The systematic review discussed in this podcast outlines inconclusive evidence for the effectiveness of diversion strategies on emergency department use and healthcare utilisation.
Dr Brian Rowe, from the Department of Emergency Medicine, University of Alberta, Canada, tells Editor-in-Chief of EMJ Professor Ellen Weber other strategies are needed to address ED overcrowding.
Read the paper at http://emj.bmj.com/lookup/doi/10.1136/emermed-2017-207045.
Related articles:
The patient’s dilemma: attending the emergency department with a minor illness (https://www.bmj.com/content/357/bmj.j1941);
Low-acuity presentations to the emergency department in Canada: exploring the alternative attempts to avoid presentation (https://emj.bmj.com/content/34/4/249).

More evidence needed to divert patients from emergency departments

Emergency Medicine Journal (EMJ) is an international peer review journal covering pre-hospital and hospital emergency medicine, and critical care. The journal publishes original research, reviews and evidence based articles on resuscitation, major trauma, minor injuries, acute cardiology, acute paediatrics, toxicology, toxinology, disasters, medical imaging, audit, teaching and reflections on clinical practice. The journal is aimed at doctors, nurses, paramedics and ambulance staff.

Medicine

Science & Medicine

Health & Fitness

Should we be bringing preventative medicine into the emergency department, or is it just using up valuable time? Our first paper this month looks at the "Cessation of Smoking Trial in the Emergency Department (COSTED)" trial, which presents the case for opportunistic smoking cessation intervention. Next up is a topical research paper on interpreting CT scans with artificial intelligence, and how machine assessment measures up against experienced physicians. Then there's a trio of troponin papers, discussing high-sensitivity testing. The final paper this time is not a paper but a guideline from the Royal College of Emergency Medicine, setting out best practices for dealing with suspected cannabinoid hyperemesis syndrome.Articles discussed in this episode:Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial. Pope I, Clark LV, Clark A, et al
Using an artificial intelligence software improves emergency medicine physician intracranial haemorrhage detection to radiologist levels. Warman P, Warman A, Warman R, et al
External validation of a rapid algorithm using high-sensitivity troponin assay results for evaluating patients with suspected acute myocardial infarction. Cullen L, Greenslade JH, Stephensen L 2022 SAMIE study group, et al
High-sensitivity troponin testing at the point of care for the diagnosis of myocardial infarction: a prospective emergency department clinical evaluation. Curran JM, Mergo A, White S, et al
Determination of a whole-blood single-test low-risk threshold for a point-of-care high-sensitivity troponin assay. Pickering JW, Hamill L, Aldous S, et al
RCEM best practice guideline: suspected cannabinoid hyperemesis syndrome in emergency departments. Humphries C, Gillings M
 
The EMJ podcast is hosted by:
Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody)
Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards)
You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

Interventions for smoking cessation, AI CT scan triaging, and cyclic vomiting : May 2024 Primary Survey

“Social distancing is a privilege,” is the core message underlying the first paper brought by Sarah to this month’s roundup, as it unpacks the stark differences in COVID-19 outcomes across the spectrum of racial and ethnic groups in the United States. A second paper examines the returning rates of COVID patients across a large group of emergency departments in Canada, and the factors at play there. The final topic is one of Rick’s favourites, focusing on troponin testing in ambulances.
Articles discussed in this episode:
Pandemic phase-related racial and ethnic disparities in COVID-19 positivity and outcomes among patients presenting to emergency departments during the first two pandemic waves in the USA. Khosla S, Del Rios M, Chisolm-Straker M, et al. 
Characteristics and outcomes of patients with COVID-19 who return to the emergency department: a multicentre observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). Rosychuk RJ, Khangura JK, Ortiz SS, et al. 
Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study. Daniels J, Robinson E, Jenkinson E, et al.
Prehospital T-MACS and HEART scores in the prediction of myocardial infarction: a prospective evaluation. Cooper JG, Donaldson LA, Coutts AJ, et al.
 
The EMJ podcast is hosted by:
Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody)
Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards)
You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

Suspicious chest pain, inequality in COVID outcomes, and staff retention problems: April 2024 Primary Survey

A feast of aortic papers this month, including a study on missed aortic dissection diagnoses and an analysis of coroners' reports. Rick runs through the findings of an interesting study from the Trainee Emergency Research Network (TERN), and Sarah finishes off with a paper on predicting adverse outcomes in elderly patients with orthopaedic trauma.
Articles discussed in this episode:
Ohle R, Savage DW, Caswell J, et al. Mortality and risk factors associated with misdiagnosis of acute aortic syndrome in Ontario, Canada: a population-based study.
Hodgson S, O'Mahony K, Nicholson J, et al. Thematic analysis of ‘Prevention of Future Deaths’ reports related to emergency departments in England and Wales 2013–2022. 
McLatchie R, Reed MJ, Freeman N on behalf of the DAShED investigators, et al. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome.
Isaac CJ, Moore L, Bérubé M, et al. Predictors of adverse outcomes in elders hospitalised for isolated orthopaedic trauma: a multicentre cohort study.
 
Related links:
RCEM Learning: Aortic Dissection podcast.
Trainee Emergency Research Network.
 
The EMJ podcast is hosted by:
Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody)
Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards)
You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

Aortic dissection, coroners' court, and age-related outcomes: March 2024 Primary Survey

There's a lot of drugs to be talked about this month, and a heap of randomised control trials to be covered too. Rick and Sarah talk though the combining of nitrous oxide and fentanyl for sedation, the environmental impact of analgesics, the efficacy of acute heart failure treatment with high-dose and low-dose nitrates, and more newly published work from the latest issue of the journal.
 
Articles discussed in this episode:
Safety and efficacy of a nitrous oxide procedural sedation programme in a paediatric emergency department: a decade of outcomeshttps://emj.bmj.com/content/41/2/76
Environmental impact of low-dose methoxyflurane versus nitrous oxide for analgesia: how green is the ‘green whistle’?https://emj.bmj.com/content/41/2/69
High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trialhttps://emj.bmj.com/content/41/2/96Trip-killers: a concerning practice associated with psychedelic drug usehttps://emj.bmj.com/content/41/2/112
Effect of intranasal sufentanil on acute post-traumatic pain in the emergency department: a randomised controlled trialhttps://emj.bmj.com/content/41/2/83
 
The EMJ podcast is hosted by:
Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody)
Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards)
You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

Trip killers, sympathetic crashing, and all sorts of sedatives: February 2024 Primary Survey

What are the questions to ask when dealing with acute behavioural disturbance? Join Sarah and Rick this month for a discussion of this difficult presentation. They also explore the topics of reducing low-acuity attendance, taking NHS 111 online, and the impact of a health coaching intervention for potentially recurrent attendees.Articles discussed in this episode:
Highlights of the January 2024 issuehttps://emj.bmj.com/content/41/1/1
Consensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managedhttps://emj.bmj.com/content/41/1/4
What impact would reducing low-acuity attendance have on emergency department length of stay? A discrete event simulation modelling studyhttps://emj.bmj.com/content/41/1/27
How could online NHS 111 reduce demand for the telephone NHS 111 service? Qualitative study of user and staff viewshttps://emj.bmj.com/content/41/1/34
Impact on all-cause mortality of a case prediction and prevention intervention designed to reduce secondary care utilisation: findings from a randomised controlled trial
https://emj.bmj.com/content/41/1/51
The EMJ podcast is hosted by:
Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody)
Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards)
You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).

More evidence needed to divert patients from emergency departments

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