ABSTRACT
Correspondence to Dr Gabrielle Prager, Emergency Department, Wythenshawe Hospital, Manchester, Greater Manchester, UK;lgprager@doctors.org.uk This month’s update has been prepared by the Emergency Medicine & Intensive Care Research Group (EMERGING) from Manchester. Head turner Predicting which patients will survive an out-of-hospital cardiac arrest (OHCA) with good functional outcomes could help guide resuscitative efforts. Lack of blinding is a potential source of bias, but the apparent preference of parents for immobilisation may influence physician choice of treatment.2 Bottom line In children treated for Torus fractures, there is no difference in self-reported pain or function using a simple bandage versus a splint or cast. Notably, since this paper was published, the UK RECOVERY trial suggested a probable benefit in using them together.5 6 Bottom line In patients with COVID-19 requiring oxygen and receiving remdesivir, there was no difference in ventilator-free survival between those treated with baricitinib or dexamethasone.
ABSTRACT
Aims/Objectives/BackgroundThis study aims to understand how emergency physicians work sustainably in an increasingly challenging environment in the context of a retention crisis across all grades of emergency physician.Senior clinicians provide better care in the emergency department;performing fewer unnecessary investigations, receiving fewer complaints and making fewer errors. Seniority is dependent on retention. Exodus from training and consultant grades is expensive.The problems of staffing an emergency department has not been previously addressed by focusing on how those who work in them manage to do so.Methods/DesignEthnography conducted at a UK emergency department for 12-weeks, totalling nearly 200-hours of observation. A second site was planned but not possible due to COVID-19.Interviews with emergency physicians of all grades from the two initially planned sites, with doctors who have left emergency medicine, and with individuals working for stakeholder organisations. 40 interviews in total, averaging 45 minutes.Systematic scoping review of the relevant academic and policy literature.Reflexive thematic analysis of the ethnographic field notes, interview transcripts and literature.Results/ConclusionsEmergency physicians are active in managing their working day to mitigate the labour and environment. These actions have multiple overlapping motives but are demonstrably forms of retention work. They utilise objects and the environment in creative ways (materialities), for example completing paperwork in the resuscitation room because it is calm and air-conditioned.They utilise humour in a primarily self-deprecating manner and prioritise education as a means of valuing other staff and creating variety in their workday. Emergency physicians describe teamwork as vital to retention, but this is disparate and developed over long periods of time and therefore better described as community.The principle sustainability strategies employed limit exposure to shop floor working. This is achieved through less-than-full-time working and portfolio careers. These strategies predate policy which describes them in terms of flexible working.
ABSTRACT
Purpose of the study: SARS-CoV-2 has caused healthcare systems globally to reorganise. A pandemic paradox emerged; while clinicians were desperate for information on a new disease, they had less time to find and evaluate the vast volume of publications at times of significant strain on healthcare systems.A multidisciplinary team undertook a weekly literature search capturing all COVID-19 publications. We also monitored free open access medical education (FOAMed) sources for emerging themes. Title and abstract screening pooled the most relevant papers for emergency medicine. Three summary types were created, a 'Top 5 Flash Update', a journal club and a rapid response to emerging FOAMed themes. From these summaries, three modes of dissemination were used: short written summaries, blogs and podcasts. These were amplified through social media. Study design: A retrospective review was conducted assessing the impact of this knowledge dissemination strategy for the period of March to September 2020. Results: In total, 64 687 papers were identified and screened. Of the papers included in the 'Top 5', 28.3% were on epidemiology, 23.6% treatment, 16.7% diagnostics, 12% prognosis, 8.7% pathophysiology with the remaining 10.7% consisting of PPE, public health, well-being and 'other'. We published 37 blogs, 17 podcasts and 18 Top 5 Flash Updates. The blogs were read 138 343 times, the Top 5 Flash Updates 68 610 times and the podcasts had 72 501 listens. Conclusion: A combination of traditional academic and novel social media approaches can address the pandemic paradox clinicians are facing.
ABSTRACT
Aims/Objectives/BackgroundEntering lockdown on 23rd March 2020 due to the COVID-19 pandemic marked an unprecedented period for healthcare evidence. An exponential increase in published work, pre-prints, guidelines, online information portals and more, has been overwhelming especially when combined with the ever-changing local emergency department responses to COVID-19. Many research projects were either suspended in favour of clinical work or re-routed into pandemic-oriented studies. All the while, the gap between clinical providers and a mountain of information was growing. Our team developed a strategy to deliver the most pertinent evidence to those working in emergency medicine, taking some stress out this aspect of COVID-19 working.Methods/DesignEach week a search was conducted using PubMed of everything produced in the previous 7 days. The number of titles varied from approximately 800 to 2500. A 3 to 5 person team distilled titles and then reviewed abstracts for papers of importance and relevance to emergency medicine. Relevant and high impact journals were individually searched over the same time period. Summaries of the short-listed papers were produced and the weekly editorial team selected 5 for inclusion in the weekly RCEM Top 5 and others were combined for extra reading as part of a 2–3 weekly ‘Director’s Cut’.Results/ConclusionsThe RCEM Top 5 (at time of writing) has been run for 13 weeks. The summaries themselves were accessed by between 3000 and 6000 RCEM members/fellows each week. The work has also fed into online journal clubs and blogs (combined views of over 30,000) and has attracted interest from wider colleagues nationally and internationally to both join and even replicate the approach to other relevant areas. The positive feedback is best summarised in the following quote: ‘when I’m too mentally overcooked to do any reading on my own this helps me feel I am doing some keeping up. Please continue!’