Acute Medicine最新文献

Background: Efficient documentation is essential in Same Day Emergency Care (SDEC) settings to maintain smooth patient flow. Manual typing, although reliable, is time-consuming and can negatively impact clinical efficiency.

Objectives: This Service Improvement Pilot study evaluates the impact of Heidi Health's Ambient Voice Technology on documentation efficiency, clinician workload, and patient satisfaction during clinical consultations.

Methods: An observational analysis was conducted on 100 case notes in an SDEC setting. Documentation times using Heidi Health's Ambient Voice Technology were recorded, while manual documentation times were estimated based on word counts and typical typing speeds. Clinician feedback was gathered on usability and administrative burden, and patient feedback focused on the consultation experience.

Results: Ambient Voice Technology reduced documentation time by 85.8%, saving an average of 5.27 minutes (equivalent to 5 minutes 16 seconds) per case compared to manual typing (p < 0.001). Clinicians reported high usability scores (mean = 9.1/10), reduced administrative burden, and improved consultation flow. Additionally, 90% of patients reported an enhanced consultation experience.

Conclusions: Ambient Voice Technology significantly improves documentation efficiency, reduces clinician workload, and enhances patient satisfaction in SDEC settings. Future research should explore its application across a variety of clinical environments.

Introduction: Patients with respiratory infection-associated changes on chest X-ray often have follow-up chest X-rays (CXRs) to exclude malignancy. In the UK, same day emergency care (SDEC) units have been developed to manage patients needing urgent hospital care on an ambulatory basis. The yield of findings and benefit from follow-up CXRs in this population is unknown. We report the non-malignant and malignant findings from our cohort of SDEC patients.

Methods: We performed a retrospective service evaluation of CXRs for adult patients who attended our SDEC between 6/1/2020 and 25/9/2023, identifying CXRs arranged as follow-up for infection-related findings and assessing outcomes stratified by lung malignancy-associated risk factors.

Results: Of 27,336 CXR requests from our SDEC unit, we identified 419 follow-up CXRs. From these, 341 follow-up CXRs were done to assess resolution of infection-related changes; 304 (89%) showed resolution and 37 (11%) showed persistent changes. Further investigation of persistent changes identified two malignancies and several non-malignant conditions including 7 cases of interstitial lung disease, 2 requiring ongoing respiratory follow up. Both patients with cancer were over 50 with risk factors.

Conclusions: The small number of malignancies detected in follow-up CXRs in SDEC patients support risk factor-based targeting of CXRs although non-malignant findings may benefit some patients.

Transfusion of red blood cells is routine in acute care settings and adverse events are not uncommon. While bleeding protocols are familiar to acute physicians, guidance is less clear for non-bleeding patients. This review offers consolidated guidance on transfusion in the adult acute patient, including restrictive targets and the use of alternatives in anaemia, the role of group O emergency red blood cells (RBC) and important considerations in individuals with childbearing potential, immunosuppressed patients and transfusion-dependent patients.

Acute Medicine Journal is evolving, in a move to prioritize the publication of more randomized controlled trials (RCTs) and large prospective cohort studies, therefore accepting fewer case reports and retrospective studies. This trend reflects a fundamental shift towards stronger, more reliable and more generalisable scientific evidence in clinical research and practice.

Aim: To determine the in-hospital mortality of eight physiological categories based on shock index, pulse pressure and ROX index, and to compare each category according to admission level of consciousness and National Early Warning Score.

Method: A non-interventional observational study of 122,262, unselected, adult emergency admissions between 2014 and 2022.

Results: In-hospital mortality increases according to physiological category and whether the admission NEWS was<3 or ≥3. For NEWS ≥3, patients were more likely to die when not alert. Irrespective of total NEWS, patients with a low ROX index <22 are more likely to die.

Conclusion: Patients with the same NEWS value can have different physiological derangements. Level of consciousness also provides greater insight than NEWS alone regarding the risk of in-patient mortality.

Background: Medical ward rounds are essential to support care delivery, however a lack of multi-disciplinary team rounding may have a knock-on effect on care coordination and may lead to delayed discharges and increased length of stays.

Methods: The aim of this study was to improve patient outcomes by improving communication and coordination surrounding medical ward rounds through bringing disciplines together during medical ward rounds or at post-round operational huddles. The primary outcome measure was to improve the number of patients discharged by noon.

Results: At the end of the study there was no impact on our primary outcome measure. Efforts for improvement were redirected from the micro- to the meso- and macrosystem of the organisation.

Conclusion: While developing this complex project, we found reforms at a macrosystem of how care is provided are needed including ward-based care. Reforms must balance system resilience and efficiency while ensuring 'slack' in the system to support communication, relationship building and coordination of care.

