Emergency Department Doctors Research Articles

The nutritional knowledge and the perception of weight‐loss strategies for obese patients among emergency medicine doctors in Hong Kong

AbstractIntroductionObesity is commonly seen in patients attending the emergency department (ED). Opportunities to provide nutritional advice to patients with obesity are often overlooked in ED settings. Numerous barriers and perceptions exist among healthcare professionals. This study aimed to explore the ED physicians' attitudes, practices, nutritional knowledge and barriers towards nutrition advice in weight management for obese patients in the ED.MethodsThis was a cross‐sectional survey conducted from February to April 2024. The self‐designed questionnaire consisted of questions regarding respondents' characteristics, attitudes, practices and barriers towards providing nutrition advice for obese patients in the ED and assessing the knowledge of nutrition among ED doctors. Non‐parametric tests and Pearson correlation were performed for statistical analysis. The responses between doctors with normal body mass index (BMI) and extreme BMI groups (“BMI < 18.5” and “BMI > 25.0”) were compared.ResultsThis study included 120 responses with a response rate of 16.9%. The mean nutritional knowledge score for doctors with normal BMI was 54.4 ± 14.5, and it was significantly higher than that of doctors who self‐reported as underweight (46.3 ± 5.6 and p = 0.049) or overweight (48.9 ± 16.1 and p = 0.029). The top barrier to nutrition support for obese patients in ED settings was “too busy to give nutrition advice” (77.5%).ConclusionsOur study highlighted the common barriers to offering nutritional advice and insufficient nutrition training among ED physicians. Integrating comprehensive nutrition education into our undergraduate medical training and providing regular evidence‐based nutritional courses may improve patients' and physicians' health.

Comparison of virtual and in-person simulations for sepsis and trauma resuscitation training in Singapore: a randomized controlled trial.

This study aimed to compare cognitive, non-cognitive, and overall learning outcomes for sepsis and trauma resuscitation skills in novices with virtual patient simulation (VPS) versus in-person simulation (IPS). A randomized controlled trial was conducted on junior doctors in emergency departments from January to December 2022, comparing 70 minutes of VPS (n=19) versus IPS (n=21) in sepsis and trauma resuscitation. Using the nominal group technique, we created skills assessment checklists and determined Bloom's taxonomy domains for each checklist item. Two blinded raters observed participants leading 1 sepsis and 1 trauma resuscitation simulation. Satisfaction was measured using the Student Satisfaction with Learning Scale (SSLS). The SSLS and checklist scores were analyzed using the 2-tailed t-test. For sepsis, there was no significant difference between VPS and IPS in overall scores (2.0; 95% confidence interval [CI], -1.4 to 5.4; Cohen's d=0.38), as well as in items that were cognitive (1.1; 95% CI, -1.5 to 3.7) and not only cognitive (0.9; 95% CI, -0.4 to 2.2). Likewise, for trauma, there was no significant difference in overall scores (-0.9; 95% CI, -4.1 to 2.3; Cohen's d=0.19), as well as in items that were cognitive (-0.3; 95% CI, -2.8 to 2.1) and not only cognitive (-0.6; 95% CI, -2.4 to 1.3). The median SSLS scores were lower with VPS than with IPS (-3.0; 95% CI, -1.0 to -5.0). For novices, there were no major differences in overall and non-cognitive learning outcomes for sepsis and trauma resuscitation between VPS and IPS. Learners were more satisfied with IPS than with VPS (clinicaltrials.gov identifier: NCT05201950).

Health inequities in cardiac care and cardiovascular guideline concordance in Australian migrant populations: data correlation for culturally and linguistically diverse populations (DatCALD) project

