The St.Emlyn’s Podcast

Exciting Collaboration Between St Emlyns and the London Trauma Conference Welcome to the latest St Emlyns podcast! I'm Iain Beardsell, and alongside Natalie Mace, we are thrilled to announce an exciting new collaboration between the St Emlyns team and the London Trauma Conference. This esteemed conference will take place in London next week, and we've been honored with the opportunity to attend as members of the press. We will be interviewing some of the prominent speakers participating in the event, marking a significant first for our team at St Emlyns. The London Trauma Conference: Dates and Highlights The London Trauma Conference is scheduled from Tuesday, December 9th to Thursday, December 11th. This three-day event promises a stellar lineup of speakers from the Trauma World, including sessions on Trauma Surgery, Trauma Nursing, and a dedicated day for trainees. There’s even a special Thoracotomy day planned. This comprehensive program ensures there’s something for everyone in the field of trauma care. Why Attend the London Trauma Conference? We are not just attending to listen; our goal is to bring you the inside stories and insights from the speakers after their sessions. We aim to ask the questions you want answers to, making this conference more interactive and engaging for all of us. Whether you are a seasoned professional or a trainee, this conference offers invaluable knowledge and networking opportunities. If you’re considering attending, we highly encourage it. You can find all the details and register at www.londontraumaconference.com. There are still places available, so don’t miss out on this exceptional event. Engaging with the Conference Online For those who can't make it to London, there are still plenty of ways to stay involved. Follow along on Twitter using the hashtag #ltc2014. We will be tweeting live updates from the sessions, and you can tweet your questions to us. We’ll do our best to catch up with the speakers and get your questions answered. Getting Ready for Trauma Week To get in the mood for the upcoming trauma week, we recommend listening to "The Fight for Life," a program by Kevin Fong on BBC Radio 4. This enlightening show traces the origins of trauma care and brings it up to the modern day. Kevin speaks with James K. Steiner, the American orthopedic surgeon who designed the ATLS course after his family was involved in a tragic air accident. The program is both moving and inspiring, highlighting the importance of coordinated trauma care. Meet the Speakers: Friends of St Emlyns We are excited to reconnect with many friends of St Emlyns at the conference. Among the notable speakers are Mark Wilson, a renowned neurosurgeon from London, and Karen Brodie, a respected vascular and trauma surgeon. Ross Fisher, a pediatric surgeon from Sheffield, will be discussing pediatric trauma. Additionally, our colleagues from Sydney Hems, including Cliff Reed and Brian Burns, will also be presenting. The lineup reads like a who's who of UK and international trauma medicine, ensuring a wealth of knowledge and experience will be shared. Our Mission at St Emlyns At St Emlyns, we are dedicated to spreading trauma care education as widely as possible. None of our team members have any financial interest in the conference; our goal is purely educational. We hope to learn and share valuable insights with you, our community, to enhance our collective understanding and capabilities in trauma care. Welcoming New Doctors to Emergency Medicine This week is particularly special as it marks the arrival of new doctors in our emergency departments across the UK. This transition happens four or five times a year, bringing fresh faces, enthusiasm, and, understandably, a bit of nervousness. We urge everyone to extend kindness and support to these junior doctors. Our emergency departments thrive on a culture of learning and collaboration, and it’s essential to make our new colleagues feel welcome and valued. If you are one of these new doctors, make sure to check out our induction blog posts and podcasts. They are available on the St Emlyns blog at stemlynsblog.org and on our iTunes podcast feed. These resources are designed to help you navigate the initial challenges and embrace the exciting journey ahead in emergency medicine. The Importance of Continued Learning in Emergency Medicine As we see from the current news, it’s a challenging time for UK emergency medicine. However, at St Emlyns, we are committed to bringing you the best resources, insights, and inspiration to help you continue delivering exceptional care to your patients. Our collaboration with the London Trauma Conference is just one example of our efforts to enhance the education and support available to all healthcare professionals in our community. Conclusion We are incredibly excited about this new venture and look forward to sharing our experiences and learnings from the London Trauma Conference with you. Whether you join us in person or follow along online, we hope this event will be as enlightening and inspiring for you as it promises to be for us. Thank you for being a part of the St Emlyns community. Please continue enjoying your work in emergency medicine, and we’ll be back with more updates and insights very soon. Take care and thanks for listening!

