Australasian Emergency Care最新文献

{"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":"2024-03-11","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":"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":"2024-02-02","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}

{"title":"The experiences of trans (binary and non-binary) patients accessing care in the emergency department: An integrative review","authors":"","doi":"10.1016/j.auec.2024.01.003","DOIUrl":"10.1016/j.auec.2024.01.003","url":null,"abstract":"<div><p>Accessing care in the Emergency Department is often fraught with stress and heightened emotions due to illness or injury, and the complexity of navigating an often busy and overwhelming healthcare setting. For people who identify as trans (binary and non-binary), accessing Emergency Department care is often associated with additional stress or avoided due to fears of discrimination, or previous negative experiences (1). The aim of this integrative review was to identify and review the literature relating to the experiences of trans (binary and non-binary) people accessing Emergency Department care, to guide practice and future research. A structured search process was used to identify 11 articles published between January 2013 and November 2023. These articles were appraised using the mixed methods appraisal tool (MMAT) (2) and included in this review. Utilising the methodology outlined by Whittemore &amp; Knafl (3), a constant comparison analytic approach identified five key themes; <em>1. emergency department context; 2. interactions with staff and language; 3. health professional knowledge; 4. advocacy;</em> and <em>5. disclosing trans status.</em> This review identified a perceived lack of competence for healthcare providers to deliver gender affirming healthcare in the Emergency Department due to perceptions of inadequate healthcare provider knowledge, and structural barriers founded on cisgender processes.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 167-176"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000046/pdfft?md5=24bd4e5fc294d367baec4c210dd38ae4&pid=1-s2.0-S2588994X24000046-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139656402","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":"Examining emergency departments practices on advance care directives and medical treatment decision making using the victorian emergency minimum dataset","authors":"","doi":"10.1016/j.auec.2024.01.001","DOIUrl":"10.1016/j.auec.2024.01.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Existence of Advance Care Planning<span><span> (ACP) documents including contact details of Medical Treatment Decision Makers (MTDM), are essential patient care records that support </span>Emergency Department (ED) clinicians in implementing treatment concordant with patients’ expressed wishes. Based upon previous findings, we conducted a statewide study to evaluate the performance of Victorian public hospital emergency departments on reporting of availability of records for ACP.</span></p></div><div><h3>Method</h3><p>The study is a quantitative retrospective observational comparative design based upon ED tier levels as defined by the Australasian College for Emergency Medicine (ACEM) for the calendar year 2021.</p></div><div><h3>Results</h3><p>Of 1.8 million total Victorian ED attendances, 15,222 patients had an ACP alert status recorded. Of these, 7296 were aged ≥ 65 years (study group). Of the thirty-one public EDs that submitted data, 65 % were accredited and assigned a level of service tier. The presence of ACP alerts positively correlated to location, tier level, age and gender (MANOVA wilk’s; p &lt; 0.001, value=.981, F = (12, 15,300), partial ƞ² = .006, observed power = 1.0 = 95.919).</p></div><div><h3>Conclusion</h3><p>The identified rate of ACP reporting is low. Strategies to improve the result include synchronising ACP (generated at different points) electronically, staff education, training and further validation of the data at the sending and receiving agencies.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 155-160"},"PeriodicalIF":2.1,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543555","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":"“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":"2024-01-17","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":"Informing Utstein-style reporting guidelines for prehospital thrombolysis: A scoping review","authors":"Louis Jenkins ,&nbsp;Tania Johnston ,&nbsp;Richard Armour ,&nbsp;Sonja Maria","doi":"10.1016/j.auec.2023.12.001","DOIUrl":"10.1016/j.auec.2023.12.001","url":null,"abstract":"<div><h3>Background</h3><p>Rural Australians with acute myocardial infarction (AMI) face higher mortality rates due to limited access to specialised cardiac services. Paramedic-administered prehospital thrombolysis (PHT) has emerged as an alternative to primary percutaneous intervention (pPCI) for patients facing barriers or delays to cardiac care. There is variability in PHT practices among Australian ambulance services, lacking standardised definitions and outcome measures. The aim of this scoping review was to identify quality indicators and influencing factors associated with outcomes for patients receiving PHT.