Emergency Medicine Journal - BMJ Group https://bmjgroup.com Helping doctors make better decisions Thu, 11 Dec 2025 09:35:51 +0000 en-GB hourly 1 https://bmjgroup.com/wp-content/uploads/2024/04/Favicon2_Orange.png Emergency Medicine Journal - BMJ Group https://bmjgroup.com 32 32 Nearly 1 in 5 UK emergency department patients cared for in corridors/waiting rooms https://bmjgroup.com/nearly-1-in-5-uk-emergency-department-patients-cared-for-in-corridors-waiting-rooms/ Thu, 11 Dec 2025 09:35:51 +0000 https://bmjgroup.com/?p=14511

Almost all emergency departments routinely deploying this approach

At any one time, nearly 1 in 5 emergency department patients in the UK is being cared for in corridors, waiting rooms, and other non-standard ‘overflow’ spaces—an approach known as escalation area care—suggest the results of a large observational study, published online in Emergency Medicine Journal.

Almost all emergency departments in the UK are routinely deploying this approach, which contravenes national guidance, the findings indicate.

Amid the high prevalence of emergency department overcrowding in the UK, escalation area care is reported to be widespread, but there is no high quality evidence describing its prevalence, say the researchers.

This is especially important as escalation area care is known to compromise patient safety, generate substandard and undignified experiences for the patient, and is thought to be a factor in the heightened risk of death among patients enduring long waits in emergency departments, they add.

To gauge its true prevalence, the researchers studied clinical activity in 165 out of 228 type 1 emergency departments—those providing consultant-led, 24-hour services with full resuscitation facilities—at 5 different time points across 10 days in March 2025.

Local reporting teams relied on electronic health records, department management systems, and real-time observations to record the number of patients in escalation areas.

They also recorded the number of patients awaiting an inpatient bed; the number of cubicles or chair spaces in each emergency department (stratified by resuscitation room and non- resuscitation room status); whether there were children and patients with a presenting mental health issue in escalation areas; and the availability of resuscitation cubicles.

An escalation area was defined as ‘any area not routinely used unless the capacity of the usual emergency department geographical footprint is exceeded’ and they included: an ambulance queueing to offload for more than 15 minutes; a repurposed clinical area; a non-clinical area, such as a hospital corridor or waiting room; and a doubled-up cubicle.

The data showed that the treatment of emergency department patients in escalation area spaces was a regular and common occurrence.

The total number of patients in escalation areas across all 5 time points totalled 10,042, or 18% of all 56,881 patients in the participating emergency departments. And the proportion of sites reporting patients in escalation areas ranged from 70% to 90%.

A break-down of the total proportion of patients treated in the various types of escalation area in use showed that repurposed clinical spaces (31.5% to 39%) and non-clinical spaces, such as waiting rooms and corridors (53% to 58%), made up the lion’s share.

Overall, the time point with the highest number of patients in emergency departments (15, 933) was Monday at 7pm. The highest proportion of patients in escalation areas was Thursday at 7 am (the end of the clinical night shift), when more than 1 in 5 (21%) of all UK emergency department patients were being cared for in these locations, despite this being the period with the lowest total number of patients (7056).

Both children and patients with a mental health presentation were being cared for in these spaces across all 5 time points. Among the emergency departments seeing children, 5% to 23% reported treating them in escalation areas. And the proportion treating patients with a mental health presentation in these spaces ranged from 26% to 35.5%.

Regionally, the proportion of patients in escalation areas was consistently highest in Northern Ireland and lowest in the Southwest of England. And this proportion was highest in adult only emergency departments and smaller local emergency hospitals, and lowest in major trauma centres.

The number of patients waiting for an inpatient bed consistently exceeded the number of patients being cared for in escalation areas.

And the proportion of sites without any immediate resuscitation cubicle capacity ranged from 10.5% to 26%, “representing a significant patient safety issue,” note the researchers.

