Ingrid Berling, Patrice Albert-Thenet, Hayley Anderson, Geoffrey K. Isbister
Objective
Involvement of consumers is critical in the management of deliberate self-harm. We aimed to review the consumer experience in clinical toxicology patient management and research.
Methods
An anonymous, consenting non-consecutive 12-question survey was administered to toxicology in-patients between April 28th and October 14th 2025.
Results
From 440 presentations, 43 (9.8%) patients participated in the survey. The patients had a positive response to communication (91%, n = 39), confidence with the treating team (95%, n = 41), respect (93%, n = 40), and access to care (88%, n = 38), but only 11 patients (26%) expressed an interest in participating in further toxicology research.
Conclusion
There was a high level of satisfaction with the toxicology services, but almost three quarters of patients do not want to engage in further consumer feedback research.
{"title":"Understanding Consumer Attitudes and Awareness After Admission to a Toxicology Unit","authors":"Ingrid Berling, Patrice Albert-Thenet, Hayley Anderson, Geoffrey K. Isbister","doi":"10.1111/1742-6723.70218","DOIUrl":"10.1111/1742-6723.70218","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Involvement of consumers is critical in the management of deliberate self-harm. We aimed to review the consumer experience in clinical toxicology patient management and research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An anonymous, consenting non-consecutive 12-question survey was administered to toxicology in-patients between April 28th and October 14th 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 440 presentations, 43 (9.8%) patients participated in the survey. The patients had a positive response to communication (91%, <i>n</i> = 39), confidence with the treating team (95%, <i>n</i> = 41), respect (93%, <i>n</i> = 40), and access to care (88%, <i>n</i> = 38), but only 11 patients (26%) expressed an interest in participating in further toxicology research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was a high level of satisfaction with the toxicology services, but almost three quarters of patients do not want to engage in further consumer feedback research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029027","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}
Chad Lumsden, Leah Maitland, Rachel Rossiter, Steven Chung
Objective
To evaluate whether a collaboration between Mid-North Coast Virtual Care (MNCVC) and NSW Ambulance (NSWA) was effective in diverting ED transfers.
Methods
A retrospective observational study over 30 months examined NSWA referrals to MNCVC. Referral characteristics, 7-day and 28-day ED presentations were analysed. ED avoidance was defined as an accepted referral without an ED presentation within 28 days.
Results
Of 629 referrals, 542 (86%) were accepted for management. ED presentations occurred in 53 (9.8%) within 7-days and 130 (24.0%) within 28-days, resulting in a 76% (412 patients) ED avoidance rate over 30 months.
Conclusions
An ambulance-diversion model to a virtual-care service showed a favourable ED avoidance rate.
{"title":"Evaluating the Rate of Emergency Department Avoidance Achieved in a Collaboration Between an Ambulance and Virtual Care Service: A Retrospective Observational Study","authors":"Chad Lumsden, Leah Maitland, Rachel Rossiter, Steven Chung","doi":"10.1111/1742-6723.70216","DOIUrl":"10.1111/1742-6723.70216","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate whether a collaboration between Mid-North Coast Virtual Care (MNCVC) and NSW Ambulance (NSWA) was effective in diverting ED transfers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective observational study over 30 months examined NSWA referrals to MNCVC. Referral characteristics, 7-day and 28-day ED presentations were analysed. ED avoidance was defined as an accepted referral without an ED presentation within 28 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 629 referrals, 542 (86%) were accepted for management. ED presentations occurred in 53 (9.8%) within 7-days and 130 (24.0%) within 28-days, resulting in a 76% (412 patients) ED avoidance rate over 30 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An ambulance-diversion model to a virtual-care service showed a favourable ED avoidance rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003380","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}
Arjune Murali, Christopher Martin, Keith Harris, Danielle Dean, Katherine Isoardi
Background
Ocular poisoning exposures are common, but there is limited research describing the Australian experience. This series aims to characterise the epidemiology and management of ocular exposures reported to a state poisons information centre.