Abstract Background Evidence of inequities in acute cardiac care and concordance with cardiovascular guidelines in migrant populations have not been well documented in Australia. Additionally, knowledge of correlations between clinical data and population health data of these marginalised groups is seriously lacking. Purpose To establish an interactive population health atlas and perform data correlations to determine health inequities in cardiac care provision in emergency departments (EDs) and examine guideline concordance in migrant populations. Methods This study correlated population health data derived from public health surveillance systems with the clinical data of migrant populations in Australia. The interactive atlas has been established and data correlations between relevant variables have been produced. Degree of correlations were presented as a correlation coefficient (r). Results The evidence revealed a strong relationship between migrant status and poor cardiac care provision. Migrant populations who were born overseas in non-English-speaking (NES) countries were less likely to access universal health coverage in Australia (Medicare) and were more likely to live with socioeconomic disadvantage (r= 0.24). Birthplaces of migrants were associated with longer processing time for cardiac care in ED, including time to meet an ED doctor and total ED stay time (Figure 1). Migrant populations were less likely to receive cardiac care at triage within the recommended timeframe of 10 minutes (r= -0.35), whereas the Australian-born group were more likely to reach ED treatment within 10 minutes (r= -0.52). Interestingly, migrants who were born in English speaking countries had the strongest relationship with an ED stay longer than the recommended time of four hours (r= -0.42). An association between migrant populations and non-concordance with guidelines for management of chest pain was evident (Figure 2). The population born overseas in NES countries, resident in Australia ≥ 5 years had the strongest correlation with non-concordance (r= 0.50); whereas the Australian-born population were the most likely to meet the concordance guideline. The evidence suggested that permanent migrants entering Australia between 2000-2006 under family and skill stream visas have a higher likelihood of non-concordance with guidelines for chest pain management (r= 0.50) compared to those of this group who arrived in Australia after 2006. Conclusions Health inequities in cardiac care in ED and concordance with cardiovascular guidelines have been found to be associated with migrant status at varying degrees, related to their birthplace and duration of residency. Universal health coverage and sociocultural factors are related to those health inequities. Addressing these determinants of health, normalizing cultural competence and increase health service accessibility are recommended to promote and sustain health equities and wellbeing in these disadvantaged populations.Birthplace and ED provisionBirthplace and non-concordance

Silver Fast Track – Prioritising People Over 75 in the Emergency Department (ED)

Abstract Background The National Emergency Medicine Programme prioritised the care of older adults in a three-year Unscheduled Care Improvement Programme, coinciding with the “Integrated NCAGL Acute Operations and Older Persons body of work on Older Adults with Frailty in Acute hospitals”. In May 2023 a three-month pilot in the ED commenced to reduce the time for people over the age of 75 awaiting assessment by a doctor. Using the Manchester Triage system, a separate filing box on triage (Category 3+) was created to identify all people aged over 75 years who would then be prioritised to be seen within 4 hours of arrival. In addition, if a person aged over 75 years was waiting over 4 hours to be seen they would be re-triaged and seen within 15 minutes (Category 2). Methods A Prospective analysis of waiting times for people aged over 75 years, assessing: (1) time to be assessed by the Older Persons Assessment and Liaison (OPAL) Team; (2) time to see the ED doctor and (3) time to discharge. Results Four months prior to commencement, the median time from arrival to be seen by OPAL was 10 hours 58 mins. Following commencement, for the remainder of 2023, the median time from arrival to seen by OPAL was 6 hours 36 mins. The time to see the doctor reduced by 49 mins and time to discharge reduced by 1 hour 19 minutes. Conclusion The category 3+ for patients aged over 75 years is now an established feature in the ED. It has enabled the OPAL team to undertake earlier assessment of the patients journey alongside the medical team ensuring a more collaborative discharge pathway. In the future, we hope to further reduce the time to be assessed by OPAL through the introduction of clinical frailty scoring at ED triage & expanding the team.

Reducing personal protective equipment waste in the emergency department of a large regional hospital: codesign informed by system science

BackgroundThis study aimed to bring together health workers from an emergency department (ED) and broader health system changemakers to cocreate a system-oriented understanding of the drivers of single-use personal protective...

