College Of Emergency Medicine Research Articles

Emergency medicine for 25\xa0Years in Iceland \u2013 history of the specialty in a nutshell

After the early implementation of Emergency Medicine (EM) 25 years ago, Iceland became the first Nordic country to nationally realize the benefits of this specialty. However, the road has been rocky as in many other countries. The early years of EM in Iceland were characterized by a significant shortage of resources, particularly a lack of medical staff dedicated to EM and properly trained for the services required. The main task for the first couple of decades was to build the infrastructure of an operational emergency department based primarily on the model of EM. Although these efforts eventually led to a critical number of specialists becoming certified in EM, recruiting more people remains a priority in order to fully meet the need for specialty trained emergency physicians in Iceland. A key step towards achieving this goal was the initiation of a two-year residency program for specialty training in EM in year 2002. The program was based on a curriculum produced by the Icelandic Society for Emergency Medicine, which had been founded in year 2000. This training program is currently being redeveloped and the curriculum of the Royal College of Emergency Medicine in the UK will be adopted for use in Iceland. Another important milestone was the appointment of the first faculty member dedicated to EM at the University of Iceland. This created an opportunity to teach medical students EM and advance training at the graduate level. Also, conditions for scientific research in EM have been improved, following the establishment of an EM research institute in 2010.Other Nordic countries may be able to benefit from lessons learned and experiences gained from the development of emergency medicine in Iceland during the past quarter of a century.

Calculating the proportion of avoidable attendances at UK emergency departments: analysis of the Royal College of Emergency Medicine’s Sentinel Site Survey data

IntroductionAvoidable attendances (AAs; defined as non-urgent, self-referred patients who could be managed more effectively and efficiently by other services) have been identified as a contributor to ED crowding. Internationally, AAs...

Emergency department standards

Essential factsSufficient numbers of nurses, patient access to Wi-Fi and regular comfort rounds are on a list of 50 standards for emergency departments (EDs) to improve care (Royal College of Emergency Medicine (RCEM) 2016).

Emergency Departments and Occupational Therapy: Integration, Unscheduled Care and Over-crowding

Introduction: Globally, over-crowding within Emergency Departments is becoming a serious concern (Walker et al 2016) impacting on patient safety (Pines et al 2011) and work-related stress (The College of Emergency Medicine 2013; Lavoie et al 2011). One reason for over-crowding is that, in addition to treating urgent medical and surgical conditions, Emergency Departments act as the ‘front doors’ of hospitals, and people wait for admission to acute-care (Walker et al 2016), a process known as unscheduled care (The Royal College of General Practitioners 2011). Occupational therapists are well-placed to address some of the issues around unscheduled care (Mearns et al 2008). This is because they assess and treat people directly in the Emergency Department and determine whether a discharge directly home is feasible (Mearns et al 2008). The College of Occupational Therapists recently claimed that 70% of patients referred to occupational therapy in this way were discharged directly (College of Occupational Therapists 2016). This presentation claims a role for occupational therapists in Emergency Departments in terms of their potential to reduce over-crowding. It will report on the findings from two linked studies: - a critical review of the literature (James et al 2016) and a qualitative study (James et al 2016a). Methods: A systematic search was performed for occupational therapy in the Emergency Department using database platforms, internet search engines and grey sources. Critical analysis of each record was undertaken and synthesised. An Interpretative Phenomenological Analysis framework was applied to the qualitative study. Nine occupational therapists with experience of working in the Emergency Departments were recruited from across Scotland. Individual, semi-structured interviews were audio-recorded and transcribed verbatim. Interview transcripts were analysed line-by-line and interpreted using Interpretative Phenomenological Analysis methods. Results: The systematic search returned 23 potentially relevant papers of which 16 met the criteria for further inclusion and seven were critically analysed. Not all study sample sizes were small, but variable methodological quality meant current evidence can only be taken into professional practice with caution. Findings from the qualitative study led to two over-arching themes. Theme one captured the experience of occupational therapists working in Emergency Departments. Theme two encapsulated what it was like to enter and establish a new role. Discussion: There are good reasons why occupational therapists are well-placed to address issues of over crowding in the Emergency Department. However, based on current evidence, there can only be a limited understanding of its role and efficacy. There is a need for large-scale, well designed research studies of occupational therapy within emergency care.

