Virtual Toxicology Service decreases the average length of stay of poisoned patients and saves bed days.

OBJECTIVE: We aimed to assess the impact a Virtual Toxicology Service had on the ALOS of poisoned patients. METHODS: This single-centre before-after study compares the ALOS of poisoned patients (diagnosis-related group X62, poisoning/toxic effects of drugs and other substances) following the introduction of a Virtual Toxicology Service in 2020. RESULTS: The ALOS decreased from 0.89 days in the 2-year pre-intervention period to 0.62 days in the 3-year post-intervention period, with a potential bed saving of 703 days. CONCLUSION: The introduction of a Virtual Toxicology Service appeared to be associated with a decreased ALOS of poisoned patients.

Incorporating teledermatology into emergency medicine.

OBJECTIVE: The aim of the present study was to investigate the feasibility of using a store-and-forward Skin Emergency Telemedicine Service (SETS) to provide rapid specialist diagnostic and management advice for dermatological cases in an ED. METHODS: This pilot study was conducted at the Princess Alexandra Hospital between August 2008 and August 2009. Study subjects were consenting patients over 18 years of age who presented with a dermatological condition to the ED. The ED doctor sent the patient's history, examination findings and the digital images of the skin conditions to a secure email address, which automatically forwarded this to the teledermatologist. The teledermatologist reviewed the cases and sent advice on diagnosis and management to the referring ED doctor via email and/or telephone. Face-to-face follow-up consultations with the patients were conducted within 2 weeks. The diagnostic and management concordance between ED doctors, teledermatologists and reviewing dermatologists were analysed. RESULTS: A total of 60 patients participated in the present study. SETS provided a rapid response with 56 (93%) of ED consultations receiving a dermatology opinion within 2 h. Face-to-face follow up occurred in 50 patients (83%). Statistical analysis showed significant levels of agreement between tele-diagnosis and ED diagnosis of 71.2% (Kappa 0.42) and tele-diagnosis and final clinical diagnosis of 98% (Kappa: 0.93). The clinical management concordance was 96% in complete agreement and 4% in relative agreement between the teledermatologists and reviewing dermatologists, based on chart review. CONCLUSION: The present study has shown that SETS can provide rapid and accurate diagnostic and treatment advice from a specialist for dermatological presentations to the ED.

Prospective evaluation of tools to assess the psychological response of CPR provision to a relative who has suffered a cardiac arrest: a pilot project.

OBJECTIVES: We aimed to evaluate assessment tools to measure the psychological impact of providing CPR to a relative. We set out to evaluate the Revised Impact of Event Scale (IES-R) and Texas Inventory of Grief (TIG) for comparing CPR providers and non-providers, and to establish whether research of this nature had a negative impact on the participants. We also collected narrative data from CPR providers. METHODS: Prospective sampling of relatives of patients presenting to hospital who had witnessed their relative have a cardiac arrest and who had performed or witnessed CPR. Participants performed two interviews and completed the IES-R and the TIG. RESULTS: Twenty-nine cardiac arrest victims presented, with ten relatives enrolled. The IES-R and TIG were feasible, and registered moderate responses from CPR providers and non-providers. There was no significant difference in the IES-R score between CPR providers and non-providers (1.96 vs. 1.04, p=0.3). There was no significant difference between scores obtained at two different time points (1.75 vs. 1.63, p=0.43). Participants demonstrated a moderate response on the TIG (mean TIG score 2.8, SD 1.7). Participants did not have a negative perception of study involvement, and actually perceived a benefit from discussion with a health professional. CONCLUSION: It is acceptable and achievable to prospectively assess the response of a cardiac arrest victim's relatives to the provision of CPR. The test instruments used were appropriate and feasible. Results suggested a sample size of 48 to achieve a statistically significant result.