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Implementing a Digital Deteriorating Patient Pathway to improve the safety and effectiveness of care of the adult deteriorating patient. 实施 "数字化病情恶化患者路径"，提高对病情恶化的成年患者的护理安全性和有效性。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0968
Adrian Jennings, Philip Brammer, Sian Annakin, Helen Bromage, Tom Cook, Michele Hickey, Jagjit Dhami, Fhezan Ashraf, Ravi Sahota-Thandi, Stephen Borrington
{"title":"Implementing a Digital Deteriorating Patient Pathway to improve the safety and effectiveness of care of the adult deteriorating patient.","authors":"Adrian Jennings, Philip Brammer, Sian Annakin, Helen Bromage, Tom Cook, Michele Hickey, Jagjit Dhami, Fhezan Ashraf, Ravi Sahota-Thandi, Stephen Borrington","doi":"10.52964/AMJA.0968","DOIUrl":"https://doi.org/10.52964/AMJA.0968","url":null,"abstract":"<p><p>Identification, escalation and clinical review of the deteriorating patient is essential for a safe and effective hospital. We present a deteriorating patient pathway developed within our electronic patient record, including implementation of a digital escalation and senior review process, triggered from a logic algorithm and vital signs. The pathway is activated by an average 43 patients per day with median mortality of 13.3%. Our Trust has seen a significant improvement in escalation and senior review and increased use of treatment escalation plans. The pathway has facilitated a cultural shift in the Trust towards the deteriorating patient. The new pathway is transferrable to both other digital Trusts as well as maternity and paediatric practice.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 1","pages":"18-23"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869488","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
Evaluating dynamic patterns in mortality before and after reconfiguration of the Danish emergency healthcare system. 评估丹麦急诊医疗系统重组前后死亡率的动态模式。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0967
Marianne Fløjstrup, Anna Kollerup, Søren B Bogh, Mickael Bech, Daniel Henriksen, Søren P Johnsen, Mikkel Brabrand
{"title":"Evaluating dynamic patterns in mortality before and after reconfiguration of the Danish emergency healthcare system.","authors":"Marianne Fløjstrup, Anna Kollerup, Søren B Bogh, Mickael Bech, Daniel Henriksen, Søren P Johnsen, Mikkel Brabrand","doi":"10.52964/AMJA.0967","DOIUrl":"https://doi.org/10.52964/AMJA.0967","url":null,"abstract":"<p><strong>Background: </strong>This study explored changes in short-term mortality during a national reconfiguration of emergency care starting in 2007.</p><p><strong>Methods: </strong>Unplanned hospital contacts at emergency departments across Denmark from 2007 to 2016. The reconfiguration was a natural experiment, resulting in individual timelines for each hospital. The outcome was in-hospital and 30-day mortality.</p><p><strong>Results: </strong>Individual patient-level data included 9,745,603 unplanned hospital contacts from 2007 to 2016 at 20 hospitals with emergency departments. We observed a sharp downwards shift in in-hospital mortality and 30-day mortality in three hospitals in relation to the reconfiguration.</p><p><strong>Conclusion: </strong>This nationwide study identified three hospitals where the reconfiguration was closely associated with reduced in-hospital and 30-day mortality. In contrast, no major effects were identified for the remaining hospitals.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 1","pages":"11-17"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866783","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
Emergency physicians' experiences with defensive medicine and their motives for acting defensively - an interview study. 急诊医生的防御性医疗经验及其采取防御性行动的动机--访谈研究。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0988
Thorbjørn Hougaard Mikkelsen, Mikkel Brabrand, Anne Friesgaard Christensen, Merethe Kousgaard Andersen
{"title":"Emergency physicians' experiences with defensive medicine and their motives for acting defensively - an interview study.","authors":"Thorbjørn Hougaard Mikkelsen, Mikkel Brabrand, Anne Friesgaard Christensen, Merethe Kousgaard Andersen","doi":"10.52964/AMJA.0988","DOIUrl":"https://doi.org/10.52964/AMJA.0988","url":null,"abstract":"<p><strong>Background: </strong>Defensive medicine (DM) has been increasingly studied in recent years. This study aims to investigate the understanding of DM and the motives for practicing DM among emergency physicians.</p><p><strong>Methods: </strong>Focus group interviews.</p><p><strong>Results: </strong>Themes identified: The understanding of DM, DM is a matter of self-confidence, DM or tests to ensure diagnosis and patient flow, DM due to confounding by availability, DM due to guidelines, Patient-initiated DM, Fear of complaints, DM in an emergency department setting.