Acute care

Practice Review: Red cell transfusion in urgent and emergency care

Original Articles, Volume 24, Issue 1, Pages 1 – 60 (2025)

Transfusion of red blood cells is routine in acute care settings and adverse events are not uncommon. While bleeding protocols are familiar to acute physicians, guidance is less clear for non-bleeding patients. This review offers consolidated guidance on transfusion in the adult acute patient, including restrictive targets and the use of alternatives in anaemia, the role of group O emergency red blood cells (RBC) and important considerations in individuals with childbearing potential, immunosuppressed patients and transfusion-dependent patients.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Practice Review: Red cell transfusion in urgent and emergency care Read More

Emergency department crowding and older patients: a nationwide retrospective cohort study

Original Articles, Volume 22, Issue 2, Pages 57 – 108 (2023)

Emergency department (ED) crowding is a worldwide problem and one of the main causes internationally is an increase in presentations by older patients with complex and chronic care needs. Although there has been a 4,3% reduction in total ED visits from 2016-2019 in the Netherlands, the EDs still experience crowding.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Emergency department crowding and older patients: a nationwide retrospective cohort study Read More

Use of procedural ultrasound for the insertion of peripheral intravenous catheters: A nationwide survey in acute care departments in Belgium

Original Articles, Volume 22, Issue 1, Pages 1 – 56 (2023)

Purpose: Assessment of ultrasound use for peripheral intravenous cannulation among acute care nurses and physicians.
Methods: Over a population of 17,437, the calculated sample size of respondents required was 376.
Results: A total of 388 health professionals; 249 (64.2%) physicians and 139 (35.8%) nurses completed the entire questionnaire. 166 (45.2%) used ultrasound for intravenous cannulation. A statistically significant difference favored physicians’ ultrasound use (p<0.001). Respondents with less than 10 years of clinical practice used ultrasound significantly more (p<0.001). The main reported obstacle among users was the lack of time. Conclusion: This survey revealed the gap between the current recommendations for ultrasound use for peripheral intravenous cannulation and the actual practices. Efforts should be made to develop specific training using ultrasound.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Use of procedural ultrasound for the insertion of peripheral intravenous catheters: A nationwide survey in acute care departments in Belgium Read More

Centralization of emergency hospital care is not associated with increased in-hospital mortality; a population-based cohort study

Original Articles, Volume 22, Issue 1, Pages 1 – 56 (2023)

Background: We describe changes in the distance travelled, the utilization of emergency services, and the in-hospital mortality before and after the centralization of hospital emergency services in Denmark.
Methods: All unplanned non-psychiatric hospital contacts from adults (aged ≥18 years) in 2008 and 2016 are included. Analyses are age-standardized and conducted at a municipality level. The municipalities are divided into groups according to the presence of emergency hospital services.
Results: Municipalities where hospitals with emergency services have been closed differed by having the most significant increase in distance travelled from 2008 to 2016. All groups experienced a reduction in overall in-hospital mortality. The reduction in mortality was not present for acute myocardial infarct contacts from municipalities where hospitals with emergency services have been closed.
Conclusion: Our data do not suggest that hospital closures, and thereby increased travel distance, have contributed significantly as a barrier to emergency-care access and changes to in-hospital mortality.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Centralization of emergency hospital care is not associated with increased in-hospital mortality; a population-based cohort study Read More

Co-design of interventions to improve acute care in hospital: A rapid review of the literature and application of the BASE methodology, a novel system for the design of patient centered service prototypes

Original Articles, Volume 21, Issue 4, Pages 165-208 (2022)

Co-design in acute care is challenged by the inability of unwell patients to participate in the process and the often transient nature of acute care.
We undertook a rapid review of the literature on co-design, co-production and co-creation of solutions for acute care that were developed with patients. We found limited little evidence for co-design methods in acute care.
We adapted a novel design driven method (BASE methodology) that creates stakeholder groups through epistemological criteria for the rapid development of interventions for acute care. We demonstrated feasibility of the methodology in two case studies:
A mHealth application with checklists for patients undergoing treatment for cancer and a patient held record for self-clerking on admission to hospital.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Co-design of interventions to improve acute care in hospital: A rapid review of the literature and application of the BASE methodology, a novel system for the design of patient centered service prototypes Read More

Evaluating quality in acute care using patient reported outcome measures: a scoping review

Clinical Reviews, Volume 20, Issue 1, Pages 1-88 (2021)

