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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
An Unusual Cause of Acute Hyponatraemia. 急性低钠血症的一个不寻常原因。
Acute Medicine Pub Date : 2024-01-01
C Gyan, O Cox, C Roseveare
{"title":"An Unusual Cause of Acute Hyponatraemia.","authors":"C Gyan, O Cox, C Roseveare","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present the case of an 81 year old man, admitted with ataxia and hyponatraemia. Biochemical analysis was suggestive of Syndrome of Inappropriate ADH (SiADH) which was initially attributed to a recent respiratory infection or treatment with omeprazole. Neurological symptoms worsened despite normalisation of sodium levels and further examination revealed generalised areflexia; subsequent investigation by the Regional Neurology team led to a diagnosis of Guillan Barre syndrome, and symptoms improved following treatment with Intravenous Immunoglobulin and prolonged in-patient rehabilitation. Guillan Barre syndrome is a recognised cause of SiADH and this case highlights the importance of considering this diagnosis along with full neurological examination when patients with hyponatraemia present with neurological symptoms.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 4","pages":"200-202"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721803","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
Patients cared for in the Corridor of a large hospital in the United Kingdom: Sick, elderly, and sad. 在英国一家大医院的走廊里照顾的病人：病人、老人和悲伤的人。
Acute Medicine Pub Date : 2024-01-01
E Barnes, N Ndlovu, L Knowles, V Price, C Subbe
{"title":"Patients cared for in the Corridor of a large hospital in the United Kingdom: Sick, elderly, and sad.","authors":"E Barnes, N Ndlovu, L Knowles, V Price, C Subbe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Care of patients in corridors of emergency departments is being normalised in many hospitals across the United Kingdom. Clinicians within Emergency Medicine and Acute Medicine have been discussing the impact of this care on patients, as well as the 'morale injury' on the staff looking after them. Whilst the authors of this paper have seen evidence of harm caused by delays of care to patients facing long waits in the emergency department, we believe that this is the first analysis that describes the case mix in a large UK hospital. Care in corridors affected patients with a broad range of conditions; 16% had a NEWS of 5 or more, 67% were elderly patients with markers of frailty, and 42% had a history of mental health problems or substance abuse.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 4","pages":"172-175"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721819","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
Taking medicines as prescribed (Picture Quiz). 遵医嘱服药（图片测验）。
Acute Medicine Pub Date : 2024-01-01
Abdulrahman Al-Mohammad, Dafydd Davies, Sally Hamour
{"title":"Taking medicines as prescribed (Picture Quiz).","authors":"Abdulrahman Al-Mohammad, Dafydd Davies, Sally Hamour","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A man in his 50s with a history of end-stage kidney disease on haemodialysis and chronic mental health issues underwent thoracoabdominal CT to characterise a prolonged lower respiratory tract infection. A single metallic density foreign object was noted within the lower oesophagus. (Figure 1).</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 4","pages":"206"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721828","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
Exertional dyspnea and orthopnea in a patient with a pacemaker: an easily overlooked diagnosis. 带起搏器患者的用力性呼吸困难和矫直性呼吸：一个容易被忽视的诊断。
Acute Medicine Pub Date : 2024-01-01
S E Butler, A Voskoboinik, H C Patel
{"title":"Exertional dyspnea and orthopnea in a patient with a pacemaker: an easily overlooked diagnosis.","authors":"S E Butler, A Voskoboinik, H C Patel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acute dyspnea represents one of the most common presentations to the emergency department. Identifying the cause of this non-specific symptom among patients with complex medical histories can be challenging. This case report describes a patient in their 60s with worsening dyspnea on exertion, fatigue and orthopnea on the background of a single chamber pacemaker. Our case demonstrates an often-missed diagnosis of pacemaker syndrome which can be identified on the bedside electrocardiogram (ECG). This is a disease with high morbidity and yet is easily treated once diagnosed.</p>","PeriodicalId":39743,"journal":{"name":"Acute Medicine","volume":"23 4","pages":"203-205"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721808","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
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
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