Unintended consequences: The impact of airway management modifications introduced in response to COVID ‐19 on intubations in a tertiary centre emergency department

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

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A Systematic Review of the Impact of Healthcare Reforms on Access to Emergency Department and Elective Surgery Services

International Journal of Health Services ◽

10.1177/0020731417722089 ◽

2017 ◽

Vol 48 (1) ◽

pp. 81-105 ◽

Cited By ~ 2

Author(s):

Sandeep Reddy ◽

Peter Jones ◽

Harsha Shanthanna ◽

Raechel Damarell ◽

John Wakerman

Keyword(s):

Systematic Review ◽

Health Care ◽

Emergency Department ◽

United Kingdom ◽

Elective Surgery ◽

Grey Literature ◽

Unintended Consequences ◽

Health Care Reforms ◽

The United Kingdom ◽

The Impact

This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant “grey” literature and websites. Included studies were checked for cited and citing papers. Primary studies corresponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using standardized forms. Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data.

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A national survey of the impact of NAP4 on airway management practice in United Kingdom hospitals: closing the safety gap in anaesthesia, intensive care and the emergency department

British Journal of Anaesthesia ◽

10.1093/bja/aew177 ◽

2016 ◽

Vol 117 (2) ◽

pp. 182-190 ◽

Cited By ~ 36

Author(s):

T.M. Cook ◽

N. Woodall ◽

C. Frerk

Keyword(s):

Emergency Department ◽

United Kingdom ◽

Intensive Care ◽

Airway Management ◽

National Survey ◽

Management Practice ◽

The Impact

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Faculty Opinions recommendation of A national survey of the impact of NAP4 on airway management practice in United Kingdom hospitals: closing the safety gap in anaesthesia, intensive care and the emergency department.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726590936.793532441 ◽

2017 ◽

Author(s):

Lauren Berkow

Keyword(s):

Emergency Department ◽

United Kingdom ◽

Intensive Care ◽

Airway Management ◽

National Survey ◽

Management Practice ◽

The Impact

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Aviation and the Microbiome

Aerospace Medicine and Human Performance ◽

10.3357/amhp.5576.2020 ◽

2020 ◽

Vol 91 (8) ◽

pp. 651-661

Author(s):

Joshua T. Davis ◽

Hilary A. Uyhelji

Keyword(s):

Psychological Health ◽

Aviation Safety ◽

Autism Spectrum ◽

Unintended Consequences ◽

Microbial Colonization ◽

Future Research ◽

Aerospace Medicine ◽

Medical Certification ◽

Physical Disorders ◽

The Impact

INTRODUCTION: Although the impact of microorganisms on their hosts has been investigated for decades, recent technological advances have permitted high-throughput studies of the collective microbial genomes colonizing a host or habitat, also known as the microbiome. This literature review presents an overview of microbiome research, with an emphasis on topics that have the potential for future applications to aviation safety. In humans, research is beginning to suggest relationships of the microbiome with physical disorders, including type 1 and type 2 diabetes mellitus, cardiovascular disease, and respiratory disease. The microbiome also has been associated with psychological health, including depression, anxiety, and the social complications that arise in autism spectrum disorders. Pharmaceuticals can alter microbiome diversity, and may lead to unintended consequences both short and long-term. As research strengthens understanding of the connections between the microbiota and human health, several potential applications for aerospace medicine and aviation safety emerge. For example, information derived from tests of the microbiota has potential future relevance for medical certification of pilots, accident investigation, and evaluation of fitness for duty in aerospace operations. Moreover, air travel may impact the microbiome of passengers and crew, including potential impacts on the spread of disease nationally and internationally. Construction, maintenance, and cleaning regimens that consider the potential for microbial colonization in airports and cabin environments may promote the health of travelers. Altogether, the mounting knowledge of microbiome effects on health presents several opportunities for future research into how and whether microbiome-based insights could be used to improve aviation safety.Davis JT, Uyhelji HA. Aviation and the microbiome. Aerosp Med Hum Perform. 2020; 91(8):651–661.

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