Emergency Medicine Refresh (priority setting in association with the JLA)

Top 10 priorities

1. How can care for mental health patients be optimised, whether presenting with either/both physical and mental health needs; including appropriate space to see patients, staff training, early recognition of symptoms, prioritisation, and patient experience?
2. In older, frail patients with injury, how can assessment be optimised (including specific trauma assessment/call activation), management, clinical outcomes and patient experience?
3. What is the optimal management strategy for patients taking anti-platelets and anticoagulants who sustain head injuries?
4. In patients with acute low back pain, are there signs and symptoms which should lead to an emergency magnetic resonance investigation (MRI) being performed to rule out cauda equina syndrome, a condition which requires urgent management?
5. How can excellence be achieved in delivering end of life care in the Emergency Department? How can patients, families and staff be best supported with handling bereavement issues?
6. What measures and interventions can be used to reduce the harms of crowding in the Emergency Department and prioritise patient care most effectively?
7. How can patients who present to the Emergency Department with Acute Aortic Syndrome be identified, and are there decision tools which can reduce overuse of computer tomography scans to identify these patients?
8. In patients suffering traumatic injuries where bleeding is suspected, what are the most effective treatments in the Emergency Department setting to improve survival?
9. Can a blood test (biomarker) help identify those patients who present with sepsis to the Emergency Department that require early treatment and improve patient outcomes?
10. How can work/life balance be improved amongst Emergency Department staff to better retain our staff, including rota design and other working conditions and with regard to how ED staff development is managed, what initiatives can improve staff engagement, resilience, retention, satisfaction, individuality and responsibility?

The following questions were also discussed and put in order of priority at the workshop:

11. How does Emergency Medicine compare in cost/quality of care/patient experience compared to other healthcare options e.g. urgent care centres, GP hubs
12. Do early undifferentiated (broad spectrum) antibiotics in suspected severe sepsis have a greater benefit and cause less harm to patients than delayed focussed antibiotics, in the Emergency Department?
13. Following injury, which patients should undergo a whole-body CT scan for investigation and management, and what is the risk and predictors of significant injury?
14. Are smaller, thinner drains as effective as large wider drains for penumothorax and haemothorax ?
15. How can patient and public involvement and engagement be increased to ensure Emergency Medicine research is patient directed and inclusive?
16. After an injury some patients lose so much blood that their life is put at risk. Does replacing the lost blood with whole blood (red cells, plasma and platelets) improve outcomes for patients and is it cost effective, compared to standard care (blood, plasma and platelets given individually)
17. Does having a senior emergency medicine clinician involved in triage of patients improve the flow of patients in the department and the experience and care that patients receive?
18. How can the Emergency Department environment be made better for patients and staff?
19. In those patients who present over 24 hours after experiencing a mild head injury who should undergo a CT head scan?
20. What is the best way to care for people who attend emergency departments very frequently?
21. Point-of-care testing (POCT) is rapid laboratory testing conducted and analysed close to the site of patient care. Is POCT in the Emergency Department for cardiac troponin safe and beneficial to use?
22. Does giving intravenous fluid to an elderly patient who has been lying on the floor for over two hours reduce the risk of developing an acute kidney injury or reduce their length of stay in hospital?
23. What interventions (such as inpatient ward ‘boarding’) can be done to reduce the excess mortality risk of patients having to spend long hours in Emergency Department waiting for admission to inpatient wards?
24. In patients presenting to the Emergency Department with minor head injury which blood biomarker tests can predict long-term outcome?
25. For patients with minor head injuries, can a blood test used alone or in conjunction with NICE clinical decision rules be used to determine which patients require a CT scan to exclude a significant brain injury?
26. What is the prevalence of neurodivergence in the Emergency Department workforce and patient populations, and how can the care experience for these patients be improved?