Emergency Medicine Australasia最新文献

{"title":"Review article: Strategies to improve emergency department care for adults living with disability: A systematic review.","authors":"Bronwyn Newman, Colleen Cheek, Lieke Richardson, Donna Gillies, Karen Hutchinson, Elizabeth Austin, Margaret Murphy, Luke Testa, Christina Rojas, Louise Raggett, Amanda Dominello, Kylie Smith, Robyn Clay-Williams","doi":"10.1111/1742-6723.14500","DOIUrl":"https://doi.org/10.1111/1742-6723.14500","url":null,"abstract":"<p><p>Equitable access means that timely, sensitive and respectful treatment is offered to all people. Adults with disability access ED care more frequently than the general population. However, in Australia and internationally, people with disability experience poorer healthcare access and outcomes than the general population. There is acknowledgement that ED environments and processes of care could be better designed to promote equitable access, so as not to further disadvantage, disable and create vulnerability. This systematic review aimed to locate and describe evaluated strategies implemented to improve care for people with disability (aged 18-65 years) in the ED. Four databases were searched from inception to June 2024. 1936 peer-reviewed papers were reviewed by pairs of independent reviewers. Four studies met our inclusion criteria, demonstrating the limited peer-reviewed literature reporting on evaluated strategies to improve ED care for adults aged 18-65 years. Three studies focused on the needs of people with intellectual disability, and one created a specific treatment pathway for people experiencing status epilepticus. No studies evaluated across patient experience, patient outcomes, system performance and staff experience, with limited evaluation of patient outcomes and system performance measures. We have referenced helpful resources published elsewhere and drawn from our previous reviews of ED care to provide guidance for the development and evaluation of targeted initiatives.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307369","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":"Hospitalisations for non-specific low back pain in people presenting to South Australian public hospital emergency departments.","authors":"Joseph F Orlando,Anne Lj Burke,Matthew Beard,Michelle Guerin,Saravana Kumar","doi":"10.1111/1742-6723.14504","DOIUrl":"https://doi.org/10.1111/1742-6723.14504","url":null,"abstract":"OBJECTIVEThe present study sought to investigate predictors of hospitalisation in adults diagnosed with non-specific low back pain (LBP) and/or sciatica from an ED.METHODSA 5-year, multicentre retrospective observational study was conducted across six public hospitals (metropolitan and regional) using data from electronic medical records. Patient presentations were identified using LBP diagnostic codes and key data extracted (patient demographics, clinical activity, discharge destination). Descriptive statistics and logistic regression were used to measure associations between identified variables and hospitalisation.RESULTSThere were 11 709 ED presentations across the study period. People aged ≥65 years (odds ratio [OR] 2.84, 95% confidence interval [CI] 2.61-3.10) and those who arrived at the ED via ambulance (age-adjusted OR 2.68, 95% CI 2.44-2.95) were more likely to be hospitalised. People were also more likely to be hospitalised when triaged as more urgent, when blood tests or advanced spinal imaging were ordered, and when i.v./subcutaneous opioids or oral benzodiazepines were administered. Hospitalisation rates for LBP were lower in regional hospitals, in people residing in lower socioeconomic areas and in Indigenous Australians.CONCLUSIONCertain patient characteristics and ED clinical activity are associated with hospitalisations for LBP. Understanding these factors will better inform the design and delivery of appropriate high-quality care.","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252031","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":"From other journals","authors":"Sierra Beck,&nbsp;Bridget Honan,&nbsp;James L Mallows,&nbsp;Joseph Ting","doi":"10.1111/1742-6723.14493","DOIUrl":"https://doi.org/10.1111/1742-6723.14493","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234777","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":"In this October issue","authors":"Geoff Hughes","doi":"10.1111/1742-6723.14488","DOIUrl":"https://doi.org/10.1111/1742-6723.14488","url":null,"abstract":"&lt;p&gt;Over ten million ED visits occur annually in Australia and Aotearoa New Zealand. Outside basic administrative data focused on time-based targets, there is minimal information about clinical performance, quality of care, patient outcomes, or equity in emergency care. The lack of a timely, accurate or clinically useful data collection is a missed opportunity to improve care. An experienced and senior group of clinicians outline a proposal for a National Acute Care Secure Health Data Environment. In a linked editorial, Anne-Maree Kelly says that such an initiative is welcome but warns big data offer big promises and bring big issues.