London Emergency Department Research Articles

The FAST Alcohol Screening Test.

Using the Alcohol Use Disorders Identification Test (AUDIT) as the gold standard, the Fast Alcohol Screening Test (FAST) was developed for use in busy medical settings. AUDIT questionnaires were completed by 666 patients in two London accident & emergency (A&E) departments. Using a principal components analysis, as well as sensitivity and specificity indices, a two-stage screening test was developed, using four of the AUDIT items. The first stage involved one item that identified >50% of patients as either hazardous or non-hazardous drinkers. The second stage made use of the other three items to categorize the rest. The performance of this four-item questionnaire was then tested across a range of settings. Opportunistic samples of 100 patients completed AUDIT questionnaires in each of the following National Health Service settings: A&E department, fracture clinic, primary health centre and a dental hospital. It was concluded that the four-item FAST questionnaire had good sensitivity and specificity, across a range of settings, when the AUDIT score was used as the gold standard. The FAST questionnaire is quick to administer, since >50% of patients are categorized using just one question.

Out-of-hospital intravenous cannulation: the perspective of patients treated by London Ambulance Service paramedics.

Previous research has highlighted concern about infection rates in field-placed intravenous (IV) cannulae. In a study of IV placement by London Ambulance Service (LAS) paramedics, 17% of placements were judged to be inappropriate. Large variations in rates of IV placement between LAS paramedics were found. The authors' hypothesis was that placement of an IV carries disadvantages-pain, discomfort, distress, and infection-which may be unacceptable to patients. This was a survey of all patients having an IV placed by LAS paramedics and transported to one of three London emergency departments (EDs) over a three-week period in December 1996. Patients were excluded if they had a self-inflicted injury/illness, were less than 14 years old, had no known address, or were visitors to the UK, or if their family doctor suggested it was not appropriate to contact the patient. Pain, discomfort, and distress; infection; satisfaction; understanding of the reason for cannulation; and out-of-hospital cannula use were all ascertained and analyzed with chi-square analysis. Thirty-nine percent of the respondents experienced some discomfort, 39% some pain, and 17% some distress. No patient reported an infection. Distress was more likely to be reported if there was no understanding of why the IV cannula was placed (chi2 [1] 6.1; p < 0.05). Further unstructured information revealed satisfaction with the IV cannulation and with general care. Despite the disadvantages of IV placement being reported by some respondents, overall levels of satisfaction were high, suggesting that these disadvantages were not unacceptable to patients. However, in the context of the 24,000 patients cannulated each year by LAS paramedics, "costs" to the patient are considerable.

Identifying alcohol-related harm in young drinkers: the role of accident and emergency departments.

Data are presented from a screening study of ambulant attendees at two London Accident and Emergency (A&E) departments. Among young people (aged 16-24 years), 37.2% were drinking harmfully [an Alcohol-Use Disorders Identification Test (AUDIT) score of 8 or more]; 17.3% admitted to drinking alcohol in the 6 h prior to attendance; and 14.6% considered that their attendance was alcohol related. Young women were as likely as men to score 8 or over. This age group had nearly twice the odds of scoring highly on the AUDIT, compared to those over 25 years old, and were more likely to report that their attendance was alcohol related. Screening in A&E departments would identify considerable numbers of young people who might benefit from brief intervention, but the problems of doing so are acknowledged.

Short-term associations between outdoor air pollution and visits to accident and emergency departments in London for respiratory complaints.

