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Why you should read this article: • To recognise that overcrowded emergency departments result in ambulance handover delays causing avoidable harm to patients awaiting assessment • To identify how forward planning and anticipatory escalation processes can reduce the potential for patients to experience avoidable harm • To learn how a strategic quality improvement project improved patient safety and the working lives of front-line healthcare professionals. Ambulance handover delays arise when emergency departments become overcrowded as patients waiting prolonged periods for admission occupy clinical cubicles designed to facilitate the assessment and treatment of emergency arrivals. In response, many organisations become reliant on temporarily lodging acutely unwell patients awaiting admission in undesignated areas for care such as corridors, to provide additional space. This results in a significant risk of avoidable harm, indignity and psychological trauma for patients and has a negative effect on the well-being of healthcare professionals, since unacceptable standards of care become normalised. A two-phase strategic quality improvement project was implemented at the authors’ acute trust. Ambulance handover data from between 2 November 2020 and 26 July 2021 provided a benchmark for the project. The first phase was implemented between 2 November 2021 and 26 July 2022 and aimed to reduce 60-minute ambulance handover delays. The second phase was implemented between 2 November 2022 and 26 July 2023 and aimed to eradicate 60-minute ambulance handover delays and improve overall performance. Phase one resulted in a 32% reduction in 60-minute ambulance handover delays. Phase two resulted in a 97% reduction in 60-minute ambulance handover delays. Over the course of the project there was a 24% increase in handovers completed within 15 minutes. This project demonstrates how strategic planning and collaboration between healthcare teams can reduce the potential for avoidable patient harm, while simultaneously promoting workforce well-being and retention. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your awareness and understanding of the Columbia-Suicide Severity Risk Scale • To learn about a project to improve suicide risk screening in three emergency departments in the US • To acknowledge the need to provide nurses with adequate training and tools on suicide risk assessment. Suicide is a significant and increasing public health concern. Research has shown that screening for suicide risk is inconsistent in acute care settings and that a variety of different tools are used for that purpose. The Columbia-Suicide Severity Risk Scale (C-SSRS) has emerged as a validated and recognised suicide risk screening tool. This article describes a quality improvement project designed to improve the screening of patients for suicide risk in a large hospital system in the Midwestern US. As part of the project, 97% of nurses working in the organisation’s emergency departments self-completed a 30-minute interactive learning module on the background, relevance and application of the C-SSRS. The C-SSRS enables nurses to classify the severity of suicide risk, which helps to provide interventions commensurate with patients’ level of risk. Following completion of the module, there was a significant increase in the percentage of patients screened for suicide risk. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the aims of and processes involved in triage • To enhance your understanding of the strategies you can use to make triage as safe and effective as possible for patients and staff • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Triage is the first stage of a patient’s journey through the emergency department and is used to determine patient acuity. There is no single quantifiable metric for determining acuity, which amalgamates different factors that are more or less relevant depending on the patient’s presentation. This article explains the aim and process of triage and how nurses can ensure the process is effective and safe. The author discusses strategies nurses can use to mitigate uncertainty and to make their acuity assessments rapid, targeted and comprehensive. The author also highlights triage safety considerations, including infection prevention and control and the physical and emotional safety of patients and staff. [ABSTRACT FROM AUTHOR]

Rationale and key points: Why you should read this article: • To understand the necessary preparation required before triaging a patient • To familiarise yourself with the steps required when triaging a patient in the emergency department • To learn about the scales and algorithms used by nurses when triaging patients. Triaging patients can be a complicated process, with multiple modes of assessment taking place simultaneously, and nurses need to be confident and competent in their assessment skills. This article explains the necessary preparation for triage and outlines the steps that nurses need to take when triaging a patient in the emergency department. • Triage requires a targeted patient assessment, using both clinical judgement and triage tools to determine appropriate acuity categories. • Different scales and algorithms are used in triage, so it is essential to clearly communicate the acuity categories assigned to patients. • A structured approach to patient assessment can guide decision-making and identify issues. • Various diagnostic tests can be used to facilitate the triage process, but care needs to be taken to ensure the process is not prolonged by their use. Reflective activity: ‘How to’ articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when assessing the acuity of patients in triage. • How you could use this information to educate nursing students or your colleagues on the appropriate technique and evidence base regarding the triaging of patients in the emergency department. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware that women presenting to emergency departments (EDs) who are experiencing a miscarriage require sensitive nursing care including empathetic communication • To recognise that breaking bad news to patients in the ED can be challenging for nurses, partly because of insufficient training • To learn about an education programme that increased the confidence levels of nurses in breaking bad news and their comfort in managing patients’ emotions. Vaginal bleeding during pregnancy is a common patient presentation in emergency departments (EDs), and in some cases this will occur due to miscarriage. However, there are several barriers to effective and sensitive communication with patients experiencing a miscarriage. Women presenting to EDs who are experiencing a miscarriage are more likely to be psychosocially vulnerable and less satisfied with their care compared with those seeking care in the outpatient setting. There is a gap in nursing and advanced practice provider preparation regarding techniques for breaking bad news to patients in the ED setting. At one high-volume, urban ED in the US, an education programme for staff regarding best practice in breaking bad news to patients experiencing a miscarriage was developed based on an established protocol. The intention was to increase the confidence levels of nurses and other healthcare professionals in breaking bad news to these patients. After the education programme, many participants self-reported increased confidence in breaking bad news and comfort in managing patients’ emotions. The results can be used to inform education for healthcare professionals who deliver bad news in the ED and other departments. [ABSTRACT FROM AUTHOR]

