Emergency Medicine Australasia最新文献

{"title":"Emergency Department Utilisation and Related Costs in People With and Without Dementia in Their Last Years of Life.","authors":"Namal N Balasooriya, Tiet-Hanh Dao-Tran, Frances Batchelor, Tracy Comans","doi":"10.1111/1742-6723.70258","DOIUrl":"10.1111/1742-6723.70258","url":null,"abstract":"<p><strong>Objectives: </strong>To compare emergency department (ED) utilisation and related costs between people with and without dementia in their last 3 years of life (including the year of death and two full years prior to the year of death).</p><p><strong>Methods: </strong>This retrospective study used linked data (2013-2015) from 8389 people with dementia and 7813 people without dementia who died in 2015 in Queensland, Australia. ED utilisation data from the Queensland public hospitals were linked to cost data from the National Hospital Costing Data Collection using the patient's unique identifier. Two-sample t-test, Chi-square test and Generalised Estimating Equations regression were used for data analysis.</p><p><strong>Results: </strong>After adjusting for potential confounders, we show that people with dementia were more likely to have ED presentations (OR = 2.001, p < 0.01), short-stay unit admissions (OR = 1.435, p < 0.01) and arrive by ambulance (OR = 2.367, p < 0.01) than those without dementia. The average ED cost per episode for people with dementia is AUD 943.24 compared to AUD 912.82 for people without dementia, with a mean difference of AUD 30.43 (p < 0.01). ED costs for individuals with dementia were 3% higher, amounting to an estimated AUD 5 million for Australia's health sector in 2023.</p><p><strong>Conclusion: </strong>People with dementia have higher ED utilisation and costs than those without dementia. The results highlight the need for improved ED care models and targeted resource allocation to accommodate the complex needs of people with dementia.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":"e70258"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671557","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 Sedation Gap Conundrum: Where's the Awareness?","authors":"Jianfeng Zhang","doi":"10.1111/1742-6723.70262","DOIUrl":"https://doi.org/10.1111/1742-6723.70262","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":"e70262"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765793","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":"Practising Medicine in a Finite World.","authors":"E Andreotti","doi":"10.1111/1742-6723.70251","DOIUrl":"10.1111/1742-6723.70251","url":null,"abstract":"<p><p>Climate change is increasingly recognised as a major determinant of human health. At the same time, healthcare systems themselves contribute significantly to greenhouse gas emissions through energy use, procurement and supply chains. This creates a complex position for clinicians and healthcare organisations, as they must respond to the health consequences of climate change while also addressing their own environmental impact. ACEM has described climate change as a medical emergency. EDs must measure their climate effects, raise awareness and make meaningful changes; however, progress so far has been limited and highly variable between departments. This Trainee Focus issue explores ethical, professional and practical perspectives on sustainability in EM, inviting reflection on the role clinicians may play in addressing the environmental determinants of health while maintaining their primary responsibility to individual patients.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":"e70251"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671489","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":"Time to Analgesia Provision for Abdominal Pain Presentations in the Emergency Department: The Effect of Biological Sex—A Retrospective Cohort Study","authors":"Lisa Walker,&nbsp;Hannah Pennicott,&nbsp;Chris J. Selman,&nbsp;Elyssia M. Bourke","doi":"10.1111/1742-6723.70249","DOIUrl":"10.1111/1742-6723.70249","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Abdominal pain is a common emergency department (ED) presentation. Currently, there is limited Australian literature detailing whether biological sex results in differences in analgesia provision for abdominal pain. The primary aim of this study is to determine whether there is a difference in time to analgesia administration based on biological sex for patients presenting with abdominal pain to the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective, single centre cohort study of adult patients presenting to the Royal Melbourne Hospital ED between April 1st and 30th 2024 with abdominal pain. Data relating to the patient's presentation and management were collected from records of eligible patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 708 eligible patients, 292 (41%) were biologically male and 416 (59%) female. There were 559 (80%) patients who received at least one dose of analgesia. Females waited a median of 75 min and males 59 min to receive their first dose of analgesia (difference in medians = 16 min, 95% confidence interval [CI] 0.9–31.0 min, <i>p</i> = 0.04). Females were also nearly half as likely to receive parenteral analgesia (OR 0.56, 95% CI 0.38–0.82, <i>p</i> = 0.003). We found minimal differences in diagnoses, triage category or pain scores between sexes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Females presenting to the ED with abdominal pain are waiting longer than males to receive their first dose of analgesia and are less likely to receive parenteral analgesia. Further research is required to determine the reason for this discrepancy and to then remediate it.