Trauma surgeon becomes consultant: Evaluation of a protocol for management of intermediate-level trauma patients

Fallon, Sara C.; Christopher, Daniel; Frost, Mary; Wesson, David E.; Naik‐Mathuria, Bindi

doi:10.1016/j.jpedsurg.2013.09.052

Cited by 7 publications

(8 citation statements)

References 7 publications

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“…Similarly, the authors of 4 studies 67,69,74,75 examined changes in resource use after a staffing and/or structural change (eg, a dedicated pediatric ED or staffing changes), although the authors of 1 study 67 saw greater reductions than was reported in other studies, and they implemented a staffing and/or structure change with supporting education. The authors opened a dedicated "small baby unit" separate from the NICU, with processes promoting continuity of care and education for staff.…”

Section: Figurementioning

confidence: 99%

Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review

et al. 2018

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Section: Figurementioning

confidence: 99%

Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review

et al. 2018

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“…Among the six before–after studies, despite high heterogeneity (I 2 = 99%) in the pooled analysis (MD −0.99, 95% CI −1.43 to –0.56), five of the studies reported a significant decrease in ED LOS among patients in the groups where consultations were bypassed compared to control patients (see Figure 5). 24,25,27,37,38,41 Finally, one cohort study also reported a significant decrease in ED LOS among intervention patients (MD −4.34, 95% CI −4.61 to –4.07; see Figure 5). 26 …”

Section: Resultsmentioning

confidence: 90%

“…The majority of the included studies were conducted in North America (United States n = 12, 16–28 Canada n = 6 29–34 ) with a smaller number of studies conducted in Asia (South Korea n = 5, 35–39 Singapore n = 2, 40,41 Thailand n = 1, 42 Taiwan n = 1, 43 India = 1 44 ) and Europe (Ireland n = 1, 45 Turkey n = 2, 46,47 ; see Table 1). The studies were mainly conducted in a single ED site 16–25,27,29–32,34–50 . The majority of studies utilized a before/after study design ( n = 25, 71%), of which one study used a controlled before/after design 39 .…”

Section: Resultsmentioning

confidence: 99%

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Interventions to improve consultations in the emergency department: A systematic review

Voaklander

Gaudet

Kirkland

et al. 2022

Academic Emergency Medicine

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Objectives Emergency department (ED) consultations with specialists are necessary for safe and effective patient care. Delays in the ED consultation process, however, have been shown to increase ED length of stay (LOS) and contribute to ED crowding. This review aims to describe and evaluate the effectiveness of interventions to improve the ED consultation process. Methods Eight primary literature databases and the gray literature were searched to identify comparative studies assessing ED‐based interventions to improve the specialist consultation process. Two independent reviewers identified eligible studies, assessed study quality, and extracted data. Individual or pooled meta‐analysis for continuous outcomes were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using a random‐effects model was conducted. Results Thirty‐five unique comparative intervention studies were included. While the interventions varied, four common components/themes were identified including interventions to improve consultant responsiveness (n = 11), improve access to consultants in the ED (n = 9), expedite ED consultations (n = 8), and bypass ED consultations (n = 7). Studies on interventions to improve consult responsiveness consistently reported a decrease in consult response times in the intervention group with percent changes between 10% and 71%. Studies implementing interventions to improve consult responsiveness (MD −2.55, 95% CI −4.88 to –0.22) and interventions to bypass ED consultations (MD −0.99, 95% CI −1.43 to –0.56) consistently reported a decrease in ED LOS; however, heterogeneity was high (I2 = 99%). Evidence on whether any of the interventions were effective at reducing the proportion of patients consulted or subsequently admitted varied. Conclusions The various interventions impacting the consultation process were predominately successful in reducing ED LOS, with evidence suggesting that interventions improving consult responsiveness and improving access to consultants in the ED also improve consult response times. Health care providers looking to implement interventions to improve the ED consultation process should identify key areas in their setting that could be targeted.

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“…They have also been shown to improve the patient experience, prevent treatment delays, reduce the length of hospital admissions and keep down overall hospital costs. [10][11][12] Epistaxis is a common emergency. The current management of this condition has changed with the technical advances in interventional radiology.…”

Section: Discussionmentioning

confidence: 99%

Compliance of ENT emergency surgery with the Royal College of Surgeons standards

Sharma

Yao

Mahalingam

et al. 2016

annals

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INTRODUCTION In 2011The Royal College of Surgeons of England (RCS) set out best practice standards for emergency surgery. This national pilot audit aimed to determine the compliance of otolaryngology departments in England with these published guidelines. METHODS A 26-item online questionnaire was devised that encompassed all the 36 best practices as set out by the RCS for ear, nose and throat (ENT) surgery. This was sent to ENT trainees and consultants based at units in England providing emergency ENT services. RESULTS Data were obtained from 55 of the 102 units (response rate: 54%). A mean compliance of 71% was achieved (range: 25-94%). No units achieved all of the best practices. The standards with the highest compliance included 24-hour availability of blood transfusion and haematology opinion for patients with epistaxis, availability of a consultant or ST3/equivalent for immediate discussion of severe post-tonsillectomy bleeding, 24-hour access to blood transfusion for arrest of haemorrhage and immediate theatre access for arrest of haemorrhage. The areas with the lowest compliance were provision of a pathway for angiography/embolisation for epistaxis and provision of an equipped ENT room on a paediatric ward. CONCLUSIONS This audit has highlighted that the majority of departments in England are providing a good standard of ENT emergency care. There is room for improvement in certain areas, such as the provision of an embolisation pathway in the context of refractory epistaxis. We hope that this audit will encourage ENT departments to evaluate their current provision of emergency care and institute changes (where necessary) to maintain and improve their practices.

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Trauma surgeon becomes consultant: Evaluation of a protocol for management of intermediate-level trauma patients

Cited by 7 publications

References 7 publications

Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review

Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review

Interventions to improve consultations in the emergency department: A systematic review

Compliance of ENT emergency surgery with the Royal College of Surgeons standards

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