Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association最新文献

The increasing use of healthcare services is leading to issues with hospital overcrowding and this is particularly apparent in emergency departments (EDs). Consequently, patients are being cared for in areas that were not designed for that purpose, such as waiting areas and corridors. This negatively affects nurses' and patients' experiences of care. This article provides a rapid review of the evidence on nurses' and patients' experiences of crowding, corridor care and boarding. The findings highlight three main elements experienced by staff and patients when caring or being cared for in such contexts: stress and frustration; dissatisfaction with care; and safety and coping mechanisms. Enhancing nurse autonomy and improving communication with patients could mitigate some of these negative experiences and thereby improve staff retention, reduce staff-patient conflict and reduce the likelihood of patients leaving the ED without being seen.

Evidence suggests that using a standardised triage system that categorises patients into levels of severity or acuity to prioritise their care can provide the greatest levels of patient safety. The use of a web-based app to record patient triage data can support operational decision-making, reduce the risk of errors and standardise the time it takes to record the data required for accurate triage. This article details one aspect of a three-stage research project undertaken in Thailand which aimed to improve the quality of nurse triage, reduce errors in triage decisions and decrease the time spent on triage through implementation of a patient triage app. The patient information input into the app at initial triage is automatically uploaded into the electronic patient record. The authors report the results of the third stage of the project, which aimed to analyse the feasibility of using the app by evaluating completion of patient records and user satisfaction levels.

Ankle fracture-dislocation is a serious injury that requires prompt and appropriate management. The proximity of various neurovascular structures around the ankle joint means there is a risk of nerve or blood vessel damage. Initial management in the emergency department (ED), therefore, includes the realignment and repositioning of the dislocated joint to its normal anatomical position, referred to as reduction. This article details a case study of a 42-year-old woman who presented to an ED in Ireland with a suspected ankle fracture-dislocation following a fall while playing sport. Following triage and initial pain management, the patient's care was managed by an advanced nurse practitioner, in collaboration with medical colleagues, which involved history taking and physical assessment, reduction of the dislocation and splinting of the ankle under procedural sedation, monitoring during and after procedural sedation, and radiological imaging.

Referrals to mental health services, and mental health-related presentations to emergency departments (EDs), among children and young people (CYP) have increased over the last decade. In the UK, national guidelines and standards recommend that CYP who present to an ED with mental health issues should receive a psychosocial assessment, while evidence suggests that the use of a psychosocial assessment tool can enhance the management of this patient cohort. However, it can be challenging for ED healthcare professionals to undertake a formal psychosocial assessment due to a range of factors. This article reports the results of a service evaluation, undertaken in two children's EDs in a large NHS trust in England. The evaluation involved a review of 308 ED clinical records of CYP who presented to the EDs with mental health issues, to assess the extent to which this cohort was receiving a structured psychosocial assessment. The results showed that only a small proportion (34%, n=104) of the clinical records contained evidence of some form of psychosocial assessment, while the use of a psychosocial assessment tool was documented in only 22 (7%) of these 104 clinical records. The results have informed a wider quality improvement project to enhance practice in this area.

NHS emergency services, including ambulance services and emergency departments (EDs), are under considerable pressure due, in part, to the lack of availability of alternative healthcare services. People with mental health issues often contact ambulance 999 services when they cannot access the care they require from other sources. Welsh Ambulance Services NHS Trust (WAST) employs mental health professionals in its 999 call centres to provide remote mental health triage and support. While this has been effective in reducing ambulance conveyance to EDs, many patients still require a face-to-face assessment. To address this, WAST explored the option of providing a mental health response vehicle (MHRV) service, which has been shown to be effective in some ambulance trusts in England. This article gives an overview of a pilot MHRV service that was delivered by WAST across the Aneurin Bevan University Health Board locality in south-east Wales in between January and March 2024. Results suggest that the MHRV service can reduce ED conveyance rates and potentially provide cost savings for WAST and the wider NHS in Wales.