</p><p><strong>Conclusion: </strong>This study shows that emergency physicians perform an abundance of diagnostic tests and investigations but only categorize few of them as DM. The many flow-mediating tests based on guidelines may, however, mask activities that individual physicians would possibly find defensive, if it was up to them to decide based on pure and simple anamnesis and clinical findings. It might be argued that flow optimization has overruled medical clinical reasoning in some ways, thereby introducing an inclination to conduct DM.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 3","pages":"132-139"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606660","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":"23 2","pages":"54-55"},"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":"23 1","pages":"2-3"},"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
Thyrotoxic Periodic Paralysis: A Case Report with Patient Perspective. 甲亢性周期性麻痹：带患者视角的病例报告
Acute Medicine Pub Date : 2024-01-01
Aliaksandra Baranskaya, Yimeng Zhang, Brian Lee
{"title":"Thyrotoxic Periodic Paralysis: A Case Report with Patient Perspective.","authors":"Aliaksandra Baranskaya, Yimeng Zhang, Brian Lee","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present a case report on a spot diagnosis of Thyrotoxic Periodic Paralysis (TPP) with a unique first-person account of events from the patient. It illustrates the importance of pattern recognition and exemplifies how timely treatment enables quick resolution of a life-threatening medical emergency. Patient X's account affirms the condition's insidious onset and rapid deterioration. This case highlights the need for raising awareness of diseases that are more prevalent in specific ethnic groups and is particularly crucial for work in culturally diverse environments. We hope by sharing our experience, readers will be prompted to consider TPP as a differential diagnosis for acute limb weakness in an acute setting; with prompt testing of thyroid function and initiation of the appropriate treatments.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 2","pages":"91-94"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917614","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
A Retrospective Comparison of Emergency Department Throughput Before and After Instituting a Waiting Room Evaluation Process. 实施候诊室评估流程前后急诊科吞吐量的回顾性比较。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0987
John Teijido, Benjamin Blackwood, Barry Knapp, Laura Strojny
{"title":"A Retrospective Comparison of Emergency Department Throughput Before and After Instituting a Waiting Room Evaluation Process.","authors":"John Teijido, Benjamin Blackwood, Barry Knapp, Laura Strojny","doi":"10.52964/AMJA.0987","DOIUrl":"https://doi.org/10.52964/AMJA.0987","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has strained the healthcare system with emergency department (ED) boarding and workforce shortages. This prompted the need for strategies to evaluate and treat patients while they waited for an ED room.</p><p><strong>Objectives: </strong>The objective is to describe a waiting room evaluation process and ED throughput in the setting of ED staffing shortages and boarding.</p><p><strong>Methods: </strong>This is a retrospective before and after cohort study evaluating ED throughput before and after initiation of the assessed waiting room (aWR) process. The aWR process is a joint effort by emergency clinicians and ancillary staff to evaluate and treat patients in the ED waiting room when no ED bed is available. Throughput data 6 months before and 6 months after institution of aWR was collected and analyzed.</p><p><strong>Results: </strong>The arrival to provider time and the number of patients who left without being seen (LWBS) decreased with initiation of the aWR process. The remainder of throughput metrics remained unchanged. There was more ED boarding at Wisconsin sites during the aWR process period.</p><p><strong>Conclusions: </strong>The aWR process may minimize LWBS and improve arrival to provider time in the setting of staff shortages and more ED boarders. It may help other ED throughput metrics although numerous confounding factors make it difficult to make definitive conclusions. This process may be trialed during times of challenging healthcare landscape, such as pandemic conditions and with workforce shortages.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 3","pages":"127-131"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606655","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
Research in Acute Medicine. The results of a national survey of Society for Acute Medicine members. 急症医学研究。对急症医学会会员进行的全国性调查的结果。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0985
Suzy Gallier, James Hodson, Kum Loon Kwok, Lily Li, Charlotte Morgan, Benjamin Lewis, C Subbe, E Punj, C Atkin, E Sapey
