Michael Lousick, Serena Edwards, Gerben Keijzers, Richard A F Pellatt
Objective: Describe the yield of computed tomography brain (CTB) scans in patients intubated for drug overdose.
Methods: Retrospective descriptive study using existing registry data from two Australian EDs between February 2021 and June 2022.
Results: Two hundred and six patients were intubated; 159 (77%) received a post-intubation CTB scan. Of these, 38 out of 159 (24%) had a documented indication (i.e. head injury and seizure) for their scans, with a yield of 5.3% (95% confidence interval [CI] = 1.5-17%). Of the 121 out of 159 (76%) patients without an indication, the yield of CTB was 0% (95% CI = 0-3%).
Conclusions: Routine imaging of patients intubated for overdose without clinical indication is unjustified.
{"title":"Utility of computed tomography brain scans in intubated patients with overdose.","authors":"Michael Lousick, Serena Edwards, Gerben Keijzers, Richard A F Pellatt","doi":"10.1111/1742-6723.14510","DOIUrl":"https://doi.org/10.1111/1742-6723.14510","url":null,"abstract":"<p><strong>Objective: </strong>Describe the yield of computed tomography brain (CTB) scans in patients intubated for drug overdose.</p><p><strong>Methods: </strong>Retrospective descriptive study using existing registry data from two Australian EDs between February 2021 and June 2022.</p><p><strong>Results: </strong>Two hundred and six patients were intubated; 159 (77%) received a post-intubation CTB scan. Of these, 38 out of 159 (24%) had a documented indication (i.e. head injury and seizure) for their scans, with a yield of 5.3% (95% confidence interval [CI] = 1.5-17%). Of the 121 out of 159 (76%) patients without an indication, the yield of CTB was 0% (95% CI = 0-3%).</p><p><strong>Conclusions: </strong>Routine imaging of patients intubated for overdose without clinical indication is unjustified.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343840","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}
Jessica Ws Wong, Nicolene Shipton, Matthew Edwards, Kate Bradman
{"title":"Implementing the electronic HEEADSSS screening tool in a paediatric emergency department.","authors":"Jessica Ws Wong, Nicolene Shipton, Matthew Edwards, Kate Bradman","doi":"10.1111/1742-6723.14509","DOIUrl":"https://doi.org/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}
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.
{"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, Catherine Wilson, Megan Duck, Gaby Nieva, Medhawani P Rao, Libby Haskell","doi":"10.1111/1742-6723.14505","DOIUrl":"https://doi.org/10.1111/1742-6723.14505","url":null,"abstract":"<p><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}
The recent coronial finding in Victoria into the death of Joshua (Josh) Kerr highlights some of the challenges of treating patients who are in custody and under the supervision of custodial staff (prison officers or police) in the ED. Issues include ED clinicians' duty of care, roles and responsibilities of ED staff and custodial staff and the need for processes that facilitate collaboration and communication between ED clinicians and custodial staff.
{"title":"Prisoners in the emergency department: Lessons from a recent inquest.","authors":"Anne-Maree Kelly","doi":"10.1111/1742-6723.14502","DOIUrl":"https://doi.org/10.1111/1742-6723.14502","url":null,"abstract":"<p><p>The recent coronial finding in Victoria into the death of Joshua (Josh) Kerr highlights some of the challenges of treating patients who are in custody and under the supervision of custodial staff (prison officers or police) in the ED. Issues include ED clinicians' duty of care, roles and responsibilities of ED staff and custodial staff and the need for processes that facilitate collaboration and communication between ED clinicians and custodial staff.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343838","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}
Bronwyn Newman, Colleen Cheek, Lieke Richardson, Donna Gillies, Karen Hutchinson, Elizabeth Austin, Margaret Murphy, Luke Testa, Christina Rojas, Louise Raggett, Amanda Dominello, Kylie Smith, Robyn Clay-Williams
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.