Background: Major thoracic trauma represents a life-threatening condition, requiring a prompt multidisciplinary approach and appropriate pathways for effective recovery. While acute morbidity and mortality are well-known outcomes in thoracic-traumatized patients, long-term quality of life in patients surviving surgical treatment has not been widely investigated before. Methods: Between November 2016 and November 2023, thirty-two consecutive patients were operated on because of thoracic trauma. Age, sex, comorbidities, location and extent of thoracic trauma, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), Organ Injury Scale (OIS), intra and extrathoracic organ involvement, mechanism of injury, type of surgical procedure, postoperative complications, ICU and total length of stay, immediate clinical outcomes and long-term quality of life—by using the EQ-5D-3L scale and Numeric Rate Pain Score (NPRS)—were collected for each patient Results: Results indicated no significant difference in EQOL.5D3L among patients with thoracic trauma based on AIS (p = 0.55), but a significant difference was observed in relation to ISS (p = 0.000011). Conclusions: ISS is correlated with the EQOL.5D3L questionnaire on long-term quality of life, representing the best prognostic factor—in terms of long-term quality of life—in patients surviving major thoracic trauma surgical treatment. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the anatomy of forearm bones and the pathophysiology of bowing fractures • To increase your awareness of the diagnostic challenges and complications associated with bowing fractures • To enhance your understanding of the management of children with bowing fractures. Bowing fractures of the forearm are characterised by numerous micro-fractures on the concave surface of the affected bone(s), usually caused by a fall on an outstretched arm. Children are more susceptible to this type of injury than adults because their long bones have more elasticity. Bowing fractures of the forearm are challenging to diagnose because there are no obvious cortical defects, which can lead to inappropriate management and associated complications, including loss of movement range and loss of function. This article discusses bowing fractures of the forearm in children, including their pathophysiology, diagnosis and management. It aims to enhance emergency nurses’ awareness and knowledge of this type of injury in children and of the challenges surrounding diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: A robust knowledge on the pattern of use of emergency care resources not only serves as an indicator of universal access to care but also provides a basis for quality improvement within the health system. This study was undertaken to describe the pattern of emergency room visits at Brits District Hospital (BDH) in North West province, South Africa. The objectives of this study were to determine the sociodemographic characteristics of emergency department (ED) users and other patterns of ED use. Methods: This was a cross-sectional descriptive study that was conducted at a district hospital. All patients who reported for emergency care in the ED in 2016 were eligible for the study. Data were extracted and analysed from a systematic sample of 355 clinical notes and hospital administrative records. Results: The age group that visited the ED most frequently (25.3%) was 25-34 years old. A high proportion of the ED users (60%) were self-referred, and only 38% were transported by the emergency medical response services (EMRS). Few (5.6%) presentations were of a non-urgent nature. Trauma-related conditions accounted for the most frequent presentation at the ED (36.5%). Conclusion: Although most ED users were self-referred, their clinical presentations were appropriate and underscore the need for policy strategies to reduce the burden of trauma in the catchment population Contribution: The study findings may have an impact on future health policies by providing decision-makers with baseline information on the pattern of use of ED resources, ensuring better resource deployment and greater access to care. [ABSTRACT FROM AUTHOR]

Evidence on the healthcare utilization associated with comorbidity in people with dementia is lacking in Chinese societies. This study aimed to quantify healthcare utilization associated with comorbidity that is common in people living with dementia. We conducted a cohort study using population-based data from Hong Kong public hospitals. Individuals aged 35+ with a dementia diagnosis between 2010 and 2019 were included. Among 88,151 participants, people with at least two comorbidities accounted for 81.2%. Estimates from negative binomial regressions showed that compared to those with one or no comorbid condition other than dementia, adjusted rate ratios of hospitalizations among individuals with six or seven and eight or more conditions were 1.97 [98.75% CI, 1.89–2.05] and 2.74 [2.63–2.86], respectively; adjusted rate ratios of Accident and Emergency department visits among individuals with six or seven and eight or more conditions were 1.53 [1.44–1.63] and 1.92 [1.80–2.05], respectively. Comorbid chronic kidney diseases were associated with the highest adjusted rate ratios of hospitalizations (1.81 [1.74–1.89]), whereas comorbid chronic ulcer of the skin was associated with the highest adjusted rate ratios of Accident and Emergency department visits (1.73 [1.61–1.85]). Healthcare utilization for individuals with dementia differed substantially by both the number of comorbid chronic conditions and the presence of some specific comorbid conditions. These findings further highlight the importance of taking account of multiple long-term conditions in tailoring the care approach and developing healthcare plans for people with dementia. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise factors that can result in communication breakdown between staff and patients, leading to potential confrontation in the emergency department (ED) • To enhance your ability to assess and manage patients safely in ED waiting rooms • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Increasing demand, overcrowding and insufficient resources have led to situations where patient care is delivered in emergency department (ED) waiting rooms. For nurses undertaking triage in the ED waiting room, overcrowding is challenging, particularly in terms of assessing patients in a timely fashion, monitoring patients for clinical deterioration and ordering investigations. Additionally, long waiting times and a lack of information can lead to communication breakdowns with patients and, at times, patient confrontations with ED staff. This article explores the effects of the busy environment in ED waiting rooms on patients and staff such as triage nurses and waiting room nurses. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your awareness of the importance of identifying and assessing older people living with frailty • To understand the concept of frailty as a clinical syndrome • To familiarise yourself with frailty assessment tools such as the Clinical Frailty Scale, the most commonly used in the emergency department. An ageing population is leading to an increase in patients attending emergency departments (EDs) with comorbidities and age-related syndromes such as frailty. Frailty is a clinical syndrome defined as an increased vulnerability to age-related or disease-related insults in older adults due to diminishing physiological reserves. It also places increased demands on staff and hospital services. Screening for frailty early in the care pathway ensures goal-directed and timely care. This article provides an overview of frailty and its assessment in older people presenting to the ED. It discusses the most commonly used frailty assessment tool in the ED, the Clinical Frailty Scale, and identifies that the results of frailty assessment should be used to initiate appropriate individualised care in older patients. [ABSTRACT FROM AUTHOR]