Many epidemiological studies have shown positive short-term associations between health and current levels of outdoor air pollution. The aim of this study was to investigate the association between air pollution and the number of visits to accident and emergency (A&E) departments in London for respiratory complaints. A&E visits include the less severe cases of acute respiratory disease and are unrestricted by bed availability. Daily counts of visits to 12 London A&E departments for asthma, other respiratory complaints, and both combined for a number of age groups were constructed from manual registers of visits for the period 1992-1994. A Poisson regression allowing for seasonal patterns, meteorological conditions and influenza epidemics was used to assess the associations between the number of visits and six pollutants: nitrogen dioxide, ozone, sulphur dioxide, carbon monoxide, and particles measured as black smoke (BS) and particles with a median aerodynamic diameter of <10 microm (PM10). After making an allowance for the multiplicity of tests, there remained strong associations between visits for all respiratory complaints and increases in SO2: a 2.8% (95% confidence interval (CI) 0.7-4.9) increase in the number of visits for a 18 microg x (-3) increase (10th-90th percentile range) and a 3.0% (95% CI 0.8-5.2) increase for a 31 microg x m(-3) increase in PM10. There were also significant associations between visits for asthma and SO2, NO2 and PM10. No significant associations between O3 and any of the respiratory complaints investigated were found. Because of the strong correlation between pollutants, it was difficult to identify a single pollutant responsible for the associations found in the analyses. This study suggests that the levels of air pollution currently experienced in London are linked to short-term increases in the number of people visiting accident and emergency departments with respiratory complaints.

"Saturday night fever": ecstasy related problems in a London accident and emergency department.

OBJECTIVES: To report on the extent and nature of acute MDMA (ecstasy) related problems presenting to a large London hospital's accident and emergency (A&E) department. METHOD: The computerised attendance records...

A chemical gas incident in London: How well prepared are London A & E departments to deal effectively with such an event?

This study aimed to investigate the preparedness of inner London Accident and Emergency (A & E) departments in the event of a major chemical incident. The dimensions of preparedness studied were procedures, facilities and equipment, protective clothing, knowledge, and attitudes towards chemical incidents. A review of the relevant literature will be published in issue 6/3 of this journal, July 1998.

Psychiatric presentations to an A&amp;E department

A survey is described of people presenting with psychiatric problems to a north London accident and emergency (A&amp;E) department over three months. Forty per cent presented with deliberate self-harm and 25% of these left before being assessed. Twenty per cent of those with problems compatible with a diagnosis of severe mental illness also left before being seen by a doctor. Differences between presentations ‘out-of-hours' and ‘in-hours' are described. Factors predicting admission were: previous psychiatric admission, symptoms of a psychotic or affective disorder and non-permanent accommodation. The survey has implications for the process of triage in A&amp;E departments and the organisation of mental health liaison services.

Urgent psychiatric assessment in an inner-city A&amp;E department

Data on day time referrals to a liaison psychiatry team from an inner London accident and emergency department (A&amp;E) were analysed over a two-year period. Despite the availability of local community-based alternatives for urgent assessment almost 5000 patients were seen. A quarter were self-referrals and two-thirds had had no previous contact with psychiatric services. The most common reason for referral was aggressive or disruptive behaviour. Characteristics of patients in this inner-city population suggest a continuing need for a high quality liaison service to the A&amp;E department.

Liaison psychiatric nursing in an inner city accident and emergency department.

The Mental Health Nursing Review Team recommend research to examine the potential of liaison mental health nursing. This paper describes a study into the work of two emergency psychiatric nurses (EPN) attached to a central London accident and emergency (A&E) department. A semi-structured interview schedule was employed to generate data on role development and purpose, and a retrospective survey of clinical activity was carried out over a 94-day period. Specific attributes and working practices, which promoted integration within the A&E department, are identified as are the reasons for referring patients to the EPNs, patients' primary problems on assessment, assessment outcome and the staff involved in each assessment. Findings are considered in relation to the various models of psychiatric consultation and liaison found in the literature. The scope and quality of the available data is also assessed and recommendations are made to enable a more robust prospective study to be undertaken.

The injured motor cycle messenger.

Injured motor cycle messengers make up a small but significant proportion of the young injured attending Central London accident and emergency (A&E) departments. The study confirms that the pattern of their injuries is similar to other injured urban motor cyclists, and discusses the background of the injured, in terms of experience and training, highlighting the frequency of injury and possible predisposing factors. A total of 116 injured motor cycle messengers attending two Central London A&E departments over a 10-month period were studied. Thirteen per cent sustained sufficiently serious injuries to necessitate admission, the rest were treated as out-patients for lesser injuries. The mean age was 23. Only 18% had received any formal training and 31% were in possession of a provisional driving license only. Fifty-eight per cent had been employed as a messenger for less than 3 months, yet two-thirds of them had sustained a previous injury whilst a messenger. The apparent absence of supervision of this potentially dangerous occupation is emphasized. In view of the repeated injuries sustained by many of these vulnerable young men, it is suggested that those responsible for their treatment might, in addition to their therapeutic role, give suitable guidance that might prevent re-attendance with further injuries.

