Emergency Medicine Journal

ObjectiveAmbulance clinicians use pre-alert calls to advise emergency departments (EDs) of the arrival of patients requiring immediate review or intervention. Consistency of pre-alert practice is important in ensuring appropriate EDs response. We used routine data to describe pre-alert practice and explore factors affecting variation in practice. MethodsWe undertook an observational study using a linked dataset incorporating 12 months ambulance patient records, ambulance clinician data and emer...

BackgroundAmbulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving Emergency Department or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel pre-alert fatigue amongst ED staff. This research aims to provide a better understanding of pre-alert de...

ObjectiveThe 21st century has seen an unexpected rise in numbers of patients with severe injuries caused by low energy transfer mechanisms such as low falls. Our objective was to determine whether this increasing "low energy transfer major trauma" disease burden is more strongly associated with population ageing, better detection or registry reporting between 2000 and 2019. DesignLongitudinal series of annual cross-sectional studies from the Trauma Audit Research Network (TARN). SettingEngland...

ObjectiveOur objective was to assess the level of COVID-19 preparedness of emergency departments (EDs) in Aotearoa New Zealand (NZ) through the views of emergency medicine specialists working in district health boards around the country. Given the limited experience NZ hospitals have had with SARS-CoV-2, a comparison of current local practice with recent literature from other countries identifying known weaknesses may help prevent future healthcare worker infections in NZ. MethodsWe conducted a...

BackgroundThe need to better manage frequent attenders or high-impact users (HIUs) in hospital emergency departments (EDs) is widely recognised. These patients often have complex medical needs and are also frequent users of other health and care services. The West of England Academic Health Science Network launched its Supporting High impAct useRs in Emergency Departments (SHarED) quality improvement programme to spread a local HIU intervention across six other EDs in five Trusts. AimSHarED aim...

ObjectiveUK ambulance services face record demand, resourcing challenges and rising clinical documentation burden. Ambient voice technology (AVT) coupled with generative AI offers a potential solution by automatically transcribing consultations and drafting clinical notes. Our aim was to test AVT in a complex and undifferentiated pre-hospital context. DesignWithin-subject pre-post evaluation SettingTwo operational pathways (remote telephone triage in the Clinical Hub ("Hear and Treat") and on-...

BackgroundRecent trends in high-income countries indicate a shift in the causes of major trauma, with low-energy transfer mechanisms, particularly falls from less than two meters, becoming increasingly prevalent. This study aimed to compare the demographics, care processes, and outcomes of major trauma patients injured by low and high-energy transfer mechanisms. MethodsThis comparative cohort study utilized anonymized data from adult patients recorded in the Trauma Audit and Research Network in...

BackgroundEmergency medicine (EM) faces workforce challenges in sustaining clinical academic careers. Academic Clinical Fellowships (ACFs) offer protected research time, but little is known about how EM ACFs experience and navigate these posts. MethodsSemi-structured interviews with 20 current and former EM ACFs across 12 UK regions. Interviews were analysed using thematic analysis following Braun and Clarkes six-phase approach. A mixed inductive and deductive framework was applied. Reflexivity...

ObjectivesTo identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and computed tomography (CT) for diagnosis of COVID-19 in the general emergency population in the UK and to find the association between imaging features and outcomes in these patients. DesignRetrospective analysis of electronic patient records SettingTertiary academic health science centre and designated centre for high consequence infectious diseases in London, UK. Participants1,198 patients who at...

BackgroundSince December 2022, the NHS has experienced large-scale strikes over pay by staff. Strikes heavily impact elective care delivery. The NHS cancels approximately 12 million elective care appointments each year. One million appointments have been cancelled due to strikes between 2022 and 2024. During this time emergency care is prioritised, and in a recent opinion piece, the president of the Royal College of Emergency medicine claimed the Emergency Department ran better than usual. The ...

