Emergency Medicine Australasia最新文献

{"title":"Doctors' and Nurses' Perceptions on Barriers and Facilitators to Implementing Clinical Pharmacy Services in the Emergency Department in Singapore","authors":"Glen Qin Yi Mun,&nbsp;Ruth Kait Rae Kwan,&nbsp;Chuan Poh Lim,&nbsp;Jie Lin Soong","doi":"10.1111/1742-6723.70062","DOIUrl":"https://doi.org/10.1111/1742-6723.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Emergency Medicine (EM) clinical pharmacy services are an increasingly widespread practice globally and have been shown to improve patient safety and care in the high-risk environment of the emergency department (ED). However, limited information is published on the implementation barriers and facilitators of these services. This study assessed the current needs of ED doctors and nurses in Singapore General Hospital (SGH) and evaluated their perceptions towards EM clinical pharmacy services. Barriers and facilitators to the implementation of these services in the new SGH EM building were further explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An anonymous survey was sent to all SGH ED doctors and nurses to assess their perceptions towards EM clinical pharmacy services. Qualitative data on barriers and facilitators were explored through open-ended questions in the survey and semi-structured interviews. Qualitative data were analysed via thematic analysis using the Consolidated Framework of Implementation Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 205 survey responses were collected, and seven interviews were conducted. The top-ranked services identified were drug information consultation, facilitating timely treatment of emergency conditions, and providing staff and patient education. Pertinent barriers to the implementation of the services comprised cost, culture, compatibility, and staffing. Key facilitators included the relative advantage of the services, tension for change within SGH ED, tailoring strategies, and engaging doctors and nurses during the implementation process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ED doctors and nurses favourably perceived EM clinical pharmacy services. Strategies to implement the services should be tailored to address barriers and leverage facilitators identified for successful implementation within the local ED context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108846","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":"Can Non-Neurosurgeons Operate on Traumatic Brain Injuries in Non-Metropolitan Areas? A Scoping Review","authors":"Lauren Bosley,&nbsp;Clinton Gibbs,&nbsp;Eunah Joo,&nbsp;Geoffrey Dobson","doi":"10.1111/1742-6723.70055","DOIUrl":"https://doi.org/10.1111/1742-6723.70055","url":null,"abstract":"<p>Traumatic brain injuries (TBIs) with increased intracranial pressure (ICP) require time-sensitive surgical intervention. In non-metropolitan areas, neurosurgeons are often unavailable to provide definitive treatment. Therapeutic surgical intervention by a non-neurosurgeon, for example, general surgeons, is a potential alternative; however, the feasibility and utility of non-specialist intervention are poorly defined within the literature. A scoping review was conducted within Scopus, Emcare, MEDLINE and CINAHL for original literature about emergency neurosurgical interventions performed by a non-neurosurgeon for TBIs in non-metropolitan settings without prompt access to a neurosurgeon. This search yielded 20 studies that included over 2000 surgical interventions in 13 countries. General surgeons most commonly performed the procedures on patients with computed tomography (CT)-confirmed lesions. Mortality rates were heterogeneous, ranging from 0% to 67% in small cohorts with variable follow-up periods. Mortality was consistently higher in patients with subdural haematomas (SDHs) opposed to extradural haematomas (EDHs). Morbidity was measured in 13 studies, commonly via the Glasgow outcome scale (GOS). Most studies had access to remote neurosurgical advice via telehealth. Overall, these 20 studies provided incomplete information regarding mortality rates and functional outcomes from this alternative practise. The present study concludes that emergency decompression by a non-neurosurgeon for patients with severe TBIs may be lifesaving for patients without timely access to a neurosurgical centre. Our study further highlights the need for further research, training and resource allocation, including strengthening telecommunication pathways, to support patient access to lifesaving neurosurgical interventions in these environments, and ultimately address surgical inequalities in rural and remote regions of the world.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108848","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":"Supraglottic Airway Device Use During Paediatric Airway Management in the Emergency Department: A Registry Study","authors":"Sarah Rathe,&nbsp;Hatem Alkhouri,&nbsp;Katie Reeves,&nbsp;Andrew Tagg,&nbsp;Bernard McCarthy,&nbsp;Sharon O'Brien,&nbsp;Eleanor Loughhead,&nbsp;Ben Lawton,&nbsp;Jeremy Furyk,&nbsp;Frances B. Kinnear,&nbsp;Matthew O'Gorman,&nbsp;Eunicia Tan,&nbsp;Andrew Brainard,&nbsp;Shane George,&nbsp;Amit Kochar,&nbsp;Simon Craig,&nbsp;Stefano Sabato,&nbsp;Franz E. Babl,&nbsp;Elliot Long","doi":"10.1111/1742-6723.70056","DOIUrl":"https://doi.org/10.1111/1742-6723.