INTRODUCTION: The Neuro-oncology Clinical Nurse Specialist team lead a daily ward round including all Neuro-oncology patients within the Trust. METHOD: The CNS team attend and lead the daily ward round of all Neuro-oncology inpatients. Twice weekly this is done in conjunction with the lead neurosciences pharmacist. This aids discharge planning leading to expedient discharge of patients. The pharmacist completes the drug list for the take home medications and the CNS completes the medical information and instructions to the GP. Once a week the CNS's lead the round with the Lead neuro-oncology therapists. This is day one post-operatively for most patients. RESULTS: Delays in getting Take home prescriptions completed are dramatically reduced. Patient satisfaction has increased by 75% with this element of their care. This can be directly related to the collaboration between CNS and pharmacist. The accuracy of information has also improved increasing GP's satisfaction. Collaborating with the Therapists has eliminated previous problems of blocked discharges due to unawareness of the patient's baseline function and prognosis. It has also led to greater access to rehab for high grade tumour patients. CONCLUSION: A daily ward round led by the Neuro-oncology patient's key worker has a direct positive impact on patient experience, a financial saving thus quantatively demonstrating to the Trust their investment in the CNS and improved communication across the MDT, a key aspect of the National cancer survey outcome.
Endocarditis is a well-known disease, yet septic embolization resulting in myocardial infarction is much rarer and very infrequently diagnosed in the emergency department (ED). Point-of-Care-Ultrasound (POCUS) can be used to confirm clinical suspicion within minutes of patient presentation, thereby expediting patient care. We report the case of a 26-year-old female with known intravenous drug use who presented with altered mental status. Her clinical presentation prompted urgent evaluation in the ED with POCUS which showed a hyperdynamic functioning left ventricle, greater than 50% inferior vena cava collapse, and a large tricuspid valve vegetation. In light of the electrocardiogram (ECG) ST changes suggesting an acute myocardial infarction, the patient was emergently taken to the cardiac catheterization laboratory where coronary angiography revealed multiple coronary emboli. Primary diagnoses included endocarditis due to Staphylococcus, septic pulmonary embolism, and ST-elevated myocardial infarction (STEMI) due to embolic occlusion of the distal left anterior descending artery. Myocardial infarction caused by septic embolization from endocarditis is a rare condition; however, POCUS is a quick, non-invasive tool that can aid the emergency medicine (EM) physician in identifying this life-threatening pathology thereby expediting appropriate care for the patient.
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