Emergency Care Specialists Research Articles

Thromboembolic disease in dogs and cats

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsLouise O'DwyerThromboembolic disease in dogs and catsAll authorsLouise O'Dwyer MBA BSc(Hons) VTS(Anaesthesia & ECC) DipAVN(Medical & Surgical) RVNhttps://doi.org/10.1080/17415349.2015.1017382Published online:18 March 2015Display full sizeLouise O'Dwyer MBA BSc(Hons) VTS(Anaesthesia & ECC) DipAVN(Medical & Surgical) RVNLouise gained her Diploma in Advanced Veterinary Nursing (Surgical) in 2004, followed by her Diploma in Advanced Veterinary Nursing (Medical) in 2007, Veterinary Technician Specialist (Emergency and Critical Care) in 2011 and Veterinary Technician Specialist (Anaesthesia) in 2014, making her a member of both AVECCT and AVTA. She has contributed to over 25 journal articles and book chapters, and lectures regularly on all aspects of anaesthesia, emergency and critical care and infection control. She has worked as Head Nurse for PetMedics in Manchester, the largest emergency clinic in the UK, for the past 13 years, and is now Clinical Director.Louise's interests include all aspects of emergency care but particularly trauma, as well as anaesthesia, infection control and wound management. Louise is the co-author of Practical Emergency and Critical Care Veterinary Nursing as well as Wound Management in Small Animals: A Practical Guide for Veterinary Nurses and Technicians, the BSAVA Pocketbook for Nurses and the forthcoming A Veterinary Nurse's Guide to Infection Prevention and Control, due 2015.

Emergency care capacity in Freetown, Sierra Leone: a service evaluation.

BackgroundThere is an increasing global recognition of the role of emergency medical services in improving population health. Emergency medical services remain underdeveloped in many low income countries, particularly in sub-Saharan Africa. There have been no previous evaluations of specialist emergency and critical care services in Sierra Leone.MethodsEmergency care capacity was evaluated at a sample of seven public and private hospitals in Freetown, the capital of Sierra Leone. A structured set of minimum standards necessary to deliver emergency and critical care in the low-income setting was used to evaluate capacity. The key dimensions of capacity evaluated were infrastructure, human resources, drug and equipment availability, training, systems, guidelines and diagnostics. A score for each dimension of capacity was calculated based on the availability of a list of specified indicators within each dimension. In addition, an Emergency Care Capacity Score was calculated to demonstrate a composite measure of capacity based on the various indicator scores. This method has been used by the World Health Organisation in evaluating the availability and readiness of healthcare systems in low- and middle-income countries.ResultsSubstantial deficiencies in capacity were demonstrated across the range of indicators and predominantly affecting publically funded facilities. Capacity was weakest in the domain of infrastructure, with an average score of 43%, while the strongest areas of capacity overall were in drug availability, 82%, and human resources, 79%. A marked disparity was noted between public and private healthcare facilities with consistently lower capacity in the former. The overall Emergency Care Capacity Score was 66%.ConclusionThere are substantial deficiencies in emergency care systems in public hospitals in Freetown which are likely to compromise effective care. This represents a serious barrier to access to emergency healthcare. Emergency care systems have an important role in improving population health and as such should a priority for local policy makers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-015-0027-4) contains supplementary material, which is available to authorized users.

A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities.

residential aged care facility (RACF) resident numbers are increasing. Residents are frequently frail with substantial co-morbidity, functional and cognitive impairment with high susceptibility to acute illness. Despite living in facilities staffed by health professionals, a considerable proportion of residents are transferred to hospital for management of acute deteriorations in health. This model of emergency care may have unintended consequences for patients and the healthcare system. This review describes available evidence about the consequences of transfers from RACF to hospital. a comprehensive search of the peer-reviewed literature using four electronic databases. Inclusion criteria were participants lived in nursing homes, care homes or long-term care, aged at least 65 years, and studies reported outcomes of acute ED transfer or hospital admission. Findings were synthesized and key factors identified. residents of RACF frequently presented severely unwell with multi-system disease. In-hospital complications included pressure ulcers and delirium, in 19 and 38% of residents, respectively; and up to 80% experienced potentially invasive interventions. Despite specialist emergency care, mortality was high with up to 34% dying in hospital. Furthermore, there was extensive use of healthcare resources with large proportions of residents undergoing emergency ambulance transport (up to 95%), and inpatient admission (up to 81%). acute emergency department (ED) transfer is a considerable burden for residents of RACF. From available evidence, it is not clear if benefits of in-hospital emergency care outweigh potential adverse complications of transfer. Future research is needed to better understand patient-centred outcomes of transfer and to explore alternative models of emergency healthcare.

Is National Emergency Access Target dumbing down emergency physicians?

