Exit block

The Royal College of Emergency Medicine has produced some excellent videos on Exit Block.

A new condition called ‘Exit Block’ is harming patients: they are put at risk when ‘Exit Block’ occurs. This happens where you can’t get patients from A&E into a hospital inpatient bed. Over 500,000 patients a year are affected. The Royal College of Emergency Medicine says that this is unacceptable. The Royal College of Emergency Medicine is currently campaigning to eradicate Exit Block from Emergency Departments.

This video highlights the work underway in Leicester Hospitals to tackle Exit Block.

CEM Spring CPD Event – Cardiff 2014

CEM CPD Event - Cardiff 2014

The College of Emergency Medicine‘s 5th Annual Spring CPD Event took place at the Mercure Cardiff Holland House Hotel in Cardiff between 17-19 March 2014.

A wide range of topics were covered including toxicology, trauma, medicine, paediatric emergency medicine, sports medicine and medical innovation. The event booklet contains the full programme and speakers’ biographies.

Please also take a moment to review Dr Ed Walker’s handout on carbon monoxide toxicity.

Next year’s CEM Spring CPD Event will be held in Belfast between 24-26 March 2015.

Can patients with recent-onset atrial fibrillation be discharged from the Emergency Department after successful cardioversion?

Congratulations to my colleague Dr Adeel Chaudhary for publishing a BestBET on this topic in this month’s EMJ.

Thee-Part Question

In (adults with recent-onset atrial fibrillation who are stable after successful cardioversion) is (immediate discharge) as safe as (admission for a period of further observation)?

Clinical Bottom Line

Stable patients with recent onset of atrial fibrillation after cardioversion and stroke risk stratification can be discharged home with adequate follow-up after a period of observation. Level 2 evidence, grade B recommendation.

Full article: (i) Can patients with recent-onset atrial fibrillation be discharged from the Emergency Department after successful cardioversion? Emerg Med J 2013;30:81-83, and (ii) on the BestBETs website.

Tips for Life Support OSCEs in the MCEM & FCEM

I give my trainees sitting the MCEM Part C (OSCE) exam the following tips for the life support OSCE stations:

  1. Keep every member of the team busy.
  2. Treat the manikin like a real person.
  3. Look at the monitor or examine the patient yourself.
  4. Do to the manikin what you say you would do.

Download this PDF for an illustration of each of these 4 points.

(This advice is equally applicable for the FCEM OSCE stations.)

OSCE Day of Central FCEM Course of Autumn 2012

Central FCEM Couse OSCE Day - 22 September 2012

The OSCE Day of the Central FCEM Course took place at Rotherham Hospital on Saturday 22nd September 2012.

The day involved 20 ST6+ senior trainees in Emergency Medicine, 17 actors & helpers, 15 faculty members and 1 corporate sponsor. We covered 37 FCEM OSCE stations spread over 4 OSCE circuits. The OSCE Day is designed to give candidates for the FCEM OSCE exam a day of intense exam practice and preparation. A big thanks to all the actors, helpers, faculty and candidates who participated!

The Viva Day of the Course will be held on Saturday 3rd November in Rotherham Hospital.

Final place remaining on OSCE Day of FCEM Course – 22 September 2012

We have ONE LAST PLACE remaining on the OSCE Day of the Central FCEM Course, on Saturday 22 September 2012 in Rotherham Hospital.

If you know anyone sitting the FCEM exam this autumn, please ask them to call/text me on 07595 391 468 immediately or direct them to http://www.CentralFCEM.com, thanks.

NSTEMI Pathway Wins “We Are Passionate & Creative In Our Work” Award

At University Hospitals of Leicester NHS Trust‘s annual "Caring at its Best" Award ceremony on 12 September 2012, my colleague Dr Martin Wiese was chosen as the overall winner in the "We Are Passionate & Creative In Our Work" category for his pioneering work in developing our Emergency Department’s Non-ST Elevation Myocardial Infarction (NSTEMI) / Chest Pain Pathway.

Martin had already won the Quarter 3 award for this work back in June 2012. At the awards ceremony last night Martin fought off stiff competition from other quarterly award winners to win the overall award for this category.