Aim: To explore the factors that affect the experiences of autistic patients in the hospital setting. Design: A scoping review. Data Sources: A systematic literature search using the databases CINAHL, Medline and Google Scholar was undertaken in September 2021 and updated in January 2023. This review is based on the methodological framework of Arksey and O'Malley (International Journal of Social Research Methodology, 8(1):19-32, 2005), which was further refined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Results: Autistic patients, as well as their families and healthcare staff, face several barriers that can impact their healthcare experiences within hospital settings. Of 211 articles screened, 30 were eligible and included. Through our review, we identified two main themes. The first theme, 'challenges to hospital experiences', includes four subthemes: (1) communication, (2) a mismatch between the needs for autistic patients and the hospital environment, (3) challenges related to parents' experiences and (4) challenges related to hospital systems. The second theme, 'facilitators that improve hospital experiences', includes three sub-themes: (1) provision of care pathways, (2) partnership between parents and experts and (3) facilitators to improve hospital systems. By understanding these themes, we can work to address the barriers that autistic patients and their families face, while leveraging the facilitators to improve their hospital experiences. Conclusion: It is critical to understand the experiences of autistic patients in the hospital setting because they present a substantial risk of hospital admission due to their associated acute to chronic health conditions. Additionally, nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. This review further highlights the crucial need to adopt a collaborative and inclusive approach between autistic patients, their families and healthcare staff. To achieve this, co-design initiatives that incorporate the perspectives and lived experiences of the autistic community are necessary. By placing autistic voices at the forefront of these initiatives, it is hoped that changes are meaningful, relevant and can be sustained. Impact: Understanding the unique hospital experiences and challenges of autistic patients can improve their quality of life and well- being by reducing stress and anxiety during hospitalization, leading to better health outcomes and potentially shorter hospital stays. It can also promote a more positive view of healthcare among autistic individuals, encouraging them to seek medical care when needed and have broader societal impacts such as reducing healthcare costs and improving the overall health and well-being of the population. Autistic patients present a substantial risk of hospital admission due to their associated acute to chronic conditions. Nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To gain insight into caring for people at the end of life in the emergency department • To enhance your understanding of the concept of a good death • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) The focus of care in the emergency department (ED) is on saving or sustaining life, but some patients admitted to the ED die in the ED. Nurses whose focus is on saving lives may therefore find themselves providing end of life care to patients and their families in a stressful and distressing environment. Providing optimal end of life care involves reflecting on what a good death looks like and how patients can be supported to have a good death. This article describes the barriers to optimal end of life care in the ED and prompts nurses to think about how they can enhance their practice when caring for dying patients and their families. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware that temporary lower-limb immobilisation increases the risk of venous thromboembolism • To recognise the need to assess venous thromboembolism risk in adults with lower-limb immobilisation • To better understand which patients with lower-limb immobilisation should be offered thromboprophylaxis Temporary lower-limb immobilisation following injury is a risk factor for the development of venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism. However, patients are not always risk-assessed for VTE in clinical practice and there is a lack of consensus among healthcare professionals on whether thromboprophylaxis should be offered and to whom. This article uses the fictional case study of a patient with an ankle fracture to explore the literature and guidance on VTE risk assessment and thromboprophylaxis in adults presenting to emergency settings with lower-limb trauma requiring immobilisation. It appears that it is important to consistently risk-assess patients and offer thromboprophylaxis to those deemed at moderate or high risk of VTE, since thromboprophylaxis is safe, efficacious and cost-effective in these patient groups. [ABSTRACT FROM AUTHOR]

Background: A robust knowledge on the pattern of use of emergency care resources not only serves as an indicator of universal access to care but also provides a basis for quality improvement within the health system. This study was undertaken to describe the pattern of emergency room visits at Brits District Hospital (BDH) in North West province, South Africa. The objectives of this study were to determine the sociodemographic characteristics of emergency department (ED) users and other patterns of ED use. Methods: This was a cross-sectional descriptive study that was conducted at a district hospital. All patients who reported for emergency care in the ED in 2016 were eligible for the study. Data were extracted and analysed from a systematic sample of 355 clinical notes and hospital administrative records. Results: The age group that visited the ED most frequently (25.3%) was 25–34 years old. A high proportion of the ED users (60%) were self-referred, and only 38% were transported by the emergency medical response services (EMRS). Few (5.6%) presentations were of a non-urgent nature. Trauma-related conditions accounted for the most frequent presentation at the ED (36.5%). Conclusion: Although most ED users were self-referred, their clinical presentations were appropriate and underscore the need for policy strategies to reduce the burden of trauma in the catchment population Contribution: The study findings may have an impact on future health policies by providing decision-makers with baseline information on the pattern of use of ED resources, ensuring better resource deployment and greater access to care.

Background: Major thoracic trauma represents a life-threatening condition, requiring a prompt multidisciplinary approach and appropriate pathways for effective recovery. While acute morbidity and mortality are well-known outcomes in thoracic-traumatized patients, long-term quality of life in patients surviving surgical treatment has not been widely investigated before. Methods: Between November 2016 and November 2023, thirty-two consecutive patients were operated on because of thoracic trauma. Age, sex, comorbidities, location and extent of thoracic trauma, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), Organ Injury Scale (OIS), intra and extrathoracic organ involvement, mechanism of injury, type of surgical procedure, postoperative complications, ICU and total length of stay, immediate clinical outcomes and long-term quality of life—by using the EQ-5D-3L scale and Numeric Rate Pain Score (NPRS)—were collected for each patient Results: Results indicated no significant difference in EQOL.5D3L among patients with thoracic trauma based on AIS (p = 0.55), but a significant difference was observed in relation to ISS (p = 0.000011). Conclusions: ISS is correlated with the EQOL.5D3L questionnaire on long-term quality of life, representing the best prognostic factor—in terms of long-term quality of life—in patients surviving major thoracic trauma surgical treatment.

