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.

Are diagnostic peritoneal lavage or focused abdominal sonography for trauma safe screening investigations for hemodynamically stable patients after blunt abdominal trauma? A review of the literature.

BACKGROUND: Assessment of patients in the emergency department who sustain blunt abdominal trauma represents a significant diagnostic challenge. Computed tomography (CT) is increasingly used as the principal investigation for these patients. A sensitive screening test could safely reduce the use of CT. OBJECTIVES: To appraise the evidence supporting the use of diagnostic peritoneal lavage and focused abdominal sonography for trauma as screening tests in the emergency department to reduce the use of CT in the initial assessment of patients sustaining blunt abdominal trauma. METHODS: A search of high-quality evidence resources was performed, followed by a hand search of the bibliographies of all relevant articles. RESULTS: Altogether, 55 articles were found during the initial search, of which 23 were relevant. An additional 11 were found by hand searching. Six relevant original research articles were found. CONCLUSION: Screening diagnostic peritoneal lavage and selective CT is a safe diagnostic strategy for the investigation of blunt abdominal trauma. Further research is needed to determine the role of focused abdominal sonography for trauma scanning in diagnostic protocols.

Partnership working in the production of clinical guidelines.

This article describes a working partnership between the Cairns Clinical Librarian Service, Health Care Libraries, University of Oxford and the Emergency Department (ED) at the John Radcliffe Hospital, Oxford. This collaboration resulted in the establishment of a guideline development group in June 2002. The aim of the group is to produce a set of easily accessible, user-orientated, evidence-based guidelines for the use of clinicians in the Emergency Department, within a realistic timescale. The Cairns Clinical Librarian Project was built on previous models of clinical librarianship and incorporated an evaluation of previous programmes. The objective was to provide information to clinicians at the time and point of need. Consultation with the ED from the outset determined the approach adopted by the Cairns team. Clinical guidelines have been shown to improve clinical practice. Pending the introduction of nationally available protocols, we have begun to establish a collection of evidence-based guidelines using web-based architecture in conjunction with the Oxford Radcliffe Hospitals NHS Trust's IT department. A piece of diagnostic analysis was undertaken to ensure a coherent strategy was developed for the guideline project. An 'intermediate approach' was adopted, where existing valid guidelines were modified to fit local circumstances. We strove to be transparent at all times about all aspects of the guideline development process. Formative evaluation has shown how the application of evidence-based health care needs adequate resources and requires people with appropriate knowledge and skills. This article charts the progress of the project and highlights how the partnership between the clinical team and the Clinical Librarian has been deemed to be essential to the success of the project.