Top Five Diagnoses to Rule Out in Patients with Chest Pain In emergency medicine, our primary objective is to rule out life-threatening conditions first. This principle guides our approach to patients with chest pain. Here are the top five diagnoses to consider: Acute Coronary Syndrome (ACS) Pulmonary Embolism (PE) Pneumothorax Pneumonia Aortic Dissection These conditions can have overlapping symptoms but differ significantly in their management and prognosis. Let’s explore these further. Acute Coronary Syndrome (ACS) When a patient presents with chest pain, ACS is often the first concern. Key symptoms include central crushing chest pain, which may radiate to the arm or neck. While classic presentations are familiar to most, not all patients exhibit textbook symptoms. Factors like age, gender, and comorbidities can alter the clinical picture. Initial Assessment and ECG Interpretation Every patient with chest pain should receive an ECG as part of the initial workup. Interpreting ECGs requires a high level of expertise, as subtle changes can indicate significant pathology. In our department, only senior emergency physicians are tasked with reading initial ECGs to minimize the risk of missing critical findings. It's important to assess each ECG independently, even if previous records are available, as baseline abnormalities can obscure new, acute changes. Troponin Testing For patients where myocardial ischemia is suspected, a troponin test, particularly high-sensitivity troponin, is essential. This biomarker helps identify myocardial injury, even in cases where the ECG does not show definitive changes. Given the serious implications of missing an ACS diagnosis, a low threshold for testing is prudent. Approximately 10% of patients with a normal ECG may still have significant disease, highlighting the importance of comprehensive evaluation. Pulmonary Embolism (PE) Pulmonary embolism is another critical condition to consider, especially in patients presenting with pleuritic chest pain, shortness of breath, or risk factors such as recent immobilization, malignancy, or surgery. The clinical presentation of PE can vary, complicating diagnosis. Clinical Decision Tools The Wells score and PERC (Pulmonary Embolism Rule-out Criteria) are valuable tools in assessing the likelihood of PE. For low-risk patients, D-dimer testing can be used to rule out the condition, reducing the need for further imaging. However, for patients deemed at higher risk, CT pulmonary angiography (CTPA) is the gold standard for diagnosis. The decision to pursue imaging should be guided by clinical judgment and, where necessary, discussed with senior colleagues to avoid unnecessary radiation exposure and follow-up testing. Pneumothorax Pneumothorax should be considered in both young, otherwise healthy individuals and older patients with underlying lung disease. The hallmark symptom is sudden onset pleuritic chest pain, often accompanied by shortness of breath. Diagnostic Approach A chest x-ray is typically sufficient to diagnose pneumothorax. Given the low radiation dose and high diagnostic yield, x-rays should be performed for most patients with suspected pneumothorax. The imaging will not only confirm the presence of air in the pleural space but also help assess the severity and guide management decisions. Pneumonia Pneumonia is a common cause of chest pain, often accompanied by fever, cough, and sputum production. It is more common in patients with a history of respiratory disease or immunosuppression. Identifying Pneumonia A chest x-ray remains the cornerstone of pneumonia diagnosis. Clinical symptoms, such as productive cough and fever, along with imaging findings of consolidation, help differentiate pneumonia from other causes of chest pain. While not immediately life-threatening in most cases, timely recognition and treatment are crucial to prevent complications. Aortic Dissection Aortic dissection is a less common but highly dangerous cause of chest pain. Classic symptoms include severe, tearing pain radiating to the back. It is critical to maintain a high index of suspicion for aortic dissection, especially in patients with risk factors such as hypertension, connective tissue disorders, or a family history of the condition. Confirmatory Testing The definitive diagnostic test for aortic dissection is a CTA aortogram. While a chest x-ray can sometimes reveal mediastinal widening, it is not sufficiently sensitive to rule out dissection. Early consultation with cardiothoracic surgery and rapid imaging are key to managing suspected cases. Communicating with Patients Once life-threatening causes have been ruled out, patients often seek answers about their symptoms. When the etiology remains unclear, it’s important to communicate transparently with the patient. Possible benign causes include musculoskeletal pain or gastroesophageal reflux disease (GERD). While it’s reassuring to exclude serious conditions, acknowledging the limitations of our diagnostic tools and advising patients to return if symptoms change is crucial. Patient Reassurance and Follow-up Patients should be advised to follow up with their primary care physician for further evaluation and management of non-urgent conditions. Clear communication, including documenting your diagnostic reasoning and plan, is vital for medico-legal protection and patient safety. Conclusion: Mastering Chest Pain in the ED Chest pain remains a complex and multifaceted challenge in the emergency department. The ability to swiftly differentiate between benign and life-threatening causes is a critical skill for emergency physicians. Our approach should be guided by a thorough history, physical examination, and appropriate use of diagnostic tools. Remember, the primary goal is to exclude serious conditions, ensuring patient safety while avoiding unnecessary investigations. As you continue your journey in emergency medicine, refine your skills in evaluating chest pain. Be diligent in your assessments, stay updated with the latest guidelines, and always communicate clearly with your patients and colleagues. This comprehensive approach will not only improve patient outcomes but also enhance your clinical practice. Read the blog post here  