Why you should read this article: • To identify the unique challenges of having to care for patients in non-clinical areas • To consider practical solutions for enhancing safety and efficiency in 'corridor care' • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Overcrowding in the emergency department (ED) is a significant issue and often leads to nursing care being delivered in areas not intended for clinical use, a practice commonly referred to as 'corridor care'. Delivering care in non-clinical areas negatively affects patient safety and poses unique professional challenges for emergency nurses while also reducing their well-being. To end – or at least reduce – corridor care, system-level interventions are needed. In the meantime, there are practical solutions that can be implemented at an individual and departmental level to mitigate some of the risks associated with it. This article discusses a pragmatic approach to patient care, and explores opportunities for nurses to mitigate risks and enhance safety and efficiency, in overcrowded EDs. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that emergency nurses have an opportunity to integrate health promotion in the care they provide • To understand the barriers to health promotion in emergency care settings • To consider how you could provide further health promotion to patients in your practice setting Background: Emergency departments (EDs) afford 'teachable moments' for health behaviour change, but staff may not see themselves as public health practitioners and it can be challenging to undertake health promotion activities in emergency care settings. Furthermore, the evidence on health promotion in these settings is limited. Aim: To investigate the views and experiences of emergency nurses and ambulance service paramedics regarding health promotion in emergency care settings. Method: A convenience sample of emergency nurses (n=3) and ambulance service paramedics (n=3) was recruited. An inductive and descriptive qualitative study design using semi-structured interviews and thematic analysis was employed. Findings: The participants understood health promotion and were willing to have conversations about it with patients. However, they cited several barriers to health promotion, including understaffing, a lack of understanding of the relevance of health promotion among staff, a lack of training and information, and the sensitivity of topics such as body weight and sexual health. Lack of time was not cited as a barrier. Conclusion: There are opportunities for developing the health promotion aspect of practice in emergency care settings, where staff and patients would benefit from a more structured, system-wide approach to health promotion. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the risks associated with pelvic fractures caused by high-energy trauma • To recognise the importance of conducting a primary survey adapted to patients with severe pelvic fractures • To identify the management priorities for patients who have sustained high-energy trauma to the pelvis Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of life-changing injuries. High-energy trauma to the pelvis is associated with major haemorrhage and injuries to the internal pelvic organs. Emergency nurses have a fundamental role in the initial assessment and management of patients, as well as in their ongoing care once the fracture has been stabilised and bleeding is controlled. This article describes the anatomy of the pelvis, discusses the initial assessment and management of patients who have sustained high-energy pelvic trauma, details the complications of pelvic fractures and explains patients' ongoing care in the emergency department. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of triage processes and of the primary aim of emergency triage • To explore how the principles of lean management can be applied in a healthcare setting • To read about a project successfully conducted to reduce triage time in an emergency department Emergency triage is a short-duration, high-volume process so small reductions in the time taken to triage one patient can have large repercussions on the total amount of triage time. At the emergency department of a large inner-city hospital, an efficiency and quality improvement project was undertaken to reduce the time taken to safely triage patients and optimise the use of triage nurses' time. The project involved removing processes that did not contribute to the primary aim of triage, supporting individual triage nurses to improve their performance where needed, and optimising the triage process. A 44% reduction in mean triage episode time was seen, equating to 18,000 minutes of triage nurses' time saved every month. This near doubling of triage capacity was associated with an improvement in triage accuracy. The article describes the project, which used lean management principles and statistical process control methods, and discusses its implications for emergency triage. [ABSTRACT FROM AUTHOR]

The article discusses the accidental hypothermia condition which refers to an unintentional decrease to below 35 degrees centigrade in core body temperature. Topics covered include its pathophysiology, its adverse effects on the cardiovascular, central nervous, and renal body systems among others, and the importance of preventing further heat loss and of quickly rewarming those stricken with it. Also described are investigations on such patients, and their management, and nursing care.

Why you should read this article: • To identify the clinical outcomes for patients with scalp lacerations using the hair apposition technique (HAT) in comparison to the traditional options for wound closure in the emergency department • To recognise that further research is required to support the existing evidence on the use of HAT for scalp lacerations • To be aware that emergency nurses must undertake appropriate education and clinical skills practice before implementation of HAT in their setting This literature review aimed to explore the clinical outcomes for adult and child patients with scalp lacerations using the hair apposition technique (HAT) compared with the traditional options of sutures and staples for wound closure in the emergency department (ED). Although the research is scant, in the studies examined HAT was received positively by patients, had limited complications, was cost-effective and was suitable for use in the age ranges that met the criteria for its application. Further research is required to support the existing evidence, but the use of HAT for low-risk scalp lacerations in the ED should be considered and is within the scope of all healthcare professionals who undertake appropriate practice of this clinical skill. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that children's acute pain should be assessed using validated tools appropriate for a child's age and developmental status • To enhance your knowledge of the different types of validated pain assessment tools for use with children with acute pain • To understand that children's self-reports of acute pain should be obtained whenever possible There is a lack of timely administration of an appropriate analgesic for children in acute pain in emergency departments in the UK and elsewhere. Unrelieved acute pain may result in deterioration in a child's physical and psychological condition therefore assessment is essential to enable triage nurses to offer an appropriate analgesic. This should be achieved by using a validated pain assessment tool which, where appropriate, enables the child to self-report their pain. This article describes various validated pain assessment tools for use with children with acute pain and considers how triage nurses can determine which is the most appropriate to use. Regardless of which tool is selected, it is important to offer the child an analgesic and to reassess their pain at appropriate intervals. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the challenges of undertaking clinical research in the emergency department setting • To learn about various strategies that could be used to support patient recruitment to research trials • To consider the role of nurses in recruiting patients to clinical research Research is essential for the implementation of evidence-based practice and can lead to improvements and innovations in care delivery. Although ultimately beneficial for patients and staff, the data collection involved in research often presents challenges, particularly in the emergency department (ED) setting. This article describes the challenges of undertaking a feasibility trial in a city centre ED. The target research population were adult patients who presented to the ED with an issue related to opioid misuse, for example opioid overdose, injection site wounds and/or abscess, or injury sustained during opioid intoxication. Challenges experienced during this trial included a demanding work environment, ED attendees not being suitable for recruitment into research, and suspension of the trial during the coronavirus disease 2019 (COVID-19) pandemic. The author details the strategies introduced to ensure effective patient recruitment to the trial, including nurse secondment onto the research team, offering incentives, raising awareness of the trial among ED staff and implementing flexible training. These strategies continued to be effective after a period of suspension due to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware of the differential diagnoses associated with petechial rash before initiating treatment for invasive meningococcal disease • To recognise the value of a tailored approach to the investigation, treatment and discharge of well children with petechial rash in the emergency department (ED) • To avoid over investigation and overtreatment of well children with petechial rash in the ED This article presents a discussion based on a case study of an eight-month-old boy with petechial rash who presented at the emergency department (ED). Blood tests were obtained and intravenous antibiotics were administered. The patient was admitted to the children's ward and was discharged the next day. It was suspected that the rash was caused by a non-specific viral illness. Non-blanching rashes, such as petechial rash, in well children often lead to diagnostic and treatment dilemmas in the ED. Clinicians fear missing the diagnosis of invasive meningococcal disease, which results in blood tests, cannulation and early administration of antibiotics. Non-blanching rashes have many potential causes and extensive tests and antibiotic treatment may not always be necessary and have the potential to cause harm. A tailored approach to investigate, treat and discharge well children with petechial rash from the ED is advocated. [ABSTRACT FROM AUTHOR]