Physician Posttraumatic Stress Disorder During COVID-19

The COVID-19 pandemic placed many physicians in situations of increased stress and challenging resource allocation decisions. Insight into the prevalence of posttraumatic stress disorder in physicians and its risk factors during the COVID-19 pandemic will guide interventions to prevent its development. To determine the prevalence of posttraumatic stress disorder (PTSD) among physicians during the COVID-19 pandemic and examine variations based on factors, such as sex, age, medical specialty, and career stage. A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant systematic review was conducted, searching MEDLINE, Embase, and PsychInfo, from December 2019 to November 2022. Search terms included MeSH (medical subject heading) terms and keywords associated with physicians as the population and PTSD. Peer-reviewed published studies reporting on PTSD as a probable diagnosis via validated questionnaires or clinician diagnosis were included. The studies were reviewed by 6 reviewers. A random-effects meta-analysis was used to pool estimates of PTSD prevalence and calculate odds ratios (ORs) for relevant physician characteristics. The primary outcome of interest was the prevalence of PTSD in physicians, identified by standardized questionnaires. Fifty-seven studies with a total of 28 965 participants and 25 countries were included (of those that reported sex: 5917 of 11 239 [52.6%] were male and 5322 of 11 239 [47.4%] were female; of those that reported career stage: 4148 of 11 186 [37.1%] were medical trainees and 7038 of 11 186 [62.9%] were attending physicians). The estimated pooled prevalence of PTSD was 18.3% (95% CI, 15.2%-22.8%; I2 = 97%). Fourteen studies (22.8%) reported sex, and it was found that female physicians were more likely to develop PTSD (OR, 1.93; 95% CI, 1.56-2.39). Of the 10 studies (17.5%) reporting age, younger physicians reported less PTSD. Among the 13 studies (22.8%) reporting specialty, PTSD was most common among emergency department doctors. Among the 16 studies (28.1%) reporting career stage, trainees were more prone to developing PTSD than attendings (OR, 1.33; 95% CI, 1.12-1.57). In this meta-analysis examining PTSD during COVID-19, 18.3% of physicians reported symptoms consistent with PTSD, with a higher risk in female physicians, older physiciansy, and trainees, and with variation by specialty. Targeted interventions to support physician well-being during traumatic events like pandemics are required.

Doctors',Patients' and Physician Associates' Perceptions of the Physician Associate Role in the Emergency Department.

The Emergency Department (ED) has seen increased patient attendance and difficultymeeting demands. New healthcare professions such as Physician Associates (PAs) are being utilised to complement the existing medical workforce. Despite the growth of their professions in the United Kingdom, little evidence is available about the perceptions of their roles. This study aims to provide evidence of doctors', PAs' and patients'perceptions of the PA role in the UK ED. A mixed methods approach consisted of the following: 1. An online exploratory survey of ED doctors at one English EDover 1 month (February-March 2022). 2. Post consultation semi-structured patient questionnaires over 2 weeks (April 2022). 3. Semi-structured virtual interviews with ED consultants across thefour regions of theUnited Kingdom (3 months in 2022). 4. Semi-structured virtual interviews with ED PAs across thefour regions of theUnited Kingdom(3 months in 2022). The analysis methods that were used includedfrequency counts and percentages from closed questions, andhybrid thematic analysis of free text and interview transcripts. Four ED consultants and four ED PAs across the United Kingdom were interviewed. Twenty-eight ED doctors participated in the online survey. Fifty-seven patients completed the post consultation questionnaire. Four main themes (PAs being fit for purpose; patient recognition of PAs, PAs providing continuity of care, and future PAs and regulation) were deduced as per the General Medical Council, Good Medical Practice domains (knowledge, skillsand development; patients, partnership and communication; colleagues, culture and safety; and trust and professionalism). Other subthemes were induced via hybrid thematic analysis. In this study, doctors and patients had mixed comments about the role of PAs. Most of them were positive as doctor participants perceived PAs to be knowledgeable, highly skilled, with mostly good communication skills, team players, providing continuity of care and overall being fit for purpose. However, some doctor participants commented negatively about PAsfor providing little quality healthcare and being inexperienced. There was a desire for career progression amongthe PA participants and a need to work to their full potential. Although the clinicians of this study displayed a clear understanding of the PA role in the ED,a high frequency of surveyed patients mistook PAs for doctors. It was suggested that future PAs could complete a postqualification programme in emergency medicine, combine roles, be paid on an alternative scaleand be formally regulated. In this study, mixed views were expressed by ED consultants, ED junior doctorsand patients regarding the role of the PA in the ED. Stakeholders can use the information presented to develop a better understanding of the perceptions of the PA role within the UK ED. The Patient and Public Involvement and Engagement (PPIE) group, led by Healthwatch, made significant contributions to the study's design by providing valuable feedback on the information sheets and consent forms utilised. The patients' responses helped guide the study's direction and shape its future work. As part of the dissemination activities, the study findings was shared with both the PPIE team and Healthwatch media production team.