They conclude: “National guidance from NHS England states that escalation area use is not acceptable; this study demonstrates that it is widespread and routine. The same guidance states that children and those with mental health problems should never experience escalation area care; this study demonstrates that this is occurring regularly.

“Admitting patients awaiting an inpatient bed from the [emergency department] would largely solve the escalation area care problem… Healthcare policy makers must address this issue or openly accept escalation area care and its associated harms as a standard experience in UK emergency care.”

In a linked editorial, the immediate past and current presidents of the Royal College of Emergency Medicine, suggest that the findings are likely to be an underestimate.

“The authors of this paper have successfully quantified the extent to which crowding leads to patients being treated in inappropriate spaces. If anything, their findings will be an underestimate.”

They point out: “Most recently, the harm associated with crowding has been quantified, such that for every 72 patients who wait 8–12 hours before admission there is one excess death.”

The study provides further evidence on the cause of overcrowding in emergency departments, they highlight. It’s not the volume of patients coming in, but the flow out.

“Basically, if all the patients who required admission were taken out of the equation, the [emergency departments] in the study (remember that is most of the [emergency departments] in the UK) would not have been overcrowded. The issue is the exit block, and the policy focus needs to be on that,” they insist.

They add that the research didn’t measure the effects on patients and staff of escalation area spaces, but it stands to reason that this can’t be the best quality care.

“Despite NHS England’s guidance on ‘providing safe and good quality care in temporary escalation spaces’, it simply isn’t possible to offer proper care in corridors and cupboards. Patients describe loss of autonomy, unmet expectations, and feelings of increased vulnerability. Many of these patients are elderly, frail, and vulnerable. Many have visual or hearing impairment, or are confused. Many have extensive nursing needs,” they write.

“The disconnect between guidance from politically driven organisations, such as NHS England, and the real world is starkly exposed here,” they add.

10/12/2025

Notes for editors
Research:  Understanding corridor and escalation area care in 165 UK emergency departments: a multicentre cross- sectional snapshot study Doi: 10.1136/emermed-2025-215301
Commentary: Another brick in the wall: why ‘corridor care’ is an oxymoron and why it is important to understand it Doi: 10.1136/emermed-2025-215664
Journal: Emergency Medicine Journal

External funding: Royal College of Emergency Medicine (research)

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

About the journal
Emergency Medicine Journal is one of 70 journals published by BMJ Group. The title is co-owned with the Royal College of Emergency Medicine
https://emj.bmj.com/

Externally peer reviewed? Yes (research); No (commentary)
Evidence type: Observational (research); Opinion (commentary)
Subjects: People

 

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4+ hour emergency care wait linked to heightened risks of death and longer hospital stay for hip fracture patients https://bmjgroup.com/4-hour-emergency-care-wait-linked-to-heightened-risks-of-death-and-longer-hospital-stay-for-hip-fracture-patients/ Wed, 09 Oct 2024 09:06:11 +0000 https://bmjgroup.com/?p=8797

More than 1 in 3 waited longer than required standard, single centre study reveals

Waiting more than 4 hours in emergency care for treatment is linked to heightened risks of death and a longer hospital stay for hip fracture patients, reveals a single centre study, published online in Emergency Medicine Journal.

The waiting time for more than 1 in 3 of these patients exceeded the 4 hour national standard, which now requires that 76% of emergency department patients must either be discharged or admitted to hospital within that time frame.

By the age of 80 an estimated third of women and 17% of men will have fractured a hip—figures which are slated to likely double by 2033, explain the researchers.

Early surgery is associated with lower risks of death and perioperative complication rates, but with emergency department waiting times currently lengthening across the UK and elsewhere, it’s highly likely that hip fracture surgery may end up being delayed, they add.

To assess the potential impact on hip fracture patients of 4+ hour waits in the emergency department, the researchers retrospectively evaluated local hip fracture database entries for all patients aged at least 50, admitted to a single trauma centre between 1 January 2019 and 30 June 2022, and subsequently monitored for at least 8 months until February 2023.

