In this February issue.

Abstract

There are two themes covering several papers published this month, namely communication and managing ED activity and patient flow. Communication failure is a significant and consistent contributor to the causes of clinical error. It occurs through poor documentation in medical records, through poor oral communication between medical, nursing and clerical staff, and poor communication with the patient. We publish two similar studies from Queensland that report on the impact that formal tuition has on the quality of documentation by interns. The principal objectives of the studies were to discover if formal tuition for emergency medicine interns in the skill of medical documentation enhanced their ability to provide effective medical records. The results are, perhaps not surprisingly, quite positive. Initiatives such as ISBAR© and Team STEPPS© aim to improve communication between staff during the transfer of patients between units in a hospital and the transfer of care between staff at the end of a shift or meal break. A team from Toronto, Canada, reminds us that ‘the ED is a high-risk environment, where communication lapses can lead to suboptimal, even negative health outcomes. Clear and concise communication between ED residents and nursing staff is essential to patient care’. For departments that have not adopted practices and philosophies promulgated by ISBAR© and Team STEPPS©, they offer some simple strategies to help improve things. The Redcliffe Hospital in Queensland reports that the National Emergency Access Target (NEAT) led to significant improvements in access block there. This is the headline statement from their paper, but the discussion at the end raises some pertinent points about the future of NEAT and the upper limits of efficiency. While we are on the topic of NEAT, the Alfred Hospital in Melbourne adopted a Total Quality Care process that resulted in improved timeliness of care for ED patients without compromising safety and quality. Success is attributed to effective engagement of a hospital-wide approach to redesigning the care pathway and establishing a new set of principles that underpin care from the time of ED arrival. Travelling to the west coast of Australia, we read that in the next 5 years, demand for ED services in Western Australia will exceed population growth and the highest growth will be seen in patients with complex care needs. The authors argue that an integrated system-wide strategy is urgently needed to ensure access, quality and sustainability of the health system. Informal feedback suggests that this section is a popular development and is of interest to readers, not just trainees; we have more intriguing topics planned for the future. This month, the discussion is about the role of registrars in teaching medical students, a vexed topic for many, especially in teaching hospitals. An accompanying editorial helps clarify some of the dilemmas that need addressing in deciding how best to manage this conundrum. This month we offer a few tips on the technique for inserting intercostal drains, which, as the authors say, is a core ED procedural skill. Do you want to know more about the uncertainty of truth? What do you know about quantum mechanics? Delve once more into the world of FOAM in the Social Media section and be challenged to think outside the square. Finally, we want to draw your attention to a link to a video; we published this last year in the October (issue 5) edition. Unfortunately we failed to link and attribute it correctly, for which we apologise. For those of you who might have missed it, and to correct the earlier error, we are publishing it again in this issue. In the next issue (April), we plan to publish a series of papers on Ebola and what it means for emergency physicians and EDs.