Emergency Medicine Australasia最新文献

Objective: To review a newly implemented medical staff self-rostering process in a small metropolitan emergency department to ensure sustainability without compromising emergency department safe staffing guidelines.

Methods: We performed a multi-methods study on the implementation and user experience of a novel rostering process for registrars and CMOs in a small emergency department. Quantitative analysis was performed using a Likert scale to assess operational and implementation success as well as data on hours spent on roster generation, number of sick calls and number of shift swaps. Qualitative structured interviews were also analysed using an inductive process resulting in a thematic analysis.

Results: Our implementation outcome scoring showed a median score of 5 for all three domains of the implementation questionnaire including acceptability (IQR 4-5), appropriateness (IQR 4-5) and feasibility (IQR 4-5). Our thematic analysis demonstrated strong themes around flexibility and choice, usability and interface, responsibility for a complete roster, as well as wellbeing and balance. Our analysis of roster metrics showed a large reduction in required shift swaps (29 vs. 163) and time spent on roster development and publication (4 h vs. 20 h) over a 13-week rostering period. While consultant time spent on roster development and publication was reduced, this was accompanied by a redistribution of workload to participating staff, who spent a median of 1.4 h per rostering cycle.

Conclusions: We conclude that in a small metropolitan hospital, self-rostering is a feasible and implementable operational intervention with improvements in employee wellbeing.

Objective: To investigate the impact of increasing age on clinical outcomes in major trauma patients. Primary outcomes assessed included time to diagnostic imaging, length of hospital stay, and mortality rates both in-hospital and at 30 days post-injury.

Methods: A retrospective observational study was conducted involving major trauma patients presenting to a tertiary referral centre over a 6-year period, 2017-2023. The effect of increasing age on triage, investigation and management, and clinical outcomes, including length of stay and mortality, was examined.

Results: Analysis demonstrated that the likelihood of trauma team activation decreased with increasing age, independent of injury severity score. Increasing age was a significant predictor of in-hospital mortality (odds ratio: 1.06, 95% confidence interval: 1.05-1.07). Rates of computed tomography (CT) utilisation were comparable between older and younger cohorts (≥ 65 vs. < 65 years, 94.8% vs. 94.9%); yet, older patients experienced significantly longer median wait times for imaging (130 min [≥ 65] vs. 79 min [< 65]).

Conclusions: Increasing age is associated with decreased trauma team activation rates irrespective of injury severity. Furthermore, older trauma patients exhibit substantially higher mortality rates, with a marked increase observed beyond initial hospital discharge. Age-specific trauma team activation criteria may reduce under-triage and potentially improve outcomes in older patients.

Objective: To assess the impact of hire e-scooters on injury presentations at Cairns emergency department (ED).

Methods: A retrospective cohort study comparing e-scooter injuries before and after the introduction of hire e-scooters.

Results: A total of 323 patients presented with e-scooter injuries. There were 133 'before' and 190 'after' cases. The majority were males aged 10-20. Hospital admissions and length of stay increased in the 'after' group (32% vs. 9%, 27 vs. 9 staying > 24 h).

Conclusions: Hire e-scooters are associated with a higher trauma burden. These findings support targeted safety interventions and collaborative injury prevention strategies.

In Australia, First Nations Peoples are reported as 1.5 times more likely to leave the Emergency Department before treatment completion. Reasons are multifactorial and complex, including length of wait times, lack of cultural safety and persistent institutional racism. This scoping review aimed to determine the impact of Aboriginal Health Liaison Officers on First Nations Peoples' rates of Take Own Leave in Emergency Departments. The Joanna Briggs Institute methodology for scoping reviews, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews, the associated checklist, and the CONSIDER criteria enabled the synthesis of the best available evidence. The search included CINAHL Plus with Full Text (EBSCOhost), Medline (Ovid), PsycINFO (Ovid), Scopus, citation searching and Grey Literature. A total of 533 articles were screened, with seven relevant studies included in this scoping review. Robust research evidence of the impact of Aboriginal Health Liaison Officers on leave events was largely absent in the literature. Strategies designed to improve cultural safety were found to improve rates of healthcare attendance. The Aboriginal and Torres Strait Islander Quality Appraisal Tool was used to appraise the quality of the included studies, finding limited consultation with First Nations Peoples in research design. Findings highlight that improved cultural safety improves First Nations Peoples' Emergency Department attendance. All studies are specific to the Emergency Department setting with projects implemented to reduce leave events and/or implementation of Aboriginal Health Liaison Officer roles. The review provides some evidence that Aboriginal Health Liaison Officers would improve Emergency Department attendance.