{"title":"Review article: Strategies to improve emergency department care for adults living with disability: A systematic review.","authors":"Bronwyn Newman, Colleen Cheek, Lieke Richardson, Donna Gillies, Karen Hutchinson, Elizabeth Austin, Margaret Murphy, Luke Testa, Christina Rojas, Louise Raggett, Amanda Dominello, Kylie Smith, Robyn Clay-Williams","doi":"10.1111/1742-6723.14500","DOIUrl":"https://doi.org/10.1111/1742-6723.14500","url":null,"abstract":"<p><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":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph F Orlando,Anne Lj Burke,Matthew Beard,Michelle Guerin,Saravana Kumar
OBJECTIVEThe present study sought to investigate predictors of hospitalisation in adults diagnosed with non-specific low back pain (LBP) and/or sciatica from an ED.METHODSA 5-year, multicentre retrospective observational study was conducted across six public hospitals (metropolitan and regional) using data from electronic medical records. Patient presentations were identified using LBP diagnostic codes and key data extracted (patient demographics, clinical activity, discharge destination). Descriptive statistics and logistic regression were used to measure associations between identified variables and hospitalisation.RESULTSThere were 11 709 ED presentations across the study period. People aged ≥65 years (odds ratio [OR] 2.84, 95% confidence interval [CI] 2.61-3.10) and those who arrived at the ED via ambulance (age-adjusted OR 2.68, 95% CI 2.44-2.95) were more likely to be hospitalised. People were also more likely to be hospitalised when triaged as more urgent, when blood tests or advanced spinal imaging were ordered, and when i.v./subcutaneous opioids or oral benzodiazepines were administered. Hospitalisation rates for LBP were lower in regional hospitals, in people residing in lower socioeconomic areas and in Indigenous Australians.CONCLUSIONCertain patient characteristics and ED clinical activity are associated with hospitalisations for LBP. Understanding these factors will better inform the design and delivery of appropriate high-quality care.
{"title":"Hospitalisations for non-specific low back pain in people presenting to South Australian public hospital emergency departments.","authors":"Joseph F Orlando,Anne Lj Burke,Matthew Beard,Michelle Guerin,Saravana Kumar","doi":"10.1111/1742-6723.14504","DOIUrl":"https://doi.org/10.1111/1742-6723.14504","url":null,"abstract":"OBJECTIVEThe present study sought to investigate predictors of hospitalisation in adults diagnosed with non-specific low back pain (LBP) and/or sciatica from an ED.METHODSA 5-year, multicentre retrospective observational study was conducted across six public hospitals (metropolitan and regional) using data from electronic medical records. Patient presentations were identified using LBP diagnostic codes and key data extracted (patient demographics, clinical activity, discharge destination). Descriptive statistics and logistic regression were used to measure associations between identified variables and hospitalisation.RESULTSThere were 11 709 ED presentations across the study period. People aged ≥65 years (odds ratio [OR] 2.84, 95% confidence interval [CI] 2.61-3.10) and those who arrived at the ED via ambulance (age-adjusted OR 2.68, 95% CI 2.44-2.95) were more likely to be hospitalised. People were also more likely to be hospitalised when triaged as more urgent, when blood tests or advanced spinal imaging were ordered, and when i.v./subcutaneous opioids or oral benzodiazepines were administered. Hospitalisation rates for LBP were lower in regional hospitals, in people residing in lower socioeconomic areas and in Indigenous Australians.CONCLUSIONCertain patient characteristics and ED clinical activity are associated with hospitalisations for LBP. Understanding these factors will better inform the design and delivery of appropriate high-quality care.","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252031","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}
Sierra Beck, Bridget Honan, James L Mallows, Joseph Ting
{"title":"From other journals","authors":"Sierra Beck, Bridget Honan, James L Mallows, Joseph Ting","doi":"10.1111/1742-6723.14493","DOIUrl":"https://doi.org/10.1111/1742-6723.14493","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234777","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}