The use of reverse transcription–polymerase chain reaction (RT-PCR) is the gold standard laboratory test for diagnosing SARS-CoV-2 infection. However, it has the disadvantage of a long turnaround time and cost. The Nigeria Centre for Disease Control (NCDC) formulated a case definition for COVID-19. We sought to determine the utility of a 14-item, point-weighted clinical screening questionnaire adapted from the NCDC case definition in identifying patients more likely to have the disease. This was to aid prompt clinical decision-making. Methods: We retrospectively reviewed the data of 113 non-surgical patients presenting to the Accident and Emergency Department (A and E) of Lagos University Teaching Hospital, Lagos, Nigeria. Patients were stratified based on screening scores into low (0–2), moderate (3–5) and high (6) pre-test categories. Patients with low and high scores ≥6 were admitted to the A and E and the COVID-19 holding ward, respectively, while the moderate group had chest computed tomography scans to aid further decision-making, pending the outcome of their RT-PCR results. The validity of the triage score as compared to the RT-PCR test result was calculated and the kappa score of agreement was utilised to evaluate the concordance between two triage scores. The optimum cut-off score was also obtained based on the maximal Younden's index. Results: The frequencies of low, moderate and high pre-test scores were 34 (30%), 43 (38.1%) and 36 (31.9%), respectively. Overall, 38.1% (43/113) were RT-PCR positive. RT-PCR was positive in 26.5% (9/34) with low screening scores, 55.8% (24/43) with moderate scores and 27.8% (10/36) with high scores. The sensitivity and specificity of a high score of 6 were 25% and 92.86%, while the lower score of 3 had sensitivity and specificity of 62.5% and 58.6%, respectively. Conclusion: The screening tool showed a high specificity in its initial design, which suggests that anyone with a low score using this tool has a high probability of testing negative. We recommend a cut-off score of 4 (score A) or 6 (score B) of the current screening tool be used to increase the chances of identifying persons with COVID-19 for RT-PCR testing.

Why you should read this article: • To be aware of factors influencing a decision to activate the trauma team • To identify the importance of trauma-specific training and the support of senior staff in enhancing the confidence of less experienced colleagues • To recognise that trauma team activation may be inconsistent in trauma units Regional trauma networks enable the rapid and safe management and transfer of patients with traumatic injury between designated trauma units and one of 27 major trauma centres throughout the UK. Multispecialty trauma teams are available 24 hours a day, seven days a week, and are activated immediately upon receipt of a patient presenting with major trauma. With most serious trauma patients going direct to major trauma centres rather than a less specialised hospital-based trauma unit, it can be challenging for hospital-based trauma unit staff to gain experience and skill in this area, leading to potential inconsistencies in the process of activating the trauma team. The aim of this service evaluation was to identify factors influencing the decision to activate the trauma team in emergency department (ED) staff working within a 700-bed trauma unit. A questionnaire was sent to 107 staff and 70 completed it, a response rate of 65%. Results indicated that shortfalls in trauma-specific training, lack of clinical experience, undefined roles and responsibilities, department culture, ambulance handover, knowledge of clinical guidelines and previous experience of trauma team activation all affected the decision to activate the trauma team. Trauma-specific training and the support of senior staff could enhance confidence and appropriate trauma team activation rates. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To identify the importance of emergency nurses being able to provide appropriate care for patients who self-harm • To learn about the findings of a systematic review that examined the effects of educational interventions on emergency nurses' attitudes towards patients who self-harm • To recognise the need for improved training for emergency nurses on suicide and self-harm Negative nurse attitudes towards emergency department patients who self-harm may increase the risk of repeated self-harm and suicide. This article details a systematic review that aimed to examine the evidence on the efficacy of educational interventions to improve the attitudes of emergency nurses towards patients who self-harm. Eight articles describing six intervention studies, published between 2001 and 2018, met the criteria for inclusion. The review found that educational interventions for emergency nurses improved their attitudes to patients who self-harm, but there was a lack of consistency in the approaches used and a reliance on self-report measures. Further training for emergency nurses is needed because of their crucial role in self-harm and suicide prevention. [ABSTRACT FROM AUTHOR]

Referrals to mental health services, and mental health-related presentations to emergency departments (EDs), among children and young people (CYP) have increased over the last decade. In the UK, national guidelines and standards recommend that CYP who present to an ED with mental health issues should receive a psychosocial assessment, while evidence suggests that the use of a psychosocial assessment tool can enhance the management of this patient cohort. However, it can be challenging for ED healthcare professionals to undertake a formal psychosocial assessment due to a range of factors. This article reports the results of a service evaluation, undertaken in two children's EDs in a large NHS trust in England. The evaluation involved a review of 308 ED clinical records of CYP who presented to the EDs with mental health issues, to assess the extent to which this cohort was receiving a structured psychosocial assessment. The results showed that only a small proportion (34%, n=104) of the clinical records contained evidence of some form of psychosocial assessment, while the use of a psychosocial assessment tool was documented in only 22 (7%) of these 104 clinical records. The results have informed a wider quality improvement project to enhance practice in this area., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Patients diagnosed with cancer or suspected cancer during an emergency department (ED) presentation are often signposted back to their GP for urgent referral to cancer services. However, this can result in delays in patients receiving specialist support, confirmation of diagnosis and, vitally, starting treatment. A quality improvement initiative that aimed to address these issues through the introduction of an ED suspected cancer diagnosis pathway was implemented by the acute oncology service in two EDs in Oxford University Hospitals NHS Foundation Trust in April 2023. Data collected during the first year of implementation of the pathway show there has been a significant increase in the numbers of patients meeting the NHS England 62-day referral to treatment standard and in the numbers of patients receiving support from an acute oncology named cancer clinical nurse specialist from the point of discharge from the ED. This article details the initiative, which is ongoing, and shares some of the results from the first year of data collection., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

A haemorrhagic ovarian cyst is a functional cyst resulting from bleeding into a follicular or corpus luteum cyst. It is a common gynaecological condition that often presents with acute pelvic pain, typically localized to one side, and may be accompanied by menstrual irregularities. Diagnosis is usually made via pelvic ultrasound, which typically reveals a complex cyst with characteristic features such as a reticular or 'lace-like' pattern. While most haemorrhagic cysts resolve spontaneously and require only conservative management, complications such as rupture or significant hemorrhage may necessitate surgical intervention. Occasionally, these cysts can present atypically, making diagnosis and management more challenging., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Elramlawy et al.)