Is National Emergency Access Target dumbing down emergency physicians?

Spinal clearance guideline for out-of hospital providers

Introduction Unnecessary spinal cord immobilisation is a common problem in South Africa, even though out-of hospital spinal clearance is becoming standard of care in international emergency medical care (EMC) communities. Large numbers of unnecessary spinal immobilisations, in low risk trauma patients, result in an increased health and economic burden in both the in-hospital and out-of hospital settings. Currently, informal spinal clearance is being practiced in South Africa creating large practice variation, potential patient safety compromise and probable economic burden. An evidence-based out-of hospital spinal clearance algorithm would minimise the unnecessary hospitalisation of low risk spinal patients. Our objectives included: (i) To provide an accurate and reproducible algorithm to identify and correctly refer clinically relevant spinal injury in the out-of hospital setting and (ii) To inform policy makers of best practice for spinal cord clearance through evidence informed decision making and provide implementation and evaluation recommendations. This document provides recommendations for a spinal clearance guideline for South Africa and includes implementation strategies and evaluation criteria. Methods A Population, Intervention, Professionals, Outcomes and Health Context (PIPOH) research question was designed to answer the guideline topic. The literature was systematically searched for spinal clearance guidelines or recommendations. These were screened, appraised and adapted by a specialist emergency care review group using the Appraisal of Guidelines Research and Evaluation (AGREE II) and ADAPTE tools recommended for guideline adaptation and development. The results were filtered by the primary author using pre-defined selection criteria. Results A total of 8 guidelines met the inclusion criteria. Each guideline was independently assessed by two emergency care specialists using the AGREE II tool. A forum discussion was held to adapt the included guidelines to the local out-of hospital needs. Emergency care policy stakeholders and operational and student paramedics were asked to review and comment on the adapted algorithm. Conclusion An out-of hospital spinal clearance guideline was developed with evaluation and implementation strategies for the out-of hospital context. The author would like to acknowledge the South African Cochrane Centre and Dr Tamara Kredo for their support.

Étude de faisabilité pour la mise en place d’une filière de chirurgie ambulatoire en urgence

IntroductionDevelopment of outpatient care is one of the major goals of public health policy in our country. For the purpose of this study, we set up an emergency outpatient surgery unit 24hours a day in our hospital. We assessed the feasibility of such a unit with a length of stay less than 12hours and no patient readmission. Patients and methodsA prospective observational and monocentric study was conducted in our hospital by systematically including patients eligible for emergency surgery outpatient care. We built a database compiling patient characteristics, lengths of stay, surgical and anesthesic procedures, complications and readmission rate. Satisfaction was then assessed by the « EVAN-G » questionnaire. ResultsFrom May 2011 to October 2012, 147 patients were included in our research. They were 31years old [25–43]. Hundred and twenty-six of them (86%) remained in the outpatient procedure without any readmission. Twenty-one (14%) were excluded, essentially for surgical contraindications or due to the absence of an accompanying person. Length of stay was of 10.5hours [8.5–13]. The satisfaction survey showed an average score of 83/100. ConclusionThe setting up of an ambulatory emergency surgery unit is possible after proper training of emergency care specialists, anesthesiologists, and surgeons. This activity is compatible with safe care and a high level of patient satisfaction. It must be considered as part of the emergency procedures available and should not be systematically ruled out.

Fin de vie et soins palliatifs en médecine d’urgence : à propos d’une enquête nationale de pratique

IntroductionThere are very few recommendations specific to emergency medicine regarding the subject of end of life and palliative care.PurposeThe aim of this study is to analyse the level of understanding, treatment and care carried out by emergency care specialists for patients in urgent palliative care situations.Material and methodA telephone survey of opinions and practices, carried out between November 2010 and March 2011, of 100 French emergency care specialists.ResultsA total of 87 doctors responded. Of these, 76% were unaware of the official definition of palliative care, 71% did not follow official recommendations and 93% did not have any training in this area. However, 74% considered that this type of care was part of their job and 91% of hospitals had a palliative care structure in place. The reasons for being seen were as much social as they were medical. Care given was mainly providing comfort and rarely involved social or psycho-spiritual aspects. Admission to hospital into a specialised facility was proposed in 64% of cases.DiscussionThis study highlights the lack of training for emergency care specialists in the field of palliative care, despite this being part of their everyday job. If the majority of doctors have access to a palliative care structure for referrals, the policy is left to their discretion. Primarily patients were seen for medico-social reasons, ranging from receiving care, which on the whole was to make them more comfortable, and issues in social, psychological and spiritual areas. The management of these patients by emergency care specialists should be improved, from initial theoretical training for doctors, to ethical questions that they may face.