<p>Over ten million ED visits occur annually in Australia and Aotearoa New Zealand. Outside basic administrative data focused on time-based targets, there is minimal information about clinical performance, quality of care, patient outcomes, or equity in emergency care. The lack of a timely, accurate or clinically useful data collection is a missed opportunity to improve care. An experienced and senior group of clinicians outline a proposal for a National Acute Care Secure Health Data Environment. In a linked editorial, Anne-Maree Kelly says that such an initiative is welcome but warns big data offer big promises and bring big issues.</p><p>A prospective observational study included children aged >2 and < 18 years presenting to any of three EDs in Victoria over an 18 month period who had their height and weight measured. Almost one-third of children were overweight or obese. Obesity was particularly high in those aged 8–14 years and those from lower SES postcodes. The high proportion of children presenting above a healthy weight is an opportunity for EDs to identify and refer children for bodyweight and lifestyle management.</p><p>A prospective descriptive study of domestic and family violence presentations to the Royal Darwin Hospital ED in November 2021 highlights the overwhelming need for a 24-h trauma informed, culturally safe, and integrated service to support people experiencing domestic and family violence. This could be achieved by a specialist unit designed and staffed by First Nations health practitioners.</p><p>Extracorporeal cardiopulmonary resuscitation (E-CPR) is primarily limited to hospitals. Some centres in the world have implemented prehospital mobile E-CPR in the form of a dedicated cardiac vehicle fitted with specialised equipment and clinicians for the performance of E-CPR on-scene. Evidence of the outcomes and cost-effectiveness of mobile E-CPR is not established. A team from Queensland evaluated the cost-effectiveness of a hypothetical mobile E-CPR vehicle operated by Queensland Ambulance Service. The conclusion is that prehospital E-CPR may be cost-effective. Successful implementation of a prehospital ECPR program needs substantial planning, training, logistics, and operational adjustments.</p><p>A survey of the current structure, capability and operational scope of prehospital and retrieval aeromedical teams across Australia concludes that aeromedicine in Australia has many consistent elements, but there is a diversity of operational models.</p><p>A team from Queensland assessed the impact of a Virtual Toxicology Service on the average length of stay of poisoned patients. The team concludes that such a service appears to be associated with a decreased average length of stay.</p><p>Antivenoms are important medications to be held within Australia, particularly in regional and remote locations. An audit of current antivenom holdings in hospitals and health services in South Australia revealed significant disparity betwe
{"title":"In this October issue","authors":"Geoff Hughes","doi":"10.1111/1742-6723.14488","DOIUrl":"https://doi.org/10.1111/1742-6723.14488","url":null,"abstract":"<p>Over ten million ED visits occur annually in Australia and Aotearoa New Zealand. Outside basic administrative data focused on time-based targets, there is minimal information about clinical performance, quality of care, patient outcomes, or equity in emergency care. The lack of a timely, accurate or clinically useful data collection is a missed opportunity to improve care. An experienced and senior group of clinicians outline a proposal for a National Acute Care Secure Health Data Environment. In a linked editorial, Anne-Maree Kelly says that such an initiative is welcome but warns big data offer big promises and bring big issues.</p><p>A prospective observational study included children aged >2 and < 18 years presenting to any of three EDs in Victoria over an 18 month period who had their height and weight measured. Almost one-third of children were overweight or obese. Obesity was particularly high in those aged 8–14 years and those from lower SES postcodes. The high proportion of children presenting above a healthy weight is an opportunity for EDs to identify and refer children for bodyweight and lifestyle management.</p><p>A prospective descriptive study of domestic and family violence presentations to the Royal Darwin Hospital ED in November 2021 highlights the overwhelming need for a 24-h trauma informed, culturally safe, and integrated service to support people experiencing domestic and family violence. This could be achieved by a specialist unit designed and staffed by First Nations health practitioners.</p><p>Extracorporeal cardiopulmonary resuscitation (E-CPR) is primarily limited to hospitals. Some centres in the world have implemented prehospital mobile E-CPR in the form of a dedicated cardiac vehicle fitted with specialised equipment and clinicians for the performance of E-CPR on-scene. Evidence of the outcomes and cost-effectiveness of mobile E-CPR is not established. A team from Queensland evaluated the cost-effectiveness of a hypothetical mobile E-CPR vehicle operated by Queensland Ambulance Service. The conclusion is that prehospital E-CPR may be cost-effective. Successful implementation of a prehospital ECPR program needs substantial planning, training, logistics, and operational adjustments.</p><p>A survey of the current structure, capability and operational scope of prehospital and retrieval aeromedical teams across Australia concludes that aeromedicine in Australia has many consistent elements, but there is a diversity of operational models.</p><p>A team from Queensland assessed the impact of a Virtual Toxicology Service on the average length of stay of poisoned patients. The team concludes that such a service appears to be associated with a decreased average length of stay.</p><p>Antivenoms are important medications to be held within Australia, particularly in regional and remote locations. An audit of current antivenom holdings in hospitals and health services in South Australia revealed significant disparity betwe","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14488","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234772","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}