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Supraglottic airway devices (SGAs) are used in airway management to provide non-invasive ventilation and oxygenation. SGAs can be used as rescue tools in failed endotracheal intubation, difficult bag-mask ventilation, or as a bridge to intubation in cardiac arrest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this study was to describe the frequency of SGA use in children in emergency departments (EDs) across Australia and New Zealand and indications for their use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational study using paediatric data from the Australian and New Zealand Emergency Department Airway Registry (ANZEDAR) to describe the frequency of SGA use in children aged 0–18 years at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites over an 11-year period. Additionally, we surveyed 20 PREDICT sites to identify which SGA were used and describe their positions in their emergency airway management protocols and received 11 responses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SGAs were used during 14 out of 403 paediatric intubations (3.5%) across 12 PREDICT sites. The overall first pass success rate for intubation was 81.05% (325/401). SGAs were used prior to intubation in 14 cases, and as a rescue device following unsuccessful intubation in one case. Among the surveyed PREDICT EDs, 8 out of 11 (72%) reported having a difficult airway plan that included SGAs as a rescue device following unsuccessful intubation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SGAs were used infrequently during emergency airway management outside of the operating room. SGA use as a rescue device following unsuccessful intubation was rare, despite their inclusion in most departments' difficult airway plan.</p>\u0000 \u0000 <p><b>Trial Registration:</b> Australia and New Zealand Clinical Trials Registry: ACTRN12613001052729.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091691","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 Exploration of Patient and Clinician Perspectives of Pelvic Examinations in Emergency Departments","authors":"Cara Frain,&nbsp;Caitlin Brandenburg,&nbsp;Eve Purdy,&nbsp;Graeme Walker,&nbsp;Gerben Keijzers","doi":"10.1111/1742-6723.70060","DOIUrl":"https://doi.org/10.1111/1742-6723.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore and describe patients' expectations, perceptions and experiences of having a pelvic examination (PV) in the emergency department (ED) and to describe ED clinicians' attitudes and perceptions regarding PVs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A mixed methods study using questionnaires and semi-structured interviews with patients and clinicians at two EDs in the same health service (tertiary ED and urban district ED) between May 2023 and February 2024. Quantitative data are reported descriptively using means and proportions. A qualitative descriptive approach and thematic analysis were used to develop themes from interviews and gather granular insights from participants' first-hand experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinicians completed 84 questionnaires and nine interviews. Patients completed 63 questionnaires and eight interviews. Quantitative and qualitative data were merged to form four themes: (1) the variable clinical utility of the PV in ED, (2) lack of ED clinician confidence and training, (3) bedside manner as primary influence on patient experience, and (4) the inadequate ED setting for performing intimate exams.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The utility of PVs in ED remains ambiguous and it is vital to avoid unnecessary invasive exams. However, urgent PVs will sometimes be needed and participants have made actionable suggestions to improve the clinical care delivered when performing PVs in ED. The four themes can inform future strategies to advance clinicians' training, confidence and skill level when performing PVs. This will lead to overall enhanced patient experience and satisfaction and reduce downstream negative consequences of having an inadequate PV experience in ED.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085245","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 Physiotherapy-Led Emergency Department Guideline (PLEDGE) for Patients Presenting With Low Back Pain: Pre- and Post-Implementation Study","authors":"Rosalie Gan,&nbsp;Caitlin Farmer,&nbsp;Alisha da Silva,&nbsp;Katharine Drummond,&nbsp;Lucinda Marr,&nbsp;John H. Y. Moi,&nbsp;Mark Putland","doi":"10.1111/1742-6723.70057","DOIUrl":"https://doi.org/10.1111/1742-6723.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We evaluated guideline adherence and healthcare utilisation in an emergency department (ED) pre- and post-implementation of a physiotherapy-led low back pain (LBP) guideline and rapid outpatient follow-up service (collectively termed PLEDGE model).