The trauma centre in question serves a population of 916,310 people in Lothian, Scotland and manages more than 1000 hip fractures annually.

Details on demographics, treatment, progress through the service, and death were collected from the patients’ case notes and the trauma centre’s documentation.

Some 3611 patients were admitted to the centre with a hip fracture during the study period. After various exclusions, including those with incomplete admission and discharge time data, 3266 patients were included in the analysis.

Their average age was 81, but ranged from 50 to 104, and 2359 (72%) were women. They spent an average of 3.9 hours in the emergency care department.

The average length of time before surgery was 27 hours, with the average time between admission and surgery 22.5 hours. Average length of their hospital stay was 9 days, with subsequent follow-up lasting 529 days, during which time 1314 (just over 40%) of these patients died.

In all, more than a third (1261; 39%) patients waited longer than 4 hours in the emergency department. They were significantly more likely to be admitted during the winter, to pose more of a surgical risk, to have sustained a fracture that is more difficult to repair, and to have waited longer for their surgery than those who spent 4 hours or less in the emergency department.

Almost 96% of those who waited less than 4 hours were alive at 90 days compared with almost 93% for those waiting longer—equivalent to one additional death at 90 days for every 36 patients who waited more than 4 hours, say the researchers.

The 90 day risk of death rose in tandem with the length of delay before surgery, reaching around 14% after 24 hours.

Male sex, older age, admission during the winter months, higher operative risk, care home residence, and longer time between admission and surgery were also all independently associated with death at 90 days.

After taking account of potentially influential factors, a 4+ hour wait  was associated with 29%, 36%, and 15% heightened risks of death at 60 days, 90 days, and at final check-up, respectively.

Patients who waited 4+ hours in the emergency department were also much more likely to spend 1 day longer in hospital, adding up to around £770,000 in total, if costed at £610/day (2014 prices), note the researchers.

This is an observational study, so cause can’t be confirmed. And the researchers acknowledge the relatively small size of their study and the lack of adjustment for the patients’ overall state of health and factors delaying their admission, all of which may have influenced their outcomes.

But while it isn’t clear exactly why spending more than 4 hours in the emergency department should be associated with poorer outcomes for hip fracture patients, given that there is a link, direct transfer to theatre from the emergency department might improve the chances of survival for these patients, the researchers suggest.

09/10/2024

Notes for editors
Research:
 Delayed admission of patients with hip fracture from the emergency department is associated with an increased mortality risk and increased length of hospital stay Doi: 10.1136/emermed-2023-213085
Journal: Emergency Medicine Journal

External funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

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Lettuce may be just as good as dock leaf for easing nettle sting symptoms https://bmjgroup.com/lettuce-may-be-just-as-good-as-dock-leaf-for-easing-nettle-sting-symptoms/ Tue, 30 Jul 2024 10:12:04 +0000 https://bmjgroup.com/?p=7929

Cooling and soothing effect of sap evaporating from a crushed leaf may be what helps

Rubbing a lettuce leaf on a nettle sting to ease the associated discomfort may be just as good as using the age-old folk remedy of a dock leaf, suggest the results of a small comparative study, published online in Emergency Medicine Journal.

It may simply be the cooling and soothing effect of sap evaporating from a crushed leaf that brings relief, and doing nothing might work just as well, although possibly not if you’re a small child, suggest the researchers.

Nettles are a common native plant in the British Isles. Their stems and leaves are covered in stinging hairs, or trichomes, with a brittle tip that snaps off when touched, releasing a mini jet of chemicals (histamine, acetylcholine, and serotonin) into the skin.

Rubbing a dock leaf on the affected area to ease the ensuing discomfort is a well-known ancient folk remedy first mentioned 600 years ago by Geoffrey Chaucer in Troilus and Criseyde, point out the researchers.

