Authors: Andy Neill, Chris Connolly, Nikki Abela / Code: CAP1 / Published: 20/09/2016
Hello and welcome to the first of our daily podcast summaries from not-so-sunny Bournemouth for the RCEM annual scientific meeting.
We hope to give you a brief sense and feel of what’s been happening. Though the best way to experience an RCEM conference is to be there in person.
The morning kicked off after an address by outgoing RCEM president Cliff Mann, who handed over his presidential role to Taj Hassan after the AGM at the end of the day.
Mervyn Singer: Sepsis 3.0
Intensive Care professor Mervyn Singer warned about there being an extreme amount of hype around sepsis and the risk harming people who dont need aggressive treatment. The third international consensus definitions on sepsis use qSOFA as a risk assessment tool and should not be confused with a definition of sepsis, he pointed out.
There is much FOAMed out there on the new sepsis definitions and NICE guidance, including our very own podcast published last week. Here are some others:
Rick Body and the St Emlyns team have a number of blogs and podcasts on Troponin, which will bring you up to speed with the latest update and Jodd Hollander’s review article on troponin is also a good one to look at. Rick warned against “Troponinitis” – where too many people were being diagnosed with ACS simply due to a false positive troponin rise.
The three things Rick recommended to ward against this were to:
- Interpret the clinical context
- Consider the patients baseline
- Work out the rise and fall of troponin using absolute delta (ie. Troponin 2- Troponin 1)
Edd Carlton followed with a talk on “TIMI- time to say goodbye”.
If low-risk chest pain scores are not your thing, I do not blame you, because there are so many decision rules out there, that it feels like the search continues:
The afternoon session had academic presentations which hit a tune on twitter. One talked about SAAP (selective aortic arch perfusion), which if you have not heard about it, I don’t blame you, but EMCrit has a great post which will get you up to speed.
The Big Debate
This debate closed the day with the twitter audience deciding in absolute majority that we should not be treating patients as customers, or as Olly, from South London put it:
We will leave you with some of the other thoughts from the audience:
Isn't treating patients as customers, often the opposite of delivering patient centred care? #RCEM16Beach
— Pamela Neilly (@PJay1707) September 20, 2016
#RCEM16Beach Tescofication is an amazing idea! Give Oli a GREATix!
— William Niven (@willyniv) September 20, 2016
A patient should be told when they arrive that treatment of piles is not in ED rather than at 4 hours #RCEM16Beach
— Brian Flavin (@BrianFlavin2) September 20, 2016
"They pay, therefore they are customers" Weak argument: Not all patients pay for their healthcare. Talking privatisation there #RCEM16Beach
— Kirsten Walthall (@K_Walthall) September 20, 2016
Elephant in the room? Is the "customer" model compatible with a "free at the point of care" model? #RCEM16Beach
— Dr Yusuke (@scepticalemdoc) September 20, 2016
do patients even WANT to be customers? Not convinced. & Not always right 2 give pt 'what they want' vs what they need
— Catherine Williams (@cathjw) September 20, 2016
What about the marginalised patients?(v.ill, mentally ill, very old and adolescents)
— Adrian Boyle (@DrAdrianBoyle) September 20, 2016
#RCEM16Beach Great statement – why would labelling patients as customers change the way we deliver our care? We are polite and smile anyway!
— Alicia Tomkinson (@piparina890) September 20, 2016