EMA April 2015

Issue 2 (Vol. 27) of EMA Journal for 2015 was published online on 25th March. Editorial overview by Andrew Gosbell & Geoff Hughes

ED Models of Care  (Abstract)A range of models of care (MOCs) have been implemented in order to improve the key ED functions of patient evaluation, treatment and/or discharge/admission. This systematic review, from Wylie et al, examined ED MOCs in terms of quality/effectiveness of care and cost, with reference to the 3 phases of emergency care: input, throughput and output. There is an absence of cost benefit analysis for MOCs to reduce ED inputs. In addition, there is substantial variation in how available resources are valued in respect of the MOCs implemented by EDs to address throughput and optimal patient disposition, and no cost-effectiveness analysis. Research into cost benefits and clinical outcomes of MOCs and ED staff mix is needed in order for reliable assessments of their impact on safety, clinical effectiveness and cost effectiveness. This is important as public hospital budgets continue to remain under pressure

Lessons from the history of Australasian disasters  (#FOAMed)In the current context of devastating natural disasters experienced across Australasia, Bradt and colleagues examined disaster management in Australasia, by undertaking an epidemiological analysis of Australasian disasters that have occurred since 1900. Timeline analysis revealed an increasing incidence in natural disasters over the last fifteen years, with the disasters occurring in most recent years having the highest death toll and greatest economic losses. The response to most disasters of national significance, and all terrorist acts, has been the introduction of reactive hazard-specific legislation. However, the increasing vulnerability of Australasia to disaster suggests that a comprehensive all hazards model of legislation is required to improve future resilience.

Diagnostic error – missed fractures  (#FOAMed)This case study from Australasian Emergency Medicine Events Register, EMER, by Deakin et al, describes the failure of a registrar to correctly identify a triquetral fracture on X-ray. It highlights the system issue of lack of timely radiological reporting that could potentially result in significant patient harm. Emergency Medicine Events Register (EMER) is an anonymous, confidential and protected incident-reporting system, supported by ACEM. Anyone working in emergency medicine can enter a near miss or error by following the link to EMER. Reporting takes 5 min and will help to inform practice and improve patient safety in emergency medicine.

CLINICAL PROCEDURES: Paediatric ENT foreign bodies  (#FOAMed)Children seem to be able to find a seemingly inexhaustible variety of objects to stick into all sorts of places they were not supposed to go! In this clinical procedures, Craig and colleagues give advice on managing common paediatric ED presentations due to aural and nasal foreign bodies, including suggestions on non-invasive techniques that can be useful; tips on analgesia and sedation; and options on the specific types of instruments that are suitable for particular types of foreign bodies. Specific mention is made on button batteries, due to the potential for significant complications, which need urgent removal.

TRAINEE FOCUS: role of short courses in EM training  (#FOAMed)A growing number of short courses are available to emergency medicine clinicians, covering a variety of areas such as trauma, resuscitation, ultrasound, paediatric emergencies and research methods. This Trainee Focus considers whether such short courses should be mandatory requirements for ACEM trainees (Reference 1). There’s no dispute that there are many benefits in undertaking short courses and Williams contends that accredited compulsory courses provide clarity on the standards to which emergency physicians are trained (Reference 2). However, MacKenzie argues that rather than mandating courses, adult learning approaches, with individual learning goals, developed against the new ACEM curriculum, should be encouraged to enable trainees to proactively identify their own training needs (Reference 3). Twitter feedback on this topic is also provided. An accompanying interview with Director of the Emergency Trauma Management course, Andy Buck (@edexam), explores the rationale for developing a new EM-focused course, the underlying educational theory and the role of external courses in the FOAMed era.

Further reading:

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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