Research Audit and Clinical Practice

Characteristics and outcome of acute medical admissions with hyponatremia: even mild hyponatremia is associated with higher mortality

Research Audit and Clinical Practice, Volume 16, Issue 4, Pages 153 – 212 (2017)

Abstract

Hyponatremia is a common finding in hospitalized patients. In this retrospective cohort study we assessed the characteristics and outcome of acute medical admissions with hyponatremia. Compared to the normal sodium group, those with hyponatremia were significantly older and the Charlson Comorbidity Index (CCI) was higher. The number of admissions to MCU/ICU between both groups was similar, but hyponatremic patients had a longer length of stay and both 28-day and one-year mortality were higher, even in patients with mild hyponatremia. Hyponatremia was independently associated with mortality after adjustment for age, CCI and polypharmacy, as was found in the subgroup with mild hyponatremia.

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Measuring impact of telephone triage in Acute Medicine

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Abstract

The Society for Acute Medicine’s Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources.

Calls from Emergency Departments rarely resulted in admission avoidance.

Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant.

Consultant triage might result in admission avoidance but the impact of local context on the effectiveness is not clear.

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Electronic Prompts Can Reduce The Number Of Unnecessary Clotting Screens Ordered For Patients

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Abstract

In an attempt to reduce the number of inappropriate clotting screens being performed in our Trust, an electronic prompt was introduced to our haematology requesting system. Over the six month period after introduction of this prompt the number of clotting screen requests reduced by 7001, representing a 21% reduction when compared to the same 6 month period one year earlier. This represented a cost saving of over £98,000 without any increase in adverse incidents being reported related to bleeding complications.

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Research Protocol: Intravenous Access during Resuscitation: the IVAR trial

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Summary

Objective: To compare the effects of central versus peripheral drug administration on the rate of return of organised electrical activity and/or spontaneous circulation during CPR.

Study design: Randomized clinical trial.

Study population: Hospitalized patients and patients presenting at the emergency department, older than 18 years, requiring CPR.

Intervention: Central venous access

Main study parameters/endpoints: Combined primary endpoint: rate of appearance of organised electrical activity or return of spontaneous circulation.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: All patients are treated according to the guidelines of the European Resuscitation Council, which are endorsed by the local VUMC CPR-committee. Central access will be obtained by cannulation of the external or internal jugular vein. To avoid interference with initial management, central venous access will be obtained after initiation of chest compressions, first attempt at defibrillation (if applicable), securing the airway and obtaining a peripheral access.

All resuscitated patients require vascular access and almost all successfully resuscitated patients require central venous access. Obtaining central access during CPR may be associated with a slightly higher complication rate, such as arterial puncture and pneumothorax. Possible benefits for study subjects are a higher success rate of CPR.

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Medical High Dependency Unit series, Article 3: Respiratory Support in the MHDU

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Abstract

Acute respiratory failure is a life threatening condition encountered by Acute Physicians; additional non-invasive support can be provided within the medical high dependency unit (MHDU). Acute Physicians should strive to be experts in the investigation, management and support of patients with acute severe respiratory failure. This article outlines key management principles in these areas and explores common pitfalls.

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Abstracts from Oral Presentations at the Society for Acute Medicine Autumn Conference

Research Audit and Clinical Practice, Volume 16, Issue 3, Pages 101 – 152 (2017)

Birmingham International Centre, 11-12th September 2017

As usual a large number of abstract submissions were received for the autumn meeting of the Society for Acute Medicine, which was held this year in the Birmingham International Centre on 11th-12th September. A large number of these were displayed as posters throughout the meeting, and twelve were selected for oral presentation. The abstracts from the oral presentation session are published here.

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The prognostic efficacy of beta2-microglobulin in acute pulmonary embolism

Research Audit and Clinical Practice, Volume 16, Issue 2, Pages 49 – 100 (2017)

Our aim was to prospectively assess the prognostic value of beta2- microglobulin (b2-M) in patients with acute pulmonary embolism (PE). We conducted a prospective study of 109 patients admitted in a pulmonary clinic due to acute PE. A panel of inflammatory markers including b2-M white blood cell (WBC) count and C-reactive protein (CRP) was determined for each patient. In this preliminary study, baseline b2-M levels significantly correlated with the impairment of oxygenation and with all the parameters that are used for the early risk stratification of patients. In multivariate analysis, patients’ age and baseline b2-M levels were significantly associated with an increased risk of death.

These findings require further prospective validation.

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Predicting length of stay for acute medical admissions using the ALICE score: a simple bedside tool

Research Audit and Clinical Practice, Volume 16, Issue 2, Pages 49 – 100 (2017)

Background: Early identification of patients likely to have a short admission permits best use of limited resources to facilitate rapid discharge where possible. The ALICE score is a simple bedside tool developed in one hospital as a decision aid. This study sought to confirm its widespread applicability.

Method: Retrospective review of 250 consecutive admissions at five acute hospitals. Clinical records were reviewed for a total of 1003 patients. ALICE score was calculated for each patient and compared to LoS data.

Results: There was a statistically significant positive correlation between rising ALICE scores and increasing length of stay irrespective of final diagnoses.

Conclusion: The ALICE score provides a simple bedside tool to predict length of stay.

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The Experience of a District General Hospital with a Large Outdoor Music Festival in England

Research Audit and Clinical Practice, Volume 16, Issue 2, Pages 49 – 100 (2017)

Objectives: To assess the impact of the Parklife annual music festival on the local hospital, North Manchester General.

Methods: Data was obtained retrospectively by analysis of emergency department records during the weekend of Parklife 2015.

Results: 32 patients were identified, 56% reported taking drugs. 34% were admitted for overnight observation. 4 patients presented with methaemoglobinaemia following oral ingestion of amyl nitrate. One patient had a methaemoglobin fraction of 90.6%, which is amongst the most extreme recorded in literature.

Conclusion: Music festivals can impose a burden on local health services. Organisers should operate an efficient surveillance system in order to prevent the sale and use of recreational drugs, providing adequate on-site health services and working in collaboration with local emergency services.

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Abstracts from the Oral Presentation session at the Society for Acute Medicine Spring meeting

Research Audit and Clinical Practice, Volume 16, Issue 2, Pages 49 – 100 (2017)

Mercure Hotel, Cardiff, 4-5th May 2017

As usual a large number of abstracts were submitted for consideration of inclusion in the spring meeting of the Society for Acute Medicine, which was held in the Mercure Holland House hotel, in Cardiff, and hosted by Dr Nerys Conway. Over 100 abstracts were selected for display as posters, and seven of these were presented orally. The abstracts from the oral presentations are published here.

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