Background: Sepsis, a devastating syndrome of organ dysfunction triggered by a dysregulated host response to infection, remains a leading cause of global mortality. Statins, renowned for lipid-lowering, also exhibit potent anti-inflammatory and endothelial-stabilizing properties, offering a theoretical advantage in the septic milieu. This study investigated whether adjunctive atorvastatin could improve survival and modulate key sepsis-related outcomes.

Methods: In this open-label, randomized controlled trial conducted in the acute medical unit of a tertiary academic center, adult patients with sepsis (defined as suspected infection plus a SOFA score increment of ≥2) were allocated to receive either standard sepsis management plus daily oral atorvastatin 20mg or standard management alone for up to 28 days. The primary endpoint was 28-day all-cause mortality. Secondary endpoints included requirements for organ support, duration of hospitalization, and kinetic changes in C-reactive protein(CRP), procalcitonin(PCT), and lactate. Analysis adhered to intention-to-treat principles.

Results: Sixty-eight patients were randomized(36 atorvastatin, 32 control). While 28-day mortality trended lower in the atorvastatin arm(36% vs. 56% in controls; Risk Difference -20%, 95% CI -45% to 5%), this difference did not achieve statistical significance(p=0.10). Similarly, no significant benefits were observed in organ support needs or hospital stay. Critically, atorvastatin administration led to a significant and more pronounced reduction in both procalcitonin (median change -8 vs 0 ng/ml, p=0.005) and lactate levels(median change -0.95 vs -0.62 mmol/l, p=0.048) by day 7.

Conclusion: While adjunctive atorvastatin did not demonstrably reduce 28-day mortality in this sepsis cohort, its significant impact on attenuating procalcitonin and lactate levels suggests a beneficial modulation of underlying inflammatory and metabolic derangements.

Background and importance: Long waiting times in the emergency department (ED) is an increasing problem in the recent years and is expected to become an even bigger problem in the future Objective: We aimed to test the hypothesis whether increasing awareness of the time lapse with the treating physician, 2 hours after patient arrival, can reduce long patient turnaround time (TAT).

Method: In this prospective single-center cohort study we compared and analyzed patient TAT in the ED before and after implementation of a so called 'traffic light' moment 2 hours after patient arrival. At this 'traffic light' moment a team member contacted the treating physician to increased awareness over the time lapse. Difference in percentage of patients who stayed more than 4 hours in the ED before and after intervention was the primary outcome Results: Between October 2nd 2021 and January 2nd,2022 1494 patients were included for primary outcome analysis. A total of 419 patients (n=740, 56.6%) had a TAT of less than 4 hour in the ED before intervention, compared to 497 (n=754, 65.9%) after intervention (p <0.001). Median time spent in de ED before intervention was 3:40 (IQR 2:24 - 5:04) compared to 3:15 (IQR 2:03 - 4:38) after intervention (p<0.001).

Conclusion: This simple and low-cost intervention reduces the ED length of stay significantly. Although multiple interventions will be required to ensure less patients spending more than 4-hours in the ED, a 'traffic light' moment can be a simple and an effective tool.

Cardio-Renal-Metabolic (CaReMe) diseases, in the form of heart failure, chronic kidney disease and diabetes mellitus, justify prescription of multiple prognostically beneficial medications, specifically renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter-2 inhibitors. Use of these medications is complicated by association with adverse effects, particularly acute kidney injury and hyperkalaemia. Balancing risk and benefit is a common dilemma in acute medicine, with increasingly frequent and complex treatment decisions. Physicians should contemplate adjustments to medications within the context of not just acute illness but also long-term benefit. In the setting of hyperkalaemia, potassium-binding medications can be utilised. At hospital discharge optimisation of therapy can be achieved through clear safety netting advice, scheduled biochemical follow-up, and planned clinical review.

Nursing staff, healthcare assistants (HCAs) and other healthcare professionals on the Acute Medical Unit (AMU) at Royal Berkshire Hospital (RBH) were taught a Point of Care Ultrasound (POCUS) skill during a twenty minute session. Practitioners learned how to take bladder volume measurements with the Butterfly iQ, a portable ultrasound device which provides a visually-aided method of volume measurement. A Likert scale was used to measure the confidence that staff had in performing volume measurements with the AMU automated scanners, and with the semi-automated Butterfly iQ. After the teaching session, confidence reported by practitioners in using the semi-automated visual method was significantly higher than confidence reported in using the automated non-visual scanners (t < 0.001). Minimal time and expense was required to teach practitioners how to perform this skill. Training nurses in POCUS for bladder visualisation and bladder volume calculation is easy and practicable.