Background: Patient centred care has a correlation to effectiveness of patient engagement, patient care, and perceived quality of care. Even in the emergency room, awareness of diagnosis and treatment plan is a critical component in every doctor-patient interface as it enhances patient-centred care. This study aims to assess awareness of diagnosis and treatment plan among patients in the accident and emergency department., Methodology: This is a cross-sectional study conducted at the accident and emergency department of the University of Port Harcourt Teaching Hospital., Result: One hundred and ninety-seven respondents were recruited into this study comprising of 51.3% males and 48.8% females. Most 86.8% of the respondents were aware of their diagnosis, of which 91.8% knew the accurate diagnosis. Majority 84.8% of the respondents were aware of the treatment, while 68.8% of the respondents were aware of the names of the medications, most of the respondents 59.4% had no knowledge of the side effects of the medications. The majority, 61.4% were involved in the management decision. No significant relationship existed between the socio-demographic characteristics and knowledge of diagnosis and treatment plan., Conclusion: The chaotic and overcrowded nature of the accident and emergency department should not hamper the delivery of patient centred care. Although, findings obtained from this study reveal that majority of the respondents are aware of their diagnosis and treatment plan, a portion of respondents do not understand their plan of care; this indicates the need for further studies to identify interventions that would ensure that gaps in the physician -patient communication are filled as this optimizes patients' satisfaction of care received, gives better sense of control of their total situation and better quality of life., Competing Interests: None, (Copyright © 2024 Nigerian Medical Association.)

Although the phenomenon of crowding in emergency departments (EDs) is not new, it remains a significant problem for patients, ED staff and the wider healthcare system. Crowding in EDs, which is also called overcrowding, has been widely explored in the literature, but there are relatively few studies of the subject from an emergency nurse perspective. This article reports the findings of a literature review that aimed to explore the effects of crowding on nurses working in EDs. Four key themes were identified from a synthesis of 16 articles included in the review: staffing and skill mix; inadequate care and the effect on nurses' well-being and stress levels; violence in the ED; and hospital metrics and patient flow. Further research is required to explore in more depth the effects of ED crowding on emergency nurses and to address the multiple factors that perpetuate the phenomenon., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Telemedicine is increasingly used in healthcare settings, including in unscheduled care. This article details the findings of a literature review that aimed to determine the benefits and limitations of using telemedicine in unscheduled care. The findings suggest that the use of telemedicine can be cost-effective for patients and healthcare providers and may reduce hospital transfer and admission rates. However, patients' digital literacy and communication needs, as well as technical issues, were identified as limitations. Further research is needed on the use of telemedicine in unscheduled care to determine how it affects patient care., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Why you should read this article: • To enhance your knowledge and understanding of intercultural communication principles and challenges • To reflect on intercultural communication in your workplace and on how you may be able to help enhance it • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Globalisation and migration trends are reflected in emergency departments (EDs), which increasingly care for patients and employ staff from diverse cultural and/or ethnic backgrounds. EDs are busy, pressured and unpredictable environments where effective communication with patients and families is challenging at the best of times. This is compounded by language and cultural barriers experienced by patients and families whose background differs from the prevailing culture. Cultural differences and language comprehension may also be a challenge for overseas nurses recruited to the ED, who may need support from colleagues and organisations. ED nurses therefore need to be competent in intercultural communication. This involves combining optimal interpersonal skills with cultural awareness, knowledge and sensitivity. [ABSTRACT FROM AUTHOR]

Background: Witnessed cardiac arrest is a common occurrence in an A&E department. The reported incidence of witnessed cardiac arrest is variable around the world. Overall unadjusted survival to hospital discharge rate was 18.4%. Objective: To assess the aetiology, factors associated in outcomes of witnessed cardiac arrests, and the rate of occurrence of cardiac arrest at the A&E of Provincial General Hospital Kurunegala (PGHK). Methods: This descriptive study was conducted between January1, 2016, to December 31, 2016 (one year) at the A&E department of PGHK. Survivors were followed up on for a one-year period. Results: There were 123 witnessed cardiac arrests (mean age 64 (+/- 15.9) years, 64% male), out of which 25 patients were successfully resuscitated {return of spontaneous circulation (ROSC)} and transferred to intensive care units for further care. However, only 6 (4.9%) patients were discharged from the hospital. The three-month and one-year survival numbers were 6 (4.9%) (males: 4, females: 2) and 4 (3.3%) (males: 3, female: 1) respectively. The age of the female survivor after one year was 43 years and the ages of the three male survivors were 46, 54, and 55 years respectively. The most common aetiology for cardiac arrest was myocardial infarction (43.1%) while the most common initial rhythm was non-shockable (82%). The initial rhythm was shockable in all 6 survivors. Conclusion: The overall ratio of survival to discharge was much lower in comparison to international figures. The poor survival rate in our study may be due a very high rate of cardiac arrests with initial non-shockable rhythms. [ABSTRACT FROM AUTHOR]

Background: The COVID -19 pandemic created a panic situation where patient interaction with the other patients and health care staff had to be restricted to avoid spreading the disease. We planned an innovative strategy to restrict the inflow of patients to those who may need nasal bone manipulation by using Video Clinics (VC). Methods: All consecutive patients presenting to three units of Accident & Emergency (A & E) NHS sites of our trust with suspicion of fractured nasal bones were included in the study group for a period of three months. The impact of VC was studied by calculating the percentage of patients who could be discharged without a recall to the hospital from those attending it, the percentage who finally needed a fracture reduction, and the satisfaction scores of patients with VC. Results: Forty-two patients were offered appointments in VC. Thirty-one could attend VC, out of which thirteen (41.9%) were discharged without a recall. Twenty-three patients were recalled for F2F (Face2Face) clinic, out of which twelve (28.5% of 42) required fracture reduction, and 11 were discharged to home. Ten patients underwent fracture reduction under local anaesthesia, and two were booked for Septorhinoplasty later. Twenty-seven (87.1 %) patients expressed satisfaction with VC, two (6.4%) were lost to follow-up, and the remaining two (6.4%) were not satisfied. Conclusion: VC could effectively filter 41.9% of patients who did not need surgical intervention from the comfort of their homes or workplace by using the available multimedia facility without compromising outcomes and satisfaction scores. The satisfaction score was 87.1% with VC. The clinics helped prevent potential coronavirus exposure by staying safe, and they are recommended in emergencies like COVID -19.