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The PLEDGE model was implemented in a metropolitan tertiary hospital. Data from LBP ED presentations were extracted from electronic medical records for 1 year pre- and post-PLEDGE model implementation. To evaluate guideline-adherent care, the primary outcome was the incidence of any opioid analgesia use. Requests for imaging and pathology were secondary outcomes. To evaluate healthcare utilisation, the primary outcome was the ED National Emergency Access Target (NEAT). Secondary outcomes included ED re-presentations within 28 days, short stay unit (SSU) admissions and ED length of stay (LOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 2732 patients were included (1384 post-implementation). For guideline-adherent care, opioid analgesia (<i>χ</i>² (1, <i>N</i> = 2732) = 17.406, <i>p</i> &lt; 0.001) and pathology ordering (<i>χ</i>² (1, <i>N</i> = 2732) = 6.363, <i>p</i> = 0.012) significantly reduced post-implementation; however, there was no reduction in imaging requests (<i>χ</i>² (1, <i>N</i> = 2732) = 1.859, <i>p</i> = 0.173). With respect to healthcare utilisation, measures of ED NEAT and ED LOS worsened. Patients were significantly less likely to be admitted to SSU (<i>χ</i>² (1, <i>N</i> = 2732) = 6.356, <i>p</i> = 0.012) or re-present to ED (<i>χ</i>² (1, <i>N</i> = 2732) = 4.098, <i>p</i> = 0.043).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Implementation of the PLEDGE model reduced opioid analgesia use, pathology ordering, SSU admissions and ED re-presentations and provided a valuable safety net. ED NEAT worsened, ED LOS increased and imaging requests remained unchanged.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085212","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":"Is Radiological Reporting of ‘Tension’ in Spontaneous Pneumothorax Driving Unnecessary Intervention?","authors":"Anne Maree Kelly,&nbsp;Roland Bammer,&nbsp;Y. C. Gary Lee,&nbsp;Julian A. Smith,&nbsp;Ethan Bacon,&nbsp;Diana Egerton-Warburton","doi":"10.1111/1742-6723.70058","DOIUrl":"https://doi.org/10.1111/1742-6723.70058","url":null,"abstract":"<div>\u0000 \u0000 <p>Decompensated (aka tension) primary spontaneous pneumothorax (PSP) is extremely rare. There is no published evidence that conservative treatment of stable patients with radiological features of so-called ‘tension’ (e.g., tracheal deviation and mediastinal shift) results in adverse outcomes. There is also preliminary evidence that these features do not correlate with significant clinical instability. However, anecdotally, clinicians report being uncomfortable not providing interventional treatment for stable PSP patients with radiological features of tension, in part for fear of litigation. This article addresses current evidence and guidelines and the likely medicolegal implications of treatment options for clinically stable PSP patients with these radiological features.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144074555","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 Response to: High Dose Insulin Is an Inodilator, Not an Antidote in the Poisoned Patient!","authors":"Daniel Tirado,&nbsp;Christopher L. Kennedy,&nbsp;B. Zane Horowitz","doi":"10.1111/1742-6723.70059","DOIUrl":"https://doi.org/10.1111/1742-6723.70059","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944810","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":"Emergency Department Presentations in Culturally and Linguistically Diverse Populations Based on Preferred Language. Characteristics and Outcomes in New South Wales Australia","authors":"Michael M. Dinh,&nbsp;Saartje Berendsen Russell,&nbsp;Michele Fiorentino,&nbsp;Radhika Seimon,&nbsp;Kendall Bein","doi":"10.1111/1742-6723.70061","DOIUrl":"https://doi.org/10.1111/1742-6723.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore demographic, clinical characteristics and predictors of outcomes of patients presenting to the emergency department (ED) from various cultural groups using preferred language as a proxy marker of culturally and linguistically diverse populations (CALD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multicentre data linkage analysis from NSW Australia. ED presentations were identified from the Emergency Department Data Collection containing individual person level data linked deterministically across datasets through a unique master linkage key from around 180 recognised public hospitals. The outcome of interest was ED length of stay and 30-day all-cause mortality following ED presentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 3,029,492 ED presentations were analysed, of which 336,414 (11%) indicated a non-English preferred language. Overall, non-English preferred language groups were associated with longer ED length of stay for both admitted and discharged patients and higher 30-day mortality (1.2% vs. 2.0%, <i>p</i> &lt; 0.001). There were marked demographic and clinical differences in characteristics across all non-English preferred language groups. After adjusting for these differences across preferred language groups, the Cantonese preferred language group was associated with a small increased risk of 30-day mortality with an adjusted OR: 1.28 (95% CI: 1.05–1.55, <i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There were substantial differences with respect to age, presentation characteristics and outcomes across patients from major non-English preferred language groups presenting to ED. Such groups should not be analysed as a single CALD group when examining access and outcomes of ED care, and differences in reported outcomes require further exploration. Any differences in outcomes such as mortality need to be interpreted with caution due to unknown and unmeasured confounders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944809","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":"Does frailty scoring help to predict outcomes in older patients with major trauma? A retrospective study at a major trauma centre","authors":"Charlotte G Underwood MBChB,&nbsp;Andrew McCombie BSc BA(Hons)(Cant), PhD(Otago),&nbsp;Maria Nonis MBChB,&nbsp;Laura R Joyce FACEM, AFRACMA, MBChB, BMedSc(Hons), MMedEd","doi":"10.1111/1742-6723.70053","DOIUrl":"https://doi.org/10.1111/1742-6723.