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'Emergency departments hold opportunities for research'

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Research in emergency medicine allows clinical research nurses to hone specialist skills, argue Rachel O’Brien and Polly Black

Performing research in the dynamic environment of an emergency department entails ethical and practical challenges, but does not mean it should not be used to advance research. Emergency medicine research has been developing steadily since it was first established in 1972. Despite its complexity, it offers a considerable patient population and is a rich resource for researchers.

Where we work, approximately 200,000 patients present each year with minor injuries and illnesses, cardiac and neurological emergencies, surgical and medical conditions, and major trauma and mental health emergencies. The emergency department holds opportunities not only for large quantitative research projects but also for qualitative studies, audit and service evaluation involving a massive spectrum of clinical presentations.

Working as a clinical research nurse (CRN) in an emergency medicine research group, you become aware that you are in a minority. Many academic doctors work in emergency medicine, but the research teams are not comparable in size to specialties, such as cardiology and oncology, where multidisciplinary research groups are well established. We need to increase the awareness of emergency medicine with research across the NHS, and increase the profile of CRNs in this clinical area.

Research nursing in emergency medicine is a unique specialty and allows CRNs to hone specialist skills. Patients in the emergency department often do not have capacity to consent to research studies, meaning either doctors or patient’s relatives are required to decide whether the patient is able take part in the research project. Having the correct skills to work in the setting, understanding the environment and being adaptable to the unpredictability of the workload is key to success.

As research nurses, we need to work opportunistically and symbiotically with clinical teams to ensure patients receive the care they require, as well as being given the opportunity to take part in research – all within a four-hour time slot. We can achieve this with constant and open communication with clinical teams. Collaborating with other specialties, including cardiology and critical care, has also led to an increase in our research output and built affiliations developing potential for future research partnerships. This involves working together on clinical studies where the recruitment starts in the emergency department but participants are followed up by other specialties as they move through their hospital journey.

Despite the challenges, 1,021 patients were recruited to research projects in our emergency department in the past 12 months. This is testimony to the efforts of the entire department, which strives to advance patient care and provide patients with research opportunities. Having an active research team builds collaborations and could potentially lead to a healthier hospital system, as well as raising the profile of emergency medicine research.

Rachel O’Brien is lead research nurse and Polly Black is senior research nurse, both at Emergency Medicine Research Group Edinburgh

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