Construction of emergency nurse specialist training evaluation index system model

Objective To build emergency specialist nurse training evaluation index system model.Methods By Delphi method,21 emergency care specialists participated in the consultation,using the Analytic Hierarchy Process (AHP)to build a hierarchical model,establishing judgment matrix,through statistical calculations to determine the indicators and weight coefficients of the index system of emergency specialist nurse training.Results Four first-level indicators,11 second-level indicators,31 third-level indicators emergency specialist nurse training evaluation system model were established.Conclusions Establishment of emergency nurse specialist training evaluation index system provides an effective method and reference to improve the overall capacity of the emergency specialist nursing team to ensure the quality of training of emergency nurse specialists. Key words: Emergency nurse specialist; Evaluation index system model; Delphi method; Analytic hierarchy process

Ambulatory surgery in emergency

ObjectiveIn France, one of the major public health objectives is the increase of outpatient care in order to reduce hospital stay. This study reports the actual feasibility of setting up an ambulatory emergency surgery unit. Material and methods: A prospective observational study was conducted in our hospital. Patient’s characteristics, length of stay, patient’s phone calls, and readmission were colligated. Results are expressed in medians [interquartile 25–75%].ResultsFrom May 2011 to April 2012, 70 consecutive patients were aged 34 (26–44). Represented specialties were visceral surgery (56%), orthopedic surgery (37%), maxillofacial surgery (4%), and urologic surgery (3%). Among these 70 patients, 61 (87.2%) stayed in the outpatient procedure without any readmission, 4 (5.7%) were excluded for complex surgical follow-ups, 3 (4.2%) for lack of accompanying person when discharged, and 2 (2.8%) for nausea and vomiting. A patient call was made for insufficient analgesia. The average length of stay was of 11.2 [8.7–12.2] hours.ConclusionThe setting up of an ambulatory emergency surgery unit is possible after proper training of emergency care specialists, anesthesiologists, and surgeons. This activity is compatible with safe care of patients and must be considered as part of available emergency procedures and not as excluded by principle.

Dental identification by comparison of antemortem and postmortem dental radiographs: Influence of operator qualifications and cognitive bias

Dental forensic identifications based on comparison of antemortem and postmortem radiographs provide effective and reliable evidence. There are no standardized procedures for assessing similarities between different types of dental radiographs (e.g. orthopantomograms, bitewings, and periapical radiographs), and the operator's subjective judgment can considerably affect identification. The purpose of this study is to evaluate the potential influence of experts’ qualifications, training, and cognitive bias on the accuracy of identification. Seventy-eight differently qualified and experienced experts underwent an identification test. The expert sample was composed of 10 specialists in emergency care (ER), 10 specialists in legal medicine (ML), 20 pregraduate dental students (STU), 12 dentists (DENT), 20 dentists educated in forensic odontology (DENT-TRA), and 6 experienced forensic odontologists (FOR). The simulated cases required participants to assess the possible matching of 42 postmortem intraoral radiographs with 16 antemortem panoramic radiographs. Accuracy and specificity for the different operator groups were as follows: ER, 0.76–0.70; ML, 0.76–0.88; STU, 0.89–0.82; DENT, 0.87–0.97; DENT-TRA, 0.88–0.92; and FOR, 0.97–1. As evidenced by high rates of accuracy and repeatability, the most experienced forensic odontologist consistently outperformed operators less or differently educated and trained, especially for difficult cases. In our sample, the dentists who received additional education in forensic odontology did not necessarily perform better than dentists who had not received this additional education. Some cognitive bias, mainly the so-called observer effect, emerged as a possible source of outcome variability among the operator groups.

Transfer of patients with ruptured abdominal aortic aneurysm from general hospitals to specialist vascular centres: results of a Delphi consensus study

AimTo explore areas of consensus and disagreement concerning the interhospital transfer of patients with a clinical diagnosis of ruptured abdominal aortic aneurysm.MethodsA three-round Delphi questionnaire approach was used among vascular...