This remedy may have been prompted by the cooling and soothing effect of sap evaporating from a crushed leaf, they say. “If so, any large, fresh and non-toxic leaf would do the job, and dock may have become the leaf of choice simply because it grows in similar habitats to nettle,” they suggest.

To find out if the remedy has any foundation in science, the researchers carried out the Nettle-induced Urticaria Treatment Study (NUTS), a randomised, double blind, active placebo-controlled trial involving 9 healthy emergency department doctors.

As the dummy treatment needed to mimic the physiological effect of the dock leaf, and be of similar size, shape, and texture, but contain no anti-inflammatory or toxic properties, a sweet gem lettuce was chosen.

Participants brushed the inside of a demarcated area of both forearms with two stems of freshly harvested nettle stem 10 times. They were then blindfolded.

After 60 seconds—to mimic the time it might take to find a dock leaf in real life—the participants rolled a die. If an odd number was rolled, 2 dock leaves were rubbed on the area for 60 seconds of their right arm and 2 lettuce leaves on their left for 60 seconds. For even numbers the application arms were reversed.

After each application participants were asked which arm they thought had been treated with dock and which with lettuce. And they rated the discomfort felt in each arm  after 1–5, 10, 15 and 20 minutes on a scale of 0 (no discomfort) to 5 (the most discomfort possible from a nettle sting).

The term ‘discomfort’ incorporated the varied sensations provoked by nettle stings, to include burning, itching, and tingling.  The score was tracked until resolution of symptoms, and named the Insult to Complete Healing (ITCH) score.

The total number of discrete wheals visible within the demarcated area at 5, 10, 15 and 20 minutes after stinging was also recorded and given as the Observable Urticaria/Count of Hives (OUCH) score.

Participants photographed their own forearms at these time points, and OUCH scores were counted subsequently by an observer unaware of the treatment arm to determine peak OUCH and time to peak OUCH.

The results showed that 3 participants correctly stated which arm had been treated with dock, 3 were incorrect, and 3 were completely unable to say which treatment had been applied.

The average absolute reduction in ITCH score at 5 minutes was 3 points for dock vs 2 points for lettuce—a difference of just 1 point, and not statistically significant.

And while there was a statistically significant fall in ITCH score over time for both interventions, there was no significant difference between dock and lettuce.

The average peak OUCH score was 27 for the dock treatment and 20 for the lettuce treatment, while the average time to peak OUCH was 5 minutes for both, neither of which was statistically significant.

The observed discomfort of nettle stings eased rapidly over 15–20 minutes with both dock and lettuce leaf applications, say the researchers. But “the effect was not significantly different between the two interventions.”

They add: “It is possible that the same relief would have occurred with no treatment at all, and our study design does not permit us to conclude that either dock or lettuce is better than simply doing nothing.”

And for children that probably isn’t an option, they suggest. “Patient/Public Involvement work from other studies suggests that children in particular do not consider doing nothing to be an acceptable option when they are in pain,and we feel this may well be applicable to nettle stings.”

They acknowledge the small sample size of the study, which precludes any firm conclusions from being drawn. And the trial was primarily carried out as part of a team building exercise and an exploration of the concepts involved in research.

But they write: “We conclude that dock leaf may work for nettle stings, [but] lettuce may be just as good, [and] relief comes quickly either way.”

30/07/2024

Notes for editors
Concepts:
 Nettle-induced Urticaria Treatment Study (NUTS): demonstrating the joy of research through a randomised, blinded, placebo-controlled trial Doi 10.1136/emermed-2023-213915
Journal: Emergency Medicine Journal

External funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Randomised controlled trial
Subjects: People

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Opportunistic emergency department stop smoking prompt helps smokers quit https://bmjgroup.com/opportunistic-emergency-department-stop-smoking-prompt-helps-smokers-quit/ https://bmjgroup.com/opportunistic-emergency-department-stop-smoking-prompt-helps-smokers-quit/#respond Wed, 27 Mar 2024 13:53:00 +0000 https://bmj.enviousdigital.co.uk/opportunistic-emergency-department-stop-smoking-prompt-helps-smokers-quit/

