VP13: A Closed-Loop Audit on the Management of Adult Facial Lacerations in a Busy Tertiary Centre Accidents and Emergency Department

Aims/Objectives/BackgroundThe British Thoracic Society (BTS) produced the world’s first guidelines on oxygen therapy in the emergency setting in 2008, with subsequent updates in 2017. The key recommendation was that oxygen should be prescribed with target saturations tailored to individual patients.Whilst most clinicians appreciate the dangers of under-oxygenation, there is a lesser regard for the dangers of over-oxygenation. This is particularly important in certain conditions which may predispose to hypercapnic respiratory failure and acidosis.We therefore set out to assess compliance to the BTS guidelines, and to educate clinicians on the importance of good oxygen prescribing practice.Methods/DesignThe first cycle was conducted in August 2019. The results were presented in a series of departmental teaching sessions, along with the BTS recommendations and the importance of good oxygen prescribing practice. The second cycle was later conducted in April 2020.For each cycle, we randomly selected records of 50 adult patients who either: (1) arrived with oxygen saturations less than 93%; or (2) were already on oxygen on arrival to the emergency department. For each record, we assessed whether the target oxygen saturations were prescribed.Results/ConclusionsA total of 100 patients were included in this study. Prior to the departmental teaching sessions, only 14% of patients had target oxygen saturations prescribed. The teaching sessions on oxygen prescription resulted in a small but statistically non-significant improvement in oxygen prescription to 20% (p=0.595).This study shows that departmental teaching sessions alone are not sufficient to improve compliance with oxygen prescribing practice. Further efforts are required to change ingrained behaviours and culture, particularly in settings such as the emergency department with high rates of clinician turnover and ad-hoc locum cover. Further recommendations to facilitate these changes will require engagement from the multidisciplinary team, such as prompting from the nursing team, and spot checks by senior clinicians.

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Assessing the Time to Ward Transfer in Patients Presenting to the Emergency Department with an Acute Hip Fracture: A Closed-loop Audit

Cureus ◽

10.7759/cureus.6794 ◽

2020 ◽

Author(s):

Marc C Grant-Freemantle ◽

Robert M Kenyon ◽

John Gibbons ◽

Sean O Flynn ◽

Martin Davey ◽

...

Keyword(s):

Emergency Department ◽

Hip Fracture ◽

Closed Loop

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Rapid access clinics: Improving the efficiency of referral after discharge from the Emergency Department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920923932 ◽

2020 ◽

pp. 102490792092393

Author(s):

Tanya Sinha ◽

Christopher Hudson ◽

Matthew Vukasovic ◽

Andrew Coggins

Keyword(s):

Emergency Department ◽

Cross Sectional ◽

Emergency Department Overcrowding ◽

Patient Demographics ◽

Rapid Access ◽

Tertiary Centre ◽

Tertiary Hospitals ◽

Discharged Patients ◽

Emergency Department Patients ◽

Rapid Access Clinic

Background: Rapid access clinics are an increasingly common model of care in tertiary hospitals. Early streaming of suitable patients to appropriate clinic services could reduce Emergency Department overcrowding. This study set out to investigate the current utilisation of rapid access clinic dispositions in a tertiary centre. The findings have led to useful mapping of local services and early nurse led identification of patients suitable for streaming to clinic locations. Methods: A cross-sectional observational study in a tertiary centre. Complete lists of consecutive discharged Emergency Department patients were generated by a trained data manger. Individual electronic medical records were reviewed for evidence of clinic disposition, patient demographics and compared with concurrent Emergency Department patients who were not referred. Results: 1367 patients included from 144 h of consecutive weekday presentations. Referral to clinic locations occurred in 179/1357 (13.2%) with rapid access clinics utilised in 129/179 (70.4%). No difference in median length of stay was observed for patients referred to clinics (3.9 h) versus patients not referred (3.8 h) (p = 0.29). Conclusion: In a tertiary Emergency Department setting, discharged patients were frequently referred to rapid access clinics. Early streaming to suitable outpatient locations may be an additional strategy to consider for mitigating Emergency Department overcrowding.

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Virtual fracture clinic delivers British Orthopaedic Association compliance

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0255 ◽

2017 ◽

Vol 99 (1) ◽

pp. 51-54 ◽

Cited By ~ 20

Author(s):

J Holgate ◽

S Kirmani ◽

B Anand

Keyword(s):

