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“Better the Devil you know”
Few would argue that it is often better to work with someone you are familiar with and know than someone you don't. This may be particularly true in the emergency department. Evidence from aviation research and other high-risk settings suggests that lack of familiarity between teammates is associated with worse outcomes. In this issue Patterson and colleagues from Pittsburgh University Hospital sought to characterise familiarity between clinician teammates in one urban teaching hospital emergency department over a 22 week study period. What they found was that very few clinicians had a high level of familiarity with teammates. They suggest that this may be a natural feature of emergency care delivery especially in academic settings partly because of the diversity of specialties and personnel that are called to attend. Nonetheless the emergency department is well recognised as a notoriously high risk environment and given the continuous challenges of crowding it behoves us in the interest of patient safety to explore this matter further. Patterson and colleagues' approach to measurement may be a useful template for exploring team structure in our own departments.
A small price for effective pain relief
Effective pain relief for children in the emergency department continues to be variable and this is often due to anxiety about using opiate analgesia …