International Emergency Nursing (2010) 18, 54–55

ava i lab le at www.sc iencedi rec t . com

journal homepage: www.elsevierheal th .com/ journals /aaen

Setting new standards – Emergency carein the 21st Century q

This year’s ECA conference was held in Harrogate,a change from its long history at the Daresbury Hotelin Cheshire. The conference, held over 2 days was at-tended by over 170 delegates from the UK andabroad. I found it a very stimulating 2 days and itwas heartening to hear about so much innovation,passion about our speciality and commitment to im-prove services despite the daily pressure we are allunder. Here are a few highlights.

Pandemic flu in ED

Kristy Challen Speciality Registrar in Emergency Med-icine and Public Health opened the conference with avery thought provoking address about swine flu andthe possible implications for ED’s over the comingwinter. Evidence from Australia and New Zealand,who have just had their winter, has highlighted thesignificant impact of the pandemic on the need forintensive care, especially in neonates and paediatrics.During the 3 months of their winter June–August 09722 admissions to ICU were due to infection withH1N1. Pregnant women and those with a BMI > 35 alsohad a significantly higher rate of ICU admission. Fur-ther information about this evidence can be foundat http://www.content.nejm.org/cgi/reprint/NEJ-Moa0908481.pdf. Research in the UK led by ScHARRat University of Sheffield is analysing whether a sim-ple of assessment of a patients symptoms at Triagecan identify the need for hospital treatment; ThePainted study (pandemic flu in ED Triage).

doi:10.1016/j.ienj.2009.11.002

q RCN Emergency Care Association annual conference and exhi-bition 16–17 October 2009 Barcelo Majestic Hotel, Harrogate,Yorkshire.

Patients with learning disability in ED

There was a very powerful plenary lecture by DavidCongdon from Mencap identifying the lessons fromthe Mencap publication Death by indifference(2007). This report highlighted institutional discrimi-nation in the NHS and patients with learning disabilityreceiving poor health care. There were harrowing ac-counts of the lack of care the adults and young peoplein the report received which contributed to theirdeath. If you have not read this report, I urge you toand then benchmark your own area of practice to con-sider critically if the care you deliver to vulnerableadults is beyond reproach (http://www.men-cap.org.uk/document.asp?id=284).

The theme of vulnerable adults continued through-out the conference with concurrent sessions aboutvulnerable adults and making ‘‘reasonable adjust-ments’’ to ED care, patients with dementia andimproving their care in ED and safeguarding adultswith negotiated care plans. When considering howto adjust ED care and treatment to make improve-ments for those who are vulnerable it is easy to dis-miss making changes due to lack of resources.However, all these sessions identified that the adjust-ments made were often basic and simple. Reasonableadjustments are often just about good communica-tion, recognising the invaluable role of parents/carersand making information more accessible by usingwords and pictures.

Fever management in children

A review of the NICE Feverish Illness in Children guide-line published in May 2007 provided a useful reminderfor all those involved in the care of ill children. Withinthe guideline are recommendations about how to takea temperature and what kind of instrument to use.

55Setting new standards – Emergency care

The traffic light system is a valuable tool to aid in theassessment of children with fever and provides guid-ance about when to refer or discharge. The parent ad-vice leaflets that accompany the guideline arecomprehensive and in an editable format. Auditingyour practice against these guidelines would be avaluable exercise in ensuring fever assessment andmanagement is evidenced-based.

Advanced practice

There were five concurrent sessions in total from theAdvanced Clinical Practitioners (ACPs) at the Heart ofEngland NHS Foundation Trust. Paediatric assess-ment, ECG interpretation and blood gas analysis weredelivered as workshops which enabled audience par-ticipation and learning to take place. A fascinatingconcurrent session comparing the role of ACPs withMiddle Grade ED doctors identified outcome data thatdemonstrated that ACPs are as safe and effective astheir medical colleagues. ACPs were developed atthe Heart of England Trust as a means to address askills deficit and provide static clinicians as middlegrade doctors could not be recruited. ACPs managethe whole patient journey in all clinical areas of ED;minors, majors, resuscitation and paediatrics andwork independently treating 48% of attendances.Working 80% clinically each of the 11 ACPs, basedacross three sites has an area of responsibility forwhich they are the clinical lead e.g. resuscitation.This enables their knowledge and advanced clinicalskills to have a wider impact across the whole teamand emergency service. The ACPs are on the medicalmiddle grade rota and provide cover until 12 midnight

7 days per week. There is no doubt that developingthe nursing workforce in this way provides safe clini-cal care and raises standards across every aspect ofcare provision.

Following on from this concurrent session was re-search presented by Garry Swann the Nurse Consul-tant in ED at the Heart of England NHS FoundationTrust. The introduction of a Acute Assessment Area(AAA) for the rapid assessment of patients in Manches-ter Triage categories 2 and 3 significantly reduced ini-tial waiting, ED journey time and improved patientsatisfaction levels. In particular patients emphasisedthe importance of information and effective commu-nication. Majors patient still tend to have the longestjourney times in ED, often only transferred to anotherward or department just before breach time. Rapidassessment of these patients by senior clinicians asthey arrive in ED focuses resources, expedites assess-ment and investigation and contributes to early deci-sion-making regarding admission or discharge.

Overall ECA conference 2009 provided much foodfor thought and I shall look forward to the 2010 con-ference in Cardiff 22–23 October for the sharing ofmore ideas, research and innovation and the opportu-nity to debate current issues.

Further information on the conference and copiesof the presentations should be available on the RCNECA website soon, for more information go to http://www.rcn.org.uk/development/communities/rcn_forum_communities/emergency_care.

Paula Bennett (Nurse Consultant)Emergency Department,

Stockport NHS Foundation Trust,United Kingdom

E-mail address: Paula.Bennett@stockport.nhs.uk