Unscheduled return visits (URV) in adults to the emergency department (ED): a rapid evidence assessment policy review.

Unscheduled return visits (URV) to the emergency department (ED) may be an important quality indicator of performance of individual clinicians as well as organisations and systems responsible for the delivery of emergency care. The aim of this study was to perform a rapid evidence assessment policy-based literature review of studies that have looked at URVs presenting to the ED. A rapid evidence assessment using SCOPUS and PUBMED was used to identify articles looking at unplanned returns to EDs in adults; those relating to specific complaints or frequent attenders were not included. After exclusions, we identified 26 articles. We found a reported URV rate of between 0.4% and 43.9% with wide variation in the time period defined for a URV, which ranged from 24 h to undefined. Thematic analysis identified four broad subtypes of URVs: related to patient factors, to the illness, to the system or organisation and to the clinician. This review informed the development of national clinical quality indicators for England. URV rates may serve as an important indicator of quality performance within the ED. However, review of the literature shows major inconsistencies in the way URVs are defined and measured. Furthermore, the review has highlighted that there are potentially at least four subcategories of URVs (patient related, illness related, system related and clinician related). Further work is in progress to develop standardised definitions and methodologies that will allow comparable research and allow URVs to be used reliably as a quality indicator for the ED

An evaluation of opportunistic health checks at cricket matches : the boundaries for life initiative

In 2009, a population level health screening programme was established in the UK for people over the age of 40 years. The primary aim of the service was to identify and treat the leading causes of preventable disease and death, including cardiovascular disease and diabetes. Checks are offered every five years through scheduled appointments at primary care settings, and uptake of such checks has been relatively low to date with 12.7% of those eligible to have a NHS health check receiving one between 2009 and 2013. Non-clinical settings such as sports stadia have previously been used to offer health interventions and opportunistic health checks. Despite relatively modest results in football and rugby settings, professional cricket fixtures with high footfall may offer higher levels of uptake and participant satisfaction, and provide a novel setting for engaging BME communities. This paper describes the process and results from the Boundaries For Life initiative that delivered health checks at professional cricket matches over the 2014 and 2015 seasons. Uptake of the checks was significantly high in comparison to other sports settings, with very strong feedback from participants on the convenience of service

Incidence and predictors of adverse events and outcomes for adult critically ill patients transferred by paramedics to a tertiary care medical facility

Objective: The aim of this study was to determine the incidence of adverse events and patients’ outcomes in inter‑facility critical care transfers by paramedics. Methods: We conducted a retrospective cohort study of adults undergoing inter‑facility transfer to a tertiary medical facility by paramedics. We included all patients transferred between 1st June, 2011 and 31st December, 2014. The primary outcome is in‑transit adverse event and the secondary outcome is in‑hospital mortality. Multiple logistic regression models were fitted to assess predictor variables for adverse events and in‑hospital mortality. Results: The incidence of adverse events was 13.7% (31/227 patients had in‑transit adverse event); the most common adverse events reported were desaturation and hypotension. A unit increase in risk score for transported patients (RSTP) significantly increased the occurrence of adverse events (adjusted odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.07–1.72 and adjusted P = 0.01). Compared to medical patients, cardiac patients were less likely to develop adverse events (adjusted OR: 0.117, 95% CI: 0.02–0.52 and adjusted P < 0.01). The in‑hospital mortality was 30.4% and 30-day survival was 68.1%. For two patients whose age differed by 1 year, the older patient was more likely to die (adjusted OR: 1.03, 95% CI: 1.01–1.05 and P < 0.01) and a unit increase in RSTP significantly increased occurrence of in‑hospital mortality (adjusted OR: 1.30, 95% CI: 1.0–1.60 and P = 0.01). Conclusion: The incidence of adverse events was 13.7%. The most common observed adverse events were desaturation and hypotension. In‑hospital mortality was 30.4% and 30-day survival was 68.1%

Imaging paediatic facial injuries in the emergency department

Objectives & Background Facial injuries are a common presentation to the ED with data suggesting that this may be as high as 4%. There is little data on the epidemiology of paediatric facial injuries and how these are managed by the ED team. The exposure of structures such as the eyes, brain and thyroid to ionising radiation may be potentially harmful and at present there are no nationally agreed guidelines on which patients require imaging in the ED. The aim of this study was to look at the patterns of imaging in a cohort of paediatric facial injuries presenting to an ED in the West Midlands. Methods A retrospective note review of all facial injuries presenting to any one of the three sites that make up the Heart of England NHS Foundation Trust in 2012 was conducted. Electronic records were examined to look for the mechanism of injury, disposal as well if any imaging had been performed during the initial presentation. Where imaging was performed the actual imaging as well as formal radiology reports were accessed to ascertain for the presence or absence of a facial fracture. Results Paediatric facial injuries made up 1131/3416 (33%) of the overall number of facial emergencies presenting to the ED in 2012. The mean age for the children was 6.9±4.3 years. 32% of the children were female as opposed to 68% who were male. 164/1131(14.5%) children were imaged and of these only 17/164 (10.4%) were confirmed to have a fracture. In contrast 47% of the adults were imaged and 26% of these were con- firmed to have a facial fracture. Chi-squared tests demonstrated that the proportion of patients who had imaging requested was significantly lower in the paediatric cohort when compared to adults (P<0.005). Also the difference in the numbers of con- firmed facial fractures in those who were imaged was signifi- cantly lower in children when compared to the adults (P<0.005). Occipitomental (OM) and orthopantomograms (OPG) were the commonest facial views requested for both the paediatric and adult facial injuries. Conclusion The study highlights that paediatric facial injuries are less common than adult facial injuries and that facial fractures make up only 1.5% of all paediatric facial injuries. Clinicians should consider this when requesting facial X-rays given the potential harm of ionising radiation to the head and neck region. Further studies are in progress to develop evidence based guidelines for imaging children with facial injuries within the ED