Managing Shortness of Breath in Pediatric Patients: A Comprehensive Guide Welcome to the St. Emlins blog. I’m Iain Beardsell, and I’m joined by our resident pediatric expert, Natalie May. Today, we’re discussing a challenging but crucial topic for those in Emergency Medicine: managing pediatric patients with shortness of breath. Understanding Pediatric Shortness of Breath Shortness of breath in children is a frequent and often intimidating presentation in the emergency department, especially during winter. This guide aims to provide a systematic approach to assess and manage these young patients effectively. Initial Assessment: Stay Calm and Structured When managing a child with shortness of breath, it's essential to stay calm and use a structured approach: Level of Consciousness: Determine if the child is alert or needs immediate resuscitation. Breathing Effort: Look for signs of respiratory distress such as the use of accessory muscles, intercostal and subcostal recession, tracheal tug, or head bobbing in infants. Breathing Efficacy: Listen for extra sounds like wheezes or stridor to identify the underlying pathology. Oxygen Delivery: Check the child's oxygen saturation, level of consciousness, and heart rate to evaluate breathing effectiveness. Oxygen Administration: A Safe First Step Administering oxygen is a safe and effective initial treatment for children with shortness of breath. It is unlikely to cause harm and can be crucial for stabilizing the patient while further assessments are made. Detailed History and Physical Examination Gathering a detailed history from the parents is essential: Chronology of Events: Determine how long the child has been short of breath. Pre-existing Conditions: Ask about any previous lung problems. Additional Symptoms: Note any associated symptoms like fever or cough. Inhaled Foreign Body: Consider this, especially if the onset of symptoms was sudden. This information helps in deciding the appropriate therapy and whether the child needs hospital admission. Common Causes of Pediatric Shortness of Breath 1. Bronchiolitis and Viral Wheeze Bronchiolitis is a common winter illness in children under two, often caused by respiratory syncytial virus (RSV). Key signs include: Respiratory distress with significant use of accessory muscles. Wheezing and low oxygen saturation. History of recent cold symptoms in the family. Viral Wheeze often presents similarly but occurs in slightly older children. Differentiating between bronchiolitis and viral wheeze involves assessing the severity and duration of symptoms. Management: Oxygen: Provide supplemental oxygen if saturation levels are low. Bronchodilators: Trial with salbutamol through a spacer or nebulizer can be beneficial. Steroids: Generally avoided in children under five unless there is a formal asthma diagnosis or previous steroid-responsive episodes. Admission Criteria: Severe respiratory distress. Persistent low oxygen saturation. Poor feeding and hydration status. History of prematurity or chronic lung disease. 2. Croup Croup is another common viral illness presenting with a characteristic seal-like barky cough and inspiratory stridor. It often worsens at night, causing significant distress to both the child and the parents. Management: Dexamethasone: A single oral dose (0.15-0.6 mg/kg) is effective in reducing airway inflammation and improving symptoms. Observation: Monitor the child for 2 hours post-treatment to ensure improvement. Calm Environment: Minimize distress and avoid unnecessary interventions that might exacerbate symptoms. Safety Netting: Provide parents with clear instructions on when to return to the hospital, especially if symptoms worsen during the night. 3. Bacterial Infections: Pneumonia Though less common than viral infections, bacterial pneumonia should be considered, particularly if the child presents with: Fever. Persistent cough. Decreased oxygen saturation. Subtle respiratory distress. Management: Chest X-ray: Useful for diagnosis if bacterial infection is suspected. Antibiotics: Initiated based on clinical judgment and X-ray findings. Admission: Necessary for children with significant respiratory compromise or those unable to maintain adequate oxygen levels. Special Considerations Feeding and Hydration Children with respiratory distress often have poor oral intake, leading to dehydration. Assess feeding history and urine output: Supportive Feeding: Nasogastric or intravenous fluids may be required. Monitor Hydration: Ensure adequate fluid intake and monitor for signs of dehydration. Obligate Nasal Breathers Infants are obligate nasal breathers, and nasal congestion can severely impact their breathing. Simple measures such as nasal saline drops can alleviate congestion and improve breathing. Inhaled Foreign Bodies Always consider the possibility of an inhaled foreign body, especially if the presentation is sudden and there is no clear viral cause. A chest X-ray or bronchoscopy may be required for diagnosis and management. Conclusion: A Structured Approach for Success Managing pediatric shortness of breath requires a calm, structured approach, leveraging skills from adult practice and adapting them for pediatric patients. Key steps include: Initial Assessment: Stay calm and systematic. Oxygen Administration: A safe first step. Detailed History and Physical Examination: Crucial for diagnosis. Management of Common Conditions: Bronchiolitis, viral wheeze, croup, and bacterial pneumonia. Remember, there is always senior support available, whether from a senior emergency physician or a pediatric colleague. By staying cool and methodical, you can effectively manage these challenging cases and provide excellent care for your young patients. Stay tuned to the St. Emlins blog for more in-depth discussions on pediatric emergencies and other critical topics in emergency medicine. Stay calm, stay curious, and keep learning.

