bestBETs

Avoiding emergency hospital admissions is an important subject, and this audit aims to seek whether patients were triaged appropriately, according to established guidelines, for admission on the Medical Assessment Unit (MAU). The importance of doctors making a correct diagnosis will also be analysed, therefore seeing whether the decision making process by doctors have an impact on avoidable admissions.

A 40 year old female arrives to the physiotherapy department with a diagnosed pelvic organ prolapse (POP) from the Gynaecology clinic. She wants to know if pelvic floor muscle exercises alone will help improve her POP symptoms.

A 22/40 pregnant lady presents to physiotherapy with pelvic girdle pain. The physiotherapist wants to know whether acupuncture will improve her pain and function.

A 44 year old man presents to the emergency department with severe epigastric pain. With a working diagnosis of acute pancreatitis, the result of serum amylase were inconclusive. As urinary trypsinogen have been recommended as an adjunct in supporting the diagnosis of pancreatitis, you wonder if it would be worthwhile performing a urine dipstick for this purpose.

After working on the A&E department for 4 months, you are presented with your umpteenth patient with renal colic. You notice that this is the third patient in a row who has presented in the morning and consider if there is a link between the Circadian rhythm and renal stones.

A 39 year old man presents to A&E with a loin pain that is diagnosed as renal colic on clinical grounds. In particular the consultant suspects an obstructive uropathy. However, you wonder if non-obstructing renal stones can cause similar pain to obstructive uropathy.

A 42 year old gentleman presents to the ED with loin pain radiating to the groin. Investigations confirm the diagnosis of a small renal stone. You wonder if, instead of invasive therapy or medical expulsion, the stone can simply be “washed out” with fluid and diuretics.

A 35 year old male presents to the emergency department with loin pain. The consultant emergency physician performs an ultrasound (US) scan and confirms diagnosis of renal calculi. The FY1 wonders if emergency physicians are competent at performing US scans.

A 43 year old gentleman presents to A&E with left loin pain, which radiates to his left testicle. The doctor on call immediately suspects renal stones due to this “classic” presentation, however you wonder how sensitive this symptom really is.

An 85 year old female patient presented to emergency department with a hip fracture. She has been on bisphosphonates for the past few months. You know that with recent fractures bisphosphonates should be stopped so as not to disturb bone healing but you wonder how soon the patient should restart them.

A 50 year old gentleman has just been admitted to the emergency department with a working diagnosis of severe acute pancreatitis. Fluid resuscitation was given to replace losses but you do not understand the rational behind giving oxygen and wonders if there are any evidences to support the reason behind oxygen supplementation.

Following the diagnosis of acute pancreatitis, a 50 year old man awaits treatment in the emergency department. With advantages of being simple to perform with only 5 parameters to consider and a quick prediction at 24 hours following admission, you are unsure if BISAP score is accurate in predicting clinical severity in acute pancreatitis when compared with the more established Ranson's/modified Glasgow score.

A 50 year old gentleman has just been admitted to the emergency department with a working diagnosis of severe acute pancreatitis. According to recommended guidelines, it has been advised to withhold oral dietary intake and you wonder why this is so.