Emergency Medicine Journal最新文献

Background: In 2019, the National Health Service (NHS) England announced the implementation of same day emergency care (SDEC) in every hospital with a type 1 emergency department (ED). SDEC aims to provide timely and appropriate specialist care to patients on the same day, expediting their investigations and avoiding unnecessary hospitalisation. There is limited evidence for SDEC adoption and its effectiveness. This mixed-method study identifies and analyses SDEC implementation methods and describes subjective workforce views through both surveys and interviews.

Methods: An electronic survey was developed and distributed via email to 60 randomly selected hospitals in England with type 1 EDs. Follow-up interviews were conducted to contextualise survey responses and explore perceptions of SDEC and subjective barriers to efficiency.

Results: In total, 39 responses (including dual responses from SDEC and ED staff) were received from 34 hospitals (57%). All hospitals had an acute medical SDEC, with more limited implementation of surgical (53%) and frailty SDECs (29%). The SDECs opened on average 12 hours on weekdays and 10 hours on weekends. Referral and patient selection models varied. 79% of hospitals used their SDECs as emergency bed spaces. 85% of units assessed between 31 and 50 patients/day, with no unit admitting >10 patients/day. Although interviews were generally positive regarding SDEC efficiency, issues included differing perceptions of SDEC purpose, variability in models of patient selection, unclear referral pathways and inconsistent staffing levels.

Conclusions: Since its introduction, SDEC has been implemented and developed with great variability across England. While the introduction of the NHS SAMEDAY guidelines in 2024 may assist in mitigating these discrepancies nationally, more research is vital to identify optimal methods of service delivery and evaluation of this new healthcare system.

A short systematic review was undertaken to assess whether silicone gel improves cosmetic and symptomatic outcomes of scars following the suturing of traumatic facial lacerations in ED. A systematic keyword search of EMBASE, MEDLINE, Cochrane and Google Scholar databases returned two papers. The author, year, country, patient characteristics, study type, key outcomes and weaknesses were tabulated. The results indicate that silicone gel improves cosmetic and symptomatic outcomes when used for at least one month. However, the limited patient characteristics and short follow-up period indicate that larger studies are needed to provide further recommendations.

Background: Treatment with the 12-hour Scottish and Newcastle Antiemetic Protocol (SNAP) acetylcysteine regimen is associated with decreased length of stay and fewer anaphylactoid reactions in adult patients, and the protocol is now recommended by several UK organisations and used widely. One potential barrier to adoption is concern regarding the potential for variation in protocol performance with patient age. Anecdotally, this has led to slower adoption in paediatric settings.

Methods: Secondary analysis of data from 2212 patients at the Royal Infirmary of Edinburgh, UK, treated with acetylcysteine for paracetamol overdose between 28 September 2013 and 27 September 2017. Patients were grouped into 10-year age ranges to allow comparison of treatment regimen performance across ages. Groups were compared for their rates of anaphylactoid reactions, duration of admission attributable to acetylcysteine infusion and severity of liver injury assessed by biochemical markers.

Results: Patients in all age groups treated with SNAP experienced statistically significant reductions in anaphylactoid reactions. There were no significant differences in the severity of acute liver injury as assessed by biochemical results.

Conclusion: This secondary analysis provides data to support the use of SNAP regardless of patient age and reassure clinicians that there is no evidence of previously unrecognised variation in protocol performance.