The Challenge and Value of Research in Emergency Medicine: at DGINA 2014 Rick Body's talk from DGINA on the need for research in EM. Check out the associated blog post at http://stemlynsblog.org

Exciting Updates from St. Emlyn's: Highlights, Conferences, and Upcoming Events Welcome to the St. Emlyn's Podcast Recap Greetings, St. Emlyn's community! We are delighted to bring you the latest updates and highlights from our podcast and blogosphere. Let's dive into our recent achievements, exciting conferences, and what's on the horizon for our team. Highlights from the Past Few Months The past few months have been phenomenal for St. Emlyn's. Our blog has seen a surge in readership, and we’ve received fantastic feedback on various posts and podcast episodes. One standout topic has been the work on high-sensitive troponin, thanks to Rick's invaluable insights. Even those of us working with troponin in our department found new learnings through the podcast. Another high point was Natalie May's episode on button battery ingestion in children. This critical topic resonated with many of our listeners and highlighted the dangers and necessary precautions surrounding this issue. Additionally, having Alan Grayson critique NICE guidelines on heart failure provided us with fresh perspectives and sparked meaningful discussions within our virtual hospital. Conferences and Collaborations Our team has been active on the conference circuit, sharing knowledge and gaining new insights. The European Society of Emergency Medicine (EUSEM) conference in Amsterdam was a significant event, offering a plethora of information and networking opportunities. Natalie is even planning to produce a book and podcast to summarize the key takeaways from the conference. Down in Exeter, the Chem conference exceeded expectations. Adam Ruben’s podcast recap provided a comprehensive overview of the event, and we had the pleasure of paddleboarding with Cliff Reed, adding a bit of fun to the professional gathering. The Evolution of Emergency Medical Conferences Emergency medical conferences have evolved remarkably over the past decade. The variety and depth of content offered now are impressive. Our team is already gearing up for the Chem conference in Manchester next September, and the recently released program for SMACC Chicago has everyone buzzing with excitement. SMACC Chicago: A Preview The SMACC conferences are renowned for their exceptional quality and dynamic content, and SMACC Chicago is no exception. The program is packed with sessions from leading experts in emergency medicine, making it challenging to choose which talks to attend. Simon Carley will be presenting alongside luminaries like Scott Weingart, Pat Cross-Kerry, Ashley Shree, and Stephen Mayer, promising a wealth of knowledge and inspiration. The release of the SMACC Chicago program has us eagerly anticipating the event. With five streams of information, choosing which sessions to attend will be a delightful dilemma. Highlights include sessions with Karim Brohee, Paul Marik, Rick Body, and Louise Cullen. Simon is excited to be part of such an esteemed lineup, despite the stiff competition. Workshops and Debates Before the main conference kicks off, a series of workshops will provide hands-on learning experiences. Simon will join Scott from the Medical Evidence Blog, Ken Milne from SGEM, Rob McSweeney, Rick Body, and David Newman from Smart EM to discuss evidence-based emergency medicine. It’s an incredible opportunity to learn from and with the best in the field. One of the anticipated sessions is the SMACC Chicago forum on Thursday afternoon, featuring debates and discussions on topics that matter deeply to the emergency medicine community. The session titled “Seeking the Truth” promises to be a highlight, with speakers like Paul Young and Simon Finfer discussing randomized controlled trials (RCTs). Networking and Building Connections Conferences like SMACC are not just about attending sessions—they’re about building connections and forming lasting relationships with peers and mentors. Meeting the greats of emergency medicine, such as Dave Newman, and discussing both cutting-edge topics and the human side of medicine, makes these conferences invaluable. The Value of Investing in Education While attending conferences can be a significant financial investment, the benefits far outweigh the costs. The opportunity to learn from leading experts, network with peers, and stay updated on the latest advancements in emergency medicine makes these events a crucial part of professional development. For those considering attending SMACC Chicago, registration opens on the 5th of November. Early registration for trainees, nurses, and paramedics offers a more affordable way to join this transformative event. What's Next for St. Emlyn's? Looking ahead, we have a robust lineup of podcasts and blog posts planned. Our induction series continues to provide valuable insights for new doctors entering emergency medicine departments across the UK. We’re also exploring topics like Gestalt and clinical thinking to deepen our understanding and improve patient care. Join the Conversation: Get Involved with St. Emlyn's We want to hear from you! Your feedback helps us tailor our content to meet your needs. Connect with us on Facebook, rate us on iTunes, and share your thoughts and ideas. We’re always looking for guest writers to contribute to our blog. If you have a topic you’re passionate about, reach out to us and join the St. Emlyn's community. A Special Thanks A special thanks to Sarah Payne for her timely articles on Ebola, which have been incredibly well-received. Her contributions have enriched our blog, providing vital information and sparking meaningful discussions. Enjoy Your Emergency Medicine Journey At St. Emlyn's, our mission is to make your emergency medicine journey more enjoyable and fulfilling. We’re committed to enhancing your professional development and patient care through engaging content and insightful discussions. Stay tuned for more podcasts, blog posts, and exciting updates. Don’t forget to register for SMACC Chicago and join us for an unforgettable experience. Thank you for being part of the St. Emlyn's community. Enjoy your emergency medicine journey, have fun, and go forth and heal the sick. We’ll be back soon with more exciting content and updates.

