We offer an eclectic range of topics in this month’s journal.

AUDIT TRANSPARENCY

A recurrent and consistent part of our work is measuring how we perform, not just against predetermined targets but also in day to day clinical activity. As such, mortality and morbidity audits are an essential part of modern emergency practice. An audit from Peterborough is interesting. There is always room for improvement (and the audit data do show this clearly). It is only by being honest about such data that the departmental and organisational change needed to change practice can be delivered.

See pages 691

PHARMACISTS IN ED

A study from Rochester, New York, emphasises the role that an emergency department (ED) based pharmacist can play in improving the quality of care offered. Despite anticipating it as a problem, there was no evidence of negativity from ED clinical staff in accepting the placement of such a role.

See pages 716

TRAINING EVOLUTION

Quality is also integral to training, be it undergraduate or postgraduate. As the geographical and administrative boundaries in health together with the employment relationships (in the UK) change, so the practical delivery of training must adapt also. The (UK) North West specialty training programme has evolved to respond to these very challenges. Mackway-Jones et al describe the approach they have taken, from didacticism to problem-based teaching as well as using the web to produce a virtual learning environment.

See pages 696

PHYSICIAN HEAL THYSELF

We are all aware of the impact that epidemic infectious disease has on a community, the responsibility of our public health colleagues. A study from Glasgow, by Vardy and colleagues, describes the impact on an ED that the norovirus caused. Most hospital guidelines for infection control are modelled on the inpatient setting, not the ED.

See pages 699

QUESTIONS, QUESTIONS, QUESTIONS

An intriguing paper from Iowa demonstrates something we probably all intuitively know, but is still none the less interesting. How do emergency physicians ask questions about patient care and what sort of questions are they?

See pages 703

FINANCE FOR BEGINNERS

Clinicians who migrate into a management or administrative role face many challenges, not least of which can be getting to grips with complex budgetary and funding issues. Even people with years of experience in such matters can be flummoxed if the rules change. For readers in the UK, Higginson and Guly offer a thoughtful and insightful paper on something known as “payment by results”. It will not transform you all into health accountants but it will be very helpful for those who need to know about such matters.

See pages 710

LESSONS FROM GUIDELINES IMPLEMENTATION

Red tape bureaucracy is the scourge of all clinicians, who just want to get on with their job with the minimum of fuss. James Gray, from South Yorkshire, reviews how guidelines for non-transport of patients to secondary units were implemented and he reports on the lessons learned.

See pages 727

AND…

Finally, we have an interesting mix of case reports. There are always lessons to learn or, if we have heard them before, to remember.