Objectives-The aim of this study was to examine the quality of handover of patients in the resuscitation room by describing the current perceptions of medical and ambulance staV. Methods-This was a descriptive survey using two anonymous questionnaires to gauge current opinion, one designed for medical staV and the other for ambulance staV. Questionnaires were distributed to medical staV in two teaching hospital accident and emergency (A&E) departments and ambulance personnel in the Tayside region of Scotland. Results-30 medical and 67 ambulance staV completed questionnaires. Some 19.4% of ambulance staV received formal training in giving a handover, 83% of the remaining felt there was a need for training. Medical staV conveyed their belief that handovers were very variable between crews and that they did not feel radio reports were well structured. Ambulance crews felt that medical staV did not pay attention to their handovers. Ambulance staV seemed satisfied with the quality of their handovers, although medical staV were less positive particularly in the context of self poisoning and chest pain. Both seem to be least confident with regards to the handover of paediatric emergencies. Medical staV were generally less satisfied with the reporting of vital signs than the history provided. Conclusions-Despite a generally positive perception of handovers there may be some room for improvement, in particular in the area of medical emergencies. Ambulance staV training should produce a structure for the handover that is recognisable to medical staV. The aim being a smooth and eYcient transfer from prehospital agencies to A&E staV. (Emerg Med J 2001;18:293-296) Keywords: handover; ambulanceThe management of patients in the resuscitation room of emergency departments has been the focus of several life support courses, dealing with trauma, cardiac arrest, medical emergencies, and paediatric emergencies. The aim is to provide speedy, focused intervention in an organised manner to reduce morbidity and mortality. The quick dissemination of information from prehospital staV to medical staV is essential to achieving this end.The handover of patients is a stressful event as it may happen in the middle of resuscitation. Anecdotal accounts are often produced by medical and ambulance staV to illustrate perceived inadequacies in the process. However, the adequacy of this interface has not previously been studied in the United Kingdom. The aim of this study is to examine this aspect of patient care by describing current perceptions of medical and ambulance staV. MethodsThis was a descriptive survey using two questionnaires to gauge current opinion. The first questionnaire was designed for medical staV to complete and the second was for ambulance staV. The questionnaires were completed anonymously. A single abstractor who was unblinded to the purpose of the study extracted the information.Questionnaires were distributed to all 47 medical staV in two teaching hospital accident and emergency (A&E) departments, seeing a combine...

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Senior doctor input in patient care in the ED adds accuracy to disposition decisions, impacting on patient safety and improving departmental flow.

Objective: Airway care is the cornerstone of resuscitation. In UK emergency department practice, this care is provided by anaesthetists and emergency physicians. The aim of this study was to determine current practice for rapid sequence intubation (RSI) in a sample of emergency departments in Scotland. Methods: Two year, multicentre, prospective observational study of endotracheal intubation in the emergency departments of seven Scottish urban teaching hospitals. Results: 1631 patients underwent an intubation attempt in the emergency department and 735 patients satisfied the criteria for RSI. Emergency physicians intubated 377 patients and anaesthetists intubated 355 patients. There was no difference in median age between the groups but there was a significantly greater proportion of men (73.2% versus 65.3%, p=0.024) and trauma patients (48.5% versus 37.4%, p=0.003) in the anaesthetic group. Anaesthetists had a higher initial success rate (91.8% versus 83.8%, p=0.001) and achieved more good (Cormack-Lehane Grade I and II) views at laryngoscopy (94.0% versus 89.3%, p=0.039). There was a non-significant trend to more complications in the group of patients intubated by emergency physicians (8.7% versus 12.7%, p=0.104). Emergency physicians intubated a higher proportion of patients with physiological compromise (91.8% versus 86.1%, p=0.027) and a higher proportion of patients within 15 minutes of arrival (32.6% versus 11.3%, p<0.0001). Conclusion: Anaesthetists achieve more good views at laryngoscopy with higher initial success rates during RSI. Emergency physicians perform RSI on a higher proportion of critically ill patients and a higher proportion of patients within 15 minutes of arrival. Complications may be fewer in the anaesthetists' group, but this could be related to differences in patient populations. Training issues for RSI and emergency airway care are discussed. Complication rates for both groups are in keeping with previous studies.

Sedation for short but potentially painful procedures is often undertaken in the emergency department. The ideal sedative regimen should provide analgesia and anxiolysis with minimal side effects and cardiorespiratory depression and rapid recovery post-procedure. Propofol has found increasing popularity with anaesthetists for sedation in the operating theatre. This is a review of the current literature looking at the use of propofol for procedural sedation in the emergency department. A comprehensive literature search of Medline from 1966 to week 4 of 2005, Embase from 1980 to week 10 of 2005, and the Cochrane Library was carried out using the OVID interface. Eight articles were selected for review. The evidence suggests that propofol is both effective and safe to use in the emergency department. However, several of the papers reviewed used deep levels of sedation that are not recommended in the UK by non-anaesthetists.