The Danger of Button Batteries: Essential Information for Emergency Physicians Introduction Hello and welcome to the St Emlyn's blog. I'm Simon Carley, and alongside me is Natalie May. This post addresses a frequent and potentially serious issue in emergency departments: the ingestion of button batteries. With Halloween and Christmas approaching, these small but hazardous objects become more prevalent in households with small children. Here, we provide critical insights for emergency physicians on identifying, managing, and preventing complications related to button battery ingestion. Understanding Button Battery Ingestion Button batteries, or disc batteries, are small, round batteries found in devices like watches, musical badges, and holiday decorations. Their size and shiny appearance make them attractive to children, who may ingest them or insert them into their noses or ears. While they appear harmless, button batteries can cause significant harm if they become lodged in mucosal surfaces. The Risks of Button Battery Ingestion When a button battery becomes wedged against a mucosal surface, it generates a small electrical current. This current can cause chemical burns and tissue damage within as little as two hours. If not promptly removed, the battery can lead to severe complications, including death. Common Scenarios and Symptoms Children often ingest various objects, but button batteries pose a unique risk due to their electrical properties. Here are common scenarios and symptoms to watch for: Ingestion: Symptoms range from mild (drooling, difficulty swallowing) to severe (vomiting, abdominal pain, gastrointestinal bleeding). Nasal Insertion: Batteries in the nose can cause nasal discharge, pain, and significant tissue damage if unnoticed. Ear Insertion: Batteries in the ear can lead to pain, discharge, and hearing loss if not promptly addressed. Radiological Identification Button batteries are radiopaque, making them visible on X-rays. They can be distinguished from coins by their characteristic double shoulder appearance. This feature is crucial for accurate diagnosis and timely intervention. Management Strategies Immediate Steps for Suspected Ingestion High Index of Suspicion: Be vigilant for signs of button battery ingestion, especially if parents report missing batteries from devices. Radiological Examination: Perform an X-ray to locate the battery and determine its position. Removal from Ears and Noses ENT Referral: Button batteries in the nose or ears should be removed promptly by an ear, nose, and throat specialist. These areas are less moist than the esophagus but can still suffer chemical burns and tissue damage. Esophageal Ingestion Surgical Emergency: Batteries lodged in the esophagus must be removed immediately. This task is typically handled by general surgeons or gastroenterologists. Delaying removal can lead to severe complications, including perforation, erosion into blood vessels, and catastrophic bleeding. Post-Removal Care and Follow-Up Even after successful removal, children must be monitored for complications. Discharge instructions should include warning signs such as gastrointestinal bleeding, severe abdominal pain, vomiting, respiratory distress, and refusal to eat. Follow-up appointments and possibly additional X-rays are essential to ensure no further damage has occurred. Prevention Tips for Parents Educating parents about the dangers of button batteries is crucial. Here are some tips to share with them: Secure Storage: Keep button batteries out of reach of children. Device Safety: Ensure battery compartments in devices are secure and childproof. Immediate Action: If a battery is missing and a child shows symptoms of ingestion, seek medical attention immediately. Case Studies and Real-Life Examples Case 1: Nasal Insertion A child was brought to the emergency department with a suspected nasal insertion of a button battery. Despite a thorough examination, no battery was visible. However, an X-ray revealed a large button battery lodged in the posterior nose. Prompt referral to ENT and removal prevented further complications. Case 2: Esophageal Lodgment A child swallowed a button battery that became lodged in the esophagus. The battery was removed within two hours, but the child was monitored closely for weeks due to the risk of delayed complications. Despite initial removal, the child developed severe symptoms days later, highlighting the importance of vigilant post-removal care. Conclusion Button batteries pose a significant risk to children, particularly during festive seasons when they are more prevalent in households. Emergency physicians must maintain a high index of suspicion, utilize radiological tools effectively, and act swiftly to manage cases of ingestion or insertion. Educating parents about the dangers and prevention strategies is equally important. Stay vigilant, stay informed, and ensure the safety of our youngest patients. Additional Resources For more information on button battery ingestion and other pediatric emergencies, visit the St Emlyn's blog. Follow us on Facebook and join our community of emergency medicine professionals dedicated to providing the best care for our patients.

