Basildon University Hospital is an acute general hospital in Basildon, Essex. It is managed by the Mid and South Essex NHS Foundation Trust.
BACKGROUND:Distal radius torus (buckle) fractures are among the most common paediatric injuries presenting to emergency departments. National Institute for Health and Care Excellence (NICE) guideline NG38 recommends management with non-rigid immobilisation and discharge without routine follow-up. Despite robust evidence supporting this approach, clinical practice varies considerably across NHS settings. AIM:This study aims to assess baseline compliance with NICE NG38 in the management of paediatric distal radius torus fractures, implement targeted quality-improvement interventions, and evaluate their effect through a complete closed-loop audit cycle. METHODS:A retrospective two-cycle clinical audit was conducted at a District General Hospital (DGH) and its associated Minor Injury Unit (MIU) within the same NHS trust in the United Kingdom. Cycle 1 (February 2023 to August 2023, n = 222) established baseline practice. Interventions included clinician education, guideline dissemination, and visual prompts. Cycle 2 (March 2024 to September 2024, n = 258) evaluated post-intervention practice. Data were collected from electronic emergency department records, radiographic systems, and Virtual Fracture Clinic (VFC) documentation. RESULTS:In Cycle 1, compliance with NICE NG38 was 97/174 (56%) at the DGH and 0/48 (0%) at the MIU; 128/222 (58%) of all patients across both sites received unnecessary fracture clinic follow-up. Following interventions, Cycle 2 demonstrated improved compliance to 131/164 (80%) at the DGH and 29/94 (31%) at the MIU. Overall fracture clinic follow-up was reduced from 128/222 (58%) to 98/258 (38%). Rigid immobilisation persisted in 33/164 (20%) of DGH patients and 65/94 (69%) of MIU patients in Cycle 2. CONCLUSION:This closed-loop audit demonstrates that targeted educational and environmental interventions can meaningfully improve adherence to evidence-based guidelines and reduce unnecessary fracture clinic referrals. However, variability in immobilisation practice persists, particularly at the MIU, underscoring the need for sustained system-level interventions, standardised clinical pathways, and ongoing audit cycles.
Background:Hospital-based violence intervention programs (HVIPs) provide victims of violence with case management services to promote healing and reduce violent reinjury. Life Outside Violence (LOV), the St. Louis region-wide HVIP, is the first multisystem HVIP in the country. The objective of this study was to describe rates of individualized treatment plan (ITP) goal completion among adolescent and young adult LOV participants and explore differences across ITP goal categories. Methods:This is a retrospective observational cohort study of patients aged 8-30 who presented to a LOV partner hospital for a violent injury between August 15, 2018 and December 31, 2024 and participated in LOV. The LOV REDCap database was queried for patient demographics, injury type, ITP goal category, and goal completion. Analysis included descriptive statistics of participant characteristics and goal categories set and completed. Results:This cohort included 263 LOV participants who were primarily black (96%), male (63%) young adults (51%) and injured by a firearm (63%). A majority of LOV participants (85%) identified an ITP goal; of these 139 (62%) completed at least one goal. The most common goal category identified was Health and healthcare (34%), within which the subcategory of Mental health was prominent (58%). Social and community goals were completed at the highest rate (70%). Conclusions:HVIPs are highly individualized programs that address the unique needs of violent injury survivors. Overall, LOV participants set and completed ITP goals at a high rate. Findings indicated robust support for social and community related goals. These findings can inform patient-centered service provision and evaluation methods among other HVIPs and violence intervention programs.
In 2024, the World Federation for Medical Education (WFME) provided agency applications for a pilot study. We analyzed applications from 43 WFME-recognized agencies against a cost identification framework to extract 4 variables and generate a list of variables for an international accreditor database. Across agencies, the median number of site visitors was 5 (range 3–10), site visit days 3 (range 1–6), committee members 12 (range 5–31), and annual budget 800 thousand (50 thousand to 141 million). Testing, refining, and maintaining an international accreditor database could facilitate standardized data collection that allows for benchmarking, public reporting, and accreditation research.
Abstract Background In recent years, Denmark has introduced mobile emergency unit (MEU) to provide patients with home-based evaluation and treatment by emergency medicine physicians. The aim is to avoid unnecessary hospital admissions and to reduce overcrowding in emergency departments. However, it is unknown which demographic, clinical, and paraclinical characteristics of patients at the index MEU assessment are related to subsequent hospital admission. Therefore, we aimed to describe these baseline characteristics and to examine their association with 30-day hospital admission. Methods In this retrospective, single-centre cohort study at Esbjerg Hospital (Region of Southern Denmark), we screened 1656 MEU contacts (from 1 January to 31 December 2024) and included adults aged ≥ 65 years, who were not directly admitted/conveyed to hospital at the index visit (i.e. initially managed at home). These patients were potential candidates for hospital admission, and the emergency physician made an on-scene decision regarding admission. Data were analysed using multivariable logistic regression. Results We included 357 MEU contacts, with a median (interquartile range) age of 83.5 (77.6–89.2) years. 140 (39.2%) of these contacts were admitted to hospital within 30 days. A higher proportion of the admitted patients had a pre-existing do-not-attempt-resuscitation (DNAR) order compared with the non-admitted patients (85.0% vs 66.4%; p < 0.001) and lived at home (57.8% vs. 47.4%; p = 0.055). Chronic pulmonary disease was more common among the admitted patients (31.4% vs 19.3%; p = 0.009), whereas dementia was less frequent (18.6% vs 28.1%; p = 0.042). Both a pre-existing DNAR order (odds ratio [OR] 3.83, 95% confidence interval [CI] 2.05–7.16) and home (vs nursing home) residence (OR 1.76, 95% CI 1.03–2.98) were significantly associated with hospital admission in the adjusted model. Conclusions Among older adults assessed at home by MEU physicians, a pre-existing DNAR order and home (vs nursing home) residence were independently associated with 30-day hospital admission. These findings may inform triage and follow-up planning. However, prospective studies are required to establish causal links.
