Are chest pain observation units essential for rapid and effective emergency care in the UK?

Abstract Background Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. Methods The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. Results Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. Conclusion This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.

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Recognising and treating arrhythmias in primary care

Practice Nursing ◽

10.12968/pnur.2019.30.6.270 ◽

2019 ◽

Vol 30 (6) ◽

pp. 270-275

Author(s):

Dave Richley

Keyword(s):

Primary Care ◽

Chest Pain ◽

Cardiac Arrhythmias ◽

Accurate Diagnosis ◽

Loss Of Consciousness ◽

Specialist Care ◽

Practice Nurses ◽

Erroneous Diagnosis ◽

The Uk ◽

Electrocardiogram Ecg

As more and more people in the UK are being affected by cardiovascular conditions, it is increasingly necessary for practice nurses to keep up-to-date with the latest developments. Dave Richley explains common ECG readings that may be seen in primary care Cardiac arrhythmias may be asymptomatic or they may be responsible for a range of symptoms including palpitations, dizziness, chest pain and loss of consciousness. Accurate diagnosis, and therefore appropriate management, depends on careful interpretation of an electrocardiogram (ECG) recording of the arrhythmia, and this is often achievable in primary care. This article presents the arrhythmias most commonly encountered in primary care, as well as those seen rarely, and describes and illustrates their defining features. It will also discuss some of the pitfalls that can lead to erroneous diagnosis. While some arrhythmias can be managed appropriately in primary care, guidance is provided in regarding referral or admission to hospital for arrhythmias that may warrant further investigation or specialist care.

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Non-traumatic chest pain: pericarditis

Journal of Paramedic Practice ◽

10.12968/jpar.2020.12.3.cpd1 ◽

2020 ◽

Vol 12 (3) ◽

pp. 1-5

Author(s):

Andrew Mootham

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Treatment Regimen ◽

Emergency Care ◽

Signs And Symptoms ◽

Heart Sounds ◽

Scope Of Practice ◽

Bacterial Pericarditis

Pericarditis is an inflammation of the two layers of pericardium, the thin, sac-like membrane that surrounds the heart. Its causes are thought to be viral, fungal or bacterial. Pericarditis may also present as a result of a myocardial infarction. Its signs and symptoms include chest pain, which may radiate to the arm and jaw and pericardial friction rub (a scratching or creaking sound produced by the layers of the pericardium rubbing over each other) on auscultation of heart sounds. The diagnosis of straightforward pericarditis may be within the scope of practice of the emergency care practitioner. It should be possible for an emergency care practitioner to reach a working diagnosis and to initiate a treatment regimen, which would predominantly consist of providing analgesia to make the patient more comfortable.

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Calculating the proportion of avoidable attendances at UK emergency departments: analysis of the Royal College of Emergency Medicine’s Sentinel Site Survey data

Emergency Medicine Journal ◽

10.1136/emermed-2017-206846 ◽

2017 ◽

Vol 35 (2) ◽

pp. 114-119 ◽

Cited By ~ 8

Author(s):

Toby Morris ◽

Suzanne M Mason ◽

Chris Moulton ◽

Colin O’Keeffe

Keyword(s):