&lt;/p&gt;&lt;p&gt;A prospective observational study included children aged &gt;2 and &lt; 18 years presenting to any of three EDs in Victoria over an 18 month period who had their height and weight measured. Almost one-third of children were overweight or obese. Obesity was particularly high in those aged 8–14 years and those from lower SES postcodes. The high proportion of children presenting above a healthy weight is an opportunity for EDs to identify and refer children for bodyweight and lifestyle management.&lt;/p&gt;&lt;p&gt;A prospective descriptive study of domestic and family violence presentations to the Royal Darwin Hospital ED in November 2021 highlights the overwhelming need for a 24-h trauma informed, culturally safe, and integrated service to support people experiencing domestic and family violence. This could be achieved by a specialist unit designed and staffed by First Nations health practitioners.&lt;/p&gt;&lt;p&gt;Extracorporeal cardiopulmonary resuscitation (E-CPR) is primarily limited to hospitals. Some centres in the world have implemented prehospital mobile E-CPR in the form of a dedicated cardiac vehicle fitted with specialised equipment and clinicians for the performance of E-CPR on-scene. Evidence of the outcomes and cost-effectiveness of mobile E-CPR is not established. A team from Queensland evaluated the cost-effectiveness of a hypothetical mobile E-CPR vehicle operated by Queensland Ambulance Service. The conclusion is that prehospital E-CPR may be cost-effective. Successful implementation of a prehospital ECPR program needs substantial planning, training, logistics, and operational adjustments.&lt;/p&gt;&lt;p&gt;A survey of the current structure, capability and operational scope of prehospital and retrieval aeromedical teams across Australia concludes that aeromedicine in Australia has many consistent elements, but there is a diversity of operational models.&lt;/p&gt;&lt;p&gt;A team from Queensland assessed the impact of a Virtual Toxicology Service on the average length of stay of poisoned patients. The team concludes that such a service appears to be associated with a decreased average length of stay.&lt;/p&gt;&lt;p&gt;Antivenoms are important medications to be held within Australia, particularly in regional and remote locations. An audit of current antivenom holdings in hospitals and health services in South Australia revealed significant disparity betwe","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14488","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234772","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":"Practical strategies for caring for patients with functional neurological disorder in the ED","authors":"Alexander Lehn MD, FRACP","doi":"10.1111/1742-6723.14489","DOIUrl":"https://doi.org/10.1111/1742-6723.14489","url":null,"abstract":"<p>Functional Neurological Disorder (FND) presents unique challenges in the emergency department (ED), where patients often arrive with varied and vague symptoms that can be difficult to address. This article provides practical strategies for effectively managing and supporting FND patients in the ED, emphasizing a compassionate, systematic approach, tailored treatments, appropriate use of investigations, and ensuring continuity of care. Key principles include clear communication of the diagnosis, preventing iatrogenic harm, and facilitating appropriate referrals for follow-up care. Consistent and respectful language is important when managing patients with FND. Creating a calm environment reduced stress and symptom exacerbation. Thorough history taking and examination can help build the patient's confidence in their diagnosis. Validating symptoms and providing a clear explanation of the diagnosis are important. FND presentations, such as functional weakness and seizures, require tailored interventions with early involvement of physiotherapy and/or psychological support. A low threshold for investigating potential comorbid neurological conditions should be maintained when patients present to ED, especially in cases of unclear diagnoses or acute presentations, while avoiding repetitive testing that may reinforce illness behaviour. Managing FND in the ED requires a patient-centered, multidisciplinary approach. By adopting these strategies, health professionals can improve outcomes and support patients in managing their condition effectively.