#RCEMasc 2019 Day 2

After a great first day (which you can read about on the day one blog here), we reconvened in Sage, Gateshead for day 2 of the RCEM Annual Scientific Conference. At the AGM the night previous, the presidency had changed hands, and so in a mirror of Taj giving the opening talk for the conference as his last act as RCEM president, Katherine Henderson started her tenure with the first talk of the day. It was great to hear her proposals for the important focuses for the college moving forward.

The main points surrounded:

  • Safer departments – getting patients off the corridors and into beds. Katherine was passionate that corridor patients should be a thing of the past and will be working hard to realise this dream
  • More consistent training across the board and improved education via the new college curriculum. This requires everyone to be up to date and on board with current training needs
  • Improved access to subspecialty interests, such as PHEM, PEM, global health, research
  • Better facilitation of portfolio careers
  • Making the ED the best place to work in the hospital

We’re all very excited to see how these points and more develop over the next few years with Katherine in charge!

Alasdair Gray gave the David Williams lecture this year, and it was refreshing to hear him start with a topic that I am sure is tough for all of us – failure. From highlighting failures early in his career, to his successes in clinical and research lives, it was a truly inspiring talk and I am sure gave much hope to those (slightly) younger generation of EM doctors in the audience.

Words of advice to junior EM trainees were certainly welcome from both Katherine and Alasdair, following their talks.

It was great to hear from researchers presenting their work during the Rod Little prize session. There were quite honestly a lot of statistics and big words that I didn’t understand. For his work on a trial determining whether there was patient benefit in using pre-hospital free-flow oxygen CPAP masks for acute respiratory failure (there wasn’t), the winner was Gordon Fuller.

After a break, over in the life to death stream, we had some great talks around obstetrics, elderly care, and palliative care in the emergency department. Andrew Loughney explained the reasons behind the physiological changes associated with pregnancy that we might see and have to try to remember (or look up) in the ED.

It was also eye-opening to hear him talk about statistics around maternal deaths based on demographics, cause of death. and how obstetricians can help with decision making early on for those higher risk patients we see, so he encouraged early referral and review, even when you don’t think the main problem is obstetric-related. For more information and data on maternal death you can look at the MMBRACE website.

There has been a big shift in focus around frailty in the emergency department, and I’m sure here at Virchester we’re not the only ones with our own “frailty team”. Maybe in the future we’ll have specialist geriatric EDs! Charlotte Bates talked us through how we can identify elderly patients at risk through frailty assessment, comprehensive geriatric assessments, and other measures in order to try to prevent decline, and restore or retain independence.

We’re probably very bad at this in the ED as clinicians, and rely heavily on our therapy teams. We need to get better – this population is the mainstay of our work and we’ll all hopefully get old one day. She gave a comprehensive but wide ranging talk covering all things medical and trauma. The latest RCEM safety alert is on Silver Trauma so do give that a read and ensure it’s publicised in your department. As an aside, here in Virchester, our local major trauma network have been focusing on trauma in older people too, using the #MeetHarry poster to try to increase recognition of injuries.

After lunch, Simon and Dan were giving talks in one stream, they’ve both written blog posts to accompany these and you can read Simon’s here, and Dan’s here so do check those out!

At the same time, Rob Galloway (annualised self-rostering champion) spoke on how annualised rotas have changed things for the better in Brighton, not just for consultants but also trainees. It’s slow going but departments across the country are gradually taking this up for their own clinicians, so do get in touch with Rob if you want some advice on how you might be able to implement this for your own ED rota! The main point seems to be to just get on and take the plunge!

In the third stream there were some quick fire papers, and with only around 3 minutes to present their data, and 10 speakers I was very surprised when it finished on time! Here are some of the highlights:

Matt Reed talked about data from Scottish Code Red – over 90% of code red patients received blood components, and they managed to decrease the time from 999 call to Code Red activation by half.

Some qualitative research from Fleur Cantle in King’s College Hospital, London next around leadership. This really fits with changes the college is making to the 2020 curriculum, with an emphasis on clinical leadership from early on in training.

Aine Mitchell spoke on using clinical frailty scores as decision aids in the ED and wanted us to remember these things:

  • Don’t use ageist cut offs for offering best care
  • Your emergency department is a deliriumogenic environment
  • Aim to prolong and improve life, but not to prolong death

Connor Putnam and team from Leicester developed a patient-input device for pain scoring, and found that patients rated their pain higher than was documented by clinicians. This ties in with other studies in the literature such as this one, and highlights a probable need to be better at pain scoring, recording and management.

Gordon Fuller (off of the Rod Little prize) has been doing some other work, this time around head scanning in patients on DOACs and whether they need one. Preliminary research is positive and will pave the way for a prospective study with a larger cohort so it will be good to follow this up in a few years.

Lastly, handover in the ED can be stressful for new or more junior trainees, you don’t know anyone and it can be sometimes difficult to feel comfortable giving someone else your unfinished work (Ed – though absolutely necessary). Through interviews and thematic analysis, Emily Park found that supportive and friendly relaxed handovers (rather than a more schoolteacher style) can help to reduce stress and provide opportunities for socialising and teaching for the juniors. Definitely something to think about.

That was all from the free papers, and the last session of the day gave principal and young investigators the spotlight, with Adrian Boyle (Principal Investigator of the Year award winner) discussing the benefits of collaboration in research.

We also heard from Juan Mercer, winner of the undergraduate essay prize, on external validation of the BIG (brain injury guidelines) criteria in traumatic brain injury, particularly focusing on a decision tool for discharge in low risk patients with traumatic injury (who at present we would usually admit solely for observation). The take-home message from this was that it may be possible to avoid admission in a select group with TBI.

Lastly the Young Investigator of the Year award winner was announced (well, actually it was announced in January but as it’s the annual scientific conference it was announced again). The winner was Sophie Richter who is an emergency medicine registrar in Cambridge with a keen interest in traumatic brain injury. You can find out more about her and her research on the RCEMlearning blog here, and we look forward to hearing from her at conferences in the future!

Well, that was day 2. A very busy day with lots to learn, and even more to go away and read up about in the days to come.

vb

Chris
@cgraydoc

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Posted by Chris Gray

Dr Chris Gray BSc(Hons) MBBS MRCP(UK) MRCEM AICSM is an ST6 in Emergency Medicine and Intensive Care Medicine, training in Manchester and the North West. He is also an ALS, APLS, and ETC instructor and keen educator. He is @cgraydoc on twitter

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