Australasian Emergency Care最新文献

{"title":"The experiences of patients not conveyed after evaluation by emergency medical services in Southwest Finland – A qualitative survey study","authors":"Anne Kuoppala ,&nbsp;Eetu Skaffari ,&nbsp;Timo Iirola ,&nbsp;Hilla Nordquist","doi":"10.1016/j.auec.2024.05.001","DOIUrl":"10.1016/j.auec.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><div>The amount of non-critical Emergency Medical Services missions has been increasing. After examination and treatment, paramedics can decide, based on guidelines, not to convey the patient to a healthcare facility. This study aimed to investigate patients’ experiences in non-conveyance situations in Southwest Finland. Our research questions were: 1) Which patient concerns were not addressed? 2) What key actions improved patient comfort? and 3) What possible enhancements could make the patient experience more positive?</div></div><div><h3>Methods</h3><div>This was a qualitative survey study. In March 2023, all the patients who met the inclusion criteria (N = 1017) received a survey via mail. The data from three open-ended questions were analyzed using inductive content analysis.</div></div><div><h3>Results</h3><div>The response rate was 22.2 % (n = 226). The unaddressed patient concerns were related to inadequate immediate care and guidance and non-clinical factors causing concern. Key actions for improved patient comfort were related to immediate treatment and guidance, as well as non-clinical factors that impact the patient experience. More thorough treatment processes and more attentive encounters would have enhanced the patient experience.</div></div><div><h3>Conclusions</h3><div>Predominantly, patients reported having received excellent services. Utilizing paramedics’ soft skills and keeping the patient as the central focus is key to improving the non-conveyance process and experience.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 237-243"},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094750","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":"Establishing enablers and barriers to implementing the HIRAID® emergency nursing framework in rural emergency departments","authors":"Belinda Kennedy ,&nbsp;Kate Curtis ,&nbsp;Sarah Kourouche ,&nbsp;Louise Casey ,&nbsp;Dorothy Hughes ,&nbsp;Vivienne Chapman ,&nbsp;Margaret Fry","doi":"10.1016/j.auec.2024.08.002","DOIUrl":"10.1016/j.auec.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Rural Australia has large geographic distances between emergency departments with variability of services and medical support. Emergency nurses must be appropriately skilled to assess and manage unpredictable and diverse presentations. HIRAID® is an evidence-based framework to support emergency nurses in assessment and care delivery. To inform implementation, the study aimed to identify the enablers and barriers to introducing HIRAID® in practice.</div></div><div><h3>Methods</h3><div>This embedded mixed methods study was conducted in 11 rural, regional emergency departments in Southern New South Wales, Australia. Respondents completed a 22-item survey, indicating their level of agreement on statements related to practice change, free text responses were optional. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were identified as barriers or enablers, then integrated and mapped to the Theoretical Domains Framework.</div></div><div><h3>Results</h3><div>The survey was completed by 102 (54 %) nurses. Two enablers and four barriers to implementation were identified and mapped to 10 Theoretical Domains Framework domains. Key barriers were workplace limitations, such as time and resources, and knowledge of the HIRAID® intervention.</div></div><div><h3>Conclusion</h3><div>Barriers varied between facilities related to adequate support to implement and the impact on patient care. The results will inform a strategy to implement HIRAID®.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 290-298"},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115215","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":"A scoping review study of patients with a primary immune deficiency who have presented to the paediatric emergency department with a fever","authors":"Samantha Ryan ,&nbsp;Elizabeth Forster ,&nbsp;Bronwyn Griffin","doi":"10.1016/j.auec.2024.09.001","DOIUrl":"10.1016/j.auec.2024.09.001","url":null,"abstract":"<div><h3>Aim</h3><div>To identify, analyse, and synthesise existing research on the characteristics and risk factors associated with primary immune deficiencies (PIDs), with focus on understanding how factors impede patient outcomes.</div></div><div><h3>Background</h3><div>There is currently limited research regarding the management of this cohort when they present to an emergency department with the presentation urgency often being overlooked.</div></div><div><h3>Method</h3><div>Three databases, google scholar, and citations were searched for relevant studies under the criteria. Included papers were analysed and reported following the PRISMA guideline, and then critically appraised using the Mixed Method Appraisal Tool.</div></div><div><h3>Results</h3><div>After a review of 625 titles and abstracts, 20 studies met the inclusion criteria. The majority being mixed method (n = 8) and case studies (n = 8). All chosen studies reported some form of management of a child with a PID, and most made recommendations for improvement.</div></div><div><h3>Conclusions</h3><div>Further research is needed to facilitate an understanding of how to enhance emergency management, to increase positive outcomes. Relevance to practice: There is a critical need for improved management strategies for children with a PID presenting to ED with fever. Creating protocols, increasing staff knowledge, and implementing patient specific interventions are essential in improving outcomes and reducing serious complications in this high-risk paediatric population.