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of the present study was to evaluate the impact of frailty on outcomes for older patients presenting with major trauma to a tertiary ED in Aotearoa New Zealand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective observational study of patients 65 years and older who presented to Christchurch ED, New Zealand, with major trauma between 1 January and 31 December 2022. The primary outcome was a composite of in-hospital mortality or increased care requirements on discharge from hospital. Demographic details, in-hospital management, and outcomes were retrieved. Clinical Frailty Scale scoring had prospectively been recorded at the time of admission. Univariable analysis of discrete dependent variables was carried out. Mediation analysis was undertaken, wherein frailty was the mediator between age and the primary outcome variable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After exclusion criteria were applied, 134 patients were included for analysis. Even after controlling for age, for every additional point on the Clinical Frailty Scale, the odds of in-hospital mortality or increased care requirements on discharge increased by 36.4% (95% confidence interval: 9.4–85). Only 33% of these major trauma patients were appropriately identified at presentation and so received a trauma team activation, with worsened activation rates with increasing frailty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The presence of significant injuries in older trauma patients is under-recognised. Frailty scoring could be used in the ED for early identification of those patients at high risk of poor outcomes, so that active management strategies can be put in place to optimise their care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926134","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":"Atrial fibrillation patients presenting to an emergency department successfully managed with a next-day community follow-up pathway: A before-and-after cohort study","authors":"Finn Brokenshire,&nbsp;John W Pickering BMedSc(Hons), PhD, BA(Hons),&nbsp;Ibrahim S Al-Busaidi FRNZCGP, MBChB, BMedSc(Hons), PGDip Obesity Weight Management,&nbsp;Martin Than FACEM, MBBS,&nbsp;Richard Troughton MBChB, PhD,&nbsp;Kaleb Addy MBChB,&nbsp;Laura R Joyce FACEM, AFRACMA, MBChB, BMedSc(Hons), MMedEd","doi":"10.1111/1742-6723.70049","DOIUrl":"https://doi.org/10.1111/1742-6723.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the effectiveness and safety of the new clinical pathway for patients presenting to an ED with AF, incorporating community next-working-day follow-up and more specific clinician guidance around medication prescribing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A before-and-after, retrospective cohort study comparing patients presenting to Christchurch ED with acute uncomplicated AF in the year before (‘hospital-based’ follow-up) and after (‘community-based’ follow-up) implementation of a new AF management approach. The ‘community’ pathway replaced hospital-based review with a next-day community follow-up and introduced more specific anticoagulation recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1065 patients met inclusion criteria, with 531 presenting during the ‘hospital-based’ pathway period and 534 during the ‘community’ pathway period. The spontaneous reversion rate was approximately 61% in both cohorts. Following the implementation of the community pathway, there was no increase in cardioversions (16.6% <i>vs</i> 20%, difference 3.5% [95% CI −1.4 to 8.3]), admission rates (32.8% <i>vs</i> 32.2%, difference − 0.6% [95% CI −6.4 to 5.3]), or AEs (60-day all-cause mortality 1.3% <i>vs</i> 0.9%, difference − 0.7% [95% CI −2.3 to 1]). Attendance at a follow-up AF clinic improved from 92.9% to 98.1% (difference 5.2% [95% CI 0.7–9.7]). Clinician adherence to anticoagulation guidelines increased by 7% (95% CI 1.6–12.4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A ‘rate-and-wait’ strategy for managing acute uncomplicated AF continues to allow a significant proportion of patients to self-revert to sinus rhythm, without requiring hospital admission or cardioversion procedures. Transitioning to an off-site, community AF clinic is both safe and effective, demonstrating increased clinic attendance and improved adherence to anticoagulation guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919353","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}