Nettle-induced Urticaria Treatment Study (NUTS): demonstrating the joy of research through a randomised, blinded, placebo-controlled trial

The use of dock leaves to ease the discomfort of nettle stings is a well-known folk remedy in the British Isles, yet has never been tested in a clinical trial....

Factors influencing the use of Point Of Care Ultrasound (POCUS) on adult patients by Accident and Emergency Department (A&E) Doctors in Tertiary Care Hospitals in Colombo District, Sri Lanka; a Descriptive Cross-Sectional Study

Introduction:Point of care ultrasound (PoCUS) is an essential component of A&E setting all over the world. It is used for diagnosis and assisting bedside procedures. Usage of PoCUS has been shown to improve quality of patient care. There are no formal studies in Sri Lankan A&E setting to assess level of its usage and the barriers of using it. This study aimed to assess these aspects among ED doctors in three tertiary care hospitals in Colombo district.Methodology:This descriptive study was conducted by self-administered questionnaires distributed among 72 ED doctors working in the above setting. Questionnaire consisted of questions related to sociodemographics, types of PoCUS performed, barriers to PoCUS use etc. Ability to perform PoCUS was assessed by Likert grading from 1 to 5 based on operator’s own opinion. Statistical analysis was done using SPSS.Results: All the tertiary care emergency services had access to an ultrasound machine. PoCUS has been used for a wide variety of bedside scans and therapeutic procedures. Majority has been used to detect free fluid in peritoneal cavity (66.6%) and FAST scans (65.3%). Post graduate doctors (PG) were more confident in configuring PoCUS machine for procedures than non PG doctors (82.8% vs 5.4%). Ability to perform PoCUS was associated with post graduate exposure, >1 year of experience using it and doing >300 procedures in last 3 months (p=0.001). Main barriers identified for PoCUS usage were lack of training and lack of quality ultrasound machine.Discussion: Though PoCUS is mainly performed by PG doctors, important scans such as FAST, intra peritoneal free fluid assessment are done by non-PG doctors too. Compared to similar international studies, less number of latter doctors were capable of doing PoCUS in Sri Lanka. Empowering these doctors with PoCUS skills will improve the sustainably of this service in emergency care setup as they work in units for longer duration. A study where candidates’ skills are assessed by a third party would have provided more accurate reflection of PoCUS usage.Conclusion: Embracing updated technology and further improvement and availability of PoCUS training among ED doctors will enhance sustainable emergency patient care in Sri Lanka.

“I feel like I’m walking on eggshells”: a qualitative study of moral distress among Chinese emergency doctors

BackgroundWhile the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources.AimThis study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it.MethodPurposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi’s phenomenological analysis method.Study findingsThis study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress.ConclusionThe moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors’ communication skills.

Triage Performance Across Large Language Models, ChatGPT, and Untrained Doctors in Emergency Medicine: Comparative Study.

Large language models (LLMs) have demonstrated impressive performances in various medical domains, prompting an exploration of their potential utility within the high-demand setting of emergency department (ED) triage. This study evaluated the triage proficiency of different LLMs and ChatGPT, an LLM-based chatbot, compared to professionally trained ED staff and untrained personnel. We further explored whether LLM responses could guide untrained staff in effective triage. This study aimed to assess the efficacy of LLMs and the associated product ChatGPT in ED triage compared to personnel of varying training status and to investigate if the models' responses can enhance the triage proficiency of untrained personnel. A total of 124 anonymized case vignettes were triaged by untrained doctors; different versions of currently available LLMs; ChatGPT; and professionally trained raters, who subsequently agreed on a consensus set according to the Manchester Triage System (MTS). The prototypical vignettes were adapted from cases at a tertiary ED in Germany. The main outcome was the level of agreement between raters' MTS level assignments, measured via quadratic-weighted Cohen κ. The extent of over- and undertriage was also determined. Notably, instances of ChatGPT were prompted using zero-shot approaches without extensive background information on the MTS. The tested LLMs included raw GPT-4, Llama 3 70B, Gemini 1.5, and Mixtral 8x7b. GPT-4-based ChatGPT and untrained doctors showed substantial agreement with the consensus triage of professional raters (κ=mean 0.67, SD 0.037 and κ=mean 0.68, SD 0.056, respectively), significantly exceeding the performance of GPT-3.5-based ChatGPT (κ=mean 0.54, SD 0.024; P<.001). When untrained doctors used this LLM for second-opinion triage, there was a slight but statistically insignificant performance increase (κ=mean 0.70, SD 0.047; P=.97). Other tested LLMs performed similar to or worse than GPT-4-based ChatGPT or showed odd triaging behavior with the used parameters. LLMs and ChatGPT models tended toward overtriage, whereas untrained doctors undertriaged. While LLMs and the LLM-based product ChatGPT do not yet match professionally trained raters, their best models' triage proficiency equals that of untrained ED doctors. In its current form, LLMs or ChatGPT thus did not demonstrate gold-standard performance in ED triage and, in the setting of this study, failed to significantly improve untrained doctors' triage when used as decision support. Notable performance enhancements in newer LLM versions over older ones hint at future improvements with further technological development and specific training.

