No Fever, No Worries? A Retrospective Audit of Bacteraemic Patients in the Emergency Department

2020 ◽  
Author(s):  
Jessica Chiodo‐Reidy ◽  
Michael J Loftus ◽  
Natasha Holmes
Keyword(s):  
Emergency Department ◽  
Retrospective Audit

Trends and outcomes of ruptured ovarian cysts

2021 ◽  
pp. postgradmedj-2020-138833
Author(s):  
Wei How Lim ◽  
Nikki Woods ◽  
Vincent P Lamaro
Keyword(s):  
Emergency Department ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Ovarian Cysts ◽  
Free Fluid ◽  
Vaginal Intercourse ◽  
Imaging Diagnosis ◽  
Retrospective Audit ◽  
Common Clinical Presentation ◽  
Health Institutions

BackgroundRuptured ovarian cysts are common gynaecological presentation to health institutions with abdominal pain. While this phenomenon is generally self-limiting, surgery may be necessary in cases of haemodynamic compromise or association with torsion. The aim of this audit is to identify the trend of hospital presentations, as well as the review the management of modern gynaecology practice.MethodsA retrospective audit of all women who presented to the emergency department with an imaging diagnosis of ruptured ovarian cysts was conducted over a 5-year period at St Vincent’s Hospital, Sydney.ResultsDuring the study period, 408 women were identified. There was a trend towards conservative management, as observed in 84.7% of women, while the remaining 15.4% underwent surgery. Haemorrhagic or ruptured corpus luteum was the most common diagnoses. As expected, women who had surgical intervention were more likely to have larger cysts (20 vs 50%; p<0.05), and larger free fluid findings on imaging (1.4 vs 23.8%; p<0.05) compared with those managed conservatively. There were no statistically significant differences in location of ovarian cysts (right or left) or antecedent to hospital presentation (vaginal intercourse or trauma).ConclusionRuptured ovarian cysts of both functional and non-functional types remained a common clinical presentation of acute pain for women to the emergency department. Majority of women were managed conservatively in our cohort, and indications for surgery were large ovarian cysts and large free fluid seen on imaging findings. Surgery was largely feasible with minimal complications.

Diagnostic error in an ophthalmic emergency department

Diagnosis ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. 129-131 ◽  
Author(s):  
Harry Yip ◽  
Carmel Crock ◽  
Elsie Chan
Keyword(s):  
Emergency Department ◽  
General Practitioners ◽  
Diagnostic Error ◽  
Error Rates ◽  
First Year ◽  
Limited Data ◽  
Retrospective Audit ◽  
Audit Data ◽  
Medical Diagnostic ◽  
Second Year

AbstractBackgroundDiagnostic error is a major preventable cause of harm to patients. There is currently limited data in the literature on the rates of misdiagnosis of doctors working in an ophthalmic emergency department (ED). Misdiagnosis was defined as a presumed diagnosis being proven incorrect upon further investigation or review.MethodsIn this retrospective audit, data was collected and analysed from 1 week of presentations at the Royal Victorian Eye and Ear Hospital (RVEEH) ED.ResultsThere were 534 ophthalmic presentations during the study period. The misdiagnosis rates of referrers were: general practitioners (30%), optometrists (25.5%), external hospital EDs (18.8%), external hospital ophthalmology departments (25%) and private ophthalmologists (0%). Misdiagnosis rates of RVEEH doctors were: emergency registrars (7.1%), RVEEH residents (16.7%), first-year registrars (5.1%), second-year registrars (7.1%), third-year registrars (7.7%), fourth-year registrars (0%), senior registrars (6.9%), fellows (0%) and consultants (8.3%).ConclusionsThe misdiagnosis rates in our study were comparable to general medical diagnostic error rates of 10–15%. This study acts as a novel pilot; in the future, a larger-scale multi-centre audit of ophthalmic presentations to general emergency departments should be undertaken to further investigate diagnostic error.

scholarly journals Opioid prescribing in the emergency department of a tertiary hospital: A retrospective audit of hospital discharge data

2019 ◽  
Vol 32 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Beata Stanley ◽  
Lisa J Collins ◽  
Amanda F Norman ◽  
Jonathon Karro ◽  
Monica Jung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Discharge ◽  
Tertiary Hospital ◽  
Hospital Discharge Data ◽  
Discharge Data ◽  
Opioid Prescribing ◽  
Retrospective Audit

scholarly journals 194 Referral of Paediatric Fractures from The Emergency Department to Virtual Fracture Clinic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Effiom
Keyword(s):  
Emergency Department ◽  
Cost Effective ◽  
District General Hospital ◽  
National Guidelines ◽  
Fracture Clinic ◽  
The United Kingdom ◽  
Retrospective Audit ◽  
National Guidance ◽  
Fracture Diagnosis ◽  
Virtual Fracture Clinic

