Emergency Medicine Australasia最新文献

Objective

Recent years have seen sporadic reports in Australia of stimulants being contaminated with opioids. Since late 2023, there has been an increase in opioid overdoses among individuals in New South Wales (NSW) using substances believed to be cocaine or methamphetamine. We analysed the frequency and characteristics of these cases and describe our public health responses.

Methods

The Prescription, Recreational & Illicit Substance Evaluation (PRISE), operated by NSW health since July 2018, is a statewide surveillance, epidemiology, and toxicity response programme. We did a retrospective analysis of each case of opioid toxicity following use of cocaine or methamphetamine submitted to the PRISE programme from January 2022 to June 2024, categorising cases into confirmed, probable, and suspected.

Results

Thirty-four cases were found, 19 involving cocaine and 15 involving methamphetamine. Twenty-two (65%) were classified as confirmed, and 12 (35%) as probable. There were two deaths (6%). Twenty-three cases (68%) were in Sydney. Multiple stakeholders reviewed trends and formulated public health responses, leading to the distribution of public drug warnings and media releases in November 2023 and February 2024 because of ongoing case detections.

Conclusions

The increase in detections, which continued in the months following the public health responses, underscores the need for comprehensive surveillance, response, monitoring, and reporting of this phenomenon in NSW. Engagement with clinicians and the community is essential for the success of this programme.

Objective

To improve understanding of sociodemographic characteristics, underlying medical conditions, and healthcare factors contributing to persistent frequent attendance to paediatric emergency departments (PED), and to explore opportunities for prevention.

Methods

A retrospective review of patients attending a PED >5 times per year for 2 years (persistent frequent attendance) was conducted with an analysis of sociodemographic characteristics, underlying health conditions, PED attendance factors, and evidence of General Practitioner (GP) continuity of care.

Results

Seventy-two paediatric patients (0.1% of PED patients) attended the PED frequently for two consecutive years (median 18.5 visits) accounting for 1.9% (n = 1914) of total PED presentations. Of these patients, 55.6% resided in disadvantaged areas, 13.8% were Aboriginal people and 52.8% had an identified GP. 100% had chronic health conditions. 40% had primarily medical conditions (median age 4.6 years) and 33.3% had primarily mental health conditions (median 15.8 years). 26.4% of patients had co-morbid chronic mental health and medical conditions (median 16.4 years) and attended the most frequently (median 33.0 presentations). Of the two groups with chronic mental health conditions, 55.8% of patients were under Guardianship (Child Protection Services).

Conclusions

Chronic health conditions, socio-economic disadvantage, child protection involvement, Aboriginal background, and lack of GP continuity contribute to persistent frequent PED attendance. Preventative strategies that increase community support and improve the underlying health and wellbeing of patients experiencing, or at risk of, frequent PED attendance would be beneficial for patients, caregivers, and clinicians. Research exploring frameworks that connect these patients with GPs for continuity of care is recommended.

Objectives

Evaluate patient satisfaction with paramedic and residential aged care facility (RACF) staff-initiated tele-emergency care through the Southeast Melbourne Virtual ED.

Methods

Patient satisfaction surveys were conducted across two of the constituent virtual EDs (VEDs).

Results

Of 452 responses, 427 (94.5%) had no negative comments, with 341 (75.4%) rating the service 8 out of 10 or higher, and 83.4% would recommend the service to family or friends.

Conclusions

Emergency telehealth services were favoured by patients, with ratings comparable to satisfaction scores in physical EDs. Upskilling of emergency clinicians for telehealth consultations and educational programmes could provide further improvements to patient experiences.

Introduction

Many time-critical neurosurgical brain conditions do not meet traditional ED major trauma or stroke team activation criteria and thus do not benefit from the associated expedited imaging and specialist review. To address this, a “Critical Head” protocol was developed. The aim was to determine the effect of this on time to CT scan, neurosurgical intervention (if indicated) and specialist team review.

Method

Quasi-experimental study, involving retrospective analyses of data of all potential Critical Head patients presenting to Wollongong ED from 1 January 2018 to 26 May 2023, with the protocol go-live on 7 March 2023. Descriptive statistics and study outcomes were compared before and after protocol implementation. R Studio 2024 was used for analyses and alpha was set to 0.05.