Royal College ◽

Emergency Care ◽

Healthcare Setting ◽

Sentinel Site ◽

Site Survey ◽

Younger Age ◽

Universal Definition ◽

Definition Of ◽

The Uk ◽

Ed Crowding

IntroductionAvoidable attendances (AAs; defined as non-urgent, self-referred patients who could be managed more effectively and efficiently by other services) have been identified as a contributor to ED crowding. Internationally, AAs have been estimated to constitute 10%–90% of ED attendances, with the UK 2013 Urgent and Emergency Care Review suggesting a figure of 40%.MethodsThis pilot study used data from the Royal College of Emergency Medicine’s Sentinel Site Survey to estimate the proportion of AAs in 12 EDs across England on a standard day (20 March 2014). AAs were defined by an expert panel using questions from the survey. All patients attending the EDs were recorded with details of investigations and treatments received, and the proportion of patients meeting criteria for AA was calculated.ResultsVisits for 3044 patients were included. Based on these criteria, a mean of 19.4% (95% CI 18.0% to 20.8%) of attendances could be deemed avoidable. The lowest proportion of AAs reported was 10.7%, while the highest was 44.3%. Younger age was a significant predictor of AA with mean age of 38.6 years for all patients attending compared with 24.6 years for patients attending avoidably (p≤0.001).DiscussionThe proportion of AAs in this study was lower than many estimates in the literature, including that reported by the 2013 Urgent and Emergency Care Review. This suggests the ED is the most appropriate healthcare setting for many patients due to comprehensive investigations, treatments and capability for urgent referrals.The proportion of AAs is dependent on the defining criteria used, highlighting the need for a standardised, universal definition of an appropriate/avoidable ED attendance. This is essential to understanding how AAs contribute to the overall issue of crowding.

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Letter to the Editor regarding the article 'The effect of applying NICE guidelines for the investigation of stable chest pain on out-patient cardiac services in the UK'

QJM ◽

10.1093/qjmed/hcr126 ◽

2011 ◽

Vol 104 (11) ◽

pp. 1009-1010 ◽

Cited By ~ 1

Author(s):

A. George ◽

S. Chattopadhyay

Keyword(s):

Chest Pain ◽

Nice Guidelines ◽

Letter To The Editor ◽

Stable Chest Pain ◽

The Uk

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The effect of applying NICE guidelines for the investigation of stable chest pain on out-patient cardiac services in the UK

QJM ◽

10.1093/qjmed/hcr011 ◽

2011 ◽

Vol 104 (7) ◽

pp. 581-588 ◽

Cited By ~ 19

Author(s):

C. Patterson ◽

E. Nicol ◽

L. Bryan ◽

T. Woodcock ◽

J. Collinson ◽

...

Keyword(s):

Chest Pain ◽

Nice Guidelines ◽

Stable Chest Pain ◽

The Uk

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Factors Associated With Patient Involvement in Emergency Care Decisions: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial

Academic Emergency Medicine ◽

10.1111/acem.13503 ◽

2018 ◽

Vol 25 (10) ◽

pp. 1107-1117

Author(s):

Marc A. Probst ◽

Craig F. Tschatscher ◽

Christine M. Lohse ◽

M. Fernanda Bellolio ◽

Erik P. Hess

Keyword(s):

Chest Pain ◽

Randomized Trial ◽

Emergency Care ◽

Patient Involvement ◽

Secondary Analysis ◽

Factors Associated ◽

Multicenter Randomized Trial

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Nitroglycerine Lingual Aerosol in Prehospital Emergency Care,

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00038474 ◽

1989 ◽

Vol 4 (1) ◽

pp. 11-14

Author(s):

Steven J. Rottman ◽

Baxter Larmon

Keyword(s):

Chest Pain ◽

Emergency Care ◽

Multiple Dose ◽

Care Setting ◽

Prehospital Emergency Care ◽

Tablet Form ◽

Sublingual Tablet ◽

Usual Form ◽

Clinical Responses ◽

Prehospital Emergency

Nitroglycerine (NTG) commonly is used in the prehospital emergency care setting for the treatment of chest pain suggestive of myocardial ischemia or infarction or for cardiac unloading in patients with presumed pulmonary edema. The usual form of this drug is as a 400 mcg tablet administered sublingually. Recently, NTG has become available as an aerosolized form (NTGA) in a multiple dose, pressurized canister containing 200 metered doses of 400 meg of NTG each. In this form, the drug is purported to be absorbed rapidly from the surface of the tongue.In the field, we have noted that the sublingual tablet form of NTG occasionally remains undissolved following administration to patients complaining of chest pain. In each of these cases, clinically, the patients were unchanged on arrival at the receiving hospital and an intact tablet was discovered properly placed under the tongue. In an attempt to evaluate the ease of administration and clinical responses of patients with chest pain to the aerosolized form of the drug, we replaced NTG sublingual tablets on paramedic units in the Burbank system with the NTGA form.

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