The aim of this scoping review is to identify patient reported outcome measures (PROMs) in acute care settings, assess their psychometric properties and provide recommendations for their use in daily practice. We performed a search in the PubMed database to identify publications concerning PROMs in an acute care setting. The COSMIN checklist was used to assess the psychometric properties of the reported PROMs. We found 1407 publications and included 14 articles, describing 15 measures. Most publications provided limited information on psychometric properties. Three generic PROMs were deemed of adequate quality for use in acute care. We recommend future development and evaluation of PROMs focussing on acute care to further evaluate and improve the quality of acute care.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Evaluating quality in acute care using patient reported outcome measures: a scoping review Read More

Clinical Reliability of point-of-care tests to support community based acute ambulatory care

Original Articles, Volume 19, Issue 1, Pages 1 - 60 (2020)

Objective: To ensure clinicians can rely on point-of-care testing results, we assessed agreement between point-of-care tests for creatinine, urea, sodium, potassium, calcium, Hb, INR, CRP and subsequent corresponding laboratory tests.

Participants: Community-dwelling adults referred to a community-based acute ambulatory care unit.

Interventions: The Abbott i-STATTM (Hb, clinical chemistry, INR) and the AfinionTM Analyser (CRP) and corresponding laboratory analyses.

Outcomes: Agreement (Bland-Altman) and bias (Passing-Bablok regression).

Results: Among 462 adults we found an absolute mean difference between point-of-care and central laboratory analyses of 6.4g/L (95%LOA -7.9 to +20.6) for haemoglobin, -0.5mmol/L (95%LOA -4.5 to +3.5) for sodium, 0.2mmol/L (95%LOA -0.6 to +0.9) for potassium, 0.0mmol/L (95%LOA -0.3 to +0.3) for calcium, 9.0 μmol/L (95%LOA -18.5 to +36.4) for creatinine, 0.0mmol/L (95%LOA -2.7 to +2.6) for urea, -0.2 (95%LOA -2.4 to +2.0) for INR, -5.0 mg/L (95%LOA -24.4 to +14.4) for CRP.

Conclusions: There was acceptable agreement and bias for these analytes, except for haemoglobin and creatinine.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Clinical Reliability of point-of-care tests to support community based acute ambulatory care Read More

Effective acute care handover to GP: optimising the structure to improve discharge documentation

Original Articles, Volume 17, Issue 2, Pages 57 – 116 (2018)

Abstract

Time and resource constraints have often led to the use of assessment records as discharge communications from acute and emergency departments. However, whether this addresses the primary care needs has not been demonstrated. This study examined the optimal structure that can impart key discharge information effectively using feedback from general practitioners (GP). We implemented an electronic assessment template that focused on the most relevant headings. Prespecified process measures were examined and qualitative thematic analysis of free-text comments from GP surveys were conducted to optimise the document. Our findings suggest that the structure of a discharge summary can influence the quality of information, users’ compliance and readers’ perceptions of the length of the letter.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Effective acute care handover to GP: optimising the structure to improve discharge documentation Read More

Improving acute care for older people at scale – the Acute Frailty Network

Research Audit and Clinical Practice, Volume 15, Issue 4, Pages 165 – 220 (2016)

Older people form a growing proportion and volume of those accessing urgent care. Non-specific presentations, multiple comorbidities and functional decline make assessment and management of this cohort challenging. Comprehensive Geriatric Assessment offers an evidence based framework to assess and mange older people, especially those with frailty. In this article we describe the CGA approach, underpinned by specific examples illustrating some of the key competencies required, and describe the role of the Acute Frailty Network (AFN). The AFN is a national improvement collaborative designed to support hospitals in delivering evidence based care for older people with frailty and urgent care needs. We describe the principles underlying the approach of the AFN, derived from working with over 20 hospitals, and some of the early successes.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Improving acute care for older people at scale – the Acute Frailty Network Read More

Improving acute care for adolescents and young adults on medical admission units: The interventions that matter

Viewpoint, Volume 15, Issue 3, Pages 109 – 164 (2016)

It had become a familiar routine. My seventh admission with diabetic ketoacidosis (DKA) in a year. Each time I was admitted it was the same; a DKA protocol, a diabetes specialist nurse visit, and a few questions from the doctors checking if “everything is okay?” On each admission, I would be discharged home after a couple of days. We all knew I’d be back again within a month or two.

Please subscribe to see more.
Subscribe
Already a member? Log in here

Improving acute care for adolescents and young adults on medical admission units: The interventions that matter Read More

Shopping Basket
Scroll to Top

Start typing and press enter to search

Start typing and press enter to search