Abstract Background Recent studies have shown a decrease of admissions to accident and emergency (A&E) departments after the local outbreaks of COVID-19. However, differential trends of admission counts, for example according to diagnosis, are less well understood. This information is crucial to inform targeted intervention. Therefore, we aimed to compare admission counts in German A&E departments before and after 12th march in 2020 with 2019 according to demographic factors and diagnosis groups. Methods Routine data of all admissions between 02.12.2019–30.06.2020 and 01.12.2018–30.06.2019 was available from six hospitals in five cities from north-western, eastern, south-eastern, and south-western Germany. We defined 10 diagnosis groups using ICD-10 codes: mental disorders due to use of alcohol (MDA), acute myocardial infarction (AMI), stroke or transient ischemic attack (TIA), heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), cholelithiasis or cholecystitis, back pain, fractures of the forearm, and fractures of the femur. We calculated rate ratios comparing different periods in 12.03.2020–30.06.2020 with 12.03.2019–30.06.2019. Results Forty-one thousand three hundred fifty-three cases were admitted between 12.03.2020–30.06.2020 and 51,030 cases between 12.03.2019–30.06.2019. Admission counts prior to 12.03. were equal in 2020 and 2019. In the period after 12.03., the decrease of admissions in 2020 compared to 2019 was largest between 26.03. and 08.04. (− 30%, 95% CI − 33% to − 27%). When analysing the entire period 12.03.-30.06., the decrease of admissions was heterogeneous among hospitals, and larger among people aged 0–17 years compared to older age groups. In the first 8 weeks after 12.03., admission counts of all diagnoses except femur fractures and pneumonia declined. Admissions with pneumonia increased in this early period. Between 07.05. and 30.6.2020, we noted that admissions with AMI (+ 13%, 95% CI − 3% to + 32%) and cholelithiasis or cholecystitis (+ 20%, 95% CI + 1% to + 44%) were higher than in 2019. Conclusions Our results suggest differential trends of admission counts according to age, location, and diagnosis. An initial decrease of admissions with MDA, AMI, stroke or TIA, heart failure, COPD, cholelithiasis or cholecystitis, and back pain imply delays of emergency care in Germany. Finally, our study suggests a delayed increase of admissions with AMI and cholelithiasis or cholecystitis.

• Burnout in emergency department nurses is a critical and under researched area using qualitative research methods. • Two major themes were established: experiencing challenging emotions and trying to establish a personal sense of control. • Emergency department nurses need to construct clear boundaries between professional identity and their personal lives. • Burnout affects both the professional and personal lives of emergency nurses. • There are a multitude of factors contributing to the development of burnout including systemic, clinical, and personal experiences. Emergency department nurses work in rapidly changing environments, which can contribute to occupational stress. Emergency department nurses utilise diverse strategies to mediate the impact of stress on their daily lives. There is a paucity of qualitative research which explores emergency department nurses' experiences and perspectives of burnout. This study aimed to explore emergency department nurses' experiences of burnout. Further, the study considered how emergency nurses conceptualised burnout and the strategies they used to manage the professional and personal effects of burnout. The COREQ research guidelines were used throughout the study from the design stage through to dissemination. Narrative inquiry was used as the underpinning theoretical framework. The researcher met individually with eight emergency department nurses from NSW hospitals to undertake a face-to-face semi-structured interview. An inductive approach was used to establish major themes within the narrative. Two major themes were established: experiencing conflicting emotions and trying to establish a personal sense of control. Emergency nurses felt passionate about their professional roles, yet encountered difficulties due to management structures, time constraints and a sense of underappreciation. The misalignment between their expectations and the reality of emergency department nursing, resulted in experiences of burnout such as dissatisfaction and frustrations at work. Consequently, these nurses adopted diverse strategies within both their professional and personal domains. The conclusions of this study are transferable to a variety of acute health services. Health service management have a role to promote a positive workplace culture for nurses, which advocates for home life balance. This will support nurses to construct clear boundaries between professional identity and their personal lives. [ABSTRACT FROM AUTHOR]

The article discusses findings of a literature review on the factors that affect nurses' triage decisions in the emergency department. The study found that experienced nurses use triage algorithms to aid decision-making. Patient factors are presenting complaints, vital signs, visual presentation, verbal history or communication issues and attributes, while nurse factors are experience, intuition, training and risk. Environmental factors are physical environment, workload and staffing.

Purpose: Pediatric forearm fractures are a common presentation to Accident and Emergency departments. Standard treatment for the majority of these is manipulation under sedation within the department, followed by cast application. Concerns have been raised about the acceptability of such interventions, and reluctance to perform these procedures has led to increased admissions and manipulations performed under general anesthetic. Methods: A prospective case series of all pediatric patients with forearm fractures who underwent a manipulation under sedation in the Accident and Emergency department was collected over 12months. All parents were invited to complete an acceptability questionnaire, adapted from the Swedish Pyramid Questionnaire for Treatment, based on their experiences. Results: A total of 77 patients were included and their parents were asked to complete a Swedish Pyramid Questionnaire of Treatment. Forty-four parents (55%) agreed to fill out the questionnaire. Patient demographics and fracture characteristics were compared between the group that responded and those that did not, with no significant differences. Average level of satisfaction was 9.4/10 (range=7–10). 98% of respondents were satisfied with the level of analgesia provided, but only 86% with the timeliness of administration. Conclusion: This parent-focused evaluation of treatment confirms high levels of parental satisfaction with the management of pediatric forearm fractures in Accident and Emergency, with regard to care, analgesia, and information. It provides insights about parental concern relating to the injury and their anxiety as information useful to further improving care, a template for assessing quality improvement and should be considered as part of further studies in this field. [ABSTRACT FROM AUTHOR]