Results

Two hundred and two patients were included (123 control/pre-intervention, 119 intervention). There was no significant difference in age, sex or presence of intracranial conditions between groups. Median time from triage to CT decreased in the intervention group by 15% (7 min, 47[33,95] to 40[25,66], P = 0.020). There was a 33% (67 min) reduction to surgery start time in the intervention (204[621752] to 137[108247] min, P = 0.042) (urgent neurosurgery). Reductions in time to specialist team reviews were observed in ICU (n = 86, 132[58192] to 42[6103] min, P < 0.001) and neurosurgery (n = 158, 104[69 202] to 44[16111] min, P < 0.001). ICU and hospital length of stay did not differ significantly, nor did Glasgow Coma Outcome Scale score at discharge.

Conclusion

The Critical Head protocol for patients with time-critical intracranial conditions reduced time to CT scan, operative intervention and specialist team review.

Objective

To describe the characteristics and potential patient cohorts suitable for a paediatric emergency medicine unit (PEMU), otherwise known as a short stay unit, at Canberra Hospital, a tertiary mixed adult/paediatric ED treating 98 000 patients annually.

Method

Retrospective descriptive study of paediatric (aged <16) presentations to Canberra Hospital ED between May and August 2022. Patients discharged from ED with a length of stay exceeding 4 h and those admitted non-surgically for less than 2 nights were deemed PEMU suitable; those requiring admission for >2 nights were classed as inpatient ward admission (IWA) patients. Royal children's hospital clinical practice guidelines were used where available to classify the severity of disease via features apparent in ED.

Results

Eight thousand three hundred and forty episodes were identified as paediatric ED presentations, with 1377 (64.8%, 95%CI 62.8–66.9) retrospectively PEMU suitable. This winter sample identified an average of 11.9 potential PEMU suitable cases daily. Chart review showed clinically mild bronchiolitis, mild asthma, anaphylaxis, mild gastroenteritis, afebrile seizure – no known seizure diagnosis, and simple febrile seizures had an excellent profile for PEMU, with subsequent ward admission rates of 17% or less. A mean 7-h stay would require 5 beds with 66% occupancy over 24 h.

Conclusions

Several common paediatric diagnoses are well-suited to a PEMU unit, with reasonable occupancy and length of stay. The low inpatient admission rate suggests less common diagnoses should also be regarded as suitable. Further research is required to identify other paediatric patients and diagnoses suitable for PEMU, and to ratify findings in a whole-of-year sample.

Objective

Comprehensively describe patient and presentation characteristics of trans and gender diverse (TGD) people attending the ED.

Methods

Retrospective case series that evaluated TGD people of all ages presenting to a tertiary, inner-city ED in Sydney, New South Wales, over a 5-year period. TGD people were identified using the ED patient tracking system, triage text and clinical notes in the electronic medical records (eMR). Patient and presentation data were extracted and descriptively analysed, including clinical characteristics, mismatches in registered gender and name, and use of non-affirming language in discharge letters.

Results

A total of 340 TGD patients with 1519 ED presentations were identified. The number of ED presentations per year by TGD people increased by 74.2% over 5 years. Presentations were prioritised Australasian Triage Scale category 1–3 in 76.7%. Hospital admission was required in 25.5%, and 8.7% left prior to treatment completion. Suicidal ideation was the most common presenting problem (13.8%) and mental health was the most common ED diagnostic category (29.4%). The gender and name registered in the eMR correctly matched the patient's current identity in 47.1% and 56.8%, respectively. Misgendering and/or deadnaming occurred in 22.6% of those receiving an ED discharge letter.

Conclusion

Most TGD people identified by the present study had high acuity ED presentations, often presenting with acute mental health problems, and one-quarter were subsequently admitted to hospital. Mismatched patient details and misgendering and/or deadnaming on discharge letters were common. These findings highlight clear opportunities to improve the care of TGD people in the ED.

Objective

To evaluate the feasibility of pre-hospital blood culture (BC) collection and intravenous (IV) antibiotic administration in patients with suspected sepsis.

Methods

In this open-label trial, BCs were collected in all participants, who were then randomised to ongoing care (control) or ongoing care plus 2 g IV ceftriaxone (intervention). Time to antibiotic administration was the primary outcome.

Results

Thirty-five patients were enrolled and randomised (21 control, 14 intervention). BCs were obtained in 89% (n = 31/35) and grew a pathogen in 42% (n = 13/31). Intervention patients received antibiotics a median of 108 (95% CI 34 to 170) minutes earlier (P < 0.01).

Conclusion

BCs were successfully obtained by paramedics, and pre-hospital IV ceftriaxone resulted in expedited antibiotic administration.

Clinical Trial Registration: ACTRN12618000199213.