COVID-19 presented unique challenges in preparing our stand-alone children’s emergency department for the pandemic and has demonstrated well the paediatric adage, ‘children aren’t little adults’.
BackgroundPoint Of Care Ultrasound (POCUS) is a potentially useful addition to the technical armamentarium of PEM clinicians. Evidence is accumulating on diagnostic and procedural applications; however despite widespread use in other countries, usage patterns are not clear in our setting. Given the lack of a standardised PEM POCUS curriculum, best practice standards, and formal training courses, we aimed to determine variability in PEM POCUS practices across our PEM research network.Method and resultsThis online survey was distributed in March 2019, with content derived iteratively by the study team from existing literature and input from PERUKI members. One response was sought from each site, to describe department practices, hardware, and major enablers and obstacles. Results are presented using descriptive statistics.Conclusions59/63 (94%) sites responded, including a mix of site and department types (eg 40% tertiary hospital, 60% mixed adult/paediatric EDs, 30% major trauma centres). Almost all (90%) had access to POCUS, and 70% reported limited use by a small proportion of staff, with no named lead. Most (95%) did not have a teaching program or identified trainer. Approximately half (55%) routinely documented findings, most often in clinical notes, and most (65%) did not store images; most (68%) had no quality assurance measures. The greatest enablers of PEM POCUS were its need, funding for equipment, and clinician engagement; the greatest obstacles were availability of training courses and trainers, and time to learn and maintain skills due to service delivery needs.Whilst hardware is available in most EDs, PEM POCUS is not yet widespread, with training being the greatest obstacle. Future work exploring clinician opinions will inform whether the specialty wishes to embrace POCUS, and training course content. However, if adopted, it must be coupled with implementation of best practice standards in domains including quality assurance and governance.
BackgroundHandover of care is one of the most perilous procedures in medicine.1The unique shift-based work in the ED, where there is a high degree of patient turnover, unpredictability and patient volume can create challenges to good quality clinician and nursing handover.The above highlights a need for an improved and standardised patient bedside handover tool for both clinicians and nurses involving and empowering patients and families. Both handover tools will cement safe continuity of information between shift changes and improved communication with patients and families.Method and resultsA standard operating procedure, flowchart and clinician’s handover tool was designed to maximise safe handover as illustrated in figure 1. The tool has been introduced into the department since June 2017. After the introduction of the tool, an evaluation survey of 30 participants across various grades of clinicians was performed.Abstract 001 Figure 1Clinicians handover toolBuilding on the success of the clinician’s handover tool; a standard operating procedure, flowchart and the first standardised nurse’s handover tool was designed as illustrated in figure 2.Abstract 001 Figure 2Nurses handover toolConclusionsFor the month of September 2017, 30 completed surveys evaluating the clinician’s handover tool was collected. 100% positive responses were received stating they found it useful. The handing over clinicians commented feeling more satisfied that ‘their patient was appropriately and safely handed over at the bed side in front of the family’.The nurse’s handover over tool was praised as nurses felt ‘happier’ with handover and more satisfied to leave shift ‘without forgetting significant patient information’.Both tools have become routine practice within the ED and are very useful adjuncts to improve patient safety within the department.Multidisciplinary handover post-shift work at the bedside has become standardised practice and improved patient safety with continuity of care with these tools. Regular ongoing audit have demonstrated that the tools are routinely used by both clinicians and nurses.ReferenceBritish Medical Association. Safe handover: safe patients. Guidance on clinical handover for clinicans and managers. London: BMA, 2004.
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