EMA February 2015

Issue 1 (Vol. 27) of EMA Journal for 2015 was published online on 27th January. Editorial overview by Andrew Gosbell & Geoff Hughes

A Beginners Guide to Medical Social Media and FOAM  (#FOAMed)All you need to know to access online medical education resources and get started with social media is explained by Weingart and Thoma in this video using the conceptual framework of a hierarchy of needs.

Predicting the numbers – ED presentations time-series analysis (Abstract) Accurate forecasting of the magnitude of future health services demand, particularly for EDs where overcrowding is indicative of an inability to cope with current demands, is critical for developing strategies aimed at improving access to safe and quality care especially in the context of constrained funding. Mai and colleagues report a population-based time series analysis of monthly Western Australian (WA) ED presentation data over a 7-year period, using models that enabled prediction of yearly ED presentation numbers over the next 5 years, stratified by location, patient age, triage and disposition. This analysis forecasts ED presentations in WA will increase 26.3% by 2017/18, exceeding population growth. Most of this growth is predicted to occur in metropolitan WA, in older patients and/or with complex care needs. Although based on WA data, the findings can be generalised, suggesting the need for an integrated system-wide approach for health service strategic planning and resource allocation to meet rising demand across Australia.

Communication & surviving in the ED trenches  (#FOAMed) Effective communication between medical and nursing staff in ED is essential to good patient care. This commentary from Abourbih and colleagues provides strategies to improve communication and collaboration between these ED clinician groups. Tips for emergency physicians include: introduce yourself; speak with nurse prior to assessment; everybody learns; explain physician orders; and include nurses in patient reassessment and signover. Strategies for emergency nurses include: introduce yourself; embrace new learners; be direct and clear; should miscommunication occur, and it will, seek clarification; and engage, partner and teach.

CLINICAL PROCEDURES: Intercostal catheter insertion  (#FOAMed) While evidence-based medicine continues to reduce the list of ‘absolute indications’ for intercostal catheter (ICC) insertion, it remains a key surgical skill for EM. In this Clinical Procedure, Butson & Kwa consider some of the relevant questions and controversies for ICC, including: optimal patient position and insertion site for ICC; use of analgesia and/or sedation; best instruments for blunt dissection; size of ICC; aim and depth of insertion; use of suction; and clamping the ICC. Advice on following a FT with an ICC and tips on maintaining the tract into the pleural space, securing the ICC and decompressing a tension pneumothorax are also provided.

TRAINEE FOCUS: medical students in the ED (#FOAMed) This Trainee Focus explores the hoary old chestnut of the tension between teaching versus service delivery in the emergency department, in terms of medical student education. While there’s no argument on the need for medical student education in EDs, Ilancheran and Osborne debate the role of emergency medicine registrars as educators of medical students, with both noting the current method of teaching students is neither sustainable nor satisfactory. Couser’s editorial view is that medical students both want and need the educational and practical experiences that only emergency departments can provide. So it is incumbent on doctors in EDs to find innovative ways for medical students have positive experiences and to receive relevant and quality education in ED regardless of the circumstances. Couser asserts that it is time to re-define teaching in ED, truly embracing medical students as junior colleagues and, in a return to apprenticeship style models, putting them to work in the style of physician assistants or even ensuring that just being exposed to the ED workplace enables an understanding of delivering high quality acute patient care. Twitter feedback on this topic and web resources on medical education are also provided.

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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