Suicide is a significant and increasing public health concern. Research has shown that screening for suicide risk is inconsistent in acute care settings and that a variety of different tools are used for that purpose. The Columbia-Suicide Severity Risk Scale (C-SSRS) has emerged as a validated and recognised suicide risk screening tool. This article describes a quality improvement project designed to improve the screening of patients for suicide risk in a large hospital system in the Midwestern US. As part of the project, 97% of nurses working in the organisation's emergency departments self-completed a 30-minute interactive learning module on the background, relevance and application of the C-SSRS. The C-SSRS enables nurses to classify the severity of suicide risk, which helps to provide interventions commensurate with patients' level of risk. Following completion of the module, there was a significant increase in the percentage of patients screened for suicide risk.

Breaking bad news is a challenging yet essential part of the role of healthcare professionals who care for major trauma patients and their families. This service evaluation investigated healthcare professionals' attitudes and experiences regarding breaking bad news in the context of major trauma. Healthcare professionals were recruited from the South Wales Trauma Network and their views collected via an online survey based on the Breaking Bad News Attitudes Scale. The survey was completed by 149 healthcare professionals and the responses demonstrated a range of experiences of breaking bad news in major trauma care, with challenges such as the environment, building rapport and setting expectations.

Ambulance handover delays arise when emergency departments become overcrowded as patients waiting prolonged periods for admission occupy clinical cubicles designed to facilitate the assessment and treatment of emergency arrivals. In response, many organisations become reliant on temporarily lodging acutely unwell patients awaiting admission in undesignated areas for care such as corridors, to provide additional space. This results in a significant risk of avoidable harm, indignity and psychological trauma for patients and has a negative effect on the well-being of healthcare professionals, since unacceptable standards of care become normalised. A two-phase strategic quality improvement project was implemented at the authors' acute trust. Ambulance handover data from between 2 November 2020 and 26 July 2021 provided a benchmark for the project. The first phase was implemented between 2 November 2021 and 26 July 2022 and aimed to reduce 60-minute ambulance handover delays. The second phase was implemented between 2 November 2022 and 26 July 2023 and aimed to eradicate 60-minute ambulance handover delays and improve overall performance. Phase one resulted in a 32% reduction in 60-minute ambulance handover delays. Phase two resulted in a 97% reduction in 60-minute ambulance handover delays. Over the course of the project there was a 24% increase in handovers completed within 15 minutes. This project demonstrates how strategic planning and collaboration between healthcare teams can reduce the potential for avoidable patient harm, while simultaneously promoting workforce well-being and retention.

Patients diagnosed with cancer or suspected cancer during an emergency department (ED) presentation are often signposted back to their GP for urgent referral to cancer services. However, this can result in delays in patients receiving specialist support, confirmation of diagnosis and, vitally, starting treatment. A quality improvement initiative that aimed to address these issues through the introduction of an ED suspected cancer diagnosis pathway was implemented by the acute oncology service in two EDs in Oxford University Hospitals NHS Foundation Trust in April 2023. Data collected during the first year of implementation of the pathway show there has been a significant increase in the numbers of patients meeting the NHS England 62-day referral to treatment standard and in the numbers of patients receiving support from an acute oncology named cancer clinical nurse specialist from the point of discharge from the ED. This article details the initiative, which is ongoing, and shares some of the results from the first year of data collection.

Although the phenomenon of crowding in emergency departments (EDs) is not new, it remains a significant problem for patients, ED staff and the wider healthcare system. Crowding in EDs, which is also called overcrowding, has been widely explored in the literature, but there are relatively few studies of the subject from an emergency nurse perspective. This article reports the findings of a literature review that aimed to explore the effects of crowding on nurses working in EDs. Four key themes were identified from a synthesis of 16 articles included in the review: staffing and skill mix; inadequate care and the effect on nurses' well-being and stress levels; violence in the ED; and hospital metrics and patient flow. Further research is required to explore in more depth the effects of ED crowding on emergency nurses and to address the multiple factors that perpetuate the phenomenon.