Functional Neurological Disorder (FND) presents unique challenges in the emergency department (ED), where patients often arrive with varied and vague symptoms that can be difficult to address. This article provides practical strategies for effectively managing and supporting FND patients in the ED, emphasizing a compassionate, systematic approach, tailored treatments, appropriate use of investigations, and ensuring continuity of care. Key principles include clear communication of the diagnosis, preventing iatrogenic harm, and facilitating appropriate referrals for follow-up care. Consistent and respectful language is important when managing patients with FND. Creating a calm environment reduced stress and symptom exacerbation. Thorough history taking and examination can help build the patient's confidence in their diagnosis. Validating symptoms and providing a clear explanation of the diagnosis are important. FND presentations, such as functional weakness and seizures, require tailored interventions with early involvement of physiotherapy and/or psychological support. A low threshold for investigating potential comorbid neurological conditions should be maintained when patients present to ED, especially in cases of unclear diagnoses or acute presentations, while avoiding repetitive testing that may reinforce illness behaviour. Managing FND in the ED requires a patient-centered, multidisciplinary approach. By adopting these strategies, health professionals can improve outcomes and support patients in managing their condition effectively.
{"title":"Practical strategies for caring for patients with functional neurological disorder in the ED","authors":"Alexander Lehn MD, FRACP","doi":"10.1111/1742-6723.14489","DOIUrl":"https://doi.org/10.1111/1742-6723.14489","url":null,"abstract":"<p>Functional Neurological Disorder (FND) presents unique challenges in the emergency department (ED), where patients often arrive with varied and vague symptoms that can be difficult to address. This article provides practical strategies for effectively managing and supporting FND patients in the ED, emphasizing a compassionate, systematic approach, tailored treatments, appropriate use of investigations, and ensuring continuity of care. Key principles include clear communication of the diagnosis, preventing iatrogenic harm, and facilitating appropriate referrals for follow-up care. Consistent and respectful language is important when managing patients with FND. Creating a calm environment reduced stress and symptom exacerbation. Thorough history taking and examination can help build the patient's confidence in their diagnosis. Validating symptoms and providing a clear explanation of the diagnosis are important. FND presentations, such as functional weakness and seizures, require tailored interventions with early involvement of physiotherapy and/or psychological support. A low threshold for investigating potential comorbid neurological conditions should be maintained when patients present to ED, especially in cases of unclear diagnoses or acute presentations, while avoiding repetitive testing that may reinforce illness behaviour. Managing FND in the ED requires a patient-centered, multidisciplinary approach. By adopting these strategies, health professionals can improve outcomes and support patients in managing their condition effectively.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234724","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}
<p>In their article, Craig <i>et al</i>.<span><sup>1</sup></span> eloquently describe how current Australasian ED administrative data sets do not address quality of care and benchmarking and research opportunities. This is unsurprising because these data sets were not designed for these purposes. I agree that the clinical data that <i>could</i> be available would provide valuable insights into the quality of care, areas for improvement and opportunities for research. I admire the ambition of this initiative, but big data comes with big issues.</p><p>Any analysis of big data is only as good as the data entered. For maximum effectiveness and validity, data need to be clean, complete, accurate and formatted consistently. The differences in the design and implementation of health information systems (including electronic medical records [EMRs]) challenge data quality and consistency. For example, not all EMR systems require procedures be specifically captured and there may be differences in coding sets and how they are used.</p><p>Current administrative data sets are jurisdiction-based and government-owned. Development of a national/binational data set will need the participation of governments. With the potential political impacts of comparisons between jurisdictions, obtaining government support will not be easy.