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 282-289"},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333079","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":"Paramedic clinical practice guideline development in Australia and New Zealand: A qualitative descriptive analysis","authors":"Sonja Maria ,&nbsp;Marc Colbeck ,&nbsp;Matt Wilkinson-Stokes ,&nbsp;Adam Moon ,&nbsp;Michelle Thomson ,&nbsp;Joel Ballard ,&nbsp;Lachlan Parker ,&nbsp;Fraser Watson ,&nbsp;James Oswald","doi":"10.1016/j.auec.2024.06.003","DOIUrl":"10.1016/j.auec.2024.06.003","url":null,"abstract":"<div><h3>Background</h3><div>This collaborative study by The Australasian College of Paramedicine's Clinical Practice Guidelines (CPG) Working Group aimed to examine CPG development practices in Australian and New Zealand ambulance services.</div></div><div><h3>Methods</h3><div>Employing a qualitative descriptive design, the research utilised thematic analysis to extract insights from interviews with eleven experts actively involved in CPG development. The study embraced a nominalist and constructivist approach, recognising the intricate connection between individual experiences and the realities of CPG development in the paramedic field.</div></div><div><h3>Results</h3><div>Key findings revealed significant heterogeneity in CPG development practices, emphasising a lack of formal training and a substantial reliance on existing guidelines. The study highlighted challenges in project management flexibility, limited research capacity, and inconsistencies in external consultations and resource utilisation.</div></div><div><h3>Conclusion</h3><div>The study recommends adopting project management frameworks, investing in training, and utilising evidence evaluation methodologies like GRADE. It emphasises the need for multidisciplinary teams and formal expertise in evidence synthesis, advocating for targeted training programs. Funding challenges highlight the importance of dedicated budgets and collaborative efforts for resource allocation. Knowledge translation and implementation issues underscore the significance of training programs for evidence evaluation and knowledge translation in overcoming these challenges.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 259-267"},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602250","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":"Adherence to low back pain clinical guidelines in Australian hospital emergency departments: A public and private comparison","authors":"Claire L. Samanna ,&nbsp;Paul Buntine ,&nbsp;Daniel L. Belavy ,&nbsp;Ron V. Sultana ,&nbsp;Clint T. Miller ,&nbsp;Vasilios (Bill) Nimorakiotakis ,&nbsp;Patrick J. Owen","doi":"10.1016/j.auec.2024.07.001","DOIUrl":"10.1016/j.auec.2024.07.001","url":null,"abstract":"<div><div>Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age ( ± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: −0.67 [−0.98, −0.36], P &lt; 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P &lt; 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P &lt; 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P &lt; 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 4","pages":"Pages 276-281"},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790095","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":"Characteristics and outcomes of emergency department presentations brought in by police with and without an emergency examination authority: A state-wide cohort study","authors":"","doi":"10.1016/j.auec.2024.02.001","DOIUrl":"10.1016/j.auec.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this study was to describe and compare the demographic characteristics, clinical characteristics and patient and health service outcomes of emergency department (ED) presentations brought in by police with and without an emergency examination authority.</p></div><div><h3>Methods</h3><p>A retrospective cohort study of adult (≥ 18 years old) presentations brought in by police to EDs in Queensland, Australia from 01 January 2018 to 31 December 2020. Routinely collected ED data were used to describe and compare the demographic characteristics, clinical characteristics, and outcomes of people brought in by police with and without an emergency examination authority.</p></div><div><h3>Results</h3><p>A total of 42 502 adult ED presentations were brought in by police over the three-year period, of which 22 981 (44.7%) had an emergency examination authority. Compared with presentations brought in by police without an emergency examination authority, those brought in by police with an emergency examination authority had a higher proportion of presentations for mental health problems, were from major cities, and were allocated more urgent Australasian Triage Scale categories. Presentations brought in by police with an emergency examination authority were less likely to be seen within their Australasian Triage Scale timeframe and experienced a longer length of stay than those brought in by police without an emergency examination authority whether admitted (217 mins vs. 186 mins, p &lt; 0.001) or discharged (212 mins vs. 97 mins, p &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>The characteristics and outcomes of people brought in by police with emergency examination authorities differed to those brought in by police without emergency examination authorities. Further research is required to enhance understanding of this relatively unexplored group of people and foster interagency collaborations.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 185-191"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000198/pdfft?md5=39ae159359cc04058606980029e0be31&pid=1-s2.0-S2588994X24000198-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095219","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":"“Mind the gap”: An exploratory qualitative study of paramedics’ experiences attending older adults who fall in Western Australia","authors":"","doi":"10.1016/j.auec.2024.01.004","DOIUrl":"10.1016/j.auec.2024.01.004","url":null,"abstract":"<div><h3>Purpose</h3><p>To explore paramedics’ experiences and perspectives about attending and managing older adults who had fallen.</p></div><div><h3>Procedures</h3><p>This qualitative, exploratory study used a purposive sample of paramedics in Western Australia. Participants had at least one year of clinical experience. Semi-structured interviews were undertaken. Data were analysed via an inductive thematic approach.