{"title":"Research in Acute Medicine. The results of a national survey of Society for Acute Medicine members.","authors":"Suzy Gallier, James Hodson, Kum Loon Kwok, Lily Li, Charlotte Morgan, Benjamin Lewis, C Subbe, E Punj, C Atkin, E Sapey","doi":"10.52964/AMJA.0985","DOIUrl":"https://doi.org/10.52964/AMJA.0985","url":null,"abstract":"<p><strong>Background: </strong>Medical research improves patient outcomes, patient satisfaction, staff morale and retention. It is unclear what research opportunities and training staff in acute medicine had.</p><p><strong>Methods: </strong>The Society for Acute Medicine supported a survey to assess current research activity, training and perceived opportunities and barriers.</p><p><strong>Results: </strong>292 responses were received from diverse professional backgrounds. Few respondents had formal research qualifications or were undertaking research, but the majority valued research and wanted more research experience including formal training. Barriers included time constraints and perception that research in acute medicine was less valued by healthcare organisations. Preferred mechanisms to increase research included mentorship, advocacy, and increased opportunities.</p><p><strong>Conclusions: </strong>Strategies to increase research in acute medicine should consider these results in forward planning.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 3","pages":"107-117"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606675","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
Evaluating acute medical service performance against assessment time metrics: the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23). 根据评估时间指标评估急症医疗服务绩效：急症医学基准审计学会 2023 (SAMBA23)。
Acute Medicine Pub Date : 2024-01-01 DOI: 10.52964/AMJA.0984
Catherine Atkin, Chris Subbe, Mark Holland, Ragit Varia, Tim Cooksley, Adnan Gebril, Adrian Kennedy, Thomas Knight, Daniel Lasserson
{"title":"Evaluating acute medical service performance against assessment time metrics: the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23).","authors":"Catherine Atkin, Chris Subbe, Mark Holland, Ragit Varia, Tim Cooksley, Adnan Gebril, Adrian Kennedy, Thomas Knight, Daniel Lasserson","doi":"10.52964/AMJA.0984","DOIUrl":"https://doi.org/10.52964/AMJA.0984","url":null,"abstract":"<p><p>Performance within acute medicine services is impacted by ongoing pressures on acute care services. Data from the Society for Acute Medicine Benchmarking Audit 2023 (SAMBA23), was used to assess performance of acute medicine services compared to key clinical quality indicators, comparing performance by initial assessment location. Data was analysed for 8213 unplanned attendances across 161 hospitals. Comparing by initial assessment location, performance against the clinical quality indicators was unchanged from 2022. Only 29% of daytime arrivals assessed within the Emergency Department received consultant review within target times. Delays were seen in transfer between acute care locations. 29% of patients requiring admission were not admitted to the AMU. There is ongoing variation in acute medical service performance nationally, with significant delays in patient access to appropriate assessment locations.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 3","pages":"100-106"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606667","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
Emergency Department Treatment of Elevated Blood Pressure in the Headache Patient. 急诊科对头痛患者血压升高的治疗。
Acute Medicine Pub Date : 2024-01-01
Lauren Eberhardt, Michelle Jankowski, Brett Todd
{"title":"Emergency Department Treatment of Elevated Blood Pressure in the Headache Patient.","authors":"Lauren Eberhardt, Michelle Jankowski, Brett Todd","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Headache accounts for 1 - 3% of emergency department (ED) visits globally and is associated with elevated blood pressure (BP). It is unclear if anti-hypertensive therapy provides benefits. This retrospective study assessed effects of anti-hypertensive therapy in ED headache patients on rescue analgesic need, hospital admissions, and length of stay (LOS). 1385 patients were included. 366 received anti-hypertensive therapy. The anti-hypertensive therapy cohort was older (p < 0.001) with increased odds of admission (p < 0.001) and 2.385 hrs longer ED LOS (p < 0.001). No difference in rescue analgesia was found (p < 0.429). Anti-hypertensive therapy in hypertensive ED headache patients is associated with increased hospital admission and ED LOS, but no difference in rescue analgesia utilization.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 2","pages":"75-80"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917697","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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