Emergency Medicine Australasia最新文献

{"title":"Response to Borland Et al. 'Criteria for Safe Hospital Discharge in Bronchiolitis: A Systematic Review'.","authors":"Jennifer T Kirkpatrick, Scott D Casey","doi":"10.1111/1742-6723.70363","DOIUrl":"https://doi.org/10.1111/1742-6723.70363","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70363"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180072","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":"Characteristics, Practice Patterns, and Outcomes of Emergency Department Intubation for Sepsis: An ANZEDAR Registry Study.","authors":"Pramod Chandru, Hatem Alkhouri, Toby Fogg, Elliot Long","doi":"10.1111/1742-6723.70362","DOIUrl":"10.1111/1742-6723.70362","url":null,"abstract":"<p><strong>Objective: </strong>Sepsis is a leading cause of critical illness in Australia and New Zealand, with over 75% of admissions occurring through emergency departments. This study aimed to characterise the demographics, process of care, pharmacology, and peri-intubation adverse events of sepsis intubations using a prospective Australasian registry.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data from the Australian and New Zealand Emergency Department Airway Registry (ANZEDAR) was performed across 79 hospitals between January 2010 and March 2026. Intubations performed for a primary indication of sepsis were identified. A paediatric subgroup analysis was performed stratified by age band. Statistical comparisons used Mann-Whitney U tests for continuous variables and chi-square or Fisher's exact tests for categorical variables.</p><p><strong>Results: </strong>Of 11,289 registry intubations, 280 (2.5%) were performed for sepsis. Paediatric patients with confirmed age under 16 years comprised 30 of 280 sepsis intubations (10.7%). Adults were older, more haemodynamically compromised, and had longer triage to intubation times than non-sepsis patients across all age groups. Laryngoscopic views and first-pass success were comparable between sepsis and non-sepsis groups. Haemodynamic complications occurred in 27.9% of sepsis intubations and peri-intubation cardiac arrest in 4.6%. Waveform capnography was used less frequently in sepsis versus non-sepsis groups (87.5% vs. 94.1%; p < 0.001).</p><p><strong>Conclusion: </strong>Emergency department sepsis intubation is associated with high rates of haemodynamic complications despite similar laryngoscopic views and first-pass success rates. Low waveform capnography use in infant sepsis represents a potential patient safety concern. These findings support targeted interventions.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70362"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135483","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":"Small Town, Big Lessons-A Blended Supervision Placement Reflection.","authors":"Jess Stocker","doi":"10.1111/1742-6723.70375","DOIUrl":"https://doi.org/10.1111/1742-6723.70375","url":null,"abstract":"<p><p>The new blended supervision placement (BSP) presents an expanded array of training opportunities for TS2/3 ACEM registrars in regional, rural and remote locations. These newly accredited sites, previously not eligible for recognised training time, offer varied learning opportunities in both clinical and non-clinical domains. The development of this placement is aligned with the 2027 curriculum alteration in rural and remote training requirements for ACEM trainees, and reflects real workforce evolution around Australia and Aotearoa New Zealand. This opinion piece is a reflection on one TS2 trainee's recent experience at the newly BSP-accredited Macksville District Hospital on the NSW mid north coast. It reflects the value of continuity in clinical supervision across a parent and peripheral site, as well as the professional and personal rewards of practising emergency medicine in a smaller and more connected community.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70375"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220084","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":"Regional, Rural and Ready: Making the New RRR Training Requirement Count.","authors":"Adam Gunner","doi":"10.1111/1742-6723.70369","DOIUrl":"https://doi.org/10.1111/1742-6723.70369","url":null,"abstract":"<p><p>From 2027, new ACEM trainees must complete 6 months of emergency medicine training at an eligible regional, rural or remote site. The requirement aligns training more closely with where emergency physicians work and offers valuable experience in generalism and decision making with limited resources. Its success will depend on authentic placements, supportive training networks and employment arrangements that recognise the burden of relocation.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70369"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192165","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 Peripheral Intravenous Catheter Use in Adult Acute Care: A Systematic Review.","authors":"Giles Barrington, Lauren E Thurlow, Sarah Wiggs, Sundy Ni-Yen Yang, Suzanne Bumpstead, Bibesh Pokhrel, Viet Tran, Diana Egerton-Warburton, Lisa Kuhn","doi":"10.1111/1742-6723.70357","DOIUrl":"10.1111/1742-6723.70357","url":null,"abstract":"<p><p>Peripheral intravenous catheters (PIVCs) are the most frequently inserted invasive device in acute care, yet up to 52% remain unused, exposing patients to avoidable risks and increasing healthcare costs. Despite growing awareness of inappropriate PIVC use, unnecessary insertion persists, driven by cultural and organisational norms and risk-averse practices. Interventions to reduce PIVC use have been implemented, but their effectiveness and sustainability have not been systematically