</p></div><div><h3>Methods</h3><p>A systematic search of literature in SCOPUS and Academic Search Complete, CINAHL and Health Source: Nursing/Academic Edition databases via EBSCO (Health) was conducted following the Joanna Briggs Institute methodology. Peer-reviewed studies from the past decade were screened using search criteria relevant to prehospital thrombolysis and quality indicators. Data extraction was performed and themed using five domains from the Utstein-style template commonly known for standardised prehospital cardiac arrest reporting.</p></div><div><h3>Results</h3><p>After removing duplicates, the search yielded 3596 articles with 28 empirical studies meeting inclusion criteria for the review. These were primarily retrospective cohort studies performed in Australia, Canada and the United States. The scoping review identified 24 clinical quality indicators and factors related to Emergency Medical Service (EMS) systems, AMI recognition and ambulance dispatch, patient variables, PHT processes and patient outcomes. These findings correlate to the Donabedian structure-process-outcome quality of care model and have utility to inform future PHT reporting guidelines for jurisdictional ambulance services.</p></div><div><h3>Conclusions</h3><p>Given the variability in prehospital practice across Australian ambulance services, standardised reporting on quality indicators for PHT is needed. The Utstein-style template used to report data on pre-hospital cardiac arrest, trauma and airway management could be used for quality improvement in PHT. This review presents 24 quality indicators representing system, recognition and response, patient, process, and outcomes related to PHT. These results could be used to inform a future Delphi study and Utstein-like reporting guideline for prehospital thrombolysis.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 2","pages":"Pages 148-154"},"PeriodicalIF":1.8,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000908/pdfft?md5=0fbf3c20128a488efae8450a1ff424c2&pid=1-s2.0-S2588994X23000908-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139483100","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":"Seizure or syncope: Is the history-based scale feasible to use in an emergency department setting?","authors":"Stevo Lukić ,&nbsp;Aleksandar Stojanov","doi":"10.1016/j.auec.2023.11.002","DOIUrl":"10.1016/j.auec.2023.11.002","url":null,"abstract":"<div><h3>Background</h3><p><span><span>This study aimed to assess the efficacy of a screening questionnaire, based on historical criteria, in distinguishing between seizures and syncope </span>in patients<span> experiencing their first episode of transient loss of consciousness (TLOC) in a </span></span>neurology<span> emergency department.</span></p></div><div><h3>Methods</h3><p>A prospective cohort of 159 patients with initial TLOC episodes underwent clinical observation<span> and answered a nine-question screening questionnaire. The questionnaire's predictive ability was compared to final diagnoses determined through detailed neurology, electrophysiology<span>, and cardiology assessments during a minimum 12-month follow-up. Logistic regression (LR) analysis was performed with final diagnosis as the outcome variable. The calibration and discrimination of the models were assessed.</span></span></p></div><div><h3>Results</h3><p>revealed that the screening score accurately classified 72.33% of patients. Among those with positive screening scores, 65 (67.71%) had seizures compared to 31 (32.29%) with syncope. Introducing a novel risk-scoring model incorporating age and gender, in addition to the screening score, significantly improved performance achieving an accurate classification rate of 81.48%. Among patients with a positive prediction, 63 (80.77%) had seizure, whereas 15 (19.23%) had syncope.</p></div><div><h3>Conclusions</h3><p>Employing a structured questionnaire based on common historical criteria is a valuable tool for distinguishing between seizure and syncope in the dynamic setting of the emergency department.