The use of reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard laboratory test for diagnosing SARS-CoV-2 infection. However, it has the disadvantage of a long turnaround time and cost. The Nigeria Centre for Disease Control (NCDC) formulated a case definition for COVID-19. We sought to determine the utility of a 14-item, point-weighted clinical screening questionnaire adapted from the NCDC case definition in identifying patients more likely to have the disease. This was to aid prompt clinical decision-making. Methods: We retrospectively reviewed the data of 113 non-surgical patients presenting to the Accident and Emergency Department (A and E) of Lagos University Teaching Hospital, Lagos, Nigeria. Patients were stratified based on screening scores into low (0-2), moderate (3-5) and high (6) pre-test categories. Patients with low and high scores ≥6 were admitted to the A and E and the COVID-19 holding ward, respectively, while the moderate group had chest computed tomography scans to aid further decision-making, pending the outcome of their RT-PCR results. The validity of the triage score as compared to the RT-PCR test result was calculated and the kappa score of agreement was utilised to evaluate the concordance between two triage scores. The optimum cut-off score was also obtained based on the maximal Younden's index. Results: The frequencies of low, moderate and high pre-test scores were 34 (30%), 43 (38.1%) and 36 (31.9%), respectively. Overall, 38.1% (43/113) were RT-PCR positive. RT-PCR was positive in 26.5% (9/34) with low screening scores, 55.8% (24/43) with moderate scores and 27.8% (10/36) with high scores. The sensitivity and specificity of a high score of 6 were 25% and 92.86%, while the lower score of 3 had sensitivity and specificity of 62.5% and 58.6%, respectively. Conclusion: The screening tool showed a high specificity in its initial design, which suggests that anyone with a low score using this tool has a high probability of testing negative. We recommend a cut-off score of 4 (score A) or 6 (score B) of the current screening tool be used to increase the chances of identifying persons with COVID-19 for RT-PCR testing. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of the role of the emergency nurse in preventing pressure ulcers • To familiarise yourself with strategies for preventing pressure ulcers in the emergency department (ED) • To learn about embedding pressure ulcer prevention into the ED workflow Patients can develop pressure ulcers within a few hours of entering an emergency department (ED). However, despite the critical role of EDs in reducing the incidence of pressure ulcers, few have protocols in place for prevention. This article describes the prevention emergency project (PEP), a quality improvement project undertaken in the ED at Karolinska University Hospital in Sweden to reduce the incidence of pressure ulcers. The article demonstrates how four simple nurse-led changes – early risk assessment, pressure-relieving equipment, intentional rounding, and using prophylactic dressings and incontinence pads – can reduce the incidence of pressure ulcers significantly when integrated into ED workflow. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To identify the importance of preparation for autonomous practitioners when breaking bad news in the emergency department (ED) • To consider further training to improve autonomous practitioners' expertise and skill in breaking bad news in the ED • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Breaking the news of potentially serious and new diagnoses to patients in the emergency department (ED) is a common but challenging aspect of the autonomous practitioner's role. It is a complex process, requiring expertise and skill. If the news is delivered appropriately there is evidence to suggest a beneficial effect on the patient's ability to cope, yet there is little formal training available and literature focused on the ED setting is limited. This article aims to guide and prepare autonomous practitioners in the ED to break bad news to patients, including during remote consultations introduced due to the coronavirus disease 2019 pandemic. It identifies the importance of preparation; different approaches to breaking bad news, namely the six-stage SPIKES framework and a case study exploring its application in practice; the range of potential patient reactions and how these can be managed, including the provision of support; and how to involve and communicate with other members of the multidisciplinary team. Suggestions for further training are outlined. [ABSTRACT FROM AUTHOR]

Background: In resource-limited countries, it is important that only genuine ophthalmic emergencies should be seen in the Accident and Emergency department to reduce the pressure on the limited human and material resources. The aim of the study is to determine the pattern of eye-related emergencies who presented to the Accident and Emergency department in a Nigerian Tertiary Hospital. Methods: This was a retrospective chart review of all consecutive ophthalmic patients who presented at the general Accident and Emergency department of the University of Benin Teaching Hospital between July 2018 and December 2020. Patients who discharged themselves against medical advice were not included in the study. Results: A total of 363 presented with ophthalmic complaints, and their mean age was 32.6 ± 20.2 years. Most of the cases presented as emergencies (61.4%) with more than half (32.8%) requiring ocular surgery. Eyelid laceration was the leading cause of presentation (12.4%). Emergency cases were more likely to present during the weekend (71.5%). Males were 5.1% less likely to present as emergencies. Conclusion: Most of the cases were emergencies with eyelid laceration and penetrating eye injuries being the leading cause. Although the number of nonemergencies was less, the need for the inclusion of primary eye care in the existing primary healthcare centers will further reduce the number of non-emergency cases seen.

Abstract Background Syndromic surveillance provides public health intelligence to aid in early warning and monitoring of public health impacts (e.g. seasonal influenza), or reassurance when an impact has not occurred. Using information collected during routine patient care, syndromic surveillance can be based on signs/symptoms/preliminary diagnoses. This approach makes syndromic surveillance much timelier than surveillance requiring laboratory confirmed diagnoses. The provision of healthcare services and patient access to them varies globally. However, emergency departments (EDs) exist worldwide, providing unscheduled urgent care to people in acute need. This provision of care makes ED syndromic surveillance (EDSyS) a potentially valuable tool for public health surveillance internationally. The objective of this study was to identify and describe the key characteristics of EDSyS systems that have been established and used globally. Methods We systematically reviewed studies published in peer review journals and presented at International Society of Infectious Disease Surveillance conferences (up to and including 2017) to identify EDSyS systems which have been created and used for public health purposes. Search criteria developed to identify “emergency department” and “syndromic surveillance” were applied to NICE healthcare, Global Health and Scopus databases. Results In total, 559 studies were identified as eligible for inclusion in the review, comprising 136 journal articles and 423 conference abstracts/papers. From these studies we identified 115 EDSyS systems in 15 different countries/territories across North America, Europe, Asia and Australasia. Systems ranged from local surveillance based on a single ED, to comprehensive national systems. National EDSyS systems were identified in 8 countries/territories: 2 reported inclusion of ≥85% of ED visits nationally (France and Taiwan). Conclusions EDSyS provides a valuable tool for the identification and monitoring of trends in severe illness. Technological advances, particularly in the emergency care patient record, have enabled the evolution of EDSyS over time. EDSyS reporting has become closer to ‘real-time’, with automated, secure electronic extraction and analysis possible on a daily, or more frequent basis. The dissemination of methods employed and evidence of successful application to public health practice should be encouraged to support learning from best practice, enabling future improvement, harmonisation and collaboration between systems in future. Prospero number CRD42017069150 .