synthesised. A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251033201). Searches of CINAHL, MEDLINE, Scopus, and Web of Science identified studies reporting interventions to reduce PIVC insertion, unused PIVCs, and common complications. Data were extracted for intervention characteristics and PIVC outcomes. Implementation strategies were mapped to Consolidated Framework for Implementation Research domains for summative analysis. Random-effects meta-analysis was performed when appropriate. Twelve studies were included from emergency departments and inpatient settings across high-income countries. Most reported reductions in PIVC insertion and unused catheters, with improvements in secondary outcomes including phlebitis and bloodstream infections. Sustainability of practice change was demonstrated in two multi-year follow-up studies. Interventions showed a significant trend for increasing complexity over time, with recent strategies incorporating multi-modal, theory-informed approaches. Meta-analysis showed substantial heterogeneity, limiting pooled estimate interpretation, while methodological limitations restricted causal inference. Multi-modal interventions addressing behavioural, organisational, and contextual determinants appear most effective for reducing PIVC insertion rates and unnecessary PIVC use. Future research should evaluate sustainability, cost-effectiveness, and scalability using implementation science frameworks.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":"e70357"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074049","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":"Implementation of a Structured Hot Debrief Tool in a Metropolitan ED: A Quality Improvement Study","authors":"Jasmine Poonian,&nbsp;Katie O'Halloran,&nbsp;Thomas Kilner,&nbsp;David Krieser","doi":"10.1111/1742-6723.70349","DOIUrl":"10.1111/1742-6723.70349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the acceptability and feasibility of implementing a structured ‘hot debrief’ tool, and its impact on team effectiveness, staff well-being and identification of system-level issues following critical events in two EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a multi-site quality improvement study across two metropolitan Australian EDs from 2023 to 2025. A standardised hot debrief process was implemented following predefined critical events, with senior staff trained as facilitators. Staff perceptions were assessed using anonymous pre-, post- and final-implementation surveys, with quantitative data analysed descriptively. Completed debrief proformas from two 6-month trial periods were analysed using reflexive thematic analysis to identify recurring themes related to team function, well-being and system issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 46 hot debriefs were conducted. In the final survey, 60 of 121 respondents (50%) had attended at least one debrief in the preceding 6 months. Amongst attendees, 98% reported that debriefs created a psychologically safe space, and 59 of 60 found them useful overall. Likert-scale responses indicated high perceived value, with most rating debriefs four or five out of five for team building, learning, issue identification and emotional processing. Thematic analysis identified five key system-level issues: interdepartmental communication, medication dosing in rare events, staffing and handover pressures, staff safety during behavioural emergencies and environmental and crowd-control challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A structured hot debrief tool was feasible and well accepted. It supported team reflection, staff well-being and identification of recurrent system issues. Further research is needed to assess sustainability and downstream impacts on staff well-being and patient safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976106","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":"Intranasal Dexmedetomidine for Paediatric Procedural Sedation in the Emergency Department: A Single-Centre Retrospective Observational Cohort Study","authors":"Emma Whyte,&nbsp;Theophilus I. Emeto,&nbsp;Frances Snowden,&nbsp;Vinay Gangathimmaiah","doi":"10.1111/1742-6723.70346","DOIUrl":"10.1111/1742-6723.70346","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To describe the use, effectiveness and safety of intranasal dexmedetomidine (IN DEX) for ED paediatric procedural sedation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted over 7 months following implementation of an IN DEX guideline at Townsville University Hospital ED. Children aged 1–16 years were eligible if they received IN DEX. Outcomes of interest were sedation depth, ED length of stay (EDLOS), adverse events, procedural success and clinician/carer satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 114 patients were recruited. Median age was 3 years (IQR 2–5), 55.3% were male and 31.6% were Aboriginal and/or Torres Strait Islander children. Median IN DEX dose was 3.11 mcg/kg (IQR 2.81–3.93). Common indications included peripheral intravenous cannulation (35.1%), laceration repair (21.1%), burns care (13.2%), foreign body removal (11.4%) and medical imaging (8.8%). Median EDLOS was 395 min (IQR 255–579). Sedation depth was moderate (mean University Michigan Sedation Scale score 2.1 (SD 0.9), a 0–4 scale on which higher scores indicate deeper sedation; documented for 90 of 114 sedations). IN DEX was successful as a sole sedative agent in 78.1% (95% CI 69.6%–84.7%) patients, ranging from 90.0% (9/10) for medical imaging to 53.8% (7/13) for foreign body removal. Adverse events occurred in 13.2% of patients (95% CI 8.1%–20.6%), predominantly mild bradycardia. Younger age was associated with higher success rates (aOR 0.86 per year, 95% CI 0.74–0.998). No dose–response relationship was identified. Clinicians (mean 4.3/5) and parents (mean 4.5/5) reported high satisfaction, although satisfaction was documented for fewer than half of sedations and significantly more often when sedation succeeded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our single-centre study IN DEX is a well-tolerated, moderately effective and safe agent for ED paediatric procedural sedation with higher success rates in younger patients. Large, prospective, multisite studies are necessary to establish IN DEX's safety, effectiveness and predictors of success.