The role of the emergency department in the management of acute heart failure: an international perspective on education and research

Emergency departments are a major entry point for the initial management of acute heart failure (AHF) patients throughout the world. The initial diagnosis, management and disposition - the decision to admit or discharge - of AHF patients in the emergency department has significant downstream implications. Misdiagnosis, under or overtreatment, or inappropriate admission may place patients at increased risk for adverse events, and add costs to the healthcare system. Despite the critical importance of initial management, data are sparse regarding the impact of early AHF treatment delivered in the emergency department compared to inpatient or chronic heart failure management. Unfortunately, outcomes remain poor, with nearly a third of patients dying or re-hospitalised within 3 months post-discharge. In the absence of robust research evidence, consensus is an important source of guidance for AHF care. Thus, we convened an international group of practising emergency physicians, cardiologists and advanced practice nurses with the following goals to improve outcomes for AHF patients who present to the emergency department or other acute care setting through: (a) a better understanding of the pathophysiology, presentation and management of the initial phase of AHF care; (b) improving initial management by addressing knowledge gaps between best practices and current practice through education and research; and (c) to establish a framework for future emergency department-based international education and research

Editor's Choice-The role of the emergency department in the management of acute heart failure : An international perspective on education and research

Emergency departments are a major entry point for the initial management of acute heart failure (AHF) patients throughout the world. The initial diagnosis, management and disposition - the decision to admit or discharge - of AHF patients in the emergency department has significant downstream implications. Misdiagnosis, under or overtreatment, or inappropriate admission may place patients at increased risk for adverse events, and add costs to the healthcare system. Despite the critical importance of initial management, data are sparse regarding the impact of early AHF treatment delivered in the emergency department compared to inpatient or chronic heart failure management. Unfortunately, outcomes remain poor, with nearly a third of patients dying or re-hospitalised within 3 months post-discharge. In the absence of robust research evidence, consensus is an important source of guidance for AHF care. Thus, we convened an international group of practising emergency physicians, cardiologists and advanced practice nurses with the following goals to improve outcomes for AHF patients who present to the emergency department or other acute care setting through: (a) a better understanding of the pathophysiology, presentation and management of the initial phase of AHF care; (b) improving initial management by addressing knowledge gaps between best practices and current practice through education and research; and (c) to establish a framework for future emergency department-based international education and research.Peer reviewe

Developing a framework for emergency nursing practice in Africa

Whilst collaborating with members of the emergency team, the emergency nurse plays a crucial role in the identification and care of patients with medical, surgical and injury related emergencies. In Africa, as well as all over the world, the practice of emergency nursing is extremely challenging. In November 2011, an international emergency nursing workgroup (both academic and clinical) was convened in Cape Town, South Africa, to explore the development of a framework for emergency nursing practice in Africa. The resultant framework has implications for nursing education and training, continuing education, and staffing at both the institutional and regional levels throughout the African continent and possibly further afield

Developing a framework for emergency nursing practice in Africa

Whilst collaborating with members of the emergency team, the emergency nurse plays a crucial role in the identification and care of patients with medical, surgical and injury related emergencies. In Africa, as well as all over the world, the practice of emergency nursing is extremely challenging. In November 2011, an international emergency nursing workgroup (both academic and clinical) was convened in Cape Town, South Africa, to explore the development of a framework for emergency nursing practice in Africa. The resultant framework has implications for nursing education and training, continuing education, and staffing at both the institutional and regional levels throughout the African continent and possibly further afield.Tout en collaborant avec les membres de l’e´quipe d’urgence, l’infirmier urgentiste joue un roˆ le crucial dans l’identification et la prise en charge des patients traite´ s pour des urgences me´dicales, chirurgicales et lie´es a` des blessures. En Afrique, mais aussi partout dans le monde, la pratique des soins infirmiers d’urgence est extreˆmement difficile. En novembre 2011, un groupe de travail international sur les soins infirmiers d’urgence (a` la fois univertaire et clinique) s’est re´uni au Cap, en Afrique du Sud, pour e´tudier le developpement d’un cadre relatif a` la pratique des soins infirmiers d’urgence en Afrique. Le cadre qui en est ressorti a des re´percussions sur l’enseignement et la formation en soins infirmiers, la fomation continue, et la dotation en personnel a` des niveaux institutionnel et re´gional sur l’ensemble du continent africain, voire au-dela`.http://www.afjem.comam2016Nursing Scienc

Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department.

This clinical policy deals with critical issues in prescribing of opioids for adult patients treated in the emergency department (ED). This guideline is the result of the efforts of the American College of Emergency Physicians, in consultation with the Centers for Disease Control and Prevention, and the Food and Drug Administration. The critical questions addressed in this clinical policy are: (1) In the adult ED patient with noncancer pain for whom opioid prescriptions are considered, what is the utility of state prescription drug monitoring programs in identifying patients who are at high risk for opioid abuse? (2) In the adult ED patient with acute low back pain, are prescriptions for opioids more effective during the acute phase than other medications? (3) In the adult ED patient for whom opioid prescription is considered appropriate for treatment of new-onset acute pain, are short-acting schedule II opioids more effective than short-acting schedule III opioids? (4) In the adult ED patient with an acute exacerbation of noncancer chronic pain, do the benefits of prescribing opioids on discharge from the ED outweigh the potential harms

Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department

This clinical policy deals with critical issues in prescribing of opioids for adult patients treated in the emergency department (ED). This guideline is the result of the efforts of the American College of Emergency Physicians, in consultation with the Centers for Disease Control and Prevention, and the Food and Drug Administration. The critical questions addressed in this clinical policy are: (1) In the adult ED patient with noncancer pain for whom opioid prescriptions are considered, what is the utility of state prescription drug monitoring programs in identifying patients who are at high risk for opioid abuse? (2) In the adult ED patient with acute low back pain, are prescriptions for opioids more effective during the acute phase than other medications? (3) In the adult ED patient for whom opioid prescription is considered appropriate for treatment of new-onset acute pain, are short-acting schedule II opioids more effective than short-acting schedule III opioids? (4) In the adult ED patient with an acute exacerbation of noncancer chronic pain, do the benefits of prescribing opioids on discharge from the ED outweigh the potential harms