Over 500 staff, volunteers and supporters of Leicester’s Hospitals gathered at The Athena for the glittering & high-profile awards ceremony. Martin was presented with a plaque and certificate by Simon Cole, the Chief Constable of Leicestershire Police.

Well done Martin!

Full press release: Staff recognised for offering patients Caring at its best
Photos and Videos from the event: "Caring at its Best" Award ceremony 2012

“Caring at its Best” Award for Dr Martin Wiese

Caring at its Best Awards – June 2012 – We Are Passionate & Creative In Our Work from Leicester's Hospitals on Vimeo.

Congratulations to my colleague Dr Martin Wiese for winning an award in recognition of his work in establishing our Emergency Department’s new Chest Pain / NSTEMI pathway.

Martin has a passion for creating evidence-based protocols and pathways. His work is recognised at a national level, and he has worked with both the National Institute for Health and Clinical Excellence and the College of Emergency Medicine on a number of clinical guidelines.

Martin has helped keep our Emergency Department at the leading edge of Emergency Medicine by producing and implementing a Chest Pain / NSTEMI pathway that not only incorporates the latest ultra-high sensitive Troponin assays (allowing NSTEMI biochemical rule-out at 3 hours, which is great for both patients and the hospital), but also incorporating a whole package of investigations and treatments including GRACE scoring and the latest coronary artery calcium CT scoring techniques.

Please watch the video above, or read this press release for more information.

"Martin has substantially re-organised the way emergency patients with chest pain are managed, making sure they see the right people at the right time during their visit to the Emergency Department. This newly developed system is successful thanks to doctors, nurses and clinicians who have put in both time and dedication and work together to provide high quality patient care."

Behind the Scenes of the FCEM Course

It was a great pleasure to deliver another successful Leicester FCEM Course on 14th & 15th April 2012. All the photos are here: http://on.fb.me/fcem-2012

Thanks to my co-organisers Dr Steven How, Dr Chris Yap and Dr Roger Dalton for making it happen. As ever, it has been a tremendous buzz working with such a dedicated and passionate team of Emergency Medicine consultants and educators.

Also, thanks to all the faculty and actors who gave up their weekend to make the course a reality. We absolutely could not run the course without the terrific support from the faculty and actors.

Each course requires 6 months of meticulous planning, preparation, teamwork and choreography. Few people realise just how much effort and attention to detail goes into each course.

It starts with the selection and preparation of the venue, faculty, equipment and catering. We have a pretty specific, unique and unusual set of requirements for the venue. We need a venue large enough to comfortably hold upto 100 people, that can provide not only ALS/APLS/ATLS manikins, defibrillators & moulage kit, but also manikins for fundoscopy, otoscopy and male & female intimate examinations. From 2013 we will need a venue that can provide an ultrasound machine.

To the careful and considered pairings of candidates and OSCE circuits. Contrary to popular belief, the OSCE pairings and allocations are NOT random! We have designed a number of rules which must be followed when making the OSCE allocations.

For example, candidates from the same region must be split up and must never be paired together. For the Viva day, candidates must not be examined by faculty members from their own region.

All the way down to making sure we have a stock of painkillers for when brains start overheating (typically, after the 3rd OSCE circuit of the day) 🙂

Each course has approximately 60-100 people (faculty, actors, candidates, sponsors & assistants), each doing something slightly different from everyone else at every minute of the day. Each person moves around the venue in their own unique and carefully choreographed way. No two people are doing the same thing at any time on the day of the course.

Late into the night, 6 hours before a course launches, the course organisers perform a final dry run of the OSCE circuits. One person in the wrong place at the wrong time can throw a big spanner into the whole circuit. Everything must be checked and double-checked.

This is the engine at the heart of the FCEM Course – 36 OSCE packs, the instructions, and the bell.

Meeting & greeting participants at the start of the OSCE Day.

As Course Director, the climax of the whole course is the moment which occurs at approximately 08.45am on the morning of the OSCE Day. The moment when all the faculty, actors and candidates have turned up, and are present & accounted for! All the pieces of the jigsaw have suddenly fallen into place. The months of preparation suddenly come into sharp focus at that point, and for the first time I can relax and start enjoying the day.

And the show can then begin…