Summary This paper reports the findings of a survey of UK consultant nurses in emergency care. The purpose of the survey was to elicit information regarding level of preparation for the consultant nurse role, the use of formal competency frameworks, current clinical scope of practice and perspectives on future preparation for the role. A semi-structured questionnaire was emailed to consultant nurses in emergency care. Respondents had an average of only 2 years in post and for 24% of respondents this was their second post as a consultant nurse. The survey identified that three quarters of the respondents had no specific preparation for the consultant nurse role. The remainder had varying levels of preparation ranging from brief induction to 6-month clinical training. It could be argued that this diversity of preparation is a reflection of the lack of clarity regarding the consultant nurse role and the ill-defined organisational frameworks within which some consultant nurse posts were established. With the exception of the expert practice domain and clinical leadership, the majority of respondents felt under prepared for one or more elements of the consultant nurse role. Clinically their scope of practice ranged from managing patients with minor illness or injury, to leading resuscitation teams. There was great

No abstract

BackgroundThe National Early Warning Score (NEWS) calculated from physiological observations provides a simple away to identify and respond to the deteriorating patient. There is increasing interest in the application of NEWS to facilitate referrals from the community.AimTo establish whether elevated NEWS are associated with adverse outcomes at 5 and 30 days when obtained in a community setting at the time of transfer to an acute setting.Design & settingA retrospective service evaluation was undertaken using a database of emergency admissions to secondary care from two NHS district general hospitals within the South of England between January 2018 and April 2019.MethodThe performance of NEWS recorded in a community setting to predict death or critical care admission at 5 and 30 days was calculated using established thresholds.Results2786 referrals from primary care were analysed. The 5 day and 30 day mortality was 2.2% (1.7 to 2.8) and 7.1% (6.2 to 8.1). The prevalence of the composite outcome was 3.4% (2.8 to 4.2) at 5 days and 8.5% (7.5 to 9.6) at 30 days. The risk of adverse outcomes increased incrementally with increasing NEWS. When calculated at the point of referral from primary care the positive predictive value of death at 5 and 30 days was 15% (95% confidence intervals [CI] = 12 to 19) and 23% (95% CI = 17 to 30) in the high-risk NEWS group.ConclusionElevated NEWS obtained in the community during the process of emergency admission are associated with adverse outcomes. Communicating NEWS may allow downstream care to be better calibrated to risk.

No abstract

than those with short evacuation times. Strategies used by mountain rescue services may be effective in preventing (possibly reversing) heat loss. However it's also possible that sick/injured casualties who are already very cold might be more likely to be evacuated by helicopter, thus reducing transit time to hospital. This preliminary, retrospective data deserves validation with a prospective study ideally with temperatures measured as rescuers arrive on-scene.Introduction Ambulance crews make 3.6 million emergency journeys each year. Effective patient transfer relies on verbal, non-verbal and documentary handover of complex information in time-limited environments. Weaknesses in ambulance handover have been noted but little work has been done to investigate the process and identify good practice. Research has looked at communication during transfer of care; standardised resuscitation handover formats have been used but do not always improve accuracy. Ineffective handover threatens patient safety, quality and efficiency of care. This study provides an in-depth examination of handover to inform practice and education. Method We are conducting an ethnographic case study of handover in an ambulance Trust. Researchers are accompanying crews as they undertake their day-to-day work, using observation and videorecording to capture handoverdfrom data collection at scene, prealerting (by radio, telephone and computer) through to the hospital. We are also collecting information from patient records along with training materials, policies and directives pertaining to handover. Ethnography allows for informal conversations to take place as appropriate during the fieldwork to clarify understandings and explore emerging themes in the analysis. In addition we are using semi-structured interviews with patients, carers, ambulance staff, nurses, doctors and non-clinical hospital staff to explore the handover process.Result The project started 2nd April 2009. This poster will outline the methodology, present some of the emerging themes from our analysis and describe future data collection and analysis plans. Discussion This is an ongoing project. We will present our experience of undertaking this unusual projectdespecially issues surrounding accessing staff and the practicalities of data collection. By presenting this work we seek to inform future research into emergency care.