A Cross-Sectional Study of Emergency Care Services During the COVID-19 Pandemic: A Multicenter Study of Healthcare Staff Perspectives.

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted various aspects of healthcare services, including emergency care services. Healthcare staff face mental issues and physical exertion when caring for patients potentially infected with COVID-19. Understanding the experiences and perspectives of emergency department (ED) healthcare staff during the COVID-19 pandemic is essential to inform evidence-based interventions and strategies to mitigate the impact on emergency care services. This study aims to investigate the experiences of ED healthcare staff regarding emergency care services during the COVID-19 pandemic, thus providing valuable insights into the challenges faced. This study utilized a cross-sectional study design. Data were collected from 256 ED healthcare staff working in nine different hospitals located in Turkey between November 15, 2021, and December 30, 2021. Data were analyzed using descriptive statistics. A total of 256 participants were included in the study. Of the participants, 58.6%were nurses, 19.5% were ED doctors, and 21.9% were emergency medical technicians. In addition, 67.2% of the participants were infected with COVID-19, and almost all of them (94.1%) were psychologically affected by the pandemic process. It was found that 85.2% of ED healthcare staff felt excluded by society due to being healthcare staff and 71.9% had to be separated from their families. Nurses were separated from their families at the highest rate (78%) during this period. More than half of the ED healthcare staff had problems accessing protective equipment and were separated from their families during the pandemic due to the risk of COVID-19 transmission. Although the number of ED visits decreased because of restrictions at the beginning of the pandemic, ED visits increased again with the abolition of restrictions.

Confidence of Emergency Department doctors in managing ophthalmic emergencies: a systematic review

BackgroundEye emergencies constitute a significant portion of attendances to general Emergency Departments (EDs) in the UK, therefore it is important to assess the confidence of doctors who work in this setting in managing these potentially sight- and life-threatening presentations. This systematic review aims to assess the confidence of UK doctors working in general EDs in managing ophthalmic emergencies.MethodsMEDLINE (Ovid), EMBASE (Ovid), ProQuest Central and Web of Science databases and grey literature were searched from inception to 1 October 2022 for publications that (1) featured doctors working in UK general EDs, (2) assessed doctors’ confidence in managing ophthalmic emergencies, (3) contained original data, (4) were full-text, and (5) written in English. Methodological quality was assessed using the AXIS tool.Results462 articles were screened, and 7 papers included for data extraction, which collectively assessed the confidence of 956 doctors working in EDs in managing ophthalmic emergencies. There was a widespread lack of confidence amongst foundation doctors, which has worsened over time. Most doctors lacked confidence in performing funduscopy and using the slit-lamp, and considered formal ophthalmology training received in EDs to be inadequate.ConclusionsEvidence suggests a lack of confidence amongst foundation doctors in managing ophthalmic emergencies. High-quality evidence investigating the confidence amongst more experienced Emergency Medicine (EM) physicians was lacking. It is important to assess why foundation doctors feel so ill-prepared to manage eye emergencies and develop further ophthalmic training for doctors working in EDs. Further investigation exploring the confidence of EM trainees and consultants is required.