Comprises brief advice, e-cigarette starter kit, and referral to local stop smoking services

Significant proportion of patients still not smoking 6 months later

An opportunistic emergency department stop smoking prompt, comprising brief advice by a trained professional, an e-cigarette starter kit, and referral to local stop smoking services can help smokers quit, with a significant proportion of them still not smoking 6 months later, finds research published online in Emergency Medicine Journal.

Some 6.4 million people in the UK still haven’t stubbed out for good, and of the large numbers of people attending emergency departments, a substantial proportion are more likely to be smokers and have poorer overall health, explain the researchers.

While initiatives in emergency departments to help people stop smoking have shown promise, it’s not clear how well they work over the long term and what elements of them are most effective.

In a bid to find out, the researchers compared usual care with the real-world effectiveness of a brief intervention based in an emergency department to help smokers quit over a 6 month period in the Cessation of Smoking Trial in the Emergency Department (COSTED).

Between January and August 2022, they recruited 972 (out of 1443 screened) adult daily smokers attending the emergency department for Medical treatment or accompanying someone who needed it.

Half the participants (484) were randomly allocated to the intervention arm and given brief smoking cessation advice of up to 15 minutes and an e-cigarette starter kit plus advice on its use (up to 15 minutes), as well as a referral to local stop smoking service.

The advice was delivered by a dedicated stop smoking advisor while the patient was waiting to be seen or after discharge. It was tailored to their presenting condition—for example, discussing how not smoking improved wound healing for patients with cuts.

The local stop smoking service routinely followed up with a phone call offering support and, if taken up, advice on how to quit, as well as free provision of nicotine replacement therapy (NRT).

The rest of the participants (488) were randomly allocated to the comparison arm of the trial and given written details of local NHS stop smoking services but weren’t referred directly.

Those reporting that they had stopped smoking at the 6 month assessment were asked to take a carbon monoxide test to biochemically confirm this.

After 6 months, continuous abstinence was just over 7% (35/484) in the intervention group and just over 4% (20/488) in the comparison group, meaning that those given the prompt were 76% more likely to have stopped smoking than those merely signposted to smoking cessation services.

Self-reported 7-day abstinence at 6 months was just over 23% (113/484) in the intervention group and 13% (63/488) in the comparison group.

Those in the intervention group were also more likely to make quit attempts than those in the comparison group: 2 (1–4) vs 1 (0–3). And of those who responded to this query, nearly 40% (125/317) were using an e-cigarette daily at this point.

No serious side effects associated with taking part in the trial were reported.

The researchers acknowledge that those in the comparison group were supported rather more than perhaps would have been the case normally, and managing to obtain a carbon monoxide test to confirm trial participants had stopped smoking proved “very challenging,” they add.

But they point out: “These results strengthen previous findings that [emergency department]-based smoking cessation interventions are effective. To our knowledge, the 6-month self-reported quit rate is the highest reported by any [such] smoking cessation intervention trial to date.”

They conclude: “We consider that this could be rolled out to reach a large proportion of current smokers, although dedicated staff are clearly needed to deliver the intervention so as not to burden clinical staff.”

And this approach is also likely to narrow health inequalities, they suggest: “Those attending [emergency departments] are generally from more deprived communities and more likely to smoke than the general population. Therefore, this intervention has the potential to address health inequalities that arise from disparities in smoking rates between different socioeconomic groups.”

In a linked editorial, Drs Gina Kruse and Jon Samet of the University of Colorado and Dr Joaquin Barnoya of the Integra Cancer Institute, Guatemala City, add that “the high uptake of the trial interventions makes a compelling argument for the potential of a cessation package that includes e-cigarettes for [emergency department] patients.”