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234724","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":"Big data, big promise and big issues","authors":"Anne-Maree Kelly MD, FACEM, MHealth&MedLaw","doi":"10.1111/1742-6723.14483","DOIUrl":"https://doi.org/10.1111/1742-6723.14483","url":null,"abstract":"&lt;p&gt;In their article, Craig &lt;i&gt;et al&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; eloquently describe how current Australasian ED administrative data sets do not address quality of care and benchmarking and research opportunities. This is unsurprising because these data sets were not designed for these purposes. I agree that the clinical data that &lt;i&gt;could&lt;/i&gt; be available would provide valuable insights into the quality of care, areas for improvement and opportunities for research. I admire the ambition of this initiative, but big data comes with big issues.&lt;/p&gt;&lt;p&gt;Any analysis of big data is only as good as the data entered. For maximum effectiveness and validity, data need to be clean, complete, accurate and formatted consistently. The differences in the design and implementation of health information systems (including electronic medical records [EMRs]) challenge data quality and consistency. For example, not all EMR systems require procedures be specifically captured and there may be differences in coding sets and how they are used.&lt;/p&gt;&lt;p&gt;Current administrative data sets are jurisdiction-based and government-owned. Development of a national/binational data set will need the participation of governments. With the potential political impacts of comparisons between jurisdictions, obtaining government support will not be easy.&lt;/p&gt;&lt;p&gt;Also, a data set of the size generated by this initiative will demand sophisticated stewardship, curation and data governance. Who will ‘own’ the data? Who will decide how it is used and by whom? Governments will want a stake in ownership which will open the possibility of influence in project selection and reporting.&lt;/p&gt;&lt;p&gt;The privacy and consent issues are complex and full discussion is beyond this editorial's remit. The authors' assertion that the use of routinely collected healthcare data for quality improvement and research is generally acceptable to people may be true when people are asked about data in general. It may be less so when asked about the use of their data. Australian evidence suggests that while most patients attending ED expect that data are used in this way, about 20% report that this use without consent will not be acceptable to them; a majority will prefer a consent requirement.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; How this can be made workable is challenging, especially if re-identifiability for data linkage is included.&lt;/p&gt;&lt;p&gt;I do not agree that data collection without consent will be acceptable under legislation. Previous approaches, such as use of privacy notices stating that information may be used for quality improvement and research, are unlikely to be acceptable under privacy legislation.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; In my experience, jurisdictions vary in their interpretation of what can be defined as a ‘directly related secondary purpose’ for use of health information, a potentially valid exemption from requiring consent. Also, bundled consent – ‘bundling’ together multiple requests for an individual's consent to a r","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234837","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":"An introduction to functional neurological disorders in the emergency department","authors":"Melanie Eden BBiomedSci (Hons), MD","doi":"10.1111/1742-6723.14492","DOIUrl":"https://doi.org/10.1111/1742-6723.14492","url":null,"abstract":"<p>Functional neurological disorders (FNDs) are conditions of nervous system malfunctioning, rather than a clearly identifiable pathophysiological disease.<span>¹</span> FND can present with an array of symptoms, including functional seizures, weakness and paralysis, movement disorders, speech disturbances, globus sensation, sensory complaints, visual and cognitive symptoms. These symptoms may be acute or chronic, episodic or sustained and patients often have a high rate of representation to the ED.<span>²</span> These factors make FND a challenge to manage within the constraints of the ED.</p><p>Previously, FND was considered a diagnosis of exclusion. Recently, FND has been described as a ‘rule-in’ diagnosis, with positive findings offering the possibility of early diagnosis and management in the ED. Shorter time from symptom onset to diagnosis is an important positive prognostic factor, leading to reduced ED utilisation and improved patient outcomes.