</p><p>Also, a data set of the size generated by this initiative will demand sophisticated stewardship, curation and data governance. Who will ‘own’ the data? Who will decide how it is used and by whom? Governments will want a stake in ownership which will open the possibility of influence in project selection and reporting.</p><p>The privacy and consent issues are complex and full discussion is beyond this editorial's remit. The authors' assertion that the use of routinely collected healthcare data for quality improvement and research is generally acceptable to people may be true when people are asked about data in general. It may be less so when asked about the use of their data. Australian evidence suggests that while most patients attending ED expect that data are used in this way, about 20% report that this use without consent will not be acceptable to them; a majority will prefer a consent requirement.<span><sup>2</sup></span> How this can be made workable is challenging, especially if re-identifiability for data linkage is included.</p><p>I do not agree that data collection without consent will be acceptable under legislation. Previous approaches, such as use of privacy notices stating that information may be used for quality improvement and research, are unlikely to be acceptable under privacy legislation.<span><sup>3</sup></span> In my experience, jurisdictions vary in their interpretation of what can be defined as a ‘directly related secondary purpose’ for use of health information, a potentially valid exemption from requiring consent. Also, bundled consent – ‘bundling’ together multiple requests for an individual's consent to a r
{"title":"Big data, big promise and big issues","authors":"Anne-Maree Kelly MD, FACEM, MHealth&MedLaw","doi":"10.1111/1742-6723.14483","DOIUrl":"https://doi.org/10.1111/1742-6723.14483","url":null,"abstract":"<p>In their article, Craig <i>et al</i>.<span><sup>1</sup></span> eloquently describe how current Australasian ED administrative data sets do not address quality of care and benchmarking and research opportunities. This is unsurprising because these data sets were not designed for these purposes. I agree that the clinical data that <i>could</i> be available would provide valuable insights into the quality of care, areas for improvement and opportunities for research. I admire the ambition of this initiative, but big data comes with big issues.</p><p>Any analysis of big data is only as good as the data entered. For maximum effectiveness and validity, data need to be clean, complete, accurate and formatted consistently. The differences in the design and implementation of health information systems (including electronic medical records [EMRs]) challenge data quality and consistency. For example, not all EMR systems require procedures be specifically captured and there may be differences in coding sets and how they are used.</p><p>Current administrative data sets are jurisdiction-based and government-owned. Development of a national/binational data set will need the participation of governments. With the potential political impacts of comparisons between jurisdictions, obtaining government support will not be easy.</p><p>Also, a data set of the size generated by this initiative will demand sophisticated stewardship, curation and data governance. Who will ‘own’ the data? Who will decide how it is used and by whom? Governments will want a stake in ownership which will open the possibility of influence in project selection and reporting.</p><p>The privacy and consent issues are complex and full discussion is beyond this editorial's remit. The authors' assertion that the use of routinely collected healthcare data for quality improvement and research is generally acceptable to people may be true when people are asked about data in general. It may be less so when asked about the use of their data. Australian evidence suggests that while most patients attending ED expect that data are used in this way, about 20% report that this use without consent will not be acceptable to them; a majority will prefer a consent requirement.<span><sup>2</sup></span> How this can be made workable is challenging, especially if re-identifiability for data linkage is included.</p><p>I do not agree that data collection without consent will be acceptable under legislation. Previous approaches, such as use of privacy notices stating that information may be used for quality improvement and research, are unlikely to be acceptable under privacy legislation.<span><sup>3</sup></span> In my experience, jurisdictions vary in their interpretation of what can be defined as a ‘directly related secondary purpose’ for use of health information, a potentially valid exemption from requiring consent. Also, bundled consent – ‘bundling’ together multiple requests for an individual's consent to a r","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234837","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}