But as nearly 40% of participants in the intervention arm were using e-cigarettes daily and over half at least weekly during the 6 month follow-up period, they sound a note of caution.

“We need more information on the long-term use of e-cigarettes after cessation of combustible cigarettes, owing to concerns that persistent use is likely to be seen as a favourable finding by the e-cigarette industry that would profit from continued nicotine dependence,” they write.

And they conclude: “We need to measure the harms to adolescents hand in hand with the potential for benefits to combustible cigarette users if we are to generate informed policies and practices about these devices.”

Notes for editors

Research: Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial doi: 10.1136/emermed- 2023-213824

Editorial: Electronic cigarettes: beneficial for smoking cessation but harmful to public health? doi: 10.1136/emermed-2024-213940

Journal: Emergency Medicine Journal

External funding: NIHR (Health Technology Assessment (research)

Link to Academy of Medical Sciences Press releases labelling system

http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (editorial)

Evidence type: randomised controlled trial (research); opinion (editorial)

Subjects: People

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Potentially harmful ‘trip-killers’ to cut short ‘bad’ drug trips, emerging concern, warn doctors https://bmjgroup.com/potentially-harmful-trip-killers-to-cut-short-bad-drug-trips-emerging-concern-warn-doctors/ https://bmjgroup.com/potentially-harmful-trip-killers-to-cut-short-bad-drug-trips-emerging-concern-warn-doctors/#respond Wed, 20 Dec 2023 17:10:26 +0000 https://bmj.enviousdigital.co.uk/index.php/2023/12/20/22514/

Benzodiazepines and antipsychotics most often recommended, but few safety warnings on social media

The use of potentially harmful ‘trip-killers’ to cut short ‘bad drug trips’ after taking psychedelics, such as LSD or magic mushrooms, is an emerging concern, warn doctors in a research letter, published online in Emergency Medicine Journal.

Their analysis of relevant threads on the social media platform Reddit, shows that drugs such as benzodiazepines (sedatives) and antipsychotics are the options most frequently recommended, but warnings about their potential side effects are rarely included, they highlight.

The intensity of a psychedelic drug trip can cause distress, agitation, and even psychosis, point out the authors, citing recent research indicating that more than 8% of drug-related attendances at European emergency care departments involve psychedelic drugs.

And this proportion may very well increase as the clinical use of these agents expands, they suggest.

One of the ways to cut short, or lessen the intensity of, a bad trip and avoid potentially requiring hospital treatment, is to take additional mind altering drugs, dubbed ‘trip-killers’. 

Although not new, this option has gained much greater traction on social media in recent years, note the authors, who did a systematic keyword search of Reddit, looking for relevant threads in English to gain a better understanding of trip-killer use.

They found 128 threads created between 2015 and 2023, yielding a total of 709 posts.

Top of the league table, with 440 recommendations, amounting to nearly half (46%) of all the trip-killers mentioned in posts, were various benzodiazepines, followed by several different antipsychotics (171;18%).

One in 10 recommendations were for antidepressants, while 1 in 20 were for alcohol. Opioids, antihistamines, herbal remedies, such as camomile and valerian, and prescribed sleeping pills, attracted 3% each. Cannabis and cannabidiol each took 2% of the vote share.

Trip-killers were mostly discussed in reference to countering the effects of LSD (235 recommendations), magic mushrooms (143), and MDMA, popularly known as ecstasy (21).

Only 58 posts mentioned potentially harmful side effects.

“The popularity of benzodiazepines raises concerns,” write the authors. “Benzodiazepines are addictive and have been repeatedly implicated in overdose deaths. The doses described on Reddit risk over-sedation, hypotension [low blood pressure], and respiratory depression [stopping breathing or shallow breathing],” they point out.

Doses of one of the recommended antipsychotics, quetiapine, were also high (25 – 600 mg), they note, with only a few posts differentiating between fast and slower release formulations.

“Information on trip-killers isn’t available through drug advice services, despite the probable risks they pose,” highlight the authors.