Public Beliefs About Accessibility and Quality of Emergency Departments in Germany.

It is well established that emergency department (ED) crowding leads to worse health outcomes. Although various patient surveys provide information about reasons to visit EDs, less is known in terms of beliefs about EDs among the general population. This study examines public beliefs regarding accessibility and quality of EDs and their associations with social characteristics (gender, age, education, immigration background) as well as knowledge about emergency care services and health literacy. We conducted a cross-sectional study based on a random sample of 2,404 adults living in Hamburg, Germany, in winter 2021/2022. We developed eight statements regarding accessibility and quality of EDs leading to two scales (Cronbach's α accessibility = 0.76 and quality of care = 0.75). Descriptive statistics of the eight items are shown and linear regression were conducted to determine associations of the two scales with social characteristics as well as knowledge about emergency care services and health literacy (HLS-EU-Q6). Nearly 44% of the respondents agreed that "you can always go to an ED, if you do not get a short-term appointment with a general practitioner or specialist." And 38% agreed with the statement, "If you do not have the time during normal practice hours due to your work, you can always go to an ED." In terms of quality, 38% believed that doctors in EDs are more competent than doctors in general practice, and 25% believed that doctors in EDs are more competent than doctors in specialized practices. In the fully adjusted model, public beliefs about emergency care accessibility and quality of EDs were significantly associated with all social characteristics and knowledge of emergency care options with the strongest associations between knowledge and accessibility (β = -0.17; P < 0.001) and between education and quality (β = -0.23; P < 0.001). We found endorsement of public beliefs about accessibility and quality of EDs that can lead to inappropriate utilization. Our results also suggest that knowledge of different emergency services plays an important role. Therefore, after system-related reorganizations of emergency care, information campaigns about such services tailored to socially deprived populations may help alleviate the issue of crowding.

Project to improve the management of the head injury patients presenting to the emergency department

IntroductionAt Sandwell General Hospital, there was no risk stratification tool or pathway for head injury (HI) patients presenting to the emergency department (ED). This resulted in significant delays in the...

Review of Abstinence Syndrome: A Comprehensive Analysis of Current Practices and Recommendations

Alcohol use disorder is frequently accompanied with the diverse and sometimes fatal consequence of alcohol withdrawal syndrome (AWS). Many patients with AUD may develop AWS during their Emergency Department stay, and AUD is one of the top causes of death worldwide. This study summarizes the etiology, epidemiology, and emergency management of Alcohol Withdrawal Syndrome and Alcohol Use Disorder.The influence of AWS on the therapy of ED is highlighted, along with its temporal course. Once AWS is diagnosed, the most common therapy is still symptom- triggered benzodiazepine injection; however, patients who have significant medical or psychiatric comorbidities or are about to be discharged may not be good candidates for this approachIn these circumstances, emergency department doctors can consider employing alternative regimens based on state-of-the-art anticonvulsants or shorter barbiturate durations. For clinical practice, specific treatment procedures are described. Lastly, in addition to managing acute patients' AWS, emergency physicians also need to provide the groundwork for effective AUD therapy. A strategy for the patient with AUD's disposition is offered.

Exploring clinicians' insertion experience with a new peripheral intravenous catheter in the emergency department

BackgroundHospitals frequently introduce new medical devices. However, the process of clinicians adapting to these new vascular access devices has not been well explored. The study aims to explore clinicians’ experience with the insertion of a new guidewire peripheral intravenous catheter (PIVC) introduced in the emergency department (ED) setting. MethodsThe study was conducted at two EDs in Queensland, Australia, utilising a qualitative explorative approach. Interviews were conducted with guidewire PIVC inserters, including ED doctors and nurses, and field notes were recorded by research nurses during insertions. Data analysis was performed using inductive content analysis, from which themes emerged. ResultsThe study compiled interviews from 10 participants and field notes from 191 observation episodes. Five key themes emerged, including diverse experience, barriers related to the learning process, factors influencing insertion success, and recommendations to enhance clinicians’ acceptance. These themes suggest that the key to successful adoption by clinicians lies in designing user-friendly devices that align with familiar insertion techniques, facilitating a smooth transfer of learning. ConclusionClinician adaptation to new devices is vital for optimal patient care. Emergency nurses and doctors prefer simplicity, safety, and familiarity when it comes to new devices. Providing comprehensive device training with diverse training resources, hands-on sessions, and continuous expert support, is likely to enhance clinician acceptance and the successful adoption of new devices in ED settings.

