Emergency Medicine Australasia最新文献

{"title":"Effects of a Virtual Trauma Clinic on admissions and length of stay for minor to moderate trauma.","authors":"Amber Shuja, Fay Balian, Michael M Dinh, Radhika Seimon, Jameela Truman, Matthew Oliver","doi":"10.1111/1742-6723.14531","DOIUrl":"https://doi.org/10.1111/1742-6723.14531","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes.</p><p><strong>Methods: </strong>One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures.</p><p><strong>Results: </strong>VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = -2.82, -0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury.</p><p><strong>Conclusion: </strong>Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617060","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":"Reducing mechanical restraint in emergency departments: International perspectives and Taiwan's experience.","authors":"Chi-Hua Lan, Lien-Chung Wei","doi":"10.1111/1742-6723.14534","DOIUrl":"https://doi.org/10.1111/1742-6723.14534","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617062","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":"Implementing the electronic HEEADSSS screening tool in a paediatric emergency department","authors":"Jessica WS Wong,&nbsp;Nicolene Shipton,&nbsp;Matthew Edwards,&nbsp;Kate Bradman","doi":"10.1111/1742-6723.14509","DOIUrl":"10.1111/1742-6723.14509","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343837","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":"Review article: A primer for clinical researchers in the emergency department: Part XIII. Strategies to engage staff and enhance participant recruitment in emergency department research","authors":"Sharon O'Brien BN, PhD,&nbsp;Catherine Wilson MPH, Ms,&nbsp;Megan Duck BN, GDipHlthRes,&nbsp;Gaby Nieva BNurs, GradDipNurs,&nbsp;Medhawani P Rao BHSc (Nsg) and PGDip AdvNsg,&nbsp;Libby Haskell NP, PhD","doi":"10.1111/1742-6723.14505","DOIUrl":"10.1111/1742-6723.14505","url":null,"abstract":"<p>Conducting research in ED is important and necessary to improve emergency care. Effective recruitment is an essential ingredient for the success of a research project and must be carefully monitored. Research coordinators are focused on optimising recruitment to research studies while also ensuring that the needs of participants and their families are met, and the research is acceptable to ED staff. In this paper, a group of experienced research coordinators from Australia and New Zealand have shared their strategies to engage staff and enhance recruitment of participants in emergency research. Although this paper is from a paediatric research network, the findings are applicable for EDs in general, both in Australasia and elsewhere.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343839","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":"Review article: Strategies to improve emergency department care for adults living with disability: A systematic review","authors":"Bronwyn Newman PhD,&nbsp;Colleen Cheek PhD,&nbsp;Lieke Richardson BSc,&nbsp;Donna Gillies PhD,&nbsp;Karen Hutchinson PhD,&nbsp;Elizabeth Austin PhD,&nbsp;Margaret Murphy RN, PhD,&nbsp;Luke Testa PhD,&nbsp;Christina Rojas MPH,&nbsp;Louise Raggett PhD,&nbsp;Amanda Dominello MPH,&nbsp;Kylie Smith,&nbsp;Robyn Clay-Williams PhD","doi":"10.1111/1742-6723.14500","DOIUrl":"10.1111/1742-6723.14500","url":null,"abstract":"<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":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14500","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":"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 BAppSci, MSc, PhD,&nbsp;Min J Teng BAppSci, MHSM,&nbsp;Danielle M Coombs BAppSci, PhD,&nbsp;Qiang Li MSc,&nbsp;Laurent Billot MSc, MRes,&nbsp;Thomas Lung MSc, PhD,&nbsp;Eileen Rogan MBBS, MHSM, PhD,&nbsp;Mona Marabani MBBS,&nbsp;Owen Hutchings MBBS,&nbsp;Joshua R Zadro BAppSci, PhD,&nbsp;Chris G Maher BAppSci, DMedSc, PhD,&nbsp;Gustavo C Machado BPhty, PhD,&nbsp;The Back@Home Investigators","doi":"10.1111/1742-6723.14487","DOIUrl":"10.1111/1742-6723.14487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>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 (<b>rpa</b>virtual), and be cared for remotely in their own homes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ethics approval was granted for protocols X21-0278 &amp; 2021/ETH10967 and X21-0094 &amp; 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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","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":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14487","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":"OA","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 B.Sc(hons), GCLT, FCHSM, PhD,&nbsp;Samuel Wilson BA, BCom, MPsych, PhD,&nbsp;Lee Wong MBBS (hons), GradDipClinEd, FACEM, PhD,&nbsp;Elizabeth Elder BA, BN, MAdvPrac, MNurs, PhD","doi":"10.1111/1742-6723.14501","DOIUrl":"10.1111/1742-6723.14501","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore how clinicians understand coaching and their clinician-coach practice in emergency medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were surveyed about the value of coaching and their beliefs about the enablers of, and barriers to, being a clinician-coach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fostering a supportive environment for coaching could significantly enhance clinician competence and well-being, healthcare delivery and professional development.