Methods
This is a retrospective observational series of ocular exposure cases reported to the Queensland Poison Information Centre between 1 January 2023 and 30 June 2023. Data abstracted included patient demographics, poison exposure details, ocular symptomatology, poisoning severity, and management advice.
Results
There were 769 ocular exposures over the study period. Adults aged 20–74 years were the primary group exposed, comprising 406 (52.8%) of cases reported. Exposures were mostly unintentional (763 [99.2%] cases) and most commonly involved exposure to alkalis (123 [16.0%]). Most exposures were symptomatic (606 [78.8%]) and of minor severity (590 [76.7%]). Referral for medical review was advised in 361 (46.9%) cases with only 15 (2%) cases being of moderate severity, most following alkali exposures.
Conclusions
Most ocular exposures reported to the poison centre were accidental and of minor severity. Severe injuries were rare and occurred following alkali exposures.
{"title":"Retrospective Case Series Ocular Exposure Referrals to a Poisons Centre","authors":"Arjune Murali, Christopher Martin, Keith Harris, Danielle Dean, Katherine Isoardi","doi":"10.1111/1742-6723.70199","DOIUrl":"10.1111/1742-6723.70199","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ocular poisoning exposures are common, but there is limited research describing the Australian experience. This series aims to characterise the epidemiology and management of ocular exposures reported to a state poisons information centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective observational series of ocular exposure cases reported to the Queensland Poison Information Centre between 1 January 2023 and 30 June 2023. Data abstracted included patient demographics, poison exposure details, ocular symptomatology, poisoning severity, and management advice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 769 ocular exposures over the study period. Adults aged 20–74 years were the primary group exposed, comprising 406 (52.8%) of cases reported. Exposures were mostly unintentional (763 [99.2%] cases) and most commonly involved exposure to alkalis (123 [16.0%]). Most exposures were symptomatic (606 [78.8%]) and of minor severity (590 [76.7%]). Referral for medical review was advised in 361 (46.9%) cases with only 15 (2%) cases being of moderate severity, most following alkali exposures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most ocular exposures reported to the poison centre were accidental and of minor severity. Severe injuries were rare and occurred following alkali exposures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003348","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}
Pramod Chandru, Darren M. Roberts, Mark Salter, Úna Nic Ionmhain, Ben Tisdell, Angela L. Chiew
Objective
Poisoning-related cardiac arrests have reported survival rates as low as 3%. These events are often unwitnessed, occur in private settings, and are less likely to receive bystander cardiopulmonary resuscitation. Non-shockable rhythms are frequently observed. However, detailed understanding of aetiologies and clinical characteristics remains limited.
Methods
We performed a retrospective review of cardiac arrest calls to a state-based poisons information centre between 2020 and 2023. Data was extracted into a preformatted table and cross-referenced with patient's electronic medical records. Two extractors were used.
Results
A total of 53 cases were included. The median age was 36 years (IQR 22–51; range 15–66), with 29 (54%) male patients. Most arrests occurred in the community (n = 37, 70%). Hypoxia was the most common suspected single aetiology (n = 24), while cardiac toxins, through various mechanisms, accounted for 29 cases (55%). Non-shockable rhythms were present in 36 patients (68%). Despite this, 38 patients (71%) survived to hospital discharge, including 23 (64%) with non-shockable rhythms.
Conclusion
In this study, poisoning-related cardiac arrest was associated with a high survival rate, even in cases with non-shockable rhythms. Hypoxia and direct cardiac toxicity were identified as the primary aetiologies in many patients.
