Outline of the 2005 European Resuscitation Council Guidelines

Resuscitation guidelines are revised and updated about every 5 years and this happens because resuscitation science continues to advance and clinical guidelines must be updated regularly to reflect these developments and advise healthcare providers on best practice. To date, the 2000 resuscitation guidelines are followed in Malta and other countries worldwide. These guidelines have been now revised by the International Liaison Committee on Resuscitation (ILCOR) and a consensus has been reached resulting in the publication of the 2005 guidelines. The ILCOR was formed in 1993 and its mission is to identify and review international science and knowledge relevant to CPR, and to offer consensus on treatment recommendations. A total of 281 experts completed 403 worksheets on 276 topics. Three hundred and eighty specialists from 18 countries attended the 2005 International Consensus Conference on Cardiopulmonary Resuscitation (CPR) Science, which took place in Dallas in January 2005. Science statements and treatment recommendations were agreed by the conference participants and the results are now the new 2005 Resuscitation Guidelines. These ILCOR guidelines will be published internationally on the 28 th November 2005 for the first time. The Malta Resuscitation Council (MRC) participated in meetings of the European Resuscitation Council (ERC) where the dissemination of these new guidelines was discussed. This article will try to summarize the major changes incorporated in the new guidelines.peer-reviewe

A review of the practice of requesting skull x-rays from the Emergency Department of St Luke’s Hospital

Background: In the Emergency Department (ED) of St. Luke's Hospital (SLH), head injuries are a common presentation. Although there are various guidelines which recommend approaches to the management of head injuries, these are not followed locally and the authors feel that a significant number of unnecessary skull x-rays (SXR) are being ordered by doctors. In this review we wished to observe the current trends in head injury investigations at the SLH ED and compare these with the NICE head injury guidelines. We also wanted to determine the impact that the NICE guidelines would have on these trends if they were to be instituted. Methods: The study is retrospective and observational. The demographics together with the rates of SXRs, CT scans and admissions were determined for patients presenting with head injury between the 1st of February and the 31st March 2006. The study also looked at the predicted rates had NICE guidelines been applied. Results: 387 patients were studied in a 2 month period. Of this total, only 2 patients (0.5%) had indications for a SXR but 312 patients (80.6 %) had this investigation. Out of this total of SXRs only 6 had positive findings (1.9%) and these went on to have a CT brain. A total of 72 patients had a CT scan of the head and of these 10 (13.9%) had positive findings. According to NICE guidelines 70 patients had indications for a CT. One hundred and twenty one patients (31.3%) were admitted, 201 were discharged (51.9%) and 65 patients (16.8%) discharged themselves against medical advice. Conclusion: The implementation of NICE guidelines would greatly reduce the rates of SXRs and hence reduce costs and radiation exposure. It also seems that the rates of CT scans will not change significantly.peer-reviewe

Is there a need for a chest pain observation unit in St. Luke's Hospital and will it be cost effective?

Objectives: Studies from the USA suggest that using an A&E department based chest pain observation unit (CPOU) saves from $567 to$2030 per patient compared with hospital admission. In the UK cost effectiveness figures are lower at around £78 per patient. This study aims to review current practice for patients presenting with chest pain in St.Luke's Hospital (SLH), to determine the proportion of patients suitable for CPOU evaluation and consequently calculate any related cost effectiveness. Methods: 236 patients presenting with a primary complaint of chest pain to the A&E department at SLH between 1 st June and 12 th July 2003 were selected. The case histories of these patients were reviewed to ascertain how many of them would qualify for a CPOU management and specific data was collected. Results: Notes were retrieved for 217 patients. A total of 103 (47.5%) patients were suitable for a CPOU management. Mean length of in-hospital stay of these patients was 67.5 hours. Estimated mean cost saving per patient was LM220 and overall LM 19,800 per month. Conclusion: Potential exists for the setting up of CPOU care to reduce health service costs and improve health utility at St.Luke's Hospital.peer-reviewe

The early impact of the COVID-19 pandemic on the emergency department at Mater Dei Hospital

BACKGROUND: On the 1st of April 2020, Malta declared a Public Health Emergency. Mater Dei Hospital (MDH) is the only public hospital catering for 441,543 inhabitants, until recent 2020 statistics. Several changes had to be implemented to improve the infrastructure, manpower and other resources of the Emergency Department.METHOD: This observational clinical study is based on retrospective data collected for patients presenting to the Emergency Department between March 2019 to December 2019 and March 2020 to December 2020. Randomisation was attained by choosing the seventh day of each month as to have a different day of the week for each month under study. Following the data collection, a Microsoft Excel Sheet® was created to document and analyse the retrieved information. Permissions to collect this data were duly obtained from the CEO, Data Protection Officer and Clinical Chairperson of the Emergency Department at Mater Dei Hospital.RESULTS: Between March and December 2019 a total of 1811 patients were seen during the randomised days while 1681 patients were seen between March and December 2020. Data collected showed that Emergency Department attendances decreased by 7.2% while the hospital’s percentage of daily admissions increased by 3.4%, when comparing ten pre-COVID-19 months with the ten initial COVID-19 months.CONCLUSION: MDH’s Emergency Department, remained the main port of call for the population whether in declared states of health emergencies or not. MDH and its Emergency Department have to remain consistently prepared and resilient to sudden and unexpected patients’ surges.peer-reviewe

Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Purpose – The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/methodology/approach – The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A&E unit of the hospital. Findings – The major and related problems being faced by the hospital under study were overcrowding at A&E and shortage of beds, respectively. The combined framework ensures better A&E services and patient flow. QFD identifies and analyses the issues and challenges of A&E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A&E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A&E unit. Practical/implications – The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value – Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta

Is an adequate travel history being documented in adult patients presenting with fever to the Emergency Department at Mater Dei Hospital?

