An Assessment of the Potential Benefits of Video Consultation in the Emergency Department: Mixed Methods Study.

BACKGROUND: District general hospital emergency departments may refer patients to a tertiary center depending on the information available to a generalist clinician in discussion with a specialist team. If there is uncertainty, the lowest-risk strategy is often to transfer the patient. Video consultation allowing the specialist team to see and talk to the patient and local clinician while still in the emergency department could improve decision-making for patient transfer. OBJECTIVE: The aim of this study is to assess the potential benefit of real-time video consultation between remote specialists and emergency department patients and clinicians across all specialties. METHODS: Detailed patient data were collected prospectively for 6 months (between January 16, 2012, and July 15, 2012) on all patients presenting to a district general hospital emergency department who required input from a specialist team at the nearest tertiary care center. These patients were discussed retrospectively with the specialist teams to determine whether videoconferencing could have benefited their management. The logistics for the use of videoconferencing were explored. RESULTS: A total of 18,799 patients were seen in the emergency department during the study period. Among the 18,799 patients, 413 referrals (2.2%) were made to the tertiary center specialist teams. A review of the patients transferred indicated that 193 (46.7%) of the 413 patients who were referred might have benefited from video consultation (193/18,799, 1% of all patients). If the specialist team could be accessed via videoconferencing only while a senior member was available in the hospital (8:00 AM-10:00 PM), then a maximum of 5 patients per week across all specialties would use the equipment. If 24-hour specialist access was available, this would increase to 7 patients per week. CONCLUSIONS: In regions where there is direct transportation of patients by ambulance to specialist centers and there is a regional picture archiving and communication system in place, video consultation between emergency department patients and specialists has limited potential to improve patient management.

How do emergency departments in England process the results of laboratory investigations?

AIMS: To determine how emergency departments in England process laboratory investigation results, to identify risk, and to note examples of good practice. METHODS: A telephone survey was conducted, and data were entered anonymously into Excel spreadsheets. Fisher's exact test was used to test the independence of pairs of variables. RESULTS: Data were collected from 167 out of 193 (87%) emergency departments in England. The majority had nurse-requested blood tests. There was a statistical association between nurse-requesting and failure by the clinician seeing the patient to check results. Fourteen (8%) departments did not allow patients to leave until all their results were available. A senior doctor did a second 'safety' check of results in 83 (50%) departments. Many respondents were able to give examples of patients who had been recalled to hospital after a second check. Only a minority of departments had information systems that could identify high-risk patients. CONCLUSION: A second 'safety' check by an experienced consultant, associate specialist or middle grade doctor identifies error. This is time-consuming, but could be supported and simplified by using intelligently designed information systems.

Fatal non-cardiogenic pulmonary oedema after intravenous non-ionic radiographic contrast.

Life-threatening reactions to radiographic contrast media are rare. We describe a case of fatal non-cardiogenic pulmonary oedema, after use of iopamidol, a widely used, low osmolar, non-ionic, radiographic contrast medium. A woman with a history of bladder tumour who had haematuria was referred for an intravenous urogram. After intravenous injection of 100 mL iopamidol, the woman became short of breath, and a chest radiograph showed severe pulmonary oedema. She was treated but subsequently died. The pathogenesis of contrast-induced, non-cardiogenic pulmonary oedema is unclear, and treatment differs from that for cardiogenic pulmonary oedema.