Abstract Introduction Virtual Fracture clinics (VFCs) are an alternative to the traditional fracture clinic. Recent evidence reports them to be safe, cost-effective, and efficient model without significant compromise to patient care. Aim This audit aims to assess VFC referrals from the paediatric emergency department (ED) and ensure the appropriateness of these referrals. Method This was a retrospective audit done at a large district general hospital in the United Kingdom (UK). We included patients under 18 years old presented to the emergency department with suspected or confirmed fractures and referred to virtual fracture clinics within a period of one month. The performance was measured against both local and national guidance (NICE & BOAST 7). Results Thirty patients were eligible. Thirty-three per cent of patients were appropriately referred to the VFC and ’seen’ within 72 hours. Comparing those referred 63.3% were appropriate, with inappropriate referrals mainly due to false-positive fracture diagnosis or fractures safe to be discharged home. Only 67.8% per cent of patients were managed correctly as per suspected or confirmed diagnosis with regards to fixation (i.e., splint). Conclusions The target of 100% compliance has failed. Fractures deemed safe to be discharged home from the ED are being repeated referred, radiographic interpretations often over-diagnose, and management within the department in sub-optimal. Recommendations include improving junior radiographic interpretation skills and awareness of the local and national guidelines, with another audit cycle to assess for improvement.

Predictive values of haematuria and hydronephrosis in suspected renal colic: An emergency department retrospective audit

2020 ◽  
Vol 32 (4) ◽  
pp. 573-577
Author(s):  
Jarel TS Saw ◽  
Nerissa Nexhmije Imeri ◽  
Emogene S Aldridge ◽  
Paul G Buntine
Keyword(s):  
Emergency Department ◽  
Renal Colic ◽  
Predictive Values ◽  
Retrospective Audit

scholarly journals Previously undiagnosed scoliosis presenting as pleuritic chest pain in the emergency department – a case series and a validating retrospective audit

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gabor Xantus ◽  
Derek Burke ◽  
Peter Kanizsai
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Chest Wall ◽  
Adult Population ◽  
Case Series ◽  
Sudden Onset ◽  
Pleuritic Chest Pain ◽  
Record System ◽  
Diverse Range ◽  
Retrospective Audit

Abstract Background Chest pain is one of the commonest presenting complaints in urgent/emergency care, with a lifelong prevalence of up to 25% in the adult population. Pleuritic chest pain is a subset of high investigation burden because of a diverse range of possible causes varying from simple musculoskeletal conditions to pulmonary embolism. Case series Among otherwise fit and healthy adult patients presenting in our emergency department with sudden onset of unilateral pleuritic chest pain, within 1 month we identified a cohort of five patients with pin-point tenderness in one specific costo-sternal joint often with referred pain to the back. All cases had apparent and, previously undiagnosed mild/moderate scoliosis. Methods To confirm and validate the observed association between scoliosis and pleuritic chest pain, a retrospective audit was designed and performed using the hospital’s electronic medical record system to reassess all consecutive adult chest pain patients. Results The Odds Ratio for having chest pain with scoliosis was 30.8 [95%CI 1.71–553.37], twenty times higher than suggested by prevalence data. Discussion In scoliosis the pathologic lateral curvature of the spine adversely affects the functional anatomy of both the spine and ribcage. In our hypothesis the chest wall asymmetry enables minor slip/subluxation of a rib either in the costo-sternal and/or costovertebral junction exerting direct pressure on the intercostal nerve causing pleuritic pain. Conclusion Thorough physical examination of the anterior and posterior chest wall is key to identify underlying scoliosis in otherwise fit patients presenting with sudden onset of pleuritic pain. Incorporating assessment for scoliosis in the low-risk chest pain protocols/tools may help reducing the length of stay in the emergency department and, facilitate speedy but safe discharge with increased patient satisfaction.

scholarly journals SP10.1.2 Increased Access to Computed Tomography Reduces Acute Surgical Admissions: Lessons Learnt During the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
S Davidson ◽  
L Cornett ◽  
K McElvanna
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Ct Scan ◽  
Surgical Patients ◽  
Lessons Learnt ◽  
Retrospective Audit ◽  
Time Period ◽  
Number Of Patients ◽  
Scan Data ◽  
Surgical Admission

Abstract Aim With increased bed pressures due to COVID-19, keeping patients out of hospital became critical. Computed Tomography (CT) utilisation was increased to aid in the assessment of acute surgical patients. The aim of this study was to assess if increased access to CT reduced inpatient admissions. Methods A Retrospective audit of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required a CT scan. Data collected from Electronic Care Records and NIPACS, including patient destination at time of CT and decision following CT. For comparison, the same time-period in 2019 was assessed. Results In 2020, 301 patients required a CT compared to 207 in 2019. 84.7% (255/301) had a CT direct from ED in 2020 vs. 56.5% (117/207) in 2019 (p &lt; 0.001). Of those who had CT direct from ED in 2020 18.4% (47/255) were discharged, compared to 1.7% (2/117) in 2019 (p &lt; 0.001). 9.8% (25/255) were directed to an alternative specialty in 2020 vs. 2.6% (3/117) in 2019 (p = 0.014). 2.7% (8/301) were discharged for an ambulatory CT in 2020, an increase from 0.5% (1/207) in 2019 (p = 0.07). Overall, there was a 24% reduction in the number of patients requiring acute surgical admission in 2020 vs. 2019. Conclusions There was a significant increase in the number of CT’s carried out directly from ED. This enabled a significant number of patients to be discharged or transferred to a more appropriate specialty. These results demonstrate that increased access to CT can reduce the need for acute surgical admission.

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