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Achieving the right care
The Right Care Alliance (RCA) is a US based coalition of clinicians, patients and community members who aim to achieve the best healthcare outcomes at the fairest price without any over diagnosis, investigation or treatment. In this month’s Reader’s Choice article, the RCA Emergency Medicine council members have used a modified Delphi process to identify the top ten recommendations on how we might have a more balanced approach to healthcare for our ED patients. Four are around ‘the quixotic search for certainty’ where clinicians do not accept any element of risk and believe that tests are more objective than clinical judgement. Examples include requesting a whole body CT scan for a trauma patient or a ‘just-in-case’ Troponin T for very low risk chest pain. The remaining six remind us that social determinants (eg, homelessness, substance addiction, deprivation) may be more important to health than medical care and we should focus on spending more time with our patients discussing and sharing objectives. Definitely worth a read and some reflection.
Centralisation of emergency departments: does it reduce mortality?
There is good evidence that centralization of major trauma, cancer, myocardial infarction and stroke services can achieve …
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