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A timely and interesting read if for no other reason colleagues and I were discussing / bemoaning recurrent abdominal pain presentations only last week. Many of the features that act as obstacles were well recognised and omnipresent.
The solutions are an excellent mixture of skills and I can see much utility, I can also foresee the care pathways being highly personalised in our healthcare institutions (Daniels et al allude to this by describing one the ED consultants with an interest in HIU) and once that person moves job the pathway crumbles.
To an extent excluding medical emergency (the 1st E in ERROR) does require medicalisation whether it be vitals being taken or the initial bloods including lactate. I can see the purpose and benefit of not repeating unnecessary blood tests and I suspect not doing tests will be a feat more easily achieved with seniority, There is benefit in letting HIUs be seen exclusively by such.
I was surprised that Daniels and the other authors claim that "pain is not a central consideration in RCEM guidelines...". The college guidelines page (https://www.rcem.ac.uk/RCEM/Quality_Policy/Clinical_Standards_Guidance/R...) lists at east 3 where pain is most certainly the central consideration, or was this in relation to abdominal pain only?
Overall good article. Timely and worthwhile for us all working in EDs.