ABSTRACT
Same Day Emergency Care (SDEC) services are at the heart of recovery plans for Emergency Care in the National Health Service. There are no validated metrics for the quality of care in SDEC. The Society for Acute Medicine's Quality Improvement Committee invited to a three-stage modified Delphi process to gather metrics used by clinicians. Proposed metrics were ranked and further explored by 33 participating experts from a broad range of backgrounds including clinicians, data scientists and operational managers. Experts ranked five system-based metrics highest. These focus on optimisation of the proportion of patients receiving same day care in and out of SDEC units. Patient and staff experience metrics were ranked low, possibly due to present lack of viable examples. The paper adds a glossary with the rationale for ranking of metrics and their use for the improvement of quality and safety of clinical care.
Subject(s)
Consensus , Delphi Technique , Humans , Emergency Medical Services/standards , Quality of Health Care/standards , Quality Improvement , Ambulatory Care/standardsABSTRACT
Urgent and emergency care services face increasing pressure, impacting patient care. We evaluated the performance of acute medicine services, assessing clinical quality indicators for unplanned medical admissions to acute hospital services. 152 acute UK hospital services accepting unplanned admissions to acute and general internal medicine completed a day-of-care survey incorporating organisational structure questionnaire and patient-level data over a pre-defined 24-hour period in June 2022. Clinical quality indicators were: Early Warning Score (EWS) measurement within 30 min of hospital arrival; clinician assessment within 4 h; assessment by consultant physician within 6 h (daytime) or 14 h (night-time). Results were compared with 2019, 2020, 2021. 7293 sequential patients were included (and compared with 19,817 patients across 2019-2021). In 2022, 69% of patients (95%CI 67.7-69.9%) had an EWS documented within 30 min. 79% of patients (95%CI 77.8-79.7%) were reviewed by a clinical decision maker within 4 h of hospital arrival. Patients assessed in Same Day Emergency Care services were more likely to meet this target than those assessed in Acute Medical Units or Emergency Departments (OR 2.4, 95%CI 2.02-2.87, p<0.001). Overall, 50% of patients received consultant physician review within the target time (3065/6161, 95%CI 48.5-51.0%); performance varied with time of arrival and location of initial assessment. Performance against all three clinical quality indicators was lower than 2019, 2020 and 2021 (p<0.001 for all). Performance against all quality indicators within acute medicine services is deteriorating. However, performance in Same Day Emergency Care Units is greater than in Acute Medical Units or Emergency Departments.
Subject(s)
Benchmarking , Emergency Medical Services , Humans , Hospitalization , Hospitals , Emergency Service, Hospital , Patient AdmissionABSTRACT
A short-cut review was carried out to establish whether intravenous adenosine is effective in the treatment of unstable paroxysmal supraventricular tachycardia. A total of 711 papers was found using the reported search, of which eight represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. The clinical bottom line is there is strong evidence to support the efficacy of using adenosine as first-line treatment in patients who present to emergency departments with unstable paroxysmal supraventricular tachycardia.