Urgent care research

Author: Dr Sandy Crofts

October 2021

Abstract:

Cannabinoid Hyperemesis Syndrome (CHS) is a syndrome of intractable vomiting with severe abdominal pain that is associated with chronic marijuana use. Classically, symptoms are relieved by hot showers and are often unresponsive to traditional acute interventions such as antiemetics.

Patients commonly undergo multiple investigations without diagnosis.  Complete resolution of symptoms occurs with abstinence from cannabis.

The following Medical Literature Project gives an overview of Cannabinoid Hyperemesis Syndrome and review of current management.

Author: Dr Alice Mason

March 2022

Abstract:

Paediatric forearm fractures are a common presentation seen in Urgent Care, often occurring from a fall onto an outstretched hand. Currently, best practice is for an x-ray when there is suspicion of a fracture.However, this comes with exposure to ionising radiation and can be associated with prolonged waiting times, pain, and further cost. This review aims to investigate whether point of care ultrasound (POCUS) could be used as an alternative or preferred option for suspected distal radius fractures in children.

Author: Dr Imran Zia

December 2021

Abstract:

A literature review was carried out to assess the safety of Adenosine in Urgent Care (UC) setting for the termination of Paroxysmal Supraventricular tachycardia (PSVT). Thorough literature evaluation advocates the use of adenosine for the acute termination of PSVT in Urgent care settings, especially in rural and remote practices. It has the potential to improve patient management and satisfaction along with a reduction in cost, ED load, and associated hospitalization.

Author: Dr Zeeshaan Khan
Type: MLP-research
December 2022
Abstract:
Paediatric lateral condylar fractures (PLCF) are the most common fractures in children under the age of 7. This article will provide an overview of paediatric lateral condylar fractures with an emphasis on the importance of obtaining adequate radiographs and providing an accurate classification to guide management. It is essential for Urgent Care clinicians to be competent in the reading of paediatric elbow radiographs and possess a sound knowledge of the different classification systems of PLCF in order to provide the correct treatment and knowing when to refer for operative and non-operative treatment.

Author: Dr Dinesh Deonarain
Type: Other research
Date: Sep 2022
Abstract:
Mountaineering is a dangerous recreational activity with falls causing severe injuries and deaths. Survival from falls longer than 100 m is uncommon. We present a case of a high-altitude porter on Mount Everest who fell 400 m and survived. He slipped from a ridge at 7000 m (22,900 ft). A rescue party found him above Camp 2 (6600 m, 21,600 ft) and arranged a helicopter rescue. The Everest ER medical team at Everest Base Camp (5400 m, 17,700 ft) received the climber. They identified a head injury without signs of other serious trauma. A doctor provided manual inline stabilization of the cervical spine, airway support, and ventilation for the patient during the helicopter and ground transport to a tertiary hospital in Kathmandu. The time from the fall to definitive hospital care was 2.5 h. The hospital emergency team diagnosed an epidural hematoma and subarachnoid hemorrhage without midline shift and right parietal, orbital, and maxillary fractures. The neurosurgical team evacuated the intracranial bleed. The patient spent 6 d in the hospital. He had a positive neurological outcome. He had mild cognitive impairment and vision loss in his left eye but could perform activities of daily living. He returned to physical work, but not to climbing. This case report provides evidence that survival is possible after falls from extreme heights and sheds light on the challenges of an evacuation from austere environments.

Author: Dr Crispian Wilson
Type: Other research
Date: April 2022
Abstract:
Aims: To assess the error rate in plain film interpretation amongst urgent care doctors in the context of minor trauma, to determine where such errors occur and whether they affect patient care, and to identify possible causative factors. Methods: Five thousand X-ray interpretations occurring between March and August 2021 across six urgent care clinics were included in this retrospective study. Data analysis focused on demographic data, site of injury, the experience of the doctor interpreting the X-ray, and whether any change in management occurred following an error. Results: Six hundred and seventy-three X-ray interpretation errors occurred (13.5%), with 171 of these (3.4%) resulting in a change in patient management. Chest and elbow X-rays were misinterpreted most often. Both the age of the patient and training of the urgent care doctor had a significant effect on this error rate. The main impacts on patient management were cast removal and recall for review in the urgent care centre or an orthopaedic clinic. Conclusions: X-ray misinterpretation occurs at equivalent rates in urgent care when compared to the emergency department. Errors occur more commonly with paediatric patients and for doctors with less urgent care-specific training. These errors rarely result in any serious impact on patient management.