The Royal College of Emergency Medicine composite pain scale for children: level of inter-rater agreement

ObjectiveTo assess the inter-rater agreement of the Royal College of Emergency Medicine (RCEM) Composite Pain Scale.MethodsA prospective, observational study of 117 children who presented to the ED with pain due...

Impact of advanced autonomous non-medical practitioners in emergency care: protocol for a scoping study

IntroductionEmergency care services are looking for new models of care delivery to deal with changing patient demographics and increased pressures. It has been suggested that advanced non-medical practitioners might be...

WHAT SHOULD BE DONE TO REDUCE EMERGENCY DEPARTMENT CROWDING? – A DELPHI STUDY

Objectives & BackgroundEmergency department crowding is a serious public health problem throughout the developed world. In 2015 the UK Royal College of Emergency Medicine was charged by its executive with...

ROUTINE HIV TESTING IN AN INNER CITY EMERGENCY DEPARTMENT

Objectives & BackgroundThe National Institute of Clinical Excellence (NICE) and the Royal College of Emergency Medicine recommend that adults should be tested for HIV in endemic areas with a prevalence...

Physician's perspective on point-of-care ultrasound: Experience at a tertiary care emergency department in Qatar

Background: Point-of-care ultrasound (POCUS) is an invaluable tool in the diagnosis and management of conditions presenting to emergency departments across the world. It has also improved the success rate of invasive bedside procedures. Objectives: This study aimed to investigate the current utilization of POCUS in a large tertiary care emergency department in the Middle East and to identify barriers to its utilization. Methods: A cross-sectional survey of emergency physicians' experience with ultrasound was conducted, which included examining the training, exposure, and barriers to use. This paper-based survey was completed by the participants in the presence of the authors of this study to improve compliance. Data were collected over a period of two months, from October to November 2014. Results: A total of 105 physicians participated in the survey. Of these participants, 56 had undergone prior training in ultrasonography by successfully completing courses approved by the Royal College of Emergency Medicine in the United Kingdom, and the Royal College of Physicians and Surgeons of Canada. Twenty-two physicians had completed other non-accredited ultrasound courses. An improvement in ultrasound procedural skills was reported by all those who completed training. A perceived lack of time in the emergency department was the main barrier to scanning patients. Other shortcomings included a deficiency of trained personnel for guidance, shortage of equipment, and a lack of experience and interest among physicians. Hands-on training was considered the preferred method among physicians for enhancing ultrasonography skills. Conclusions: The study identified an underutilization of POCUS by emergency physicians. Availability of dedicated time, equipment, supervision, and training may help to increase its usage.

Physician's perspective on point-of-care ultrasound: Experience at a tertiary care emergency department in Qatar

Background: Point-of-care ultrasound is an invaluable tool in the diagnosis and management of many conditions presenting to emergency departments across the world. It has also improved the success rate of invasive bedside procedures. Objectives: This study aimed to investigate the current utilization of point of care ultrasound in a large tertiary care emergency department in the Middle East and to identify barriers to its utilization. Methods: A cross sectional survey of emergency physician's experience with ultrasound was conducted, examining training, exposure and barriers to use. This paper-based survey was completed by the participants in the presence of study authors to improve compliance. Data was collected over a period of two months, from October to November 2014. Results: One hundred and five (105) physicians participated in the survey. Fifty-six physicians had prior training in ultrasonography from courses approved by The Royal College of Emergency Medicine in the United Kingdom, and The Royal College of Physicians and Surgeons of Canada. Twenty-two physicians had undertaken other non-accredited ultrasound courses. All of them reported an improvement in their procedural skills by employing ultrasound. Perceived lack of time in the Emergency Department was the main barrier to scanning. Other hurdles included a deficiency of trained personnel for guidance, shortage of equipment and a lack of experience and interest. Hands on training were stated as the preferred method for enhancing ultrasonography skills. Conclusions: There has been underutilization of point-of-care ultrasound by emergency physicians. Availability of dedicated time, equipment, supervision and training will help to increase its usage.

