Antibiotics-First Vs Surgery for Appendicitis

Talan, D.A. et al. Annals of Emergency Medicine. Published online: December 11 2016

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Study objective: Randomized trials suggest that nonoperative treatment of uncomplicated appendicitis with antibiotics-first is safe. No trial has evaluated outpatient treatment and no US randomized trial has been conducted, to our knowledge. This pilot study assessed feasibility of a multicenter US study comparing antibiotics-first, including outpatient management, with appendectomy.

Conclusion: A multicenter US trial comparing antibiotics-first to appendectomy, including outpatient management, is feasible to evaluate efficacy and safety.

Read the full abstract here

Details of new waiting targets for trusts

New guidance, seen by HSJ, sets out what is expected of mental health and acute trusts to meet the new emergency access and waiting time targets.

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  • All emergency and urgent mental health patients in A&E and hospital wards should be seen within one hour by liaison psychiatry staff
  • Emergency patients should be treated within four hours and urgent patients within 24 hours
  • Trusts to submit how quickly they respond to emergency mental health crises at hospitals from April
  • New guidance tells trusts to report if they are hitting emergency and urgent mental health liaison target

Read the full news story here

NHS England sets out steps to improve mental health care and help those attending A&E in crisis

NHS England | Published online: 26 November 2016

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NHS England is for the first time inviting regional A&E Delivery Boards, which oversee urgent and emergency care locally and include partners from hospitals, councils and other local bodies, to bid for £30m funding for expert psychiatrists and mental health nurses to provide better care for people with urgent and emergency mental health needs attending A&E and being treated on general hospital wards.

People with mental ill health are three times more likely to end up in A&E than the general population and five times more likely to be admitted to general hospital wards in an emergency.

Read the full news story here

Urgent and emergency care pilot reports

As part of their plans to explore how they might comment on the quality of care across a local health and care system, the Care Quality Commissions has published reports of two pilots which explore what this could look like for urgent and emergency care.

The reports focus on urgent and emergency care systems in South Warwickshire and in Airedale, Wharfedale, Craven & Bradford.  In both areas the CQC looked at the contribution of the services that support people with urgent and emergency care needs, including NHS 111, A&E departments, ambulance services, GP practices, GP out of hours-services and care homes and how well they worked together for the benefit of the local population.

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Delayed transfers of care continue to worsen

Hazel, W. HSJ. Published online: 10 November 2016

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  • Delayed transfers of care reach highest level with 196,246 delayed days in September
  • NHS England figures show demand up and performance in most areas down
  • NHS Providers warn demands “only likely to increase as we move into winter”

According to performance statistics for September, released on Thursday, 196,246 delayed days occurred in the month compared to 188,340 in August – previously the highest level since monthly data started being collected six years ago.

The NHS England figures show a continued increase in demand and a deterioration of performance in most areas.

Accident and emergency attendances were 4.9 per cent higher than in September 2015, and emergency admissions were 2.6 per cent higher than the previous year.

In September 90.6 per cent of patients were admitted, transferred or discharged from A&E within four hours of arrival, against a target of 95 per cent.

Read the full article here

Nurses’ Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments

Wolf, L. A. et al. Journal of Emergency Nursing. Published online: November 8 2016

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Introduction: The emergency department is a unique practice environment in that the Emergency Medical Treatment and Active Labor Act (EMTALA), which mandates a medical screening examination for all presenting patients, effectively precludes any sort of patient volume control; staffing needs are therefore fluid and unpredictable. The purpose of this study is to explore emergency nurses’ perceptions of factors involved in safe staffing levels and to identify factors that negatively and positively influence staffing levels and might lend themselves to more effective interventions and evaluations.

Methods: We used a qualitative exploratory design with focus group data from a sample of 26 emergency nurses. Themes were identified using a constructivist perspective and an inductive approach to content analysis.

Results: Five themes were identified: (1) unsafe environment of care, (2) components of safety, (3) patient outcomes: risky care, (4) nursing outcomes: leaving the profession, and (5) possible solutions. Participants reported that staffing levels are determined by the number of beds in the department (as in inpatient units) but not by patient acuity or the number of patients waiting for treatment. Participants identified both absolute numbers of staff, as well as experience mix, as components of safe staffing. Inability to predict the acuity of patients waiting to be seen was a major component of nurses’ perceptions of unsafe staffing.

Discussion: Emergency nurses perceive staffing to be inadequate, and therefore unsafe, because of the potential for poor patient outcomes, including missed or delayed care, missed deterioration (failure to rescue), and additional ED visits resulting from ineffective discharge teaching. Both absolute numbers of staff, as well as skill and experience mix, should be considered to provide staffing levels that promote optimal patient and nurse outcomes.

Read the abstract here