This issue of EMA introduces a brand new cover format and page layout for the journal. IN this editorial, new Editor-in-Chief, Prof Geoff Hughes outlines his vision for encouraging good quality scientific contributions, as well as expanding the magazine content, in EMA
In the new Social Media section of EMA, Spiegel (@EMNerd_), Johnston (@Eleytherius), Ercleve (@Ercleve) and Nickson (@precordialthump), transport us through a window-in-time to a future where FOAM is the norm. We meet Sienna Adjoin, Professor of Astro-Archaeology, in a rollicking tale, as she seeks out FOAM artefacts to look back in time to try to understand how FOAM helped to change the way medical education was delivered and encouraged debate and challenging of traditional approaches emergency medicine practice, such as the diagnosis and management of ACS
Inappropriate indicators can result in unintended consequences in terms of implementation of healthcare reforms, resource allocation and quality of service provided to patients. Jones et al present a systematic review and validation of the attributes that should be considered in selecting healthcare quality indicators. This led them to develop a quality indicator critical appraisal (QICA) tool to enable all important attributes to be considered when assessing health service performance measures in order to improve decision-making on indicator selection. This is particularly relevant for emergency medicine to assist with selection of appropriate indicators for healthcare improvement initiatives that are being driven by the current time-based access targets
Troponin is a widely used, highly sensitive biomarker for the diagnosis of acute myocardial infarction (AMI) and for risk stratification of patients presenting to ED with acute coronary syndrome (ACS). However, this review from Rahman and Broadley considers the broad range of non-ischemic causes and mechanisms for troponin elevation. It is a salient reminder that elevated troponin in the absence of AMI is common and careful attention is needed with regards to the reasons for testing troponin levels and the subsequent interpretation of abnormal findings
Most research into acute coronary syndrome (ACS) in ED has focused on preventing errors or missed diagnosis. This retrospective case series from Handrinos and colleagues, considers the hospital discharge diagnosis for patients admitted from the ED with a provisional diagnosis. Approximately one-third of these patients did not have an ACS on discharge. Further prospective research is required to analyse the effects of non-concordant diagnosis of ACS, including in-patient investigations used and decision steps along with patient outcomes, in order to determine if steps can be taken in ED to improve concordance.
An understanding of parental/guardian’s perceptions of their child’s journey through an ED has the potential to increase treatment compliance, minimise complications and reduce subsequent visits to other health practitioners. Fitzpatrick and colleagues surveyed parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care at a metropolitan ED. Time waiting for, or receiving, care did not primarily influence parental perceptions of, or satisfaction with, their child’s care; however the need for ED professionals to ensure adequate communication and respect for patients was reinforced by the survey responses