{"title":"A Review of 3 Years of Cardiac Arrest Phone Calls to a State-Based Poisons Centre","authors":"Pramod Chandru, Darren M. Roberts, Mark Salter, Úna Nic Ionmhain, Ben Tisdell, Angela L. Chiew","doi":"10.1111/1742-6723.70211","DOIUrl":"10.1111/1742-6723.70211","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Poisoning-related cardiac arrests have reported survival rates as low as 3%. These events are often unwitnessed, occur in private settings, and are less likely to receive bystander cardiopulmonary resuscitation. Non-shockable rhythms are frequently observed. However, detailed understanding of aetiologies and clinical characteristics remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective review of cardiac arrest calls to a state-based poisons information centre between 2020 and 2023. Data was extracted into a preformatted table and cross-referenced with patient's electronic medical records. Two extractors were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 53 cases were included. The median age was 36 years (IQR 22–51; range 15–66), with 29 (54%) male patients. Most arrests occurred in the community (<i>n</i> = 37, 70%). Hypoxia was the most common suspected single aetiology (<i>n</i> = 24), while cardiac toxins, through various mechanisms, accounted for 29 cases (55%). Non-shockable rhythms were present in 36 patients (68%). Despite this, 38 patients (71%) survived to hospital discharge, including 23 (64%) with non-shockable rhythms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study, poisoning-related cardiac arrest was associated with a high survival rate, even in cases with non-shockable rhythms. Hypoxia and direct cardiac toxicity were identified as the primary aetiologies in many patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959006","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}
Thomas Stefoulis, Kendall Bein, Radhika Seimon, Michael M. Dinh
Objective
The study aimed to analyse trends in emergency department (ED) presentations in New South Wales (NSW) from 2015 to 2022, focusing on demographic and clinical factors influencing these trends and evaluating their impact on ED performance metrics.
Methods
This was a retrospective, longitudinal study using routinely collected data from all NSW public hospital EDs presentations between 2015 and 2022.
Main Outcome Measures
Key measures included the rate of ED presentations per 1000 population, emergency treatment performance (ETP), length of stay (LOS), and Did Not Wait (DNW) cases.
Results
The study identified that the rate of unique ED presentations increased by 0.51% per annum, in contrast to the higher rates reported in previous studies. The most notable increase was observed among individuals aged 60–80 and over 80 years. High-acuity cases (Categories 1 and 2) increased from 12.0% in 2015 to 15.0% in 2022, while low-acuity cases (Categories 4 and 5) decreased from 55.9% to 49.0%. ETP declined from 72.1% in 2015 to 56.4% in 2022, and DNW cases rose from 5.4% to 8.5%, indicating issues with patient flow and resource allocation.
Conclusions
This long-term study of ED presentations highlighted the stable demand for ED services associated with a dramatic decrease in ETP and an increase in DNW cases suggesting a health system operating at critical levels of capacity. Addressing these challenges requires a multifaceted approach, and our study may assist in providing a foundation for future research and policy development aimed at improving ED efficiency and patient outcomes.
{"title":"Long Term Trends in Emergency Department Presentation Characteristics and Performance 2015–2022: A State-Wide Data Linkage Analysis From New South Wales Australia","authors":"Thomas Stefoulis, Kendall Bein, Radhika Seimon, Michael M. Dinh","doi":"10.1111/1742-6723.70213","DOIUrl":"10.1111/1742-6723.70213","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The study aimed to analyse trends in emergency department (ED) presentations in New South Wales (NSW) from 2015 to 2022, focusing on demographic and clinical factors influencing these trends and evaluating their impact on ED performance metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective, longitudinal study using routinely collected data from all NSW public hospital EDs presentations between 2015 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Key measures included the rate of ED presentations per 1000 population, emergency treatment performance (ETP), length of stay (LOS), and Did Not Wait (DNW) cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study identified that the rate of unique ED presentations increased by 0.51% per annum, in contrast to the higher rates reported in previous studies. The most notable increase was observed among individuals aged 60–80 and over 80 years. High-acuity cases (Categories 1 and 2) increased from 12.0% in 2015 to 15.0% in 2022, while low-acuity cases (Categories 4 and 5) decreased from 55.9% to 49.0%. ETP declined from 72.1% in 2015 to 56.4% in 2022, and DNW cases rose from 5.4% to 8.5%, indicating issues with patient flow and resource allocation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This long-term study of ED presentations highlighted the stable demand for ED services associated with a dramatic decrease in ETP and an increase in DNW cases suggesting a health system operating at critical levels of capacity. Addressing these challenges requires a multifaceted approach, and our study may assist in providing a foundation for future research and policy development aimed at improving ED efficiency and patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951565","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}
Balancing training needs and service provision is a challenge in Emergency Departments (EDs). We implemented an ED Clinical Teacher (EDCT) role to provide bedside teaching for our trainees. Our objective was to establish in which domains of the Australasian College for Emergency Medicine training curriculum benefit was delivered.