The Crucial Role of Accurate Coding in Emergency Medicine: Insights from St Emlyns Welcome to the St Emlyns blog! Today, we dive into a topic often overlooked but crucial to the functioning and financial health of emergency departments (ED): coding. This subject might not have the drama of resuscitations or surgical interventions, but it significantly impacts how we are perceived and funded. In this post, we explore how coding works in the context of emergency medicine in England, why it matters, and how we can improve our practices for better outcomes. Understanding Coding in Emergency Departments What is Coding? In the simplest terms, coding is the process of translating medical activities into standardized codes that determine how much a hospital gets paid for the services provided. This is done through systems like the HRG-4 (Health-Related Grouping) codes, which classify the treatments and investigations performed on patients. Why is Coding Important? Accurate coding is essential because it directly affects the revenue of an emergency department. The details recorded in discharge summaries play a significant role in determining the funds a hospital receives. For instance, different procedures and investigations, like CT scans or blood tests, have specific codes that contribute to the total amount of money paid to the hospital. The Financial Implications of Coding Top Earning Codes in Emergency Medicine The highest amount an ED can earn for a single patient episode is £237, applicable in cases involving resuscitation, thrombolysis, or laser eye surgery. However, if no tests or treatments are performed, the hospital only earns £58 for that patient. This stark difference underscores the importance of detailed and accurate coding. Common Investigations and Their Codes MRI/CT Scans: High-value procedures that significantly boost the hospital's revenue. Ultrasound Scans: Similarly valued to MRI/CT scans, contributing substantial amounts to the hospital's income. Vital Signs Recording: Even basic procedures like recording vital signs can elevate the payment from the lowest tariff. Challenges in Implementing Accurate Coding Perception vs. Reality Many healthcare professionals, including doctors and nurses, often view coding as an administrative burden rather than a critical part of patient care. This perception needs to change, as the quality of coding affects not only financial outcomes but also how the department's efficiency and effectiveness are perceived by external bodies like the CCG (Clinical Commissioning Groups). The Role of IT Systems Modern IT systems have made the coding process more streamlined, though they are not without their challenges. Integrating coding tasks into daily routines, such as through discharge summaries and GP letters, can help ensure that all activities are recorded accurately. Improving Coding Practices Education and Awareness Educating staff about the importance of coding and its impact on both departmental funding and patient care is crucial. Junior doctors and new consultants should be made aware of how their input affects the overall picture. Dedicated Coding Staff Some hospitals have experimented with employing dedicated coding staff who review and correct coding entries, leading to significant increases in revenue. This approach can alleviate the burden on clinicians and ensure more consistent and accurate coding. Streamlining Processes Integrating coding into clinical workflows can make it less of a chore. For example, requesting an X-ray through the hospital's system should automatically record it in the patient's coding data. Such improvements can simplify the process and reduce the likelihood of missed entries. The Impact of Coding on Departmental Perception Meeting Standards and Avoiding Fines In England, EDs are required to meet specific standards, such as the four-hour wait time target. Failing to meet these standards can result in fines, which further strain departmental resources. Accurate coding helps present a true picture of the department's workload and efficiency, potentially mitigating some of these financial penalties. Communicating with Commissioners Accurate coding ensures that commissioners have a clear understanding of the services provided by the ED. Misrepresentations can lead to misconceptions about the department's performance and the appropriateness of patient attendances, affecting future funding and policy decisions. Case Study: VB11Z Code The VB11Z code, which indicates that no investigations or treatments were performed, often misrepresents the actual work done in the ED. For example, patients admitted under the care of other specialists but using ED resources might be incorrectly coded, leading to a loss of revenue. By addressing such coding inaccuracies, departments can better reflect their true workload and resource needs. Practical Tips for Better Coding Record Everything Ensure that all procedures, tests, and treatments are recorded, no matter how minor they might seem. This includes vital signs, which can elevate the payment bracket significantly. Integrate Coding with Patient Care Make coding part of the routine patient care process. For example, use discharge summaries to not only inform GPs but also to ensure all activities are coded. Leverage Technology Utilize the full capabilities of IT systems to automate and streamline coding tasks. This can reduce the manual burden and improve accuracy. Continuous Training Regularly update staff on coding practices and the importance of accurate data entry. This helps maintain awareness and reduces the risk of complacency. Conclusion While coding might not be the most glamorous aspect of emergency medicine, it is undeniably one of the most crucial. Accurate coding not only ensures that departments are properly funded but also that they are accurately represented in terms of workload and efficiency. By integrating better coding practices into daily routines and educating staff on its importance, emergency departments can significantly improve their financial health and operational effectiveness. For more detailed information, including specific codes and their values, visit our blog or contact us directly. Keep coding and keep improving patient care!

