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Reorganising resuscitation A recurring nightmare for emergency nurses is finding out, in the middle of resuscitating a patient, that an essential item is missing. Checking and restocking resus rooms are important activities, but they take up time that nurses could spend on other essential activities. Swanson describes how emergency nurses can undertake these activities more quickly if they follow six sigma principles, which are: sort, simplify, sweep, standardise, [ensure] safety for the workplace and sustain. Swanson C (2014) Reorganizing a resuscitation room using six sigma (6S) principles. Journal of Emergency Nursing. 40, 4, 371-376.
Antibiotic use
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Over the past decade, the number of people with cutaneous abscesses who present to emergency departments, walk-in centres or minor injury units has increased. While there is general agreement that incision and drainage is an appropriate treatment for this condition, it is less clear whether antibiotics should be routinely prescribed. Given that antibiotic resistance is on the rise, and has been described by the World Health Organization as a ‘major global threat’, it is important that the reasons for prescribing antibiotics are reviewed. Singer and Thode conducted a meta-analysis of four trials involving a total of 589 patients with cutaneous abscesses who were treated with incision and drainage. They found that the percentage of patients who had been prescribed
Algorithm can help in predicting attendance rates EMERGENCY NURSE
iStock
Journal scan
As resistance to antibiotics rises, their prescription for cutaneous abscesses comes under question
systemic antibiotics, and whose abscesses were completely resolved within between seven and ten days of treatment, was no greater than the percentage of patients who had not been prescribed antibiotics but whose abscesses had resolved within the same period. This evidence suggests that antibiotics are not routinely required in the treatment of simple cutaneous abscesses that are appropriately incised and drained, and are without associated cellulitis. Singer AJ, Thode HC (2014) Systemic antibiotics after incision and drainage of simple abscesses: a meta-analysis. Emergency Medicine Journal. 31, 576-578.
Predicting the unpredictable Emergency department (ED) attendances are, by their nature, unplanned. But if staff can predict the number of people likely to attend over the months ahead, they can make plans to mitigate overcrowding. Researchers in Belgium have tested a forecasting algorithm for calculating the number of ED visits each month for up to one year. The mean absolute percentage error in the results of such calculations is between 2.6% and 4.8%, which is too wide a margin for the algorithm to be useful in predictions of staffing levels one week ahead. However, such results could inform strategic decisions based on estimates of average attendances. Bergs J, Heerinckx P, Verelst S (2014) Knowing what to expect, forecasting monthly emergency department visits: a time-series analysis. International Emergency Nursing. 22, 2, 112-115.
Stroke services In London and Greater Manchester, two slightly different models of centralised stroke service have been adopted. In London, anyone who appears to be having a stroke is taken directly to one of eight hyperacute stroke units. In Manchester, only patients whose stroke symptoms became apparent over the previous four hours are taken directly to stroke centres; all other patients with such symptoms are taken to one of ten district hospitals that provide stroke services. Researchers compared the effects of the two different services on mortality and length of hospital stay by studying 258,915 patients with stroke who had been admitted to hospitals in the two cities between January 2008 and March 2012. In both cities, the average length of stay declined over the 90-day study period. However, the risk-adjusted mortality rate declined in London but not in Manchester. The absolute reduction in mortality achieved in London was -1.1%. The authors conclude that, if this reduction were to be achieved in Greater Manchester, 50 lives could be saved a year. Morris S, Hunter RM, Ramsay AIG et al (2014) Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis. British Medical Journal. 349, 4757. doi: 10.1136/bmj.g4757 Journal scan is compiled by Mark Cooper, who is a lecturer-practitioner in advanced practice at NHS Greater Glasgow and Clyde September 2014 | Volume 22 | Number 5 17
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Reorganising resuscitation A recurring nightmare for emergency nurses is finding out, in the middle of resuscitating a patient, that an essential item is missing. Checking and restocking resus rooms are important activities, but they take up time that nurses could spend on other essential activities. Swanson describes how emergency nurses can undertake these activities more quickly if they follow six sigma principles, which are: sort, simplify, sweep, standardise, [ensure] safety for the workplace and sustain. Swanson C (2014) Reorganizing a resuscitation room using six sigma (6S) principles. Journal of Emergency Nursing. 40, 4, 371-376.
Antibiotic use
iStock
Over the past decade, the number of people with cutaneous abscesses who present to emergency departments, walk-in centres or minor injury units has increased. While there is general agreement that incision and drainage is an appropriate treatment for this condition, it is less clear whether antibiotics should be routinely prescribed. Given that antibiotic resistance is on the rise, and has been described by the World Health Organization as a ‘major global threat’, it is important that the reasons for prescribing antibiotics are reviewed. Singer and Thode conducted a meta-analysis of four trials involving a total of 589 patients with cutaneous abscesses who were treated with incision and drainage. They found that the percentage of patients who had been prescribed
Algorithm can help in predicting attendance rates EMERGENCY NURSE
iStock
Journal scan
As resistance to antibiotics rises, their prescription for cutaneous abscesses comes under question
systemic antibiotics, and whose abscesses were completely resolved within between seven and ten days of treatment, was no greater than the percentage of patients who had not been prescribed antibiotics but whose abscesses had resolved within the same period. This evidence suggests that antibiotics are not routinely required in the treatment of simple cutaneous abscesses that are appropriately incised and drained, and are without associated cellulitis. Singer AJ, Thode HC (2014) Systemic antibiotics after incision and drainage of simple abscesses: a meta-analysis. Emergency Medicine Journal. 31, 576-578.
Predicting the unpredictable Emergency department (ED) attendances are, by their nature, unplanned. But if staff can predict the number of people likely to attend over the months ahead, they can make plans to mitigate overcrowding. Researchers in Belgium have tested a forecasting algorithm for calculating the number of ED visits each month for up to one year. The mean absolute percentage error in the results of such calculations is between 2.6% and 4.8%, which is too wide a margin for the algorithm to be useful in predictions of staffing levels one week ahead. However, such results could inform strategic decisions based on estimates of average attendances. Bergs J, Heerinckx P, Verelst S (2014) Knowing what to expect, forecasting monthly emergency department visits: a time-series analysis. International Emergency Nursing. 22, 2, 112-115.
Stroke services In London and Greater Manchester, two slightly different models of centralised stroke service have been adopted. In London, anyone who appears to be having a stroke is taken directly to one of eight hyperacute stroke units. In Manchester, only patients whose stroke symptoms became apparent over the previous four hours are taken directly to stroke centres; all other patients with such symptoms are taken to one of ten district hospitals that provide stroke services. Researchers compared the effects of the two different services on mortality and length of hospital stay by studying 258,915 patients with stroke who had been admitted to hospitals in the two cities between January 2008 and March 2012. In both cities, the average length of stay declined over the 90-day study period. However, the risk-adjusted mortality rate declined in London but not in Manchester. The absolute reduction in mortality achieved in London was -1.1%. The authors conclude that, if this reduction were to be achieved in Greater Manchester, 50 lives could be saved a year. Morris S, Hunter RM, Ramsay AIG et al (2014) Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis. British Medical Journal. 349, 4757. doi: 10.1136/bmj.g4757 Journal scan is compiled by Mark Cooper, who is a lecturer-practitioner in advanced practice at NHS Greater Glasgow and Clyde September 2014 | Volume 22 | Number 5 17
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 30, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