Author: Dr Matt Wright, Dr Fiona Pienaar
Type: Other research
Date: Oct 2022
Abstract:
aims: The purpose of this study was to compare the frequency and profile of abdominal pain calls to Healthline with that from other national healthcare providers; to evaluate the outcomes for this symptom against international telehealth providers; and to explore any inter-clinician variation in the response to abdominal pain that could be part of a quality improvement cycle. methods: Data routinely collected about abdominal pain calls to Healthline from 2017 to 2019 were extracted, analysed; and compared to the literature, hospital, and ambulance data and international telehealth providers. A specialist group was convened to review the profile of Healthline callers and outcome data. Variation in outcome changes and acuity grouping was evaluated at an individual level. results: Approximately 50,000 abdominal pain calls to Healthline over three years were analysed, with three-quarters from women, mostly of childbearing age. The majority call afterhours, with NZ European and, to a lesser extent, Māori, and callers from smaller geographical areas are over-represented. One quarter of patients had a hospital outcome (including 4% receiving an ambulance), which was found to be less acute than comparable health systems. Whakarongorau’s Clinical Governance Committee and the Specialist Group both supported the relative distribution of outcomes given by Healthline for abdominal pain. There was found to be variation in the outcomes given to abdominal pain callers at an individual clinician level. This was both in their changes to the disposition given by the Odyssey decision support tool and in their overall outcome distribution. conclusion: Healthline should be considered a key part of New Zealand’s healthcare system, as illustrated by the volume of calls that it receives and the fact that presentation types are similar to general practice and emergency departments. Given that abdominal pain is a difficult symptom to accurately address without in-person examination and investigation, the findings support Healthline’s outcomes as appropriate with hospitalisation rates lower than comparable healthcare systems. Whakarongorau’s (the organisation which runs Healthline) ability to identify individual clinician behaviours gives it a unique opportunity to improve care through decreasing variation..

Author: Dr Ivan Koay
Type: Other research
Date: September 2022
Abstract: This pilot study was designed to investigate the ability of incorporating lean methodology into the delivery of medical education. The project worked within the academic remits of the University College Dublin (UCD), Master’s in Advanced Practice (Nursing) program, which provided the academic rigor for the project. Practical and procedural skills were taught based on an adapted version of the RNZCUC’s core skills list (CSL)

Author: Dr Alison Curran
Type: MLP-research
Date: July 2022
Abstract:
Procedural sedation in the urgent care setting may be used to perform minor procedures, thereby enabling a patient to receive treatment sooner and in many cases avoiding a hospital admission1. There are safety concerns around using procedural sedation, therefore the use of clinical guidelines and credentialing is strongly recommended to reduce the risk of adverse events2,3,4,5,6. This project aims to review and make recommendations on the Procedural Sedation guideline at Pegasus 24 Hour Surgery, based on up-to-date literature and inclusion of the ‘Australian and New Zealand College of Anaesthetists’ (ANZCA) guidance2,7.

Author: Dr Matthew Reay
Type: MLP-research
Date: June 2022
Abstract:
Lower limb immobilisation increases the risk of Venous Thrombo-Embolism (VTE). The aim of this medical literature project is to firstly examine the risk factors most associated with an increased risk of VTE and the accuracy of risk stratification scores in predicting who will benefit from thrombo-prophylaxis. There are a number of risk stratifications scores available, all with varying accuracy. The TRiP (cast score) shows the most promise with 2 prospective trials (CASTING and TILLIRI) currently running, with results yet to be published.
The ideal risk stratification score, will have low rates of both under (sensitivity) and over treatment (specificity).