Emergency Medicine Australasia最新文献

Objective

This study aimed to identify presentations to the Alice Springs Emergency Department that could be managed in an Urgent Care Centre (UCC).

Methods

We reviewed 1 year of ED presentation data at Alice Springs Hospital (ASH) from August 2022 to August 2023 and used a sequence of exclusion criteria to identify patients most likely to be eligible for UCC management.

Results

Our model indicated that 35.0% of ED presentations at ASH during this period could have been managed in a UCC. Only 41.5% of these presentations (14.5% of total presentations) occurred during UCC operating hours.

Conclusions

According to this model, a significant proportion of ED presentations could potentially be managed in a UCC, although a large proportion of these occurred outside of UCC opening hours. The impact of the introduction of a UCC into a remote community on ED presentations, patient experience, patient outcomes and the broader system requires further study.

Background

Viscoelastic haemostatic assays (VHAs) guide transfusion decisions in bleeding patients. We assessed testing volumes, clinical indications and patient characteristics in a statewide population in Australia.

Methods

This retrospective study included all patients who underwent rotational thromboelastometry (ROTEM) or thromboelastography (TEG) across Queensland Health hospitals (1 January 2019 to 15 April 2025), using data from AUSLAB, the statewide laboratory information system and surveyed all hospitals for VHA device availability.

Result

Of 39 VHA devices, 31 were transmitting to AUSLAB, with 43,220 tests performed in 21,178 patients, during 18,389 admissions and 6418 ED presentations; 92.0% were ROTEM (n = 39,776) and 8.0% TEG (n = 3444). Most tests occurred during inpatient care (n = 35,527, 82.2%) versus ED (n = 7693, 17.8%). Indications included trauma (n = 23,875, 55.2%), non-variceal gastrointestinal bleeding (n = 4238, 9.8%), obstetrics (n = 3307, 7.7%) and chronic liver disease (CLD) (n = 3853, 8.9%), including 1097 (2.5%) with variceal bleeding.

Emergency department (ED) use increased overall (IRR 1.14; 95% CI 1.12–1.15), including trauma (IRR 1.15), CLD (1.16), variceal bleeding (1.12) and non-variceal bleeding (1.12) (all p < 0.001); obstetric use in ED did not change significantly (IRR 0.93; 95% CI 0.86–1.00). Inpatient use also increased (IRR 1.21; 95% CI 1.21–1.22), including trauma (IRR 1.22), CLD (1.16), variceal (1.10), non-variceal bleeding (1.17) and obstetrics (1.07) (all p < 0.001).

Conclusion

VHA use increased in both ED and inpatient settings, with prominent use in trauma and CLD. The results indicate growing recognition by clinicians of VHA's value in guiding haemorrhage management. The need for a consistent, evidence-based approach to testing and interpretation of results is paramount.

Objective

Investigate the effect of interim care plans (ICP) for direct inpatient general medical and cardiology admissions on Emergency Department (ED) length of stay (LOS), and whether ICP were associated with adverse patient outcomes.

Methods

This was a single-site retrospective study across 12 months in 2023, where ICP was implemented from 1st January. Adults presenting to ED and admitted under general medicine or cardiology, but not requiring high dependency unit care, were included. Patients admitted under ICP (ICP group) were matched to those admitted without ICP (NO-ICP group) via variable ratio up to 1:4 (ICP:NO-ICP) based on age (±10 years), sex, date of presentation (±7 days) and presentation time (day, evening or night). Patients in the NO-ICP group were excluded if vital signs at the time of triage or referral did not fulfil the ICP criteria. The primary outcome was ED LOS, with secondary outcomes including time to inpatient referral, time to bed booking, hospital LOS, and Medical Emergency Team (MET) calls within 24 h after referral.

Results

ICP facilitated admissions were associated with shorter ED LOS compared with admissions without ICP (ICP 535.16 [342.28–728.03] min (median [interquartile range]); NO-ICP 995.00 [642.49–1347.51] min, p < 0.001). However, there was no difference in total hospital LOS (p = 0.28) or rate of adverse events between ICP and NO-ICP groups (Odds ratio 0.73; 95% confidence interval 0.24–2.21).

Conclusion

This single-site study suggests that the ICP model of care for direct inpatient admissions was associated with reduced ED LOS, without increasing adverse outcomes for patients.

Objective

To determine the proportion of patients who are admitted to hospital following a ‘did not wait’ (DNW) encounter that are related to the initial episode of care, and to assess the frequency of clinical deterioration in this cohort.

Methods

A retrospective observational study conducted at Dubbo Health Service in Western New South Wales, Australia, using patient-level data from 29 May to 1 October 2023. Patients with a DNW episode recorded anywhere within the Western NSW Local Health District who subsequently presented to Dubbo Emergency Department (ED) and were admitted within 28 days were included. Clinical records were reviewed to determine if the admission was related to the original DNW episode and whether clinical deterioration had occurred.

Results

Out of 14,247 ED presentations, 1123 (7.4%) were classified as DNW. 315 patients re-presented to Dubbo ED within 28-days of a DNW episode of care and 32 were admitted to hospital. 26 of these admissions were related to the initial DNW episode, and 5 patients with admissions related to the initial DNW episode showed evidence of clinical deterioration (0.4% of the DNW cohort).

