Emergency Medicine Australasia最新文献

{"title":"An Embedded Low-Acuity Pathway Should Be Judged Beyond Throughput.","authors":"Michał Komenda","doi":"10.1111/1742-6723.70358","DOIUrl":"https://doi.org/10.1111/1742-6723.70358","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70358"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-Design of a Theory-Informed, Multicomponent, Intervention for Diagnostic Stewardship in a Major-Referral Emergency Department: A Qualitative Descriptive Study.","authors":"Vinay Gangathimmaiah, Rebecca Evans, Tarun Sen Gupta, Karen Carlisle","doi":"10.1111/1742-6723.70356","DOIUrl":"10.1111/1742-6723.70356","url":null,"abstract":"<p><strong>Objective: </strong>Low-value diagnostic tests harm patients. Stewardship of tests can improve patient safety. Co-design and behavioural change theories can enhance the effectiveness of diagnostic stewardship interventions. This study aimed to co-design a theory-informed diagnostic stewardship intervention at a major-referral emergency department in Queensland, Australia.</p><p><strong>Methods: </strong>A qualitative study was conducted at Townsville University Hospital Emergency Department. The Theoretical Domains Framework underpinned intervention design. Emergency clinicians ordering pathology tests were eligible for inclusion. A purposive sample of consenting participants was recruited. Data were collected via workshops facilitated by the lead author. Conversations were audio recorded and digitally transcribed. Data were managed with NVivo. Data were analysed by inductive and deductive approaches to generate codes, categories and themes. Thematic saturation and optimal stakeholder engagement influenced the final sample size. Trustworthiness was ensured via reflexivity, audit trail, thick description and participant validation.</p><p><strong>Results: </strong>Seven workshops were conducted with 35 emergency physicians (18 male, 17 female) with a range of specialist experience (1-31 years). Urine culture was the diagnostic test of choice. Culture, complexity, and efficiency were identified as the major drivers of low-value urine cultures. Education, nudge, clinical champions, and audit/feedback were selected as intervention components. Credibility of change and workflow inefficiency were perceived as intervention challenges.</p><p><strong>Conclusion: </strong>Stakeholder engagement has enhanced perceived acceptability of this co-designed intervention for urine culture diagnostic stewardship. Behavioural change theories strengthen co-designed interventions by addressing context-specific drivers of low-value tests. Co-design and behavioural change theories can inform bespoke interventions to nurture a culture of diagnostic stewardship in emergency medicine practice.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70356"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of 48-h Pain-Related Re-Presentation Following Emergency Department Discharge: A Multicentre Retrospective Case-Control Study.","authors":"Pramod Chandru, Sandhya Venkatswami, Erika Mendes, Nameer van Oosterom, Marnilar Nang, Khanh Nguyen","doi":"10.1111/1742-6723.70365","DOIUrl":"10.1111/1742-6723.70365","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify patient and clinical factors associated with 48-h pain-related re-presentation following ED discharge across four metropolitan emergency departments.</p><p><strong>Methods: </strong>A retrospective matched case-control study across four public EDs in Western Sydney Local Health District between September and December 2024. Adult patients presenting with a primary complaint of pain were eligible. Cases were patients who re-presented within 48 h with a pain-related complaint, matched to up to four controls on hospital site, pain location and age. Binomial and conditional logistic regression were performed to identify independent predictors of re-presentation.</p><p><strong>Results: </strong>A total of 876 participants were included (179 cases, 697 controls). Findings were consistent across both models. Pain score documentation was most strongly associated with re-presentation (binomial aOR 7.90, 95% CI 5.35-11.66; conditional aOR 25.50, 95% CI 12.90-50.43). Mental health comorbidity was independently associated with increased odds of re-presentation (binomial aOR 2.48, 95% CI 1.40-4.38; conditional aOR 2.43, 95% CI 1.23-4.81). Discharge opioid prescribing was inversely associated with re-presentation after adjustment (binomial aOR 0.53, 95% CI 0.34-0.83; conditional aOR 0.47, 95% CI 0.26-0.83).</p><p><strong>Conclusions: </strong>Pain score documentation and mental health comorbidity were most strongly associated with re-presentation, though the binary nature of the pain score variable renders this finding hypothesis-generating. Pain location and triage category were not independently associated with re-presentation. The crude opioid association may partly reflect confounding by indication; the inverse adjusted association warrants cautious interpretation and prospective investigation.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70365"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe Discharge From ED for Infants With Bronchiolitis.","authors":"M L Borland, K Loveys, S R Dalziel","doi":"10.1111/1742-6723.70370","DOIUrl":"https://doi.org/10.1111/1742-6723.70370","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70370"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Mixed Methods Evaluation of a Model of Care for Domestic Violence Within the Emergency Department.","authors":"Azhaan Haq, Kimberley R Allison, Helen Rhodes, Craig Peter Coorey, Natalie Edmiston","doi":"10.1111/1742-6723.70371","DOIUrl":"10.1111/1742-6723.70371","url":null,"abstract":"<p><strong>Objective: </strong>To describe the scope and extent of the Domestic Violence (DV) Model of Care at Campbelltown Emergency Department (ED). We detail patient population characteristics, means of identifying victim-survivors, care provided, and factors associated with social work review.