</p>\u0000 </section>\u0000 </div>","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":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14501","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations for developing a comprehensive point-of-care ultrasound (POCUS) program in the emergency department: an Emergency Medicine Ultrasound Group advocacy statement","authors":"Luke Phillips MBBS, BSc (BioMed) (Hons), FACEM, CCPU, GradCertClinSim,&nbsp;Alastair Maclean MB ChB, BSc Med Sci (Hons), Post Grad Cert CPU, MRCP (Lon), FRCEM, FACEM,&nbsp;Josh Monester MBBS(Hons), CCPU, GradCertClinEd,&nbsp;Joanne Douglas DMU, SEED, ASUM CCPU provider,&nbsp;Stacey Davidson ICF ACC, Zenergy Master Facilitator,&nbsp;Gabriela King MBBS, FACEM, Post Grad Cert CPU","doi":"10.1111/1742-6723.14484","DOIUrl":"10.1111/1742-6723.14484","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Point-of-care ultrasound (POCUS) use is widespread in EDs and throughout those practising medicine. Between institutions and specialities, there is widespread variety and training. With this comes the risk of patient harm and backlash to a clinically useful modality. Our objective is to form a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Emergency Medicine Ultrasound Group (EMUG) identified this gap and volunteers from the group undertook a literature search of current best practice and institution guidelines relating to POCUS programs. They contacted colleagues from other specialities to find and get access to other countries and colleges' POCUS guidelines. EMUGs regularly run discussion forums (Collab-labs) and points from these were considered. Recommendations were then formed from these and recurrent unpublished obstacles the group had encountered. The result was reviewed by clinical leaders in ultrasound and POCUS users in Australasia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The recommendations were organised under five pillars: Infrastructure, Governance, Administration, Education and Quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These recommendations complement existing guidelines and are not intended to replace them; however, we hope to promote discussion and provide reference support for those developing POCUS programs. Implementing a comprehensive and robust ED POCUS program will ensure safe, effective and standardised high-quality POCUS use, with the aim of improving patient care across Australia and New Zealand. Patient safety will be enhanced through effective risk management and quality assurance and there will be consistency in POCUS education, training and credentialing across institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132175","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":"Optimising POCUS programs: A summary of EMUG's recommendations for the development and maintenance of ED POCUS programs","authors":"Luke Phillips MBBS, BSc (BioMed) (Hons), FACEM, CCPU, MClinSim,&nbsp;Alastair Maclean MB ChB, BSc Med Sci (Hons), Post Grad Cert CPU, MRCP (Lon), FRCEM, FACEM,&nbsp;Josh Monester MBBS(Hons), CCPU, GradCertClinEd,&nbsp;Joanne Douglas DMU, SEED, ASUM CCPU provider,&nbsp;Stacey Davidson ICF ACC, Zenergy Master Facilitator,&nbsp;Gabriela King MBBS, FACEM, Post Grad Cert CPU","doi":"10.1111/1742-6723.14485","DOIUrl":"10.1111/1742-6723.14485","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Point-of-care ultrasound (POCUS) use is widespread in EDs and throughout those practising medicine. Between institutions and specialities, there is widespread variety and training. With this comes risk of patient harm and backlash to a clinically useful modality. Our objective is to form a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Emergency Medicine Ultrasound Group (EMUG) identified this gap and volunteers from the group undertook a literature search of current best practice and institution guidelines relating to POCUS programs. They contacted colleagues from other specialities to find and get access to other countries and colleges' POCUS guidelines. EMUGs regularly run discussion forums (Collab-labs) and points from these were considered. Recommendations were then formed from these and recurrent unpublished obstacles the group had encountered. The result was reviewed by Clinical Leads in Ultrasound and POCUS users in Australasia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The recommendations were organised under five pillars: Infrastructure, Governance, Administration, Education and Quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These recommendations complement existing guidelines and are not intended to replace them; however, we hope to promote discussion and provide reference support for those developing POCUS programs. Implementing a comprehensive and robust ED POCUS program will ensure safe, effective, and standardised high-quality POCUS use, with the aim of improving patient care across Australia and New Zealand. Patient safety will be enhanced through effective risk management and quality assurance and there will be consistency in POCUS education, training and credentialing across institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132174","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":"Review article: Back to life from being declared dead in the Resus Bay: An integrative review of the phenomenon of autoresuscitation and learning for ED","authors":"Joanna Manton BSc (Hons), MBChB, FACEM, CCPU","doi":"10.1111/1742-6723.14482","DOIUrl":"10.1111/1742-6723.14482","url":null,"abstract":"<p>This is a literature review of ED autoresuscitation. The impetus for this review was a case which revealed a lack of understanding about Lazarus syndrome among ED staff. The primary objective was to see the proportion of cases who survived neurologically intact to discharge and the time frame when this occurred after death had been declared. A secondary outcome was to see whether these studies mention whether bedside echo was performed prior to deciding whether to terminate resuscitation. A systematic search of five databases was undertaken with keywords, ‘autoresuscitation’, ‘cardiac arrest’ and ‘emergency department’. Articles published in the English language were selected for inclusion. No time frame was selected because of the low number of articles. A total of 240 articles were identified, that yielded 26 cases that were relevant and could be synthesised to create a discussion on the current clinical guidelines around resuscitation. Our analysis demonstrates that of the 11 survivors who were discharged neurologically intact, the average age was 42.9 years; otherwise, the average was 62.6 years. The majority (23/26) 88% auto-resuscitated within 10 min after being pronounced dead. Only five patients are mentioned as having had a bedside echo prior to deciding to cease efforts. Under-reporting of autoresuscitation is suspected because of fears of blame. Passive monitoring for 10 min after resuscitation is ceased, is recommended. There is need for more data on this phenomenon to help inform further research on the topic.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072288","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}