Rick and Iain explore how the latest guidance about the use of high sensitivity troponin was developed and how far we can be assured that it is evidence based. The NICE guidance is available here. http://www.nice.org.uk/guidance/dg15 vb S

In Situ Simulation in Emergency Medicine: Insights from St. Emlyn's Welcome to the St. Emlyn's blog. I'm Ian Beardsell, and I'm Simon Carley. Today, we're exploring in situ simulation, a vital method for improving patient care and team efficiency in emergency medicine. I'll be discussing this at UCEM, and we want to share our insights on implementing it effectively in your department. What is In Situ Simulation? In situ simulation takes place in your clinical environment, such as the resuscitation room or patient cubicles. Unlike traditional simulation centers that require significant resources, in situ simulation happens where you work every day. This method allows teams to practice and refine their skills in the actual setting, making training more relevant and practical. Gorilla Simulation vs. In Situ Simulation Gorilla simulation, a subset of in situ simulation, involves an element of surprise. It means conducting unplanned simulations during odd hours to test spontaneous team responses. For instance, pressing the resus buzzer at 3 AM with no prior warning and having the team manage a mock patient. While gorilla simulation is riskier and more challenging, it provides valuable insights into team dynamics and readiness. The Importance of Simulation in Emergency Medicine Initially, many clinicians, including myself, were skeptical about the impact of simulation training. However, extensive research and our experiences at St. Emlyn's show that simulation significantly improves clinical skills, team coordination, and patient outcomes. Studies have demonstrated its effectiveness across various departments, and we've observed marked improvements in team behavior, organization, and efficiency since implementing regular simulation sessions. Overcoming Challenges in Simulation Training Not everyone is comfortable with simulation, especially those who are more introverted or less familiar with the process. It's essential to acknowledge this and create a supportive environment. Normalizing simulation as part of routine training helps, as does ensuring that initial sessions are positive and constructive. We learned through trial and error to gauge participants' comfort levels and adjust the training accordingly. Practical Tips for Conducting In Situ Simulation Integration into Daily Routine: Conduct simulations around handover times, usually at 8 AM. This timing ensures double staffing, and if handover finishes early, the simulation can proceed without disrupting the department's workflow. Multi-professional Participation: Involving nurses, healthcare support workers, radiographers, and other relevant staff enhances the realism and effectiveness of the simulation. For example, if a scenario involves a CT scan, we physically take the mannequin to the CT scanner. Patient and Staff Engagement: Inform patients and staff beforehand to gain their support. Most patients are understanding and even find it interesting when they know a training exercise is happening. Handling Distractions: Real-world distractions are an integral part of emergency medicine. Incorporating these into simulations teaches teams how to manage interruptions effectively. Securing Buy-in from Your Department Gaining support from senior clinicians and nursing leaders is vital. At St. Emlyn's, our clinical director and senior nurses championed the initiative. Presenting simulation as a solution to improve patient care and team coordination, backed by incident reports and data, helps persuade colleagues of its value. Frequency and Topics for Simulation We aim to conduct simulations three to four times a week. The focus is often on resuscitation and emergency scenarios, but we also cover other essential skills and processes, such as handover communication and teamwork. Keeping scenarios simple and relevant to daily practice ensures that training remains practical and impactful. The Role of Debriefing Debriefing is a critical component of simulation training. We conduct hot debriefs immediately after the simulation to capture fresh insights and feedback. This process is conversational, focusing on participants' experiences and learning points rather than a rigid critique. We also document key learning outcomes to track progress and identify areas for improvement. Involving Other Departments For scenarios involving multiple specialties, such as major trauma, we include relevant teams like anesthetists, surgeons, and radiologists. With high-level consent and coordination, these simulations provide comprehensive training and improve inter-departmental collaboration. Implementing Guerrilla Simulation While we haven't extensively practiced guerrilla simulation due to its high-risk nature, it offers significant learning opportunities. Conducting simulations in unexpected settings or times, such as a cardiac arrest in the minors area, tests the team's adaptability and response under pressure. However, it's crucial to balance this with the department's workload and stress levels to avoid overwhelming staff. Conclusion: The Value of Simulation in Emergency Medicine Simulation training, particularly in situ simulation, is a powerful tool for enhancing clinical skills, team dynamics, and patient care. It requires careful planning, support from leadership, and a commitment to continuous improvement. At St. Emlyn's, we've seen firsthand the positive impact of regular, practical simulation training, and we encourage other departments to adopt and adapt these practices to suit their needs. By integrating simulation into your routine, involving multi-professional teams, and maintaining a focus on practical, relevant scenarios, you can significantly improve your department's readiness and performance. As we continue to refine our approach and share our experiences, we hope to inspire others to embrace simulation as a cornerstone of emergency medicine training. Thank you for joining us on the St. Emlyn's blog. We look forward to sharing more insights and updates from UCEM and beyond. If you have any questions or would like to share your own experiences with simulation, please leave a comment or get in touch with us.