1849 Implementing a comprehensive geriatric assessment (CGA) in older adults presenting to a district general emergency department

Abstract Introduction Frailty is the concept of increasing vulnerability to minor stressors in the context of a reduction in physiological reserves (Clegg et Al. The Lancet 2013, Volume 381, pages 752-762). It affects 10% of people presenting to Emergency departments (ED) and around 30% of inpatients in acute medical units (NHS England and NHS Improvements. 2019). Implementing a CGA is known to result in a significant increase in your likelihood of being alive and in your own home at 6 months (Ellis et Al. BMJ 2013). Aims To implement an ED in reach frailty service with the goal of performing a CGA at the earliest opportunity. Methods We undertook a 3-week pilot with a small team comprising a consultant, frailty ACP, SHO and geriatric registrar. The team were based in ED and worked alongside the existing ED navigator team and in conjunction with various community teams. Data was collected assessing completion of the usual domains within the CGA and discharge data. Results 62 patients were seen in total. Mean age was 82.4 years with a mean CFS of 5. Each patient received a CGA. 9/62 (15%) of patients were discharged on the same day. 15/53 (28%) were discharged within 72 hours of admission. Other notable results include: 100% completion of 4AT and 70 medications de-prescribed. Feedback from patient and relatives in addition to ED and AMU doctors was extremely positive. Conclusion We demonstrated that performing a CGA in ED resulted in higher numbers of patients being discharged on the same day or within 72 hours of admission. We were able to demonstrate a significant increase in assessment of delirium allowing earlier detection and a much higher rate of deprescribing with significant benefits for both patient and the trust.

Persistent High Fever After Metchloropramide Treatment; Neuroleptic Malignant Syndrome

Introduction: Neuroleptic Malignant Syndrome(NMS) is a state neurotransmitter levels fluctuate subsequent to administration of neuroleptic agents. Etiology of NMS is unclear. It’s a neurological emergency includes symptoms like altered mental status, rigidity, fever and dysautonomy. Our aim in here is to mention the side effects of metochlopramide, which is commonly used in Emergency Departments(ED). In our case, subsequent to intravenous admission of metochlopramide, patients clinic worsened with NMS symptoms and this was quite unexpected and unwanted for ED doctors. By this case report it is wanted to raise awareness against, side effects of metoclopramide and NMS.&#x0D; Case Report: Subsequent to intravenous administration of single dose metoclopramide to relieve abdominal pain into 21 years old male with no history of chronical diseases, symptoms of fever, muscle rigidity, confusion and fluctuating blood pressure levels quickly emerged along with leukocytosis and high levels of Creatine Kinase. ED Doctors suspected NMS. Futher laboratory and imaging stuides has excluded other central nervous system pathologies and infections. Eventually, patients clinic got better with symptomatic theraphy and he was discharged fully recovered.&#x0D; Conclusion: NMS due to metoclopramide is quite rare, but usage of therapies includes Metoclopramid at ED’s are quite often. Subsequent to administration of this drug, if patients clinical state worsens with fever, confusion and muscle rigidity, phycisians should keep NMS in mind.

"You treat what you have to treat, and you don't care as much if they understand or if they feel good about it": Communication barriers and perceptions of moral distress among doctors in emergency departments.

Doctors facing communication barriers when assessing patients in emergency departments (ED) is a frequent phenomenon, as the global prevalence of dementia and migration have increased. This study aims to explore how communication barriers influence moral distress as perceived by medical doctors working at emergency departments. Twelve doctors at 2 different EDs in Stockholm, Sweden, participated. Answers on communication barriers were collected from an interview guide on moral distress. Informants' responses were analyzed using qualitative thematic analysis. The results suggest that doctors experience moral distress when assessing patients with communication barriers due to an inability to mediate calm and safety and understand their patients, and due an increased need of resources and difficulties in obtaining consent before conducting examinations or interventions. In conclusion, communication barriers can be a cause of moral distress, which should be considered when developing tools and methods to mitigate and manage moral distress.