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 2","pages":"Pages 142-147"},"PeriodicalIF":1.8,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500338","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":"Editorial: Resuscitation science for emergency care clinicians","authors":"Julie Considine","doi":"10.1016/j.auec.2023.11.001","DOIUrl":"10.1016/j.auec.2023.11.001","url":null,"abstract":"","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 2","pages":"Pages 79-80"},"PeriodicalIF":1.8,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138441781","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":"Education interventions and emergency nurses’ clinical practice behaviours: A scoping review","authors":"Julie Considine ,&nbsp;Ramon Z. Shaban ,&nbsp;Margaret Fry ,&nbsp;Kate Curtis","doi":"10.1016/j.auec.2023.10.004","DOIUrl":"10.1016/j.auec.2023.10.004","url":null,"abstract":"<div><h3>Background</h3><p>Many education interventions in emergency nursing are aimed at changing nurse behaviours. This scoping review describes and synthesises the published research education interventions and emergency nurses’ clinical practice behaviours.</p></div><div><h3>Methods</h3><p>Arksey and O’Malley’s methodological framework guided this review, which is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). CINAHL, MEDLINE complete, ERIC, and Psycinfo were searched on 3 August 2023. Two pairs of researchers independently conducted all screening. Synthesis was guided by the Behaviour Change Wheel and Bloom’s Taxonomy of Educational Objectives.</p></div><div><h3>Results</h3><p>Twenty-five studies were included. Educational interventions had largely positive effects on emergency nurses’ clinical practice behaviours. Ten different interventions were identified, the most common was education sessions (n = 24). Seven studies reported underpinning theoretical frameworks. Of the essential elements of behaviour change, seven interventions addressed capability, four addressed motivation and one addressed opportunity. Mapping against Bloom’s taxonomy, thirteen studies addressed analysis, eleven studies addressed synthesis and two studies addressed evaluation.</p></div><div><h3>Conclusion</h3><p>Few studies addressed elements of behaviour change theory or targeted cognitive domains. Future studies should focus on controlled designs, and more rigorous reporting of the education intervention(s) tested, and theoretical underpinning for intervention(s) selected.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 2","pages":"Pages 119-135"},"PeriodicalIF":1.8,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000866/pdfft?md5=ed8acfa38951748d5c065fd6b2e96372&pid=1-s2.0-S2588994X23000866-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138048891","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":"Assessment of inter-rater reliability of screening tools to identify patients at risk of medication-related problems across the emergency department continuum of care","authors":"Jessica D’lima ,&nbsp;Simone E. Taylor ,&nbsp;Elise Mitri ,&nbsp;Andrew Harding ,&nbsp;Jerry Lai ,&nbsp;Elizabeth Manias","doi":"10.1016/j.auec.2023.10.005","DOIUrl":"10.1016/j.auec.2023.10.005","url":null,"abstract":"<div><h3>Background</h3><p>Following a national multicentre study, two emergency department (ED) screening tools were developed to determine risk of medication-related problems; one for use at ED presentation and another at ED discharge to the community. This study aimed to determine the inter-rater reliability amongst ED health professionals when applying these screening tools to a series of case scenarios.</p></div><div><h3>Methods</h3><p>A prospective, cross-sectional study was undertaken in the ED of a major metropolitan hospital. Twelve case scenarios were developed following ED observation of a range of patients, which were incorporated into a questionnaire and distributed to 50 health professionals. Inter-rater reliabilities of each explanatory variable of the screening tools and overall assessment were calculated using Fleiss’ multi-rater kappa.</p></div><div><h3>Results</h3><p>The questionnaire was completed by 15 doctors, 19 nurses and 16 pharmacists. Fleiss’ kappa showed an overall inter-rater reliability for the ED presentation tool of 0.83 (95% CI 0.83–0.84), indicating near perfect agreement. Fleiss’ kappa for the ED discharge tool was 0.83 (95% CI 0.83–0.85), which also showed near perfect agreement.</p></div><div><h3>Conclusions</h3><p>The screening tools produced favourable inter-rater reliability amongst ED health professionals. These results have important implications for ensuring consistency of ED decision-making in screening patients at risk of developing medication-related problems.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 2","pages":"Pages 136-141"},"PeriodicalIF":1.8,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000878/pdfft?md5=a0bd8d5bacc1cd49c64d8a68684e306d&pid=1-s2.0-S2588994X23000878-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135763844","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}