Conclusions

The majority of DNW episodes did not result in clinical deterioration or related hospital admission. These findings support existing evidence that challenges the assumption of high risk among DNW patients and suggest that health systems should re-evaluate performance metrics and resource investments focused on reducing DNW episodes of care.

Objective

To explore the role of food in patient-centred care for culturally diverse communities within Emergency Departments (ED).

Methods

The ‘Not Just a Meal’ project conducted four focus groups with 28 Culturally and Linguistically Diverse (CALD) participants, examining ED food experiences and preferences.

Results

ED food was perceived as cold, unappealing, and culturally inappropriate, heightening vulnerability and leaving dietary needs unmet for patients and carers.

Conclusions

ED food provision must improve to enhance care equity and outcomes. Practice innovation, policy reform, and multi-site studies are needed to scale these preliminary findings.

Objective

This study aimed to describe healthcare utilisation and costs associated with the assessment of suspected acute coronary syndrome (ACS) under standard care and to compare these outcomes with the Limit of Detection in Emergency Department (LEGEND) strategy, an accelerated diagnostic pathway identifying low-risk patients using a single highly sensitive troponin (hs-cTnI).

Method

A stepped-wedge cluster randomised trial was conducted in four Queensland hospitals. Each transitioned from standard care (2016 ACS guidelines) to the LEGEND intervention at randomised intervals. Data were collected for index presentations and 6-month outcomes.

Results

Data were collected from 5347 patients in the standard care phase and 4597 in the LEGEND intervention phase. The intervention reduced mean ED length of stay (−72.0 min, 95% CI: −85.0 to −59.0 min) and inpatient admissions (−2.3%, 95% CI: −4.2% to −0.4%). For low-risk patients, the intervention further reduced ED length of stay (−97.0 min, 95% CI: −120.5 min to −73.5) and inpatient admissions (−4.2%, 95% CI: −6.9 to −1.6%). Exercise stress testing (EST) utilisation decreased by 3.6% (95% CI: 2.3%–4.9%) overall and 7.7% (95% CI: 5.0%–10.4%) among low-risk patients during the intervention phase. Total costs decreased from $6849 to $5794 per patient overall, saving $1055 per patient and from $2847 to $2129 per low-risk patient, saving $718 per patient.

Conclusions

The LEGEND strategy demonstrated reduced resource utilisation and costs compared to guideline-based ACS assessment, particularly for low-risk patients. Widespread adoption could improve the efficiency and cost-effectiveness of ACS assessment in the healthcare system.

Background

People with a National Disability Insurance Scheme (NDIS) plan and a psychosocial disability (PSD) at times may require emergency care for physical or mental health needs. As such, it is important to examine the suitability of the emergency department to provide care for people with PSD and an NDIS plan, and to understand how emergency clinicians engage with the NDIS.

Objective

This study compared ED clinicians experiences of caring for people with a PSD and an NDIS plan in the ED with the experiences of the people they care for.

Method

Two national online surveys were conducted with people with a PSD and an NDIS plan and ED clinicians. All qualitative responses were analysed thematically, and descriptive statistics for quantitative data were prepared.

Results

Clinicians (n = 30) and consumers (n = 44) agree that ED staff need more training in mental health care; the ED environment and model of care are unsuitable and may cause trauma for people seeking care and clinicians. People with PSD and an NDIS plan report that ED clinicians are not aware that the NDIS provides disability support only. ED staff report that they do not have faith in the NDIS.

Conclusion

Training for clinical staff in what the NDIS provides, mental health trained staff being available, and suitable environments would provide better outcomes for people with a PSD and an NDIS plan when presenting to the ED. Creating communication pathways between the ED and the NDIS to assist with service integration would ensure continuity of care.

Objective

To explore the rate, mode, and reasons for re-presentations for emergency department (ED) patients with musculoskeletal diagnoses and examine factors associated with increased odds of re-presentation.

Methods

A retrospective cross-sectional audit of re-presentation patterns for patients with musculoskeletal diagnoses presenting to the study ED in 2023.

The study ED was in a secondary hospital in Perth, Western Australia, which operates a diversion pathway (daily, 10 am–6 pm) for patients with musculoskeletal diagnoses.

Results

In 2023, 3677 patients with musculoskeletal diagnoses were diverted from the ED, 972 provided research consent and of those, 143 (14.7%) re-presented. Importantly, 10 (1.0%) patients re-presented to the ED itself, and 133 (13.7%) re-presented to the physiotherapy outpatient diversion clinic.

There were 65 scheduled and 78 unscheduled re-presentations, with telehealth the preferred mode of contact (n = 86, 60.1%). Clinician diagnostic uncertainty, identified patient psychosocial issues, and concern that the patient would re-present to the ED most commonly resulted in scheduled re-presentation (n = 31, 47.7%). Unscheduled re-presentations focused on administrative inquiries (e.g., hospital referrals, medical certificates) (n = 31, 39.7%) and concern for symptoms (n = 25, 32.1%).

Older age, high pain severity, and lower limb affected body region were associated with increased odds of re-presentation.

Conclusions

ED clinicians may reduce re-presentation by employing targeted strategies such as shared decision-making about pain management, ensuring a shared understanding of the diagnosis, or stage of the diagnostic process and likely course of symptoms. Further, a follow-up plan that is clinically indicated and patient acceptable may be critical for those with increased odds of re-representation.