</p><p><strong>Methods: </strong>This mixed-methods evaluation utilised (1) retrospective audits of medical records of patients admitted to Campbelltown ED in 2024, who (a) responded affirmatively on the DV Routine Screening (DVRS) tool, and/or (b) were reviewed by social work relating to DV; and (2) semi-structured interviews with 19 clinicians and support workers about their understanding of and role within the model of care. Descriptive analyses quantified the scope and characteristics of the DV patient population and care provision; logistic regression identified factors associated with DVRS-identified patients seeing social work. Thematic analysis of interview data supplemented audit findings.</p><p><strong>Results: </strong>In 2024, 249 ED patients responded affirmatively to the DVRS tool (DV identified prior for 52.2%), and 231 patients were reviewed by social work relating to DV. Victim-survivors were identified through DVRS tool use, explicit disclosure, referral from community partners, and clinician judgement. Transfer to the ED short stay unit facilitated safety and trauma/violence-informed care, including social work consultation for 49.8% of identified victim-survivors. Explicit disclosure or help-seeking, presenting concerns, and child safety risks were associated with seeing social work; however, presentation day/time was not.</p><p><strong>Conclusions: </strong>This evaluation demonstrates that a comprehensive ED model of care, employing multiple means of identifying victim-survivors, is able to facilitate trauma/violence-informed psychosocial care alongside medical management for patients experiencing DV.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70371"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Replacing the 48-h Rule Requires a Reproducible Emergency Pathway.","authors":"Michał Komenda","doi":"10.1111/1742-6723.70360","DOIUrl":"https://doi.org/10.1111/1742-6723.70360","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70360"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Echocardiographic Interpretation in the Emergency Department: Agreement, Interpretation Yield and Reporting Scope.","authors":"Vijay Manivel, Michael Hession, Behzad Mirmiran, Patrick Feeny, Nadi Pandithage, Nasim Erfani, Riaz Humayun, Steven Beatty","doi":"10.1111/1742-6723.70364","DOIUrl":"10.1111/1742-6723.70364","url":null,"abstract":"<p><strong>Objective: </strong>To assess the agreement between artificial intelligence (AI) interpretation and expert emergency physician sonologist review of echocardiograms performed in the Emergency Department (ED).</p><p><strong>Methods: </strong>Retrospective multicentre agreement study in four Australian EDs. A total of 195 echocardiograms (2016-2023) underwent three-stage adjudicated human expert review. Human reports were compared with us2.ai reports. Agreement across 10 validated parameters was reported as percentage exact match with 95% confidence intervals and kappa under two pre-specified tiers: Guideline Compliant (GC; ASE/EACVI multi-view criteria) and Pragmatic (PR; any available measurement). Reference standard reliability was quantified.</p><p><strong>Results: </strong>Pooled agreement was 76% at both tiers (GC n = 875; PR n = 1323); AI returned an interpretation in 46% of evaluations at GC and 70% at PR. Four structural parameters reached 78%-87%: right atrial size 87% (κ = 0.62), right ventricular (RV) contractility 83% (κ = 0.42), left ventricular (LV) size 83% (κ = 0.52) and RV size 78% (κ = 0.37). Binary LV systolic agreement was 79% GC and 83% PR. Expert reviewers agreed on 85% of interpretations. Pericardial effusion, aortic regurgitation and mitral stenosis, present in 7%-20% of patients, are not reported in the current us2.ai algorithm.</p><p><strong>Conclusion: </strong>AI agreed with expert review in about three-quarters of evaluations but provided a guideline-compliant interpretation in less than half; a pragmatic approach raised yield to 70% at the same agreement. The AI withheld classifications that experts could reach; its validated scope covers only part of what ED echocardiography must address, and reports did not mark unassessed parameters. This study reports agreement, not accuracy. For now, human expert review of AI reports is required.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70364"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Safety and Interventions for Redirecting Non-Urgent Patients From Emergency Departments to Primary Care Services: A Scoping Review.","authors":"Walaa Alsulami, Aidawati Bustam, Adina Abdullah, Jazlan Jamaludin, Siti Nurkamilla Ramdzan","doi":"10.1111/1742-6723.70361","DOIUrl":"10.1111/1742-6723.70361","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) experience overcrowding, resulting in delayed care for life-threatening conditions, increased healthcare costs, and prolonged waiting times. Non-urgent patients contribute to ED overcrowding, and redirecting these patients to primary care (PC) is a strategy to reduce pressure on emergency services. However, the safety and procedural components of redirection have not been comprehensively described due to limited evidence. This scoping review aimed to identify the safety outcomes and intervention components associated with redirecting non-urgent patients from EDs to PC.