Volume 23, Issue 1, Pages 1 – 52 (2024)

ORF disease: a case report with images

Case Reports, Volume 23, Issue 1, Pages 1 – 52 (2024)

This article presents the case of a 25-year-old Moroccan male who contracted Orf disease (Ecthyma contagiosum), a common zoonotic viral infection in sheep and goats. The disease, caused by a parapoxvirus, can be transmitted to humans through contact with infected animals. The patient developed painful lesions on his fingers after interacting with a sheep during the Feast of Sacrifice. Diagnosis was clinically established considering exposure history and lesion characteristics. Treatment involved local antiseptics and 2% fusidic acid cream. The lesions resolved spontaneously over a few weeks without functional impairment

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An unexpected case of acute intermittent porphyria

Case Reports, Volume 23, Issue 1, Pages 1 – 52 (2024)

Acute Intermittent Porphyria (AIP) can be a challenging diagnosis to make, due to its rarity in actual practice and presenting symptoms often being attributed to more common conditions. This is particularly the case, since many patients will likely present to acute and general hospitals where the diagnosis may often not be considered. However, it remains pivotal to diagnose the condition as early as possible to prevent significant morbidity and even death. Here we present an unexpected case of AIP, illustrating the diagnostic delay that is commonly seen with the condition and yet emphasise the importance of its detection to commence urgent treatment.

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Point-of-care ultrasound for the diagnosis of an atypical small bowel obstruction in a cannabis user: a case report

Case Reports, Volume 23, Issue 1, Pages 1 – 52 (2024)

This case report describes an atypical small bowel obstruction in a 71- years old cannabis user and how point-of-care of ultrasound (PoCUS) helped to its management by further orientating the physician toward the bowel obstruction etiology, namely intussusception. Intussusception is the invagination of an intestinal segment into the adjacent segment. The acute clinical presentation of intussusception often has non-specific symptoms, and the diagnosis can be challenging. While the most common etiology is neoplasm, intussusception also occurs in bowel motility disorder such as after cannabis use. Although this case report illustrates intussusception PoCUS findings, these should nevertheless be integrated into the clinical picture and CT-scan should remain the gold standard complementary examination in case of a suspected bowel obstruction.

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Point of Care Ultrasound Bladder Volume Calculation on the Acute Medical Unit

Original Articles, Volume 23, Issue 1, Pages 1 – 52 (2024)

Nursing staff, healthcare assistants (HCAs) and other healthcare professionals on the Acute Medical Unit (AMU) at Royal Berkshire Hospital (RBH) were taught a Point of Care Ultrasound (POCUS) skill during a twenty minute session. Practitioners learned how to take bladder volume measurements with the Butterfly iQ, a portable ultrasound device which provides a visually-aided method of volume measurement. A Likert scale was used to measure the confidence that staff had in performing volume measurements with the AMU automated scanners, and with the semi-automated Butterfly iQ. After the teaching session, confidence reported by practitioners in using the semi-automated visual method was significantly higher than confidence reported in using the automated non-visual scanners (t < 0.001). Minimal time and expense was required to teach practitioners how to perform this skill. Training nurses in POCUS for bladder visualisation and bladder volume calculation is easy and practicable.

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Improving Telemetry use in the Acute Assessment Unit

Original Articles, Volume 23, Issue 1, Pages 1 – 52 (2024)

Background and Aims: Despite published guidelines, telemetry use is inappropriate in 25-43% of cases. This impacts patient safety and telemetry effectiveness. QI methodology was used to review telemetry in a hospital acute medical unit with the aim of reducing inappropriate use and addressing alarm fatigue.
Methods: A ‘Telemetry Indication Form’ was created. Eight weeks of baseline data was collated before introducing the ‘Indication Form’. Four plan-do-study-act cycles were conducted. At each cycle, data was analysed using statistical process control charts.
Results: Inappropriate telemetry use significantly reduced from 32% to 4%. Total telemetry use also fell. Unfortunately, interventions to address alarm rates did not result in significant reduction in false alarms.
Conclusions: A ‘Telemetry Indication Form’ has significant potential to improve patient safety through reducing inappropriate use.

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Implementing a Digital Deteriorating Patient Pathway to improve the safety and effectiveness of care of the adult deteriorating patient

Original Articles, Volume 23, Issue 1, Pages 1 – 52 (2024)

Identification, escalation and clinical review of the deteriorating patient is essential for a safe and effective hospital. We present a deteriorating patient pathway developed within our electronic patient record, including implementation of a digital escalation and senior review process, triggered from a logic algorithm and vital signs. The pathway is activated by an average 43 patients per day with median mortality of 13.3%. Our Trust has seen a significant improvement in escalation and senior review and increased use of treatment escalation plans. The pathway has facilitated a cultural shift in the Trust towards the deteriorating patient. The new pathway is transferrable to both other digital Trusts as well as maternity and paediatric practice.

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Evaluating dynamic patterns in mortality before and after reconfiguration of the Danish emergency healthcare system

Original Articles, Volume 23, Issue 1, Pages 1 – 52 (2024)

Background: This study explored changes in short-term mortality during a national reconfiguration of emergency care starting in 2007.
Methods: Unplanned hospital contacts at emergency departments across Denmark from 2007 to 2016. The reconfiguration was a natural experiment, resulting in individual timelines for each hospital. The outcome was in-hospital and 30-day mortality.
Results: Individual patient-level data included 9,745,603 unplanned hospital contacts from 2007 to 2016 at 20 hospitals with emergency departments. We observed a sharp downwards shift in in-hospital mortality and 30-day mortality in three hospitals in relation to the reconfiguration.
Conclusion: This nationwide study identified three hospitals where the reconfiguration was closely associated with reduced in-hospital and 30-day mortality. In contrast, no major effects were identified for the remaining hospitals.

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Improving emergency department flow by introducing a simple time out moment (The TRAFFIC LIGHT study)

Original Articles, Volume 23, Issue 1, Pages 1 – 52 (2024)

Background and importance: Long waiting times in the emergency department (ED) is an increasing problem in the recent years and is expected to become an even bigger problem in the future
Objective: We aimed to test the hypothesis whether increasing awareness of the time lapse with the treating physician, 2 hours after patient arrival, can reduce long patient turnaround time (TAT).
Method: In this prospective single-center cohort study we compared and analyzed patient TAT in the ED before and after implementation of a so called ‘traffic light’ moment 2 hours after patient arrival. At this ‘traffic light” moment a team member contacted the treating physician to increased awareness over the time lapse. Difference in percentage of patients who stayed more than 4 hours in the ED before and after intervention was the primary outcome
Results: Between October 2nd 2021 and January 2nd,2022 1494 patients were included for primary outcome analysis. A total of 419 patients (n=740, 56.6%) had a TAT of less than 4 hour in the ED before intervention, compared to 497 (n=754, 65.9%) after intervention (p <0.001). Median time spent in de ED before intervention was 3:40 (IQR 2:24 – 5:04) compared to 3:15 (IQR 2:03 – 4:38) after intervention (p<0.001). Conclusion: This simple and low-cost intervention reduces the ED length of stay significantly. Although multiple interventions will be required to ensure less patients spending more than 4-hours in the ED, a ‘traffic light’ moment can be a simple and an effective tool.

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