Government must act now to prevent looming winter crisis.

It may seem odd to be talking about winter pressures now, but there are signs that the next 6-8 months are going to be challenging in the extreme. A report from the RCN and the Royal College of Emergency Medicine suggests that emergency department staff are locked in a cycle of permanent crisis. Add a spell of icy weather into the mix and the NHS could collapse under the strain.

Subspecialisation in emergency medicine: A specialty at the crossroads.

Subspecialisation in emergency medicine: A specialty at the crossroads.

Royal colleges work to broker a junior contract deal

Medical royal colleges are working behind the scenes to broker a deal between junior doctors and the government, and prevent the first all out strike by junior doctors in England. Meetings and discussions between government officials, heads of royal colleges, senior doctors, and senior health service figures have sought to break the deadlock between the government and the BMA over changes to junior doctors’ contracts. The King’s Fund’s chief executive, Chris Ham, called on the royal colleges to intervene to resolve the current dispute.1 He argued that although contract negotiations lay outside the responsibilities of the medical royal colleges their presidents have on previous occasions stepped outside their formal responsibilities to protect patient care. A spokesman for the Royal College of Emergency Medicine said that medical royal colleges were considering a move to work together to broker an agreement between doctors and the government. The Advisory, Conciliation, and Arbitration Service, which previously facilitated talks between the BMA and the government, confirmed that its “door will remain open to both parties.” Neena Modi, president of the Royal College of Paediatrics and Child Health said, “The medical royal colleges have a role to play …

Standard of outpatient management of renal colic

The aim of the research was to assess the standard of emergency outpatient management of renal colic at Khyber Teaching Hospital, Peshawar, Pakistan. A retrospective clinical audit of 197 randomly selected outpatients presenting with renal colic received and treated at the emergency department of Khyber Teaching Hospital, Peshawar, was carried out over a 1-year period from June 2014 to June 2015. Data were collected from the outpatient sheets of selected patients. The management they received was compared with the Royal College of Emergency Medicine’s (RCEM) guidelines for the management of renal colic. The results of this research showed that management fell short of RCEM guidelines for pain score on admission, which was not assessed or recorded in any of the 197 cases. Administration of analgesia for severe pain within 20, 30 and 60 minutes of admission was better than RCEM guidelines by 9%, 25% and 2%, respectively. It fell short of RCEM guidelines for moderate pain at 30 and 60 minutes by 69.9% and 19.1%, respectively. Re-evaluation of analgesia for severe pain exceeded RCEM guidelines by 10%, but fell short of the guidelines for moderate pain by 13%. Patients not receiving analgesia should be documented in all cases but, in this respect, the audit fell short of the guidelines by 9.1%. A full blood count and urea and electrolyte levels were assessed in only 73 (37.1%) and 8 (4.1%) cases, respectively, and fell short of the guidelines by 62.9% and 95.9%, respectively. None of the patients qualifying for assessment for abdominal aortic aneurysm (AAA) was investigated or assessed for the illness and the audit fell short of the RCEM guidelines in all 47 cases (23.9%). Our conclusions are that current practices partially complied with standards set by the RCEM guidelines for the management of renal colic. This should be addressed by presentations to doctors and nurses at the emergency outpatient department on RCEM guidelines and the findings of the present audit. Categories that fell short of the RCEM guidelines included pain score on admission; re-evaluation for moderate pain; documentation in all aspects of RCEM guidelines, including reasons for not receiving analgesia; performing RCEM laboratory investigations for all cases of renal colic; and assessment and management of cases qualifying for abdominal aortic aneurysm. Posters detailing the RCEM guidelines have been set up in the emergency

Taking stock: UK national antidote availability increasing, but further improvements are required

BackgroundA 2010/2011 audit of the Royal College of Emergency Medicine (RCEM) National Poisons Information Service (NPIS) UK guidelines on antidote availability demonstrated variable stocking of antidotes for the management of...

