Emergency Department Escalation in Theory and Practice

Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients) | Annals of Emergency Medicine

The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying “normal” processes. The study objective is to examine escalation policies in theory and practice.

Editor’s Capsule Summary:

  • What is already known on this topic

Care delivery organizations commonly develop “escalation policies” for managing crowding and surges in emergency department (ED) demand. The effectiveness of these policies has seldom been studied.

  • What questions this study addressed

This study used mixed methods to identify common patterns in escalation policies in UK EDs and to evaluate how well they performed in practice.

  • What this study adds to our knowledge

Formal escalation policies often presumed the availability of resources that were missing or degraded when escalation was needed. Consequently, the actual practice of managing crowding deviated from that inscribed in policy.

  • How this is relevant to clinical practice

Recognizing and monitoring the gap between formal policies and actual practice should help in the development of more realistic and useful escalation policies.

Full reference: Back, J. et al. (2017) Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience. Annals of Emergency Medicine. Published online: 26 June 2017

Management of major trauma

Trauma remains one of the leading causes of mortality and morbidity in the UK | Anaesthesia and Intensive Care Medicine

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Trauma is the primary cause of mortality in the first four decades of life and has a significant impact on the economy of the nation. In recent years the structure of trauma care has undergone significant restructuring. This article will review the reports that led to these changes, discuss the changes that have occurred and describe some of the anaesthetic management of this important group of patients.

Full reference: pearson, J. et al. (2017) Management of major trauma. Anaesthesia and Intensive Care Medicine. Published online: June 24, 2017

 

Sepsis care in UK Emergency Departments is improving

Sepsis care is improving but treatment needs to be faster, according to a new audit by the Royal College of Emergency Medicine.

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Image source: http://www.rcem.ac.uk

The report published this month audited 13,129 adults presenting to 196 Emergency Departments (EDs), and was endorsed by the Sepsis Trust.  It shows an improvement in the proportion of patients receiving the best care for severe sepsis and septic shock, but that improvements are needed to make treatment available faster.

The audit is designed to drive clinical practice forward by helping clinicians examine the work they do day-to-day and benchmark against their peers, and to recognise excellence.  There is much good practice occurring and RCEM believes that this audit is an important component in sharing this and ensuring patient safety.

The report finds that there has been a steady improvement in the ‘Sepsis-Six’, an initial resuscitation bundle designed to offer basic interventions within the first hour of arriving at an ED. However, despite seeing improvements in care, the report finds that RCEM standards are not yet being met by all EDs.

Full report:  Severe Sepsis and Septic Shock. Clinical Audit 2016/17

Emergency department frequent users

Birmingham, L.E. et al. BMC Emergency Medicine | Published online: 10 May 2017

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Background: There is no common understanding of how needs of emergency department (ED) frequent users differ from other patients. This study sought to examine how to best serve this population. Examinations of why ED frequent users present to the ED, what barriers to care exist, and what service offerings may help these patients achieve an optimal level of health were conducted.

 

Conclusion: This study characterized ED frequent users and identified several opportunities to better serve this population. By understanding barriers to care from the patient perspective, health systems can potentially address unmet needs that prevent wellness in this population.

Read the full article here

Patient flow within UK emergency departments

Mohiuddin, S. et al. (2017) BMJ Open. 7:e015007

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Objectives: Overcrowding in the emergency department (ED) is common in the UK as in other countries worldwide. Computer simulation is one approach used for understanding the causes of ED overcrowding and assessing the likely impact of changes to the delivery of emergency care. However, little is known about the usefulness of computer simulation for analysis of ED patient flow. We undertook a systematic review to investigate the different computer simulation methods and their contribution for analysis of patient flow within EDs in the UK.

 

Conclusions: We found that computer simulation can provide a means to pretest changes to ED care delivery before implementation in a safe and efficient manner. However, the evidence base is small and poorly developed. There are some methodological, data, stakeholder, implementation and reporting issues, which must be addressed by future studies.

Read the full article here

Emergency departments under pressure

The Institute of Health Care Management has published The Winter’s Tale: leadership lessons from emergency departments under pressure.

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Image source: ihm.org.uk/

The report focuses on the processes and behaviours of the emergency teams that are managing to deliver outstanding results despite the ever increasing challenges.

This report highlights the importance of using data to identify and shape solutions to the pressures in emergency departments.  It identifies key lessons for managers working in or with emergency departments.

The full report can be read online here.