</p><p><strong>Methods: </strong>Five electronic databases were searched. Eligible studies included non-urgent patients presenting to EDs who were redirected to PC, reported safety outcomes, and described redirection procedures. Two reviewers independently conducted title and abstract screening and full-text screening using Rayyan.ai and assessed study quality. Safety outcomes included return visits, hospitalisation, death, and adverse events, which were compared across studies. Redirection procedures were identified using the Innovation domain of the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Main results: </strong>Nine studies met the inclusion criteria, including eight observational studies and one randomised controlled trial. The highest reported safety outcomes were a 9.7% return rate, a 1.7% hospitalisation rate, and a 0.07% mortality rate. Most reported components across all studies included documentation of chief complaints, patient registration, measurement of vital signs, and triage. Studies reporting zero hospitalisations and deaths included multiple constructs within the CFIR Innovation domain.</p><p><strong>Conclusion: </strong>Redirecting non-urgent patients from EDs to PC appears safe and acceptable when clear criteria are implemented; however, evidence remains limited.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70361"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Descriptive Analysis of Consultations Provided by the National Poisons Centre Relating to Medicines on the Aotearoa New Zealand Antidote Stocking Guideline, 2020-2025.","authors":"Eeva-Katri Kumpula, William Boroughf","doi":"10.1111/1742-6723.70366","DOIUrl":"10.1111/1742-6723.70366","url":null,"abstract":"<p><strong>Objective: </strong>Many antidotes are relatively rare-use, indication-specific medicines with a variable evidence base. In Aotearoa New Zealand, there are no national statistics available on their use. This study aimed to characterize the numbers of cases and advice provided by the Aotearoa New Zealand National Poisons Centre (NZNPC) on the use of true antidotes and antidote-adjacent medicines to treat poisonings from 2020 to 2025.</p><p><strong>Methods: </strong>The numbers of NZNPC medical/clinical toxicologist consultations advising on the use of antidotes and antidote-adjacent medicines were determined and data categorized by health region, the caller type of healthcare provider and the numbers of cases advising for and against the use of specific medicines.</p><p><strong>Results: </strong>Consultations occurred in 2952 exposure incidents with hospital-based clinicians comprising 2800 (95%); covered all regions; and consisted of advising on use of individual antidotes/adjacent medicines 3408 times. N-acetylcysteine (1371; 40%) and charcoal (775; 23%) were most frequently discussed. Of relatively high-cost antidotes, NZNPC advised against use of fomepizole in 22/58 (38%) and digoxin-binding antibody in 36/74 (49%) cases. Of labour-intensive interventions, NZNPC advised against use of high-dose insulin euglycemic therapy in 52/89 (58%) and whole bowel irrigation in 68/135 (50%) cases.</p><p><strong>Conclusions: </strong>There was use of the NZNPC consultation service across all regions, and the recommendations provided for each antidote ranged from mostly in favour of use to mostly against use based on the patient presentation. Utilizing a specialist medical/clinical toxicologist consultation service may assist in rationalizing care and optimizing use of healthcare resources.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70366"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate and Severe Traumatic Brain Injury Outcomes-A 20 Year (2002-2021) Analysis.","authors":"Yuewei Xiao, Yesul Kim, Gerard O'Reilly, Jeffrey V Rosenfeld, Madeline Green, Ron Jithoo, Jin Tee, Noel Sceriha, Andrew Udy, Lara Kimmel, Christopher Buntting, Joseph Mathew, Mark C Fitzgerald","doi":"10.1111/1742-6723.70374","DOIUrl":"https://doi.org/10.1111/1742-6723.70374","url":null,"abstract":"<p><strong>Objective: </strong>Although recognised as a leading cause of death and disability, it is unclear whether current treatment strategies have improved outcomes from blunt moderate to severe traumatic brain injuries (msTBI) due to a lack of available epidemiological data. This study sought to determine if in-hospital mortality and early functional outcomes of msTBI patients have changed over 20 years. Early functional outcomes were determined through the surrogate measure of the proportion of patients discharged directly to home.</p><p><strong>Methods: </strong>A longitudinal cohort study using The Alfred Health Trauma Registry data. Subjects were aged 16-70 years with blunt msTBI (Head Abbreviated Injury Scale 3-5) admitted to The Alfred Trauma Service between 1 January 2002 and 31 December 2021.</p><p><strong>Results: </strong>A total of 8222 patients presented with msTBI over the period, with 692 deaths (8.5%). Unadjusted in-hospital mortality decreased from 12.1% in 2002 to 4.0% in 2021 (OR 0.96, 95% CI 0.95-0.97, p < 0.001). Sensitivity analysis demonstrated a statistically significant reduction in the odds of death even after adjusting for injury severity (OR 0.96, 95% CI 0.93-0.99, p < 0.0001). The proportion of patients discharged to home increased from 30.6% to 60.8% over the period (OR 1.05, 95% CI 1.04-1.06, p < 0.001).</p><p><strong>Conclusion: </strong>There was a reduction in in-hospital mortality and an increase in the proportion discharged home for adults hospitalised with msTBI at The Alfred Hospital over the last two decades. These results foster optimism for the care of neurotrauma patients, but further research is required to identify the modifiable factors associated with these improved outcomes.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70374"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}