Feedback on ‘Tracheostomy management’, BJA Education, June 2015

Editor®I wish to comment on behalf of my colleagues who work with the National Tracheostomy Safety Project in response to the article by Katharine Hunt and Sue McGowan in the June edition of BJA Education.1Hunt K McGowan S. Tracheostomy management.BJA Education. 2015; 15: 149-153Abstract Full Text Full Text PDF Scopus (5) Google Scholar The article updates the reader on some of the progress in multidisciplinary tracheostomy care in the intervening years since a similar article in April 2008's CEACCP journal. It was refreshing to see the contribution of a nationally recognized Speech and Language Therapist in this latest article, emphasizing some of the progress in multidisciplinary care and management of tracheostomy patients. We were very surprised however not to find any mention of the National Tracheostomy Safety Project (NTSP), especially when many of the NTSP resources were considered as the benchmark in the 2014 NCEPOD report ‘On the right trach?’ referred to in the article. The Intensive Care Society Guidelines referenced in the article were updated in June 2014 and again emphasize the importance of standardized (NTSP) guidelines. The reproduction of Hunt and Regan's 2008 emergency management guideline figure was also surprising and potentially misleading for the readership of BJA Education. The NTSP published multidisciplinary emergency guidelines in 2012 (Fig. 1) which were endorsed by the Royal College of Anaesthetists, the Difficult Airway Society, the Intensive Care Society, ENT UK, the British Association of Oral and Maxillofacial Surgeons, the College of Emergency Medicine, the Resuscitation Council (UK) the Royal College of Nursing, the Royal College of Speech and Language Therapists, the Association of Chartered Physiotherapists in Respiratory Care, and the National Patient Safety Agency.2McGrath BA Bates L Atkinson D Moore JA Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies.Anaesthesia. 2012; 67: 1025-1041Crossref PubMed Scopus (134) Google Scholar The algorithms are universally taught in this country and beyond and were developed primarily in an attempt to standardize the response to tracheostomy emergencies. Whilst we certainly do not claim ownership of emergency care for tracheostomy patients, to publish alternative guidance without reference to the current national standard is confusing at best. The NTSP algorithms have been tested in both Anaesthetic and Intensive Care Medicine examinations and we would like to draw attention to this for your readership, especially those who are searching for up-to-date resources or specifically revising for such examinations. The article also makes valid reference to role anaesthetists can play as part of a multidisciplinary team managing in patients with a tracheostomy. The weaning process described is one of many published strategies and we would direct the reader searching for additional resources to the websites of the NTSP (www.tracheostomy.org.uk) or that of the Global Tracheostomy Collaborative (www.globaltrach.org).

The role of universities in Australasian emergency medicine training.

The role of universities in Australasian emergency medicine training.

Is “boarding” appropriate to help reduce crowding in emergency departments?

Moving patients from full emergency departments to corridors outside full wards is safe and necessary when accommodating new emergencies, say Adrian Boyle and Peter Viccellio . But Chris Whale warns...

Recruitment problems are creating a two tier system in emergency department staffing, college warns

Problems in persuading emergency medicine doctors to work in some areas of the country have created a two tier system of staffing in UK emergency departments, the College of Emergency Medicine has warned. Kevin Reynard, a vice president of the college, raised the issue at its conference this month. He noted “many problems with recruitment across the country” when it came to filling non-training grade posts in emergency medicine. “We …

Emergency medicine doctors should have “fair equality of leisure time” to compensate for unsociable hours, College of Emergency Medicine says

Doctors working in emergency medicine should have a “fair equality of leisure and family time” to compensate for night, evening, and weekend work, the College of Emergency Medicine has said. Speaking at the college’s conference earlier this month, Kevin Reynard, its vice president of the college, said that efforts to boost the total number of doctors working in the specialty needed to focus on retention. “It is clear that the issue isn’t about recruiting people into the specialty,” he said. “The issue is about retaining them once they get there.” Reynard said that developing “equitable terms and conditions” would be key to this. “This isn’t just going to happen by crossing our fingers and hoping,” he said. “We need to change the way we work and the conditions that people work in so we don’t drive people away.” He said that the organisations that would need to be involved in implementing such developments already acknowledged that changes had to …