NHS 111 - a mixed start but potential for the future

The report of ScHARR's NHS 111 evaluation is now available

Press release

Project web page and full report

EMRiS at the CEM Annual Scientific Conference

The College of Emergency Medicine Annual Scientific Conference is being held in Sheffield on 7th November.
The contributions from members of EMRiS are shown below. Following the conference copies of the posters and presentation will be available to download from the EMRiS website. They will also be available via this blog.

Lightening Poster Session 1 The Edge Foyer 08:45

Kirsty Challen

• Pandemic Influenza Triage in the Emergency Department
• Predicting critical illness and death in the ED: not the same thing

Lightening Poster Session 2 High Tor 2 10:15

Robin Chatters

• Prospective Study to Explore the Link Between the use of First Aid and Patient Outcomes Following Emergency Medical Events

Jack Whitely

• Patient expectations of minor injury care

Rod Little prize abstract session High Tor 2 11:00

Kirsty Challen

• Scoping emergency planning: literature and stakeholders

Track 2 High Tor 4 13:30

Alastair Pickering

• Academic Emergency Medicine: The training years

Four top-scoring abstracts session High Tor 2 14:00

Colin O'Keeffe

• Confidence and experience of training junior doctors: Assessing the
  impact of the Emergency Department

Suzanne Mason

• Evaluating well-being in junior doctors: impact of emergency medicine

Lightening oral Session 2 High Tor 2 15:00

Steve Goodacre

• Systematic review and meta-analysis of the diagnostic and prognostic accuracy of CT coronary angiography in suspected acute coronary syndrome.
• Systematic review and meta-analysis of the diagnostic and prognostic accuracy of exercise ECG in suspected acute coronary syndrome.

Posters

Steve Goodacre

• Cost-effectiveness of presentation and delayed troponin testing for acute myocardial infarction 
• Systematic review and meta-analysis of alternative early biomarkers for myocardial infarction

MSc in Advanced Emergency Care- February intake

Following the popularity of the ScHARR's new MSc in Advanced Emergency Care we can confirm that will be having a second intake of part time students in February in time for semester two.
This is in keeping with our aims to make the course as flexible as possible,  enabling busy clinicians to combine studying with work and family life.

The MSc web pages will be updated soon with details of the semester two admission process.

MSc in Advanced Emergency Care

University of Sheffield postgraduate applications page

Thomas Locker

Patient deaths go up 20 per cent every ten miles travelled

Jon Nicholl's article has recently been published in the Mail on Sunday

"Patient deaths go up 20 per cent every ten miles travelled... so bigger isn't better for most families"

What have medical ward rounds got to do with the ED?

Yesterday the RCP and RCN published a joint statement on the conduct of medical wards rounds. This document details best practice guidance for the conduct of multidisciplinary medical ward rounds. What has this got to do with emergency medicine?
 Access to inpatient beds is well recognised as a key contributor to emergency department crowding. The recently revised College ofEmergency Medicine guideline on crowding states that “The main reason for crowding in almost all EDs is lack of hospital capacity”. Unfortunately today’s publication fails to mention the significant impact that the timing of medical wards rounds has upon the flow of patients through an emergency department.

The RCP/RCN report acknowledges that “Consultant-led ward rounds should be conducted in the morning to facilitate timely completion of tasks during the working day.” However it should also be recognised that the early morning review of patients is vital so that appropriate patients may be discharged and beds made available in time for the predictable rise in the requirement for inpatient beds that occurs from late morning until the evening.

It will be interesting to see if renewed focus upon consultant ward rounds can alleviate the problems of ED crowding in the UK as we approach the most demanding time of year. 

Ward rounds in medicine: Principles for best practice

Thomas Locker

Could the RATPAC trial have been stopped earlier with a different design?

The RATPAC trial [1] showed that using a point of care panel of troponin, CK-MB and myoglobin at presentation and 90 minutes could increase the proportion of patients successfully discharged after emergency department assessment for non-specific chest pain. The trial originally planned to recruit 3130 participants. After a lot of hard work and an extension to the planned time, the trial stopped with 2243 patients recruited after an interim analysis showed that further recruitment was unlikely to add worthwhile new information.

A reanalysis of the RATPAC trial data, published in the October issue of Annals of Emergency Medicine [2], suggests that the trial could have been stopped a year earlier, after 722 patients had been recruited, if a group sequential design had been used. This is a type of adaptive design which allows a trial to be stopped prematurely because of efficacy, futility or safety, according to the results of pre-planned interim analyses.

The reanalysis and an accompanying editorial [3] suggest that adaptive designs could be used more widely in emergency medicine to allow early recognition of an effective intervention or early termination of a futile trial. There are potential drawbacks to an adaptive design, however. Early termination of the RATPAC trial would have left it with less power to detect differences in secondary outcomes, such as adverse events and health care costs. This could be a problem as the RATPAC economic analysis [4] showed that, despite reducing admissions, use of the point of care panel may have been associated with increased health care costs.

Steve Goodacre

1. Goodacre SW, Bradburn M, Cross E, Collinson PO, Gray A, Hall AS on behalf of the RATPAC research team. The RATPAC Trial(Randomised Assessment of Treatment using Panel Assay of Cardiac markers): Arandomised controlled trial of point-of-care cardiac markers in the emergencydepartment. Heart 2011;97:190-196.
   
2.  Sutton L, Julious S, Goodacre S. Impact ofAdaptive Analysis on Unnecessary Patient Recruitment: Re-Analysis of the RATPACTrial. Ann Emerg Med 2012;60:442-448.
    
3.  Durkalski V. Adaptive designs: A true panaceafor the common clinical trial? Ann Emerg Med 2012;60:449-450.
    
4.  Fitzgerald P, Goodacre SW, Cross E, Dixon S. Cost-effectiveness of point-of-care biomarker assessment for suspectedmyocardial infarction: The RATPAC Trial (Randomised Assessment of Treatmentusing Panel Assay of Cardiac markers). Acad Emerg Med 2011;18:488-495.