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580969","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":"Somatisation Scores Associated With Healthcare Costs and Utilisation in a Sample of Emergency Department Patients","authors":"Ben Britton,&nbsp;Ria Mittal,&nbsp;Keira Barnard,&nbsp;Samantha Chapman,&nbsp;Damian Chen,&nbsp;Benjamin De Berg,&nbsp;Vinodkumar Raveendran,&nbsp;Elizabeth Pepper","doi":"10.1111/1742-6723.70246","DOIUrl":"10.1111/1742-6723.70246","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Somatic Symptom and Related Disorders (SSRD) are associated with frequent healthcare utilisation and elevated costs, yet their impact within Emergency Departments (EDs) remains underexplored. This study investigates the relationship between somatisation score and healthcare utilisation and costs in an Australian ED setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A tertiary public hospital ED in Australia serving metropolitan and rural populations. Healthcare utilisation and cost data were extracted from the local network's Activity Based Management database for 3.5 financial years preceding the index presentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>375 ED patients aged 18–70 years screened using the PHQ-15 and WI-7 tools over a two-week period. Participants were classified as high or low somatisers using dynamic cutoffs. Total available healthcare costs and occasions of service over the 42 months preceding the index ED presentation were gathered. Negative binomial regression models were used to identify predictors of total costs and service occasions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High somatisers (59.84% of the sample) incurred significantly greater healthcare costs (mean AUD $23,713 vs. $10,392) and service occasions (mean 38.7 vs. 18.7) than low somatisers. regression analyses identified somatisation severity, age and female sex as significant predictors of increased healthcare utilisation and costs. Presentation-based variables such as triage category and diagnosis were not significant predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>High somatisation scores are strongly associated with increased healthcare utilisation and costs in ED patients. These findings suggest that SSRD may be a previously neglected factor in hospital resource planning. Early identification and appropriate management of SSRD in EDs could yield substantial economic and clinical benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580923","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 Content of Major Haemorrhage Protocols (MHP) in Public Hospitals Throughout Queensland—Are We Following the Evidence?","authors":"Josea Brown,&nbsp;Elizabeth Wake,&nbsp;Shane George,&nbsp;James Winearls,&nbsp;Michael C. Reade,&nbsp;Michelle Jeffress,&nbsp;Dan Bodnar,&nbsp;Clinton Gibbs,&nbsp;Alistair Hamilton,&nbsp;Caitlin Brandenburg,&nbsp;John Casey,&nbsp;Natasha Adams,&nbsp;Pareesa Cresswell,&nbsp;Jessica Forbes","doi":"10.1111/1742-6723.70245","DOIUrl":"10.1111/1742-6723.70245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The National Blood Authority (NBA) provides a Major Haemorrhage Protocol (MHP) template for Australian hospitals to develop and modify an MHP algorithm for their needs. However, it is unclear whether the evidence-based guidance from NBA is utilised by individual facilities. The aims of this study were to: (1) establish the baseline composition of MHP from public hospitals across Queensland and (2) compare content using the NBA algorithm and evidence-based recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An explanatory qualitative design was used. Individual health service MHP were assessed against the NBA algorithm by a minimum of two members of the research team.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-eight MHP algorithms were retrieved from 113 hospitals and health facilities within Queensland. 99% (<i>n</i> = 77) of algorithms provided recommendations for red blood cell delivery and fibrinogen replacement. Variations existed on the availability of fresh blood products between hospitals and geographical locations. 90% of algorithms (<i>n</i> = 70) contained activation criteria; 21% (<i>n</i> = 14) incorporated additional non-NBA specific criteria. Less than half of MHP algorithms (<i>n</i> = 30, 40%) contained information regarding the management of critically bleeding paediatric patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is significant variability in the content of MHP algorithms across Queensland, Australia, despite the availability of evidence-based guidelines for patients who are severely bleeding. Whilst individual health facilities are encouraged to modify MHPs to suit local contexts, the evidence on how to safely accomplish this remains limited and could account for the variations identified in this study. Further guidance is required for hospitals with restricted access to blood products, limited pathology testing capabilities, and who manage critically bleeding paediatric patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473031","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":"The Potential for Artificial Intelligence to Augment Peer Review","authors":"W. Kenneth Milne,&nbsp;Daniel Fatovich","doi":"10.1111/1742-6723.70243","DOIUrl":"10.1111/1742-6723.70243","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466491","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 Patterns of D-Dimer Assay Ordering at an Australian Rural Referral Hospital: A Retrospective Audit","authors":"Suzanne Hill,&nbsp;Emma Webster,&nbsp;Daniel Stewart","doi":"10.1111/1742-6723.70244","DOIUrl":"10.1111/1742-6723.70244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore patterns of D-dimer assay ordering for the diagnosis of pulmonary embolism (PE) and evaluate its clinical usefulness at Dubbo Health Service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective audit of patients presenting to Dubbo Health Service between 1 January and 31 December 2024 who underwent D-dimer testing. D-dimer and CTPA ordering patterns were categorised according to their alignment with the guideline-recommended investigation sequence, which informed interpretation