Parents benefit from specialist emergency care training

Parents benefit from specialist emergency care training

Pharmacy services to UK Emergency Departments: a descriptive study

To describe current hospital pharmacy services and facilities provided to United Kingdom Emergency Departments (EDs), identify potential roles for pharmacy technicians and possible benefits pharmacists may bring to the ED. Emergency care specialist interest group workshop at an UK Clinical Pharmacy Association (UKCPA) conference in 2004. Workshop attendance was open to pharmacists and technicians. A descriptive study using a voluntary self-completed questionnaire covering ED services, pharmacy services and facilities to the ED and potential roles and benefits. Of 40 questionnaires distributed, 31/40 (78%) were returned representing 25 NHS hospitals. Most (72%) EDs received some level of pharmacy service. Emergency Department skill-mix, ED service models and pharmacy services varied. Pharmacists' current roles were similar across EDs, with input into guideline development and review 12/25 (48%), patient group directions 11/25 (44%), provision of training 11/25 (44%), provision of advice (general and clinical)/liaison 10/25 (40%) and drug history taking 11/25 (40%). Potential roles identified for pharmacy technicians included assessment of patients' own drugs, support for drug history taking, stock management and drug storage. Further benefits pharmacists could bring to EDs included rationalisation of medicines on admission, identification of ADRs causing admission, support with complex medicine issues, new prescribing skills, supporting the maximum waiting time target and facilitating discharge. Pharmacy services have developed to support service provision in EDs with similar roles to in-patient pharmacists. Pharmacy services in some EDs are now extensive with funded, full-time pharmacy posts but pharmacy service review is required to optimise ED patient care where there is limited or no current pharmacy input. New pharmacy services must fit with local ED service models and skill mix. Evaluation of these new services is vital to maximise benefit to patients and the NHS.

National library for health emergency care specialist library – Update

National library for health emergency care specialist library – Update

The Emergency Management of Adult Bacterial Meningitis

Over the last decade, new protein-conjugate vaccines against Haemophilus influenzae type b (Hib) and Neisseria meningitidis serogroup C (MenC) have had a dramatic effect on the epidemiology of childhood meningitis in the United Kingdom. Amongst adults, bacterial meningitis remains an important cause of preventable morbidity and mortality. Clinicians need to remain vigilant for the possibility of this infection. The identification of the one patient with meningitis out of many with trivial viral infections remains a difficult task. Even once the diagnosis is made clinically, the subsequent investigation and management of the patient remains controversial, with strong opinions often influenced by one or two adverse experiences. Potential improvements in the way we identify and manage meningitis patients have been identified in recent years. This review will focus on those areas relevant to the emergency care specialist. Meningitis in the immunocompromised patient often has a different clinical and epidemiological pattern and is beyond the scope of this review.

The Flying Obstetric and Gynaecology Service in rural Queensland: its first two years

To present a report of the first two years of the Queensland Flying Obstetric and Gynaecology (FOG) Service which commenced operation in July 1988, and to assess the impact of the service on rural Queensland. Data were collected retrospectively for the surgical treatment and consultations provided by the FOG Service in its first two years, and for the obstetric and gynaecological surgery performed at Alpha Hospital, a typical rural hospital, before and after the inception of the service. The service provides specialist routine and emergency care for the women of 24 western Queensland towns scattered over approximately three-quarters of the area of the State. In the first two years of operation of the service, the team performed 4985 consultations, 1127 colposcopies, 1793 operations, 1143 ultrasound scans, answered 100 emergency calls and flew 318,650 km, equivalent to eight times around the world. In the seven years before the FOG Service began, only 17 gynaecological operations were performed at Alpha Hospital; in the first two years of the service the team performed 47 operations in this town. The FOG Service has made a very significant impact on the delivery of specialist services to the women of outback Queensland, and has also provided continuing education opportunities and professional support for remotely placed rural medical and nursing staff. The service has proved its worth in Queensland, and provides a model for the development of similar services in other large States of Australia.

Nursing Negligence in the Hospital Emergency Department

The hospital emergency department- those who receive care there and those who provide it-has changed rapidly in recent years. The number of patients going to emergency departments is steadily increasing, and the care which they seek is not confined to traditional emergency care. More and more patients utilize the hospital emergency department for routine health problems, either as substitutes for personal health care providers or as replacements when their own providers are unavailable.Physicians, nurses, and other health care providers in the hospital emergency department have changed from generalists to emergency care specialists. The rotating, on-call staff physician serving in a department with low priority is being replaced by the emergency medicine practitioner. Since 1980, the American Board of Emergency Medicine has been certifying physicians qualified in this new specialty, and the Emergency Department Nurses’ Association has been administering an examination for certification in emergency nursing.

The impact of emergency medicine on surgical care in the emergency ward

The Committee on Issues of the Association for Academic Surgery surveyed the Association's membership, surgical department chairmen, and university hospital emergency department directors as to their attitudes about the role of surgeons and emergency medicine specialists in emergency care. Major differences in attitudes exist between surgeons and nonsurgeons regarding the surgeon's role in the emergency department. Although surgeons want to preserve a dominant role in emergency care, they have little interest in being in charge of emergency wards on a day to day basis. Emergency medicine specialists have a tendency to function independently, even to the point of independently performing emergency surgical procedures. In emergency departments led by nonsurgeons there is decreased participation of surgical house staff in the resuscitation of the critically injured patients. This may result in inadequate training of surgical residents in acute trauma care and ultimately result in lowered overall standards of care in critically ill patients. An important question is whether surgeons can continue to abdicate their present reponsibilities in the emergency ward and yet maintain their essential role in the preoperative care of the emergency patient.