Emergency department care

Emergency department care – best practice guideline

The Royal College of Emergency Medicine has published a Best Practice Guideline Emergency department care.   Developed to help medical staff within Emergency Departments provide better care for patients, this publication is a fifty-point checklist that covers all aspects of emergency care including the patient environment and pathway; education about care; care of elderly patients, children and those with complex needs; team working and leadership.

International comparison of emergency hospital use for infants: data linkage cohort study in Canada and England

Harron K, Gilbert R, Cromwell D, et al.   International comparison of emergency hospital use for infants: data linkage cohort study in Canada and England
BMJ Qual Saf Published Online First: 12 June 2017. doi: 10.1136/bmjqs-2016-006253

Abstract
Objectives  To compare emergency hospital use for infants in Ontario (Canada) and England.
Methods We conducted a population-based data linkage study in infants born ≥34 weeks’ gestation between 2010 and 2013 in Ontario (n=253 930) and England (n=1 361 128). Outcomes within 12 months of postnatal discharge were captured in hospital records. The primary outcome was all-cause unplanned admissions. Secondary outcomes included emergency department (ED) visits, any unplanned hospital contact (either ED or admission) and mortality. Multivariable regression was used to evaluate risk factors for infant admission.
Results The percentage of infants with ≥1 unplanned admission was substantially lower in Ontario (7.9% vs 19.6% in England) while the percentage attending ED but not admitted was higher (39.8% vs 29.9% in England). The percentage of infants with any unplanned hospital contact was similar between countries (42.9% in Ontario, 41.6% in England) as was mortality (0.05% in Ontario, 0.06% in England). Infants attending ED were less likely to be admitted in Ontario (7.3% vs 26.2%), but those who were admitted were more likely to stay for ≥1 night (94.0% vs 55.2%). The strongest risk factors for admission were completed weeks of gestation (adjusted OR for 34–36 weeks vs 39+ weeks: 2.44; 95% CI 2.29 to 2.61 in Ontario and 1.66; 95% CI 1.62 to 1.70 in England) and young maternal age.
Conclusions Children attending ED in England were much more likely to be admitted than those in Ontario. The tendency towards more frequent, shorter admissions in England could be due to more pressure to admit within waiting time targets, or less availability of paediatric expertise in ED. Further evaluations should consider where best to focus resources, including in-hospital, primary care and paediatric care in the community.

Full text is available here

Violence against nurses working in the emergency department

Workplace violence (WPV) in healthcare organizations can lead to serious consequences that negatively affect nurses’ lives and patient care | International Emergency Nursing

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Highlights:

  • Nurses who experience WPV complain of mental and physical health problems.
  • Nurses’ social and professional lives were affected negatively after facing WPV.
  • WPV consequences negatively impact nurses and the entire healthcare organization.
  • The serious consequences of WPV ultimately harm patient care.
  • Preventing violence will ensure a safe workplace and safer patient care.

Full reference: Hassankhani, H. et al. (2017) The consequences of violence against nurses working in the emergency department: A qualitative study. International Emergency Nursing. Published online: 31 July 2017

Triaging the emergency department, not the patient

Triage, as it is understood in the context of the emergency department, is the first and perhaps the most formal stage of the initial patient encounter | Journal of Emergency Nursing

Bottlenecks during intake and long waiting room times have been linked to higher rates of patients leaving without being seen. The solution in many emergency departments has been to collect less information at triage or use an “immediate bedding” or “pull until full” approach, in which patients are placed in treatment areas as they become available without previous screening. The purpose of this study was to explore emergency nurses’ understanding of—and experience with—the triage process, and to identify facilitators and barriers to accurate acuity assignation.

Full reference: Wolf, L.A. et al. (2017) Triaging the emergency department, not the patient: United States emergency nurses’ experience of the triage process. Journal of Emergency Nursing. Published online: 24 July 2017