of test utilisation in the clinical context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 245 D-dimer results were included (119 positive, 126 negative). In 79.2% of cases, investigation sequences followed the guideline-recommended order of testing. The diagnostic yield of CTPA among patients who underwent D-dimer testing was 4.9%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Ordering patterns were broadly consistent with published reports of increasing utilisation of D-dimer testing and CTPA. Discordant pathways most commonly involved positive D-dimer results without subsequent CTPA, or CTPA performed despite a negative D-dimer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patterns of D-dimer ordering were variably aligned with guideline-recommended pathways, which may limit the clinical usefulness of the test in some cases. Improved documentation of pre-test probability and targeted education regarding appropriate test selection and interpretation may enhance the integration of D-dimer testing into diagnostic workflows.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147462765","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":"Exploring Advanced Practice Physiotherapist Scope of Practice by Discharge Diagnosis: A Review of 10 Years of Data From a Tertiary Hospital Emergency Department","authors":"Piers Truter,&nbsp;Louise Giglia-Smith,&nbsp;Luke Bongiascia,&nbsp;Andrew Moffat,&nbsp;James Wrightson,&nbsp;Susan Brooker,&nbsp;Paul Atkinson,&nbsp;Pippa Flanagan","doi":"10.1111/1742-6723.70241","DOIUrl":"10.1111/1742-6723.70241","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Musculoskeletal conditions are the most common low acuity ED presentation. In response, over the last 13 years, Advanced Practice Physiotherapist (APP) roles have been established in emergency departments (ED) across Australia. Despite APP roles being well established in many Australian EDs, the current scope of practice for APPs as defined by discharge diagnosis is not accurately defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To derive a scope of practice based on ED diagnosis for APPs in an Australian tertiary hospital ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Descriptive classification study of patients who received care from an APP in the study ED between January 2015 and September 2024, with an iterative consensus process to establish the scope of APP practice by ED discharge diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>APPs provided 37,771 individual episodes of care with 388 assigned International Classification of Diseases (10th revision) (ICD-10) discharge diagnoses. 204 ICD-10 diagnoses were rated as representing the local scope of practice for ED APPs. These codes accounted for 37,000 (98.2%) of the episodes of care. The APP team provided care for 33,713 adult patients, 4058 paediatric patients, 1197 patients who arrived by ambulance and 3477 patients referred to the ED by a GP. The consensus process demonstrated that APPs have clarity on their scope of practice and the capability to manage a differential diagnosis process that includes non-musculoskeletal diagnoses in the ED setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Using 10 years of ED data, a consensus process mapped the local scope of practice of APPs in a single Western Australian Tertiary Hospital ED to 204 ICD-10 diagnoses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376561","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 Sydney Triage to Admission Risk Tool With Artificial Intelligence (START-AI): Prediction of Inpatient Admission From Emergency Departments Using Ensemble Machine Learning","authors":"Michael Dinh,&nbsp;Elizabeth Corbett,&nbsp;Eliot Salmon,&nbsp;Saleem Ahmed Khan,&nbsp;Nicholas Moore,&nbsp;Sreenadh Brahmapuram,&nbsp;Radhika Seimon,&nbsp;Naomi Derrick,&nbsp;Saartje Berendsen Russell,&nbsp;Thuy Truc Ngo,&nbsp;Irena Koprinska","doi":"10.1111/1742-6723.70240","DOIUrl":"10.1111/1742-6723.70240","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Use artificial intelligence (AI) to extend the Sydney triage to admission risk tool (START) and improve prediction of emergency department (ED) patient disposition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was conducted at an inner-city tertiary referral hospital ED. Adult (age ≥ 16 years) presentations from 1 January 2023 to 30 June 2025 were included. Participants were excluded if dead on ED arrival or left ED prior to completing treatment. The primary outcome was admission to an inpatient ward. A sequential ensemble modelling approach was used. To predict patient disposition, the original START was combined (stacked) with vital signs, blood results and CT imaging orders using a gradient boosting decision tree algorithm (XGBoost) and a pre-trained transformer model for clinical free text.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>162,915 cases were analysed with 27.31% overall inpatient admission rate. The final stacked meta-XGBoost model had an area under receiver operating curve (AUROC) of 0.88 (95% CI: 0.88, 0.89) with overall weighted accuracy of 0.84 (95% CI: 0.84, 0.85) and F1 score of 0.83 (95% CI: 0.83, 0.84) in the testing dataset. The model was adequately calibrated with <i>R</i>² of 0.92 (95% CI: 0.67, 0.99) with a drop-off in correlation at the highest predicted probability ranges (&gt; 0.80). After classifying inpatient stays &lt; 24 h as potential discharges, a sensitivity analysis demonstrated AUROC for the final model of 0.89 (95% CI: 0.88, 0.89).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An ensemble machine learning model was developed to accurately predict patient disposition from ED using structured and unstructured data. Prototype development and prospective evaluation of START-AI are required to assess model performance in clinical settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376546","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}