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982346","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":"Medicolegal Statements by Emergency Clinicians: ‘A How’ to Guide","authors":"Anne-Maree Kelly,&nbsp;Michael Eburn","doi":"10.1111/1742-6723.70343","DOIUrl":"10.1111/1742-6723.70343","url":null,"abstract":"<div>\u0000 \u0000 <p>Emergency clinicians may be asked by relevant authorities to provide statements, usually in criminal proceedings or for coroners' courts. These are statements of fact, not of opinion. Understanding the purpose and requirements of each statement type is essential to inform structure and content. Relevant information needs to be communicated in a clear and structured way. This article provides an overview of these statement types, their purpose and requirements, and some suggestions regarding format and style.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982372","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":"Embedded Low-Acuity Pathway in the Emergency Department: An Alternative to Stand-Alone Urgent Care Services","authors":"Daniel Stewart,&nbsp;Patrick Caldwell","doi":"10.1111/1742-6723.70348","DOIUrl":"https://doi.org/10.1111/1742-6723.70348","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the impact of an embedded Ultra-Low Acuity Pathway (ULAP) on emergency department performance indicators for low-acuity patients in a rural referral hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This pragmatic, single-centre, quasi-experimental study included Australian Triage Scale Categories 4 and 5 patients presenting to Dubbo Health Service between 10:00 and 20:00 from 29 May to 1 October 2023 (<i>n</i> = 4798). Workforce-dependent ULAP availability created a comparison between ULAP (<i>n</i> = 2178) and standard care periods (<i>n</i> = 2620). Primary outcomes were Did Not Wait (DNW), Seen Within Benchmark (SWB), Emergency Treatment Performance (ETP) and length of stay (LOS). Multivariable analyses adjusted for patient characteristics, temporal factors and resource state.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ULAP was associated with improvements across all outcomes. DNW decreased from 14.2% to 6.9% (adjusted OR 0.43, 95% CI 0.35–0.53), SWB increased from 72.6% to 82.0% (adjusted OR 1.90, 95% CI 1.64–2.20) and ETP increased from 73.1% to 83.3% (adjusted OR 1.96, 95% CI 1.69–2.28). Mean LOS was 51.7 min shorter after adjustment (95% CI −65.1 to −38.4). All associations remained statistically significant (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An embedded ULAP was associated with substantial improvements in emergency department performance that were independent of patient characteristics, temporal factors and resource state. Embedding urgent care within existing emergency departments may provide a practical alternative to stand-alone urgent care services for rural communities where separate services are not feasible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148943173","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":"High-Flow Nasal Oxygen Versus Conventional Oxygen Therapy and Non-Invasive Ventilation for Acute Respiratory Failure in the Emergency Department: A Systematic Review and Meta-Analysis","authors":"Rupert Phillips,&nbsp;Adrianna Klejnotowska,&nbsp;Harry Claxton,&nbsp;Matthew Cadd","doi":"10.1111/1742-6723.70350","DOIUrl":"https://doi.org/10.1111/1742-6723.70350","url":null,"abstract":"<div>\u0000 \u0000 <p>This systematic review and meta-analysis compares the use of high-flow nasal oxygen (HFNO) with conventional oxygen therapy (COT) and non-invasive ventilation (NIV) in the management of acute respiratory failure (ARF) in the emergency department (ED). A comprehensive search of relevant sources was undertaken. Randomised controlled trials (RCTs) assessing adult patients (≥ 18 years) treated in the ED for ARF and comparing HFNO to COT/NIV were included. The primary outcome was the need for endotracheal intubation and mechanical ventilation (IMV). Secondary outcomes included physiological and biochemical parameters, ICU admission, hospital length of stay, dyspnoea scores and mortality. A total of 17 RCTs (1955 patients) were included. There was a significant reduction in IMV favouring the HFNO group compared to COT and NIV (RR 0.64, 95% CI 0.47–0.88). HFNO showed significant improvements in RR, SpO₂, PaO₂ and Modified Borg Dyspnoea Scale. Subgroup analysis showed reduced rates of IMV with HFNO compared to COT (RR 0.61, 95% CI 0.41–0.91), but not compared to NIV (RR 0.69, 95% CI 0.42–1.14). HFNO additionally showed a reduction of IMV compared to NIV and COT in undifferentiated patients (RR 0.61, 95% CI 0.41–0.93), but not in exacerbations of COPD or acute heart failure. Ten of the 17 studies had at least some concern for risk of bias, with several analyses having notable heterogeneity. HFNO showed a significant reduction in rates of IMV, improvement in peripheral oxygen saturations, PaO₂, respiratory rate and patient dyspnoea scores compared to COT and NIV.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148943174","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}