</p></div><div><h3>Findings</h3><p>Fourteen paramedics were interviewed (Median age: 38 years, n = 5 females). The main theme identified that experiences were positive when attending patients with high-acuity medical problems or injuries following falls because binary decision-making (transport vs non-transport) was appropriate. Themes highlighted that decision-making for low-acuity falls attendances was a complex balance between 1) patient context, 2) risk management, 3) paramedic reactions, and 4) the lack of alternate referral pathways available. Experiences could be stressful and frustrating when attending falls call-outs for older adults with no injuries or medical problems. Participants concurred that when transport to hospital was not required there were no available, alternative pathways to refer onwards for appropriate health or social care.</p></div><div><h3>Conclusion</h3><p>Attending low-acuity call-outs for falls was often frustrating and required complex decision-making, with gaps in services identified. Further exploration of alternative referral pathways for health care for pre-hospital management of adults who fall is required.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 177-184"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000034/pdfft?md5=a7631145220a3c41550719a31ffb1641&pid=1-s2.0-S2588994X24000034-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139483015","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 significance of paramedic communication during women’s birth experiences: A scoping review","authors":"","doi":"10.1016/j.auec.2024.04.002","DOIUrl":"10.1016/j.auec.2024.04.002","url":null,"abstract":"<div><h3>Background</h3><p>Internationally, over one-third of women experience birth trauma, leading to adverse mental health outcomes. Poor communication with healthcare professionals is a primary contributing factor. Paramedics attend various clinical presentations, including childbirth, yet their potential impact on women's birth experiences has been largely overlooked.</p></div><div><h3>Methods</h3><p>A systematic literature search was conducted following the Joanna Briggs Institute methodological framework. The search identified 1015 potentially suitable articles, and 5 articles met the inclusion criteria. Data was analysed using reflexive thematic analysis from a feminist standpoint.</p></div><div><h3>Results</h3><p>Three themes were generated: 1. <em>First Impressions Count:</em> paramedic demeanour impacted the woman's sense of safety and perception of paramedic clinical competence. 2. <em>Choice as a Pathway to Control:</em> when paramedics involved women in decision-making, it led to empowerment, while non-involvement led to women becoming passive participants. 3. <em>Exposed, Violated and Disempowered:</em> some paramedics disrespected and abused women, treating them solely as objects for the purpose of producing a baby.</p></div><div><h3>Conclusions</h3><p>This review highlights the influence of paramedic communication on women's birth experiences. While some paramedics communicated respectfully, other paramedics were the perpetrators of Obstetric Violence. Future research should inform paramedic education and improve outcomes for birthing women.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 218-226"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X2400023X/pdfft?md5=db073b87497e7113f51febc56284a211&pid=1-s2.0-S2588994X2400023X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909617","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":"Vital signs monitoring in Australasian emergency departments: Development of a consensus statement from ACEM and CENA","authors":"","doi":"10.1016/j.auec.2024.04.001","DOIUrl":"10.1016/j.auec.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><p>Emergency Department (ED) care is provided for a diverse range of patients, clinical acuity and conditions. This diversity often calls for different vital signs monitoring requirements. Requirements often change depending on the circumstances that patients experience during episodes of ED care.</p></div><div><h3>Aim</h3><p>To describe expert consensus on vital signs monitoring during ED care in the Australasian setting to inform the content of a joint Australasian College for Emergency Medicine (ACEM) and College of Emergency Nursing Australasia (CENA) position statement on vital signs monitoring in the ED.</p></div><div><h3>Method</h3><p>A 4-hour online nominal group technique workshop with follow up surveys.</p></div><div><h3>Results</h3><p>Twelve expert ED nurses and doctors from adult, paediatric and mixed metropolitan and regional ED and research facilities spanning four Australian states participated in the workshop and follow up surveys. Consensus building generated 14 statements about vital signs monitoring in ED. Good consensus was reached on whether vital signs should be assessed for 15 of 19 circumstances that patients may experience.</p></div><div><h3>Conclusion</h3><p>This study informed the creation of a joint position statement on vital signs monitoring in the Australasian ED setting, endorsed by CENA and ACEM. Empirical evidence is needed for optimal, safe and achievable policy on this fundamental practice.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 207-217"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000228/pdfft?md5=67da3fa112be55f99e1df1c1253cea70&pid=1-s2.0-S2588994X24000228-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077294","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":"Providing end of life care in the emergency department: A hermeneutic phenomenological study","authors":"","doi":"10.1016/j.auec.2024.01.002","DOIUrl":"10.1016/j.auec.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department.</p></div><div><h3>Methods</h3><p>A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants’ narratives was undertaken.</p></div><div><h3>Findings</h3><p>Seven registered nurses were interviewed; six of whom were women. Participant’s experience working in the emergency department setting ranged from 2.5–20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department.</p></div><div><h3>Conclusions</h3><p>Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 161-166"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000022/pdfft?md5=232c2a40be81379115e2c51c5de6b8b0&pid=1-s2.0-S2588994X24000022-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139663843","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}