through reducing inappropriate use.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The intensive care population profile in Denmark before and during the first wave of the SARS-CoV-2 pandemic; a national register-based study. SARS-CoV-2 第一波大流行之前和期间丹麦重症监护人群概况；一项基于国家登记册的研究。
Acute Medicine Pub Date : 2024-01-01
Søren Bie Bogh, Marianne Fløjstrup, Christian Fynbo Christiansen, Anne Craveiro Brøchner, Erika Christensen, Anders Perner, Thomas Strøm, Mikkel Brabrand
{"title":"The intensive care population profile in Denmark before and during the first wave of the SARS-CoV-2 pandemic; a national register-based study.","authors":"Søren Bie Bogh, Marianne Fløjstrup, Christian Fynbo Christiansen, Anne Craveiro Brøchner, Erika Christensen, Anders Perner, Thomas Strøm, Mikkel Brabrand","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To describe the change in admission rate and demographic profile of patients admitted to ICUs throughout Denmark before and during first wave of the SARS-CoV-2 pandemic.</p><p><strong>Methods: </strong>A register-based national observational study of all patients admitted to ICU from December 2019 until April 2020, comparing ICU admission before and after lockdown.</p><p><strong>Results: </strong>The number of admissions declined, especially in the age groups below 18 and above 70. The sex distribution and the comorbidity-level remained unchanged. The length of hospital stay prior to ICU admission increased. Overall fewer patients were admitted electively.</p><p><strong>Conclusion: </strong>Fewer patients were admitted to ICU and waited longer for admission during the first wave of the COVID-19 pandemic.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An unexpected case of acute intermittent porphyria. 一个意外的急性间歇性卟啉症病例。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0972
Aaron Jesuthasan, Michael Wride, Harriet Esdaile, Adam Daneshmend
{"title":"An unexpected case of acute intermittent porphyria.","authors":"Aaron Jesuthasan, Michael Wride, Harriet Esdaile, Adam Daneshmend","doi":"10.52964/AMJA.0972","DOIUrl":"https://doi.org/10.52964/AMJA.0972","url":null,"abstract":"<p><p>Acute Intermittent Porphyria (AIP) can be a challenging diagnosis to make, due to its rarity in actual practice and presenting symptoms often being attributed to more common conditions. This is particularly the case, since many patients will likely present to acute and general hospitals where the diagnosis may often not be considered. However, it remains pivotal to diagnose the condition as early as possible to prevent significant morbidity and even death. Here we present an unexpected case of AIP, illustrating the diagnostic delay that is commonly seen with the condition and yet emphasise the importance of its detection to commence urgent treatment.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Point-of-care ultrasound for the diagnosis of an atypical small bowel obstruction in a cannabis user: a case report. 用于诊断大麻使用者非典型小肠梗阻的护理点超声波：病例报告。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0971
Alaa Beshir, Jonas Bruyns, Maximilien Thoma, Florence Dupriez
{"title":"Point-of-care ultrasound for the diagnosis of an atypical small bowel obstruction in a cannabis user: a case report.","authors":"Alaa Beshir, Jonas Bruyns, Maximilien Thoma, Florence Dupriez","doi":"10.52964/AMJA.0971","DOIUrl":"https://doi.org/10.52964/AMJA.0971","url":null,"abstract":"<p><p>This case report describes an atypical small bowel obstruction in a 71- years old cannabis user and how point-of-care of ultrasound (PoCUS) helped to its management by further orientating the physician toward the bowel obstruction etiology, namely intussusception. Intussusception is the invagination of an intestinal segment into the adjacent segment. The acute clinical presentation of intussusception often has non-specific symptoms, and the diagnosis can be challenging. While the most common etiology is neoplasm, intussusception also occurs in bowel motility disorder such as after cannabis use. Although this case report illustrates intussusception PoCUS findings, these should nevertheless be integrated into the clinical picture and CT-scan should remain the gold standard complementary examination in case of a suspected bowel obstruction.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Performance of AI-powered chatbots in diagnosing acute pulmonary thromboembolism from given clinical vignettes. 人工智能聊天机器人根据给定的临床案例诊断急性肺血栓栓塞症的性能。
Acute Medicine Pub Date : 2024-01-01
Banu Arslan, Mehmet Necmeddin Sutasir, Ertugrul Altinbilek
{"title":"Performance of AI-powered chatbots in diagnosing acute pulmonary thromboembolism from given clinical vignettes.","authors":"Banu Arslan, Mehmet Necmeddin Sutasir, Ertugrul Altinbilek","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chatbots hold great potential to serve as support tool in diagnosis and clinical decision process. In this study, we aimed to evaluate the accuracy of chatbots in diagnosing pulmonary embolism (PE). Furthermore, we assessed their performance in determining the PE severity.</p><p><strong>Method: </strong>65 case reports meeting our inclusion criteria were selected for this study. Two emergency medicine (EM) physicians crafted clinical vignettes and introduced them to the Bard, Bing, and ChatGPT-3.5 with asking the top 10 diagnoses. After obtaining all differential diagnoses lists, vignettes enriched with supplemental data redirected to the chatbots with asking the severity of PE.</p><p><strong>Results: </strong>ChatGPT-3.5, Bing, and Bard listed PE within the top 10 diagnoses list with accuracy rates of 92.3%, 92.3%, and 87.6%, respectively. For the top 3 diagnoses, Bard achieved 75.4% accuracy, while ChatGPT and Bing both had 67.7%. As the top diagnosis, Bard, ChatGPT-3.5, and Bing were accurate in 56.9%, 47.7% and 30.8% cases, respectively. Significant differences between Bard and both Bing (p=0.000) and ChatGPT (p=0.007) were noted in this group. Massive PEs were correctly identified with over 85% success rate. Overclassification rates for Bard, ChatGPT-3.5 and Bing at 38.5%, 23.3% and 20%, respectively. Misclassification rates were highest in submassive group.</p><p><strong>Conclusion: </strong>Although chatbots aren't intended for diagnosis, their high level of diagnostic accuracy and success rate in identifying massive PE underscore the promising potential of chatbots as clinical decision support tool. However, further research with larger patient datasets is required to validate and refine their performance in real-world clinical settings.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Guest Editorial - Ambulatory Care: Turning Urgent and Emergency Care inside out. 特邀社论--非住院医疗：将急诊和急救护理翻转过来。
Acute Medicine Pub Date : 2024-01-01
Rosalind Rowland, Daniel Lasserson
{"title":"Guest Editorial - Ambulatory Care: Turning Urgent and Emergency Care inside out.","authors":"Rosalind Rowland, Daniel Lasserson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Emergency departments are under year-round pressure, driven by high hospital bed occupancy and compounded by increasing attendances and admissions. In 2023, 1.5 million people waited 12 hours or more for a bed. Long waits are associated with increased mortality and there is a disproportionate impact on people living in more deprived areas. Addressing this problem begins with unity of purpose and vision, such that we all view emergency department performance as our responsibility, whatever our place in the healthcare system.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Editorial - Acute Medical Care: "Exit block". 社论--急诊护理："退出障碍"。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0965
T Cooksley
{"title":"Editorial - Acute Medical Care: \"Exit block\".","authors":"T Cooksley","doi":"10.52964/AMJA.0965","DOIUrl":"10.52964/AMJA.0965","url":null,"abstract":"<p><p>NHS urgent and emergency care (UEC) remains under immense and unsustainable pressure. This is increasingly causing harm to patients and emotional trauma to the staff striving to deliver basic standards of care.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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