Emergency Department ◽

Closed Loop ◽

Waiting Times ◽

District General Hospital ◽

Fracture Clinic ◽

Mean Waiting Time ◽

The Cost ◽

Pro Forma ◽

Virtual Fracture Clinic ◽

British Orthopaedic Association

INTRODUCTION The British Orthopaedic Association recommends that patients referred to fracture clinic are thereafter reviewed within 72 hours. With the aim of improving care by seeking to meet this target, waiting times for fracture clinic appointments in a district general hospital were audited prospectively against this national guideline, with the intervening implementation of a virtual fracture clinic. MATERIALS AND METHODS The study was conducted as a prospective closed-loop audit in which the second cycle took place several months after a change in the clinical pathway for all referrals from the emergency department to fracture clinic. Data were gathered in real-time via a pro forma during fracture clinic consultations. RESULTS The first cycle demonstrated a non-compliant mean waiting time of 10.7 days, with 6% of patients being seen within the 72-hour target. Following the implementation of the virtual fracture clinic, the second cycle found that all patients were reviewed within the 72-hour target (mean 1.3 days). DISCUSSION The improvement in performance was delivered with no increase in clinic capacity. The cost of implementation was negligible. CONCLUSION A simple virtual fracture clinic model delivered a significant reduction in waiting times and achieved compliance with the British Orthopaedic Association guideline. Similar results could be achieved in subsequent deployment elsewhere in the NHS.

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Challenge of COVID-19 crisis managed by emergency department of a big tertiary centre in Saudi Arabia

International Journal of Pediatrics and Adolescent Medicine ◽

10.1016/j.ijpam.2020.08.001 ◽

2020 ◽

Vol 7 (3) ◽

pp. 147-152

Author(s):

Muhammad Nauman Qureshi ◽

Abdulaziz AlRajhi

Keyword(s):

Emergency Department ◽

Saudi Arabia ◽

Tertiary Centre

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Profile of Ocular Trauma in a Tertiary Centre in Western Nepal

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v10i2.20801 ◽

2018 ◽

Vol 10 (2) ◽

pp. 6-10

Author(s):

S Tuladhar ◽

S Dhakal ◽

S Poudel ◽

B Poudel

Keyword(s):

Emergency Department ◽

Visual Acuity ◽

Ocular Trauma ◽

Road Traffic ◽

Public Awareness ◽

Tertiary Care ◽

College Teaching ◽

Ocular Injury ◽

Care Hospital ◽

Tertiary Centre

Introduction: Ocular trauma is an important cause of blindness and ocular morbidity throughout the world. The present study was done to establish the common causes of ocular trauma in a Tertiary Care Hospital of Western Nepal.Methods: In this prospective study, all the patients with ocular trauma visiting eye Out Patient Department (OPD) and Emergency Department of Gandaki Medical College Teaching Hospital (GMCTH) from June 2015 to June 2016 were included. A complete history and detailed ophthalmological evaluation was done.Results: Over a period of one year, 226 patients attended to the OPD and Emergency Department of GMCTH. Mean age of patients was 30.41 ±15.7 years. Males were 70.8% and females 29.2%. About 82.5% patients had visual acuity better than 6/18 while 17.7% had visual acuity <3/60. Road traffic accident (RTA) was the most common cause followed by foreign bodies.Conclusions: Males are more prone to ocular trauma than females and majority of ocular trauma occurred at workplace. RTA is the commonest cause of ocular trauma. Very few patients used protective device. Public awareness and strict legislation for the use of personal protective devices can also help reduce the occurrence of ocular injury. J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 6-10

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Video-consultation in the Emergency Department: An Assessment of the Potential Benefit for a UK District General Hospital (Preprint)

10.2196/preprints.36081 ◽

2021 ◽

Author(s):

Malcolm Clarke ◽

Linda Hands ◽

Jane Turner ◽

Grizelda George ◽

Russell Wynn Jones ◽

...

Keyword(s):

Emergency Department ◽

Potential Benefit ◽

Video Conferencing ◽

District General Hospital ◽

Emergency Department Patient ◽

Senior Member ◽

Tertiary Centre ◽

Video Consultation ◽

Improve Patient Management ◽

Improve Patient

BACKGROUND DGH Emergency department referrals to a tertiary centre depend on information available from a ‘generalist’ clinician in discussion with a specialist team. If there is uncertainty, the lowest risk strategy is often to transfer the patient. Video consultation allowing the specialist team to see and talk to the patient whilst still in the Emergency department could improve decision making about patient transfer. OBJECTIVE This study assessed the potential benefit of real time video consultation between remote specialist and Emergency department patient across all specialities. METHODS Detailed patient data was collected prospectively for 6 months on all patients presenting to a DGH Emergency department who required input from a specialist team in the nearest tertiary centre. These patients were discussed retrospectively with the specialist teams to determine whether video conferencing could have benefited the patient’s management. The logistics for use of videoconferencing were explored. RESULTS 18,799 patients were seen in the Emergency department during the study period. 413 referrals were made to the tertiary centre specialist teams. Review of patients transferred indicated 193 might have benefited from video consultation. If the specialist team could be accessed via video conferencing only whilst a senior member was available in hospital (0800-2200hr) then a maximum of only 5 patients per week across all specialities would use the equipment. If 24hr specialist access was available this would increase to 7 patients per week. CONCLUSIONS Video consultation between emergency department patient and specialist has limited potential to improve patient management.

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