<span>³</span></p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234725","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":"Process and implementation evaluation of a virtual hospital model of care for low back pain (Back@Home).","authors":"Alla Melman, Min J Teng, Danielle M Coombs, Qiang Li, Laurent Billot, Thomas Lung, Eileen Rogan, Mona Marabani, Owen Hutchings, Joshua R Zadro, Chris G Maher, Gustavo C Machado","doi":"10.1111/1742-6723.14487","DOIUrl":"https://doi.org/10.1111/1742-6723.14487","url":null,"abstract":"<p><strong>Objectives: </strong>Low back pain was the sixth most common reason for an ED visit in 2022-2023 in Australia, one-third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (rpavirtual), and be cared for remotely in their own homes.</p><p><strong>Methods: </strong>Ethics approval was granted for protocols X21-0278 & 2021/ETH10967 and X21-0094 & 2021/ETH00591. We conducted a mixed-method process evaluation, using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care.</p><p><strong>Results: </strong>This preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724-AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function.</p><p><strong>Conclusions: </strong>Preliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non-serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282194","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":"Exploring the value, enablers and barriers of being a clinician‐coach: A qualitative pilot study of clinician‐coaches in emergency medicine","authors":"Andrew Rixon, Samuel Wilson, Lee Wong, Elizabeth Elder","doi":"10.1111/1742-6723.14501","DOIUrl":"https://doi.org/10.1111/1742-6723.14501","url":null,"abstract":"ObjectiveTo explore how clinicians understand coaching and their clinician‐coach practice in emergency medicine.MethodsParticipants were surveyed about the value of coaching and their beliefs about the enablers of, and barriers to, being a clinician‐coach.ResultsThree themes were developed for the value of coaching: empowerment and growth; enhanced interpersonal dynamics; and reflective transformation. Key enablers were supportive infrastructure, self‐driven development and recognition of value. Key barriers were time constraints and scheduling conflicts, cultural challenges and financial and structural obstacles.ConclusionsFostering a supportive environment for coaching could significantly enhance clinician competence and well‐being, healthcare delivery and professional development.","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252037","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":"Associations with early vomiting when using intranasal fentanyl and nitrous oxide for procedural sedation in children: A secondary analysis of a randomised controlled trial","authors":"Emmanuelle Fauteux‐Lamarre, Stephen Hearps, Michelle McCarthy, Nuala Quinn, Andrew Davidson, Donna Legge, Katherine J Lee, Greta M Palmer, Sandy M Hopper, Franz E Babl","doi":"10.1111/1742-6723.14497","DOIUrl":"https://doi.org/10.1111/1742-6723.14497","url":null,"abstract":"ObjectiveIntranasal (IN) fentanyl and nitrous oxide (N<jats:sub>2</jats:sub>O) can be combined to provide procedural sedation and analgesia to children. This combination is advantageous because of rapid onset of action and non‐parenteral administration, but is associated with increased vomiting. We sought to describe the associations of demographic and procedural factors with early vomiting when using this combination in children.MethodsThis was a planned secondary analysis of a randomised controlled trial comparing the effect of oral ondansetron <jats:italic>versus</jats:italic> placebo at a single paediatric hospital. Children aged 3 to &lt;18 years with planned procedural sedation with IN fentanyl and N<jats:sub>2</jats:sub>O were randomised to receive oral ondansetron or placebo prior to N<jats:sub>2</jats:sub>O administration. Vomiting was defined as early if occurring during or up to 1 h after N<jats:sub>2</jats:sub>O delivery. We assessed the relationship between early vomiting, demographic and procedural characteristics.ResultsParticipants were recruited between October 2016 and January 2019 and 62 out of 436 (14%) had early vomiting. The risk of early vomiting was 30% higher with higher total dose of fentanyl, risk ratio = 1.3 (95% confidence interval = 1.004–1.59). There was little evidence of a relationship between the occurrence of early vomiting and sex, age, weight, type of procedure, fasting duration, time between fentanyl administration and start of procedure, and procedure duration.ConclusionWe found that higher doses of IN fentanyl were associated with higher risk of early vomiting when administered with N<jats:sub>2</jats:sub>O in children. Other factors did not appear to be associated with vomiting.","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252113","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}