Adverse outcomes in older adults attending emergency departments

Galvin, R. et al. (2017) Age Ageing. 46(2) pp. 179-186. 

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Background: older adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care.

Conclusion: the ISAR has modest predictive accuracy and may serve as a decision-making adjunct when determining which older adults can be safely discharged.

Read the full abstract here

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Winter Insight: NHS 111

An analysis of how NHS 111 has fared, especially over the winter period | Nuffield Trust

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Image source: Nuffield Trust

Key Points:

  • The proportion of callers being dispatched from NHS 111 to emergency services over the last three years has risen. There has been a particular rise in the share of people who are passed to ambulances.
  • There is great variability between different areas in how likely NHS 111 is to send people to A&E or the ambulance service. This might suggest that some areas are too likely, or not likely enough, to send people to emergency services. NHS 111 is also more likely to dispatch an ambulance than to simply send people to A&E – which is the reverse of the usual pattern of NHS use. This lends credence to claims that the service is too risk-averse in some cases.
  • However, contrary to criticism that it adds to the pressure on A&E, the service overall seems to steer people away from emergency services. Patient surveys suggest as many as 8 million more people would have gone to A&E and the ambulance service over the last three years without 111. The call line also soaks up extra demand during winter, when it becomes less likely to refer people to urgent services.
  • NHS 111 still answers the vast majority of calls within a minute, and few people hang up after having to hold for more than 30 seconds. However, it has not met its target of answering 95 per cent of calls within 60 seconds for two-and-a-half years, and it seems prone to serious under-performance when calls spike after Christmas and the New Year.

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US Legal, Social, Ethical, and Medical Perspectives on the Care of the Statutory Rape Adolescent in the ED

Tsai, S-L. et al. Annals of Emergency Medicine. Published online: 24 February 2017

Rapes involving adolescents who present to the emergency department (ED) are fraught with ethical and legal complexities and are often emotionally turbulent for patients, their families, and medical providers.

Management requires a thoughtful approach from multiple standpoints, including legal, psychosocial, ethical, and medical ones. However, there is no standardized sexual assault education for emergency medicine residents, and management practices vary widely.

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Resiliency and quality of life trajectories after injury

Zarzaur, B. et al. Journal of Trauma and Acute Care Surgery. Published online: 23 February 2017

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Background: Injury can greatly impact patients’ long-term quality of life. Resilience refers to an individual’s ability to positively adapt after facing stress or trauma. The objective of this study was to examine the relationship between pre-injury resiliency scores and quality of life after injury.

Conclusion: Patient resiliency predicts quality of life after injury in regards to mental health with over 25% of patients suffering poor mental health outcome trajectories. Efforts to teach resiliency skills to injured patients could improve long-term mental health for injured patients. Trauma centers are well positioned to carry out such interventions.

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An ED paradox: patients who arrive by ambulance and then leave without consulting an ED provider

Doupe, M.B. et al. (2017) Emergency Medicine Journal. 34:151-156.

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Background: Scientists have called for strategies to identify ED patients with unmet needs. We identify the unique profile of ED patients who arrive by ambulance and subsequently leave without consulting a provider (ie, a paradoxical visit, PV).

Conclusions: PV patients have needs that do not align with the acute model of ED care. These patients may benefit from a more integrated care approach likely involving allied health professionals.

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What is the relationship between age and deprivation in influencing emergency hospital admissions?

Pereira Gray, D. et al. (2017) BMJ Open. 7:e014045

Objectives: To clarify the relationship between social deprivation and age as two factors associated with emergency admissions to hospital.

Conclusions: Risk curves for all social groups have similar shapes, implying a common biological pattern for ageing in any social group. Over age 65, the biological effects of ageing outweigh the social effects of deprivation. Our model enables CCGs to anticipate and plan for emergency admissions to hospital. These findings provide a new logic for allocating resources to different populations.

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Community-Based Palliative Care & Reduced Emergency Department Visits

Spilsbury, K. Annals of Emergency Medicine. Published online: 3 February 2017

Historically, palliative care evolved to meet the end-of-life needs of cancer patients. It has since become apparent that it benefits noncancer terminal conditions such as renal failure, heart failure, chronic obstructive pulmonary disease, and liver failure, although access to and quality of palliative care for these conditions could be improved. In Australia, there has been evidence of this improved access to palliative care in noncancer conditions during the last 10 years.

The objective of this study was to describe patterns of use of EDs by people in their last year of life and how this varied when they received community-based palliative care. We also investigated whether any patient health, social, and demographic factors modified the rates of ED visits while patients were receiving community-based palliative care.

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