Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Aims and Objectives In Australian Emergency Departments (EDs), patients experience long waits for imaging, particularly for presentations such as renal colic. Computed Tomography (CT) imaging is the gold-standard for renal stones, although ultrasonography is recommended for young patients and those susceptible to radiation, an approach supported by The Canberra Hospital (TCH) ED guidelines for renal colic. This audit aims to not only assess how well these guidelines are adhered to, but also to discuss possible methods of improving flow through ED and thus patient outcomes. Method and Design A retrospective audit was conducted using 100 attendances to TCH ED between the dates of 02/04/2022 and 15/06/2022 with the diagnosis of renal colic or calculus. Data was collected on biochemical and radiographic results and patient outcomes with the associations between these data sets statistically analysed. Results and Conclusion Blood tests demonstrating abnormal renal function, white cell count and C-Reactive protein (CRP) together with haematuria on urine analysis conferred high positive and negative predictive values (83.3% and 100% respectively) for renal stones. Larger renal stones were associated with higher creatinine and CRP levels and a lower estimated glomerular filtration rate (P = 0.0145; P = 0.0062; P = 0.0022 respectively). We propose that patients with significant clinical and biochemical features of renal stones could be referred to urology earlier to await CT as an inpatient and those without be referred to their general practitioner for outpatient imaging and medical management. This could improve flow through the department and improve patient outcomes through reduced waiting times and radiation burden.

This month’s update is by the Royal Blackburn Hospital. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as: Worth a peek—interesting, but not yet ready for prime time. Head turner—new concepts. Game changer—this paper could/should change practice.

Aims and Objectives In 2019, NHS England (NHSE) announced the implementation of Same Day Emergency Care Services (SDEC) in every hospital with a type 1 emergency department (ED). SDEC aims to provide timely and appropriate ambulatory care to patients on the same day, thus avoiding admission. There is limited evidence for SDEC adoption and its effectiveness. This mixed-method study identifies and analyses SDEC implementation methods and describes subjective workforce views through both surveys and interviews. Method and Design An electronic survey was developed and distributed via email to 60 randomly selected hospitals in England with type 1 EDs. Follow-up interviews were conducted to expand on survey responses and identify key themes. Results and Conclusion In total, 39 responses (including dual responses from SDEC and ED staff) were received from 34 hospitals (57%). All hospitals had an acute medical SDEC, with more limited implementation of surgical (53%) and frailty SDECs (29%). The SDECs opened on average 12 hours on weekdays and 10 hours on weekends. Although staffing models varied, a senior decision maker (consultant or registrar) was always present, with additional input from advanced clinical practitioners (ACPs) and physician associates (PAs), (85%). Availability of assessment spaces and IT resources was consistent, despite 79% of hospitals using their SDECs as emergency bed spaces. 85% of units assessed between 31-50 patients/day, with no unit admitting >10 patients per day. Although interviews were generally positive regarding SDEC efficiency, identified themes included variability in perceptions of SDEC purpose, issues with referral pathways and inconsistent staffing levels. Since its introduction, SDEC has been implemented and developed with great variability across England, with a paucity of literature regarding its efficacy. While the introduction of the NHS SAMEDAY guidelines this year may assist in mitigating these discrepancies nationally, more research is vital to identify optimal methods of service delivery and evaluation of this new healthcare system.