BackgroundAdvanced Practice Providers (APPs), including physician assistants and nurse practitioners, represent a growing proportion of the emergency medicine workforce, including in high-acuity community emergency departments (EDs). Despite this growth, many sites lack formal onboarding structures, particularly for new graduate or inexperienced APPs transitioning to practice. Unlike postgraduate residencies and fellowships, limited literature exists on structured onboarding models outside acade...

ObjectivesWe aimed to derive and validate a triage tool, based on clinical assessment alone, for predicting adverse outcome in acutely ill adults with suspected COVID-19 infection. MethodsWe undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. The primary outcome was death or organ support (respi...

ObjectiveTo investigate the association between patient time spent in Type 1 emergency departments (EDs) and all-cause mortality 30 days after leaving the department alive. DesignCross-sectional, retrospective, observational study using national linked data. SettingAll NHS Type 1 emergency departments in England. Participants6,721,179 individuals (mean age 41.3 years, 52.6% female, 81.4% White ethnicity) attended an ED at least once between 21st March 2021 and 31st March 2022; had a record po...

BackgroundMajor trauma is a highly heterogeneous clinical condition, posing significant challenges for accurate diagnosis, timely transfer, and effective treatment. Identification of meaningful subgroups using Latent Class Analysis (LCA) can inform clinicians and policymakers, but this approach has seldom been applied to diverse trauma cohorts. We therefore aim to identify clinically meaningful subgroups of trauma patients and explore predictors of group membership. MethodologyWe merged data fo...

IntroductionResearch conducted in the Emergency Department (ED) is essential for improving patient care and advancing evidence-based practice. However, there are several challenges to research engagement in the ED, including lack of time, awareness of research opportunities, and concerns about the impact on clinical duties. This study aimed to explore the attitudes and perceptions of ED staff involved in an enhanced syndromic surveillance of hospitalised severe acute respiratory illness (CHARIS...

BackgroundTimely treatment is essential for achieving optimal outcomes after traumatic spinal cord injury (TSCI), and expeditious transfer to a specialist spinal cord injury unit (SCIU) is recommended within 24 hours from injury. Previous research in New South Wales (NSW) found only 57% of TSCI patients were admitted to SCIU for acute post-injury care; 73% transferred within 24 hours from injury. MethodsThis record linkage study included administrative pre-hospital, admissions and costs data fo...

BackgroundPressures on hospital emergency care services have led to increasing interest in new models of acute care provision. One such model is a medical emergency department where medical patients are triaged directly to acute internal medicine, without assessment by emergency medicine. The evidence for this model of care is unclear. DesignSystematic review. MethodsStudies included direct referral pathways to acute internal medicine. The protocol was registered prospectively (Prospero: CRD42...

IntroductionTriage is a key principle in the effective management of major incidents, yet there is a paucity of evidence surrounding the optimal method of paediatric major incident triage (MIT). This study aimed to derive consensus on key components of paediatric MIT among healthcare professionals involved in the management of paediatric major incidents. MethodsThis modified two-round online Delphi consensus study, delivered between July and October 2021, included participants from pre-hospital...

BackgroundThis study examined whether the presence and severity of Type 1 Respiratory Failure (T1RF), as measured by the ratio of pulse oximetry to estimated fraction of inspired oxygen (SpO2/eFiO2 ratio), is a predictor of in-hospital mortality in patients presenting to the ED with suspected COVID-19 infection. MethodsWe undertook a prospective observational cohort study of patients admitted to hospital with suspected COVID-19 in a single ED in England. We used univariate and multiple logistic...

BackgroundThe onset of the COVID-19 pandemic was characterized by rapidly increasing patient volumes, which necessitated a swift emergency department (ED) overhaul. Challenges mainly concerned surge capacity, frontline staff protection and the segregation of patients with suspected COVID-19. To date, only few studies have assessed nation-wide ED preparedness for the COVID-19 pandemic. This study aimed to form an overview of preparations that were taken in Dutch EDs during the initial phase of th...