What are the latest evidence-based practices in emergency medicine?

Latest Evidence-Based Practices in Emergency Medicine

Emergency medicine should implement evidence-based protocols that focus on patient-centered outcomes, with particular emphasis on reducing morbidity and mortality through standardized approaches to care.

Systems-Based Approaches to Patient Safety

• High-reliability organizations (HROs) operate in high-risk environments while maintaining low rates of injury by acknowledging that mishaps can occur at any time and implementing systems to minimize risk 1
• Standardization of processes based on evidence rather than individual preference is a key component of the systems-based approach to emergency care 1
• Hand-washing remains one of the simplest yet most effective evidence-based practices for infection control in emergency settings 1

Stroke Management in Emergency Settings

• For acute ischemic stroke with large vessel occlusion, mechanical thrombectomy (with or without intravenous thrombolysis) is now standard of care, with potential to prevent severe disability and mortality 1
• The time window for mechanical thrombectomy has been extended based on imaging criteria, allowing more patients to benefit from this intervention 1
• Implementation of stroke protocols requires addressing barriers such as knowledge gaps, environmental constraints, and resource limitations 1
• Behavior change techniques focused on "past success" and "information about health consequences" are most effective in improving adherence to stroke protocols 1

Cardiopulmonary Resuscitation and Cardiac Care

• The American Heart Association has transitioned from periodic reviews to continuous evidence evaluation for resuscitation guidelines, allowing for more immediate implementation of new evidence 1
• Emergency departments have shown improvement in STEMI care processes, with decreased door-to-catheterization times (from 62 to 37 minutes) and increased use of antithrombotic and antiplatelet agents 2
• High-quality CPR remains the cornerstone of resuscitation efforts, with emphasis on minimizing interruptions and ensuring adequate depth and rate 1

First Aid and Initial Management

• For life-threatening bleeding, evidence supports the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices 1
• Glucose administration methods for hyperthermia, cooling techniques for hyperthermia, and temporary storage of avulsed teeth have been evaluated with evidence-based recommendations 1
• Early recognition of acute stroke and appropriate first aid measures are critical for improving outcomes 1

Antimicrobial Stewardship in Emergency Departments

• Implementation of antimicrobial stewardship in emergency departments requires consideration of specific barriers including high staff turnover, rapid patient turnover, and the need for quick decisions 1
• Successful implementation requires a diagnostic analysis to identify facilitators and barriers specific to each prescribing practice 1
• Seven domains of determinants affect implementation: guideline factors, individual health professional factors, patient factors, professional interactions, incentives and resources, capacity for organizational change, and social/political/legal factors 1

Antidote Stocking and Management

• Inadequate stocking of antidotes has been repeatedly documented in many countries, including the United States and Canada 1
• Expert consensus recommends specific antidotes that should be stocked in hospitals providing emergency care, based on systematic review of the literature 1
• Barriers to adequate antidote stocking include limited awareness, infrequent use, supply interruptions, and allocation of limited hospital pharmacy resources 1

Community-Acquired Pneumonia Management

• Risk stratification tools help determine whether patients with community-acquired pneumonia can be treated as outpatients or require admission 1
• Clinical judgment should be complemented by validated risk stratification tools to guide disposition decisions 1
• Patients from nursing homes with pneumonia should be included in community-acquired pneumonia protocols 1

Medication Safety in Emergency Settings

• Careful monitoring of cardiovascular and respiratory vital signs is essential when administering local anesthetics like lidocaine 3
• Early warning signs of central nervous system toxicity include restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression, and drowsiness 3
• Management of local anesthetic emergencies requires immediate attention to airway maintenance and assisted ventilation with oxygen 3

Implementation Challenges in Emergency Medicine

• Emergency medicine faces unique challenges in implementing evidence-based medicine due to multiple, synchronous, and interdependent management questions 4
• The episodic nature of emergency care, high staff turnover, and overcrowding create barriers to implementation of evidence-based practices 1
• More than 50% of emergency procedures lack robust evidence, highlighting the need for more high-quality research specific to emergency settings 5

Palliative Care in Emergency Settings

• Emergency department-based palliative care interventions have been shown to reduce hospital length of stay in six out of eight studies 6
• Evidence for the impact of ED-based palliative care interventions on other outcomes such as return visits and mortality remains less robust 6
• More high-quality comparative studies are needed to better understand the overall impact of ED-based palliative care interventions 6

Practical Implementation Strategies

• Evidence-based practices should be implemented using a systematic, step-by-step approach that considers local barriers and facilitators 1
• Successful implementation requires understanding the specific factors that influence success or failure in a particular hospital or ward 1
• Emergency departments should develop methods for incorporating evidence into practice in anticipation of clinical situations, given the challenges of "real-time" application 4