Nursing management of common accident wounds.

Patients with skin wounds account for 15% of attenders at accident and emergency departments. This article gives an insight into wound care as it is practised in an inner London accident and emergency department.

Tick-borne encephalitis complicated by monoplegia and sensorineural deafness

Tick-borne encephalitis (TBE) is rarely seen in Britain. We report a case of TBE in a 44-year-old Swedish woman presenting to an accident and emergency department in London. The clinical features of the case, while in many ways typical, were nonspecific and led to difficulty in early diagnosis. The course of the illness was complicated by monoplegia and evidence of bulbar involvement with sensorineural deafness. The last is a very rare manifestation of TBE. With increasing foreign travel, TBE is likely to present more commonly in the U.K. and should be considered in any case of febrile illness with neurological complications following travel abroad. Serological tests to aid early diagnosis should be more readily available.

Use of a questionnaire to obtain an alcohol history from those attending an inner city accident and emergency department.

A screening questionnaire designed to take an alcohol history was used on 996 patients attending the London Hospital Accident and Emergency Department. Questions concerned with 'binge' drinking detected many problem drinkers who were not identified by questions on weekly alcohol intake or 'CAGE' questions. The relative increase in detection was particularly marked in women.

Recommendations by accident and emergency staff about drug-overdose patients

Doctors and nurses ( N = 858) working in London Accident and Emergency Departments were asked in a questionnaire survey for their recommendations about the management of drug-dependent and deliberate self-poisoning patients and for their opinions on related topics. There was general agreement that these patients should receive full psychiatric evaluation and that a resident psychiatrist should be available to advise them. Two-thirds of respondents thought that there should be a full-time security officer available in Accident and Emergency Departments to deal with aggressive patients while 79% felt that drug-dependent patients should be taken to special emergency centres rather than to Accident and Emergency Departments. Approximately 60% of the Accident and Emergency Staff supported the idea of a voluntary ban on the prescription of barbiturates.

Congenital Abnormalities of Anus and Rectum: Mortality and Function

<h3>Objective</h3> To estimate the potential impact of enhanced primary care and new out-of-hospital models (OOHMs) on emergency department (ED) presentations by children and young people (CYP). <h3>Design</h3> Observational study. <h3>Patients &amp; setting</h3> Data collected prospectively on 3020 CYP 0–17.9 years from 6 London EDs during 14 days by 25 supernumerary clinicians. CYP with transient acute illness, exacerbation of long-term condition (LTC), complex LTC/disability and injury/trauma were considered manageable within OOHM. OOHMs assessed included nurse-led services, multispecialty community provider (MCP), primary and acute care system (PACS) plus current and enhanced primary care. <h3>Measures</h3> Diagnosis, severity; record of investigations, management and outcome that occurred; objective assessment of clinical need and potential alternative management options/destinations. <h3>Results</h3> Of the patients 95.6% had diagnoses appropriate for OOHM. Most presentations required assessment by a clinician with skills in assessing illness (39.6%) or injuries (30.9%). One thousand two hundred and ninety-one (42.75%) required no investigations and 1007 (33.3%) were provided only with reassurance. Of the presentations 42.2% were judged to have been totally avoidable if the family had had better health education. Of the patients 26.1% were judged appropriate for current primary care (community pharmacy or general practice) with 31.5% appropriate for the combination of enhanced general practice and community pharmacy. Proportions suitable for new models were 14.1% for the nurse-led acute illness team, MCP 25.7%, GP federation CYP service 44.6%, comprehensive walk-in centre for CYP 64.3% and 75.5% for a PACS. <h3>Conclusions</h3> High proportions of ED presentations by CYP could potentially be managed in new OOHMs or by enhancement of existing primary care.