20/12/2023 

Notes for editors
Research letter: Trip-killers: a concerning practice associated with psychedelic drug use doi: 10.1136/emermed-2023-213377
Journal: Emergency Medicine Journal

Funding: None declared

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

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Patients overestimate the success of CPR https://bmjgroup.com/patients-overestimate-the-success-of-cpr/ https://bmjgroup.com/patients-overestimate-the-success-of-cpr/#respond Tue, 14 Jul 2020 09:04:35 +0000 https://bmj.enviousdigital.co.uk/patients-overestimate-the-success-of-cpr/

Doctors should discuss CPR to clarify and inform patients before they consent to it, say researchers

Patients and the general public appear to significantly overestimate the success of cardiopulmonary resuscitation (CPR) and underestimate the negative impact it can have on a person’s health, suggests research published online in Emergency Medicine Journal

US researchers have therefore recommended clinicians discuss CPR with patients and their loved ones to clarify the practice’s success rate and the real benefits and risks involved before patients or their families are asked to consent to it.

Emergency physicians often talk to patients or their families about end-of-life care and the outcomes of resuscitation efforts. Patient and family preconceptions of CPR can have a significant effect on the tone of discussions and the subsequent medical care provided.

Previous studies have shown that most lay people overestimate the success of CPR and underestimate its morbidity but no studies on the subject have been carried out amongst patients and visitors in an emergency department.

Patients in previous studies have cited television as a large source of their belief that rates of survival after CPR vary between 19% and 75%, whereas actual rates of survival of CPR range from an average of 12% for out-of-hospital cardiac arrests to 24–40% for in-hospital arrests.

Therefore, a team of researchers from the University of California in the US carried out a survey of 500 emergency department patients and their companions to assess their expectations and examine whether or not variation in information sources, prior exposure to CPR, and healthcare experience would influence peoples’ predicted CPR success rates.

The survey was carried out amongst adults in the emergency department waiting area within a tertiary care hospital in Sacramento, California, between June and September 2016.

An “optimism scale” was created to reflect expected likelihood of survival after CPR, or CPR success, under several sets of circumstances.

Results showed that of the 500 respondents, more than half (53%) had performed or witnessed CPR, and/or participated in a CPR course (64%).

Television was the main source of information about CPR for around 95% of respondents.

At least half of the people interviewed estimated the success rate of CPR as being more than 75% in all situations. The estimated CPR success rates were unrelated to age, sex, race, spiritual beliefs or personal healthcare experience.

The vast majority (90%) of people interviewed said they wanted to receive CPR if it was possibly needed.

Comments also revealed that only 28% of respondents had discussed CPR with a physician, but most participants believed that a physician should talk to them about their CPR preference.

The study had some limitations such as the fact that it took place at a single institution and for convenience, the sample only included English speakers which limits the generalisability of findings. Some participants might also have been distracted by illness or the emergency department waiting area environment.

Nevertheless, the researchers conclude: “Patients and visitors to an emergency department, regardless of prior healthcare or CPR experience, overestimate the likelihood of success with CPR.

“These findings should prompt emergency department physicians to initiate discussions about resuscitation with their patients while also providing them with key information to help facilitate informed decision-making.

“When discussing CPR preferences, emergency department providers should focus on true rates of survival and outcomes in any shared decision-making conversation and should not assume that a patient or companion with healthcare experience will have realistic expectations.”

[Ends]

13/07/2020

Notes for editors
Research: 
Perspectives of emergency department attendees on outcomes of resuscitation efforts: origins and impact on cardiopulmonary resuscitation preference doi 10.1136/emermed-2018-208084
Journal: Emergency Medicine Journal

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors

Link to AMS labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Peer reviewed? Yes
Evidence type: Observational, survey
Subjects: People

Link to research: https://emj.bmj.com/lookup/doi/10.1136/emermed-2018-208084

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