Mastering the Art of Presentation: Insights from St. Emlyns and Victoria Brasile Welcome to the St. Emlyns blog! I'm Iain Beardsell, and today, we're diving into a recent enlightening session with the rest of the St. Emlyns team—Simon, Nat, and Rick—alongside the exceptional educator, Victoria Brasile. Victoria recently visited the UK and shared invaluable tips on delivering excellent presentations to the emergency medical community in Manchester. For those familiar with Victoria’s engaging talks at SMACC, either in person or online, you're in for a treat as we explore the key points from this memorable evening. The Power of a Great Presentation Victoria Brasile's visit was a golden opportunity for the emergency medicine community. Her session focused on how to deliver impactful presentations—an essential skill for any healthcare professional. Here are the core messages she shared: Connect with Your Audience: Establishing a strong connection with your audience is fundamental. Look and Sound Great: Presentation is not just about content but also about delivery. Keep It Simple: Simplicity ensures clarity and retention. These principles form the bedrock of an excellent presentation, whether addressing a large lecture hall, a small group, or even a single patient. Connecting with the Audience Victoria emphasized the importance of making a genuine connection with your audience. She believes that regardless of the audience size, the ability to connect on a personal level is crucial. Here’s how you can achieve this: Engage Interactively: Encourage audience participation by asking questions or incorporating interactive elements. Use Relatable Stories: Share anecdotes that resonate with the audience’s experiences. Maintain Eye Contact: Establishing eye contact can make your audience feel involved and valued. During the Manchester session, Victoria practiced what she preached by fostering interaction and creating an inclusive environment. Her approach demonstrated how effective communication can transform a presentation into an engaging dialogue. The Importance of Presentation Victoria highlighted that looking and sounding great goes beyond mere aesthetics; it’s about being confident and authentic. Here are her top tips: Dress Appropriately: Your attire should be professional but comfortable, ensuring you feel confident. Voice Modulation: Vary your tone to maintain interest and emphasize key points. Body Language: Use purposeful gestures to reinforce your message and avoid distracting habits. In Manchester, Victoria’s presentation was a masterclass in these techniques. Her confident demeanor, combined with dynamic voice modulation and engaging body language, kept the audience captivated. Simplicity is Key The third cornerstone of a great presentation is simplicity. Victoria advised that a clear and straightforward message is more likely to be remembered and appreciated. Here’s how to keep it simple: Focus on Key Points: Identify and emphasize the main takeaways. Avoid Jargon: Use language that is easily understandable, avoiding technical terms unless necessary. Visual Aids: Use slides and visuals that are clear and directly related to your points. Victoria’s own presentations are a testament to this principle. She distilled complex information into easily digestible parts, ensuring her audience could follow along and retain the key messages. Lessons from the St. Emlyns Team Our team also shared their reflections and learnings from Victoria’s session: Rick Boddie: Managing Nerves Rick found the session particularly insightful for managing presentation nerves. He realized that controlling nerves is essential not only for the speaker but also for the audience’s comfort. Rick’s takeaway included: Preparation and Practice: Regular practice to build confidence. Breathing Techniques: Simple breathing exercises to calm nerves. Audience Empathy: Recognizing that the audience might be just as nervous. Natalie May: Planning for Interaction Natalie focused on incorporating audience interaction into her presentations. She plans to use: Social Media and Technology: Integrating modern tools to engage the audience. Structured Interactivity: Planning specific moments for audience participation. Pacing: Slowing down her speech to ensure clarity and engagement. Simon Carly: First Impressions Simon highlighted the importance of making a strong first impression. His key points included: Immediate Engagement: Captivating the audience right from the start. Preparation: Ensuring thorough preparation before stepping onto the stage. Action-Packed Opening: Starting with a memorable and impactful opening, akin to a Bond movie. Enhancing Audience Interactivity Victoria’s innovative approach to audience interaction was a standout feature of her session. She shared how dedicating a few minutes for the audience to interact amongst themselves can enhance the overall experience. This strategy not only breaks the ice but also makes the audience feel more connected and engaged. During her SMACC Gold talk, Victoria’s use of theatre—changing the stage setup and creating a visually intriguing environment—demonstrated how a bit of drama can capture and hold the audience’s attention. Conclusion: The Three Pillars of a Great Presentation Victoria Brasile’s session at Manchester reinforced the three pillars of a great presentation: connecting with the audience, looking and sounding great, and keeping it simple. These principles are not just theoretical; they are actionable strategies that any speaker can implement to enhance their presentations. The St. Emlyns team’s reflections further underscore the importance of preparation, interaction, and first impressions. As we continue to learn and grow in our professional journeys, let’s keep these valuable lessons in mind. Whether you’re presenting at a conference, teaching a class, or communicating with patients, these insights will help you deliver your message more effectively and confidently. Stay tuned for more insights and tips from the St. Emlyns team. We hope you enjoyed this deep dive into the art of presentation. Until next time, embrace your emergency medicine practice with enthusiasm and excellence! For more resources and links to Victoria Brasile’s talks, visit our blog site. If you have any questions or thoughts to share, please leave a comment below. We’d love to hear from you!