Background: Travelling has increased exponentially, especially to destinations with tropical and sub-tropical climates. The importance of obtaining a travel history was first coined by Maegraith in his publication entitled 'Unde Venis'. Emergency Physicians often fail to inquire for a travel history for a multitude of reasons. Such absence can have serious implications on both the clinical and the public health aspect.Method: A retrospective analysis of patients' holder of Identification number ending with 'F' who have returned from abroad (21 days) and presented to the Emergency Department with a fever between the period of December 2017 and June 2018, were included. The emergency clerking sheet from the Emergency Department reception (for patients who were discharged) or the medical file from medical records (for patients who were admitted), were analysed for the presence or absence of an adequate travel history against the travel history proforma created.Results: A total of 234 case notes were analysed. 1.3% were asked about the diurnal variation of fever and 85.9% inquired about the duration of fever in days. With regards to symptomatology, only 36% were inquired about respiratory symptoms and 48% about gastrointestinal ones. 0.4% were asked about the possibility of casual sex abroad and 1.7% about the risk of exposure to contaminated food and water.Conclusion: Results obtained show that there is a significant lack of awareness. Researchers are therefore proposing the use of a ready-made proforma which should be used at all times for patients who present to the Emergency Department with fever and a recent history of travel.peer-reviewe

The European Trauma Course (ETC) and the team approach:past, present and future

Lott C, Araujo R, Cassar MR, et al. The European Trauma Course (ETC) and the team approach: Past, present and future. Resuscitation. 2009;80(10):1192-1196.The European Trauma Course (ETC) was officially launched during the international conference of the European Resuscitation Council (ERC) in 2008. The ETC was developed on behalf of ESTES (European Society of Trauma and Emergency Surgery), EuSEM (European Society of Emergency Medicine), the ESA (European Society of Anaesthesiology) and the ERC. The objective of the ETC is to provide an internationally recognised and certified life support course, and to teach healthcare professionals the key principles of the initial care of severely injured patients. Its core elements, that differentiates it from other trauma courses, are a strong focus on team training and a novel modular design that is adaptable to the differing regional European requirements. This article describes the lessons learnt during the European Trauma Course development and provides an outline of the planned future development

The European Trauma Course: Transforming systems through training

The European Trauma Course (ETC) exemplifies an innovative approach to multispecialty trauma education. This initiative was started as a collaborative effort among the European Society for Emergency Medicine, the European Society for Trauma and Emergency Surgery, and the European Society of Anaesthesiology under the auspices of the European Resuscitation Council. With the robust support of these societies, the project has evolved into the independent European Trauma Course Organisation. Over the past 15 years, the ETC has transcended traditional training by integrating team dynamics and non-technical skills into a scenario-based simulation course, helping to shape trauma care practice and education. A distinctive feature of the ETC is its training of doctors and allied healthcare professionals, fostering a collaborative and holistic approach to trauma care. The ETC stands out for its unique team-teaching approach, which has gained widespread recognition as the standard for in-hospital trauma care training not only in Europe but also beyond. Since its inception ETC has expanded geographically from Finland to Sudan and from Brazil to the Emirates, training nearly 20,000 healthcare professionals and shaping trauma care practice and education across 25 countries. Experiencing exponential growth, the ETC continues to evolve, reflecting its unmet demand in trauma team education. This review examines the evolution of the ETC, its innovative team-teaching methodology, national implementation strategies, current status, and future challenges. It highlights its impact on trauma care, team training, and the effect on other life support courses in various countrie

Using clinical research networks to assess severity of an emerging influenza pandemic

BACKGROUND: Early clinical severity assessments during the 2009 influenza A H1N1 pandemic (pH1N1) overestimated clinical severity due to selection bias and other factors. We retrospectively investigated how to use data from the International Network for Strategic Initiatives in Global HIV Trials, a global clinical influenza research network, to make more accurate case fatality ratio (CFR) estimates early in a future pandemic, an essential part of pandemic response. METHODS: We estimated the CFR of medically attended influenza (CFRMA) as the product of probability of hospitalization given confirmed outpatient influenza and the probability of death given hospitalization with confirmed influenza for the pandemic (2009-2011) and post-pandemic (2012-2015) periods. We used literature survey results on health-seeking behavior to convert that estimate to CFR among all infected persons (CFRAR). RESULTS: During the pandemic period, 5.0% (3.1%-6.9%) of 561 pH1N1-positive outpatients were hospitalized. Of 282 pH1N1-positive inpatients, 8.5% (5.7%-12.6%) died. CFRMA for pH1N1 was 0.4% (0.2%-0.6%) in the pandemic period 2009-2011 but declined 5-fold in young adults during the post-pandemic period compared to the level of seasonal influenza in the post-pandemic period 2012-2015. CFR for influenza-negative patients did not change over time. We estimated the 2009 pandemic CFRAR to be 0.025%, 16-fold lower than CFRMA. CONCLUSIONS: Data from a clinical research network yielded accurate pandemic severity estimates, including increased severity among younger people. Going forward, clinical research networks with a global presence and standardized protocols would substantially aid rapid assessment of clinical severity