New draft recommendations for the care of acute medical emergencies

This draft guideline includes recommendations for the organisation and delivery of emergency and acute medical care | NHS Networks

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Image source: USW-UniLife – Flickr // CC BY-NC-SA 2.0

It includes recommendations for practice and for research. Recommendations are included on:

  • first points of contact with emergency and acute care services
  • alternatives to hospital care
  • opening hours and locations of acute care services
  • services within hospitals
  • ward rounds, transfers and discharges
  • monitoring and managing hospital bed capacity.

Who is it for?

  • Commissioners and providers of health and social care.
  • Health and social care practitioners.
  • People with or at risk of a medical emergency or acute illness, and their families and carers.

Read the full draft here

Winter pressure in A&E: response to Health Select Committee

The government’s response to the House of Commons Health Select Committee report on winter pressure in accident and emergency departments.

This report responds to each of the 27 conclusions and recommendations in the Health Select Committee’s report, Winter Pressure in A&E Departments . It highlights how the NHS prepares for winter, as part of its year-round operational resilience planning, to ensure the health and social care system in England is fully prepared for the increased pressures at that time of year.

Full document: Government Response to Health Select Committee Report on Winter Pressure in Accident and Emergency Departments

New ambulance service standards

NHS England has announced a new set of performance targets for the ambulance service which will apply to all 999 calls for the first time.

  • National response targets to apply to every single 999 patient for the first time
  • Faster treatment for those needing it to save 250 lives a year
  • An end to “hidden waits” for millions of patients
  • Up to 750,000 more calls a year to get an immediate response
  • New standards to drive improved care for stroke and heart attack
  • World’s largest clinical ambulance trial updates decades-old system

The new targets will save lives and remove “hidden” and long waits suffered by millions of patients, including reducing lengthy waits for the frail and elderly. The new system is backed by the Association of Ambulance Chief Executives, the Royal College of Emergency Medicine, the Stroke Association and the British Heart Foundation amongst others.

Call handlers will change the way they assess cases and will have slightly more time to decide the most appropriate clinical response. As a result cardiac arrest patients can be identified quicker than ever before, with evidence showing this could save up to 250 lives every year.

Full story via NHS England

 

NHS needs more advanced paramedics to ease A&E pressure

Paramedics with advanced training can reduce the number of patients admitted to hospital unnecessarily, says NICE.

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Image source: Carl Spencer – Flickr // CC BY-NC 2.0

NICE is recommending the NHS provides more advanced paramedic practitioners (APPs) to relieve pressure on emergency departments, in new draft guidance. Evidence reviewed by NICE shows that using APPs can reduce hospital admissions by 13% compared with standard paramedics.

The draft guidance also makes wider recommendations about emergency and acute medical services to standardise care across the NHS. It supports NHS England’s Five Year Forward View for the future of emergency medical services.

Full story available here

Antimicrobial stewardship to optimize antimicrobial use for outpatients at emergency department

Antimicrobial stewardship programs (ASPs) have proven to be effective in optimizing antibiotic use for inpatients. However, Emergency Department (ED)’s fast-paced clinical setting can be challenging for a successful ASP | The Journal of Hospital Infection

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Aim: In April 2015, an ASP was implemented in our ED and we aimed to determine its impact on antimicrobial use for outpatients.

Methods: Monocentric study comparing the quality of antibiotic prescriptions between a one-year period before ASP implementation (November 2012 to October 2013) and a one-year period after its implementation (June 2015 to May 2016).

For each period, antimicrobial prescriptions for all adult outpatients (hospitalized for <24hours) were evaluated by an infectious disease specialist (IDS) and an ED physician to assess compliance with local prescribing guidelines. Inappropriate prescriptions were then classified.

Findings: Before and after ASP, 34,671 and 35,925 consultations were registered at our ED, of which 25,470 and 26,208 were outpatients. Antimicrobials were prescribed in 769 (3.0%) and 580 (2.2%) consultations, respectively (p<0.0001). There were 484 (62.9%) and 271 (46.7%) (p<0.0001) instances of non-compliance with guidelines before and after ASP implementation. Non-compliances included unnecessary antimicrobial prescriptions, 197 (25.6%) vs. 101 (17.4%) (p<0.0005); inappropriate spectrum, 108 (14.0%) vs. 54 (9.3%) (p=0.008); excessive treatment duration, 87 (11.3%) vs. 53 (9.1%) (p>0.05); and inappropriate choices, 11 (1.4%) vs. 15 (2.6%) (p>0.05).

Conclusions: The implementation of an ASP dramatically decreased the number of unnecessary antimicrobial prescriptions, but had little impact on most other aspects of inappropriate prescribing.

Full reference: Dinh, A. et al. (2017) Impact of an antimicrobial stewardship program to optimize antimicrobial use for outpatients at emergency department. The Journal of Hospital Infection. Published online: 8th July 2017

Risk factors and outcomes associated with post-traumatic headache after mild traumatic brain injury

This study aims to determine the prevalence and potential risk factors of acute and chronic post-traumatic headache (PTH) in patients with mild to moderate traumatic brain injury (TBI) | Emergency Medicine Journal

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Objectives: Acute PTH (aPTH) is defined by new or worsening of pre-existing headache occurring within 7 days after trauma, whereas chronic PTH (cPTH) is defined as persisting aPTH >3 months after trauma. An additional goal was to study the impact of aPTH and cPTH in terms of return to work (RTW), anxiety and depression.

Conclusions: PTH is an important health problem with a significant impact on long-term outcome of TBI patients. Several risk factors were identified, which can aid in early identification of subjects at risk for PTH.

Full reference: Tansel, Y. et al. (2017) Risk factors and outcomes associated with post-traumatic headache after mild traumatic brain injury. Emergency Medicine Journal. Published Online First: 8th July 2017

A&E cuts will hit 23m people, British Medical Association says

Nearly 23 million people in England – more than 40% of the population – could be affected by proposed cuts to A&E departments, doctors are warning | BBC News

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The analysis of NHS plans by the British Medical Association also warned the changes were being rushed through without the evidence they will work. The proposals have been put forward by local managers seeking to make savings under the direction of NHS England. Bosses have argued services in the community will be boosted in return.

Under the so-called “sustainability and transformation programme” (STP), England has been divided into 44 areas and each asked to come up with its own proposals.

After analysing local plans, the BMA found:

  • 18 of them, covering a population of 22.9 million, involved the closing or downgrading of an A&E department
  • 14 of them, responsible for 17.6 million patients, propose closing or merging a hospital
  • 13 of them, covering a population of 14.7 million, have put forward closing hospital beds

Read the full news story here