Methods
An EDCT shift was introduced in February 2024. EDCTs were expected to perform a Work-place Based Assessment (WBA) each shift but no further guidance was provided. Clinicians performed the role as they deemed appropriate. Following each shift, a feedback form was completed referencing domains of the training curriculum in which the EDCT felt they delivered benefit. Free text supported the feedback.
Results
18/27 feedback forms were completed over a 5-month period. Training was most beneficial to the domains of ‘Medical Expertise’ (89% of shifts) and ‘Prioritisation and Decision Making’ (72%). All eight curriculum domains benefitted from the EDCT role. On a scale of 1–7 the benefit of the shift to the trainees was rated 5.39, with 78% of shifts rated as 5 or above (p = < 0.001). A Mini CEX, DOPS and communication WBA were performed during 72%, 56% and 17% of shifts, respectively. In total 24 Mini CEXs, 11 DOPS and 3 communication WBAs were performed.
Conclusions
Participating ED physicians felt that a designated EDCT role benefits trainees in all domains of the Australasian College for Emergency Medicine training program and provides an opportunity to perform workplace-based assessments.
{"title":"Clinical Teacher in the Emergency Department: How Does It Benefit Emergency Medicine Trainees?","authors":"Christopher L. Jones","doi":"10.1111/1742-6723.70197","DOIUrl":"10.1111/1742-6723.70197","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Balancing training needs and service provision is a challenge in Emergency Departments (EDs). We implemented an ED Clinical Teacher (EDCT) role to provide bedside teaching for our trainees. Our objective was to establish in which domains of the Australasian College for Emergency Medicine training curriculum benefit was delivered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An EDCT shift was introduced in February 2024. EDCTs were expected to perform a Work-place Based Assessment (WBA) each shift but no further guidance was provided. Clinicians performed the role as they deemed appropriate. Following each shift, a feedback form was completed referencing domains of the training curriculum in which the EDCT felt they delivered benefit. Free text supported the feedback.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>18/27 feedback forms were completed over a 5-month period. Training was most beneficial to the domains of ‘Medical Expertise’ (89% of shifts) and ‘Prioritisation and Decision Making’ (72%). All eight curriculum domains benefitted from the EDCT role. On a scale of 1–7 the benefit of the shift to the trainees was rated 5.39, with 78% of shifts rated as 5 or above (<i>p</i> = < 0.001). A Mini CEX, DOPS and communication WBA were performed during 72%, 56% and 17% of shifts, respectively. In total 24 Mini CEXs, 11 DOPS and 3 communication WBAs were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Participating ED physicians felt that a designated EDCT role benefits trainees in all domains of the Australasian College for Emergency Medicine training program and provides an opportunity to perform workplace-based assessments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917289","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}
We sought to identify predictor variables for a future clinical decision rule for CXR ordering in non-traumatic chest pain.
Methods
Emergency Medicine Physicians were asked to select variables that would result in a CXR being ordered. Inter-rater reliability (using Fleiss' kappa) was calculated for the most commonly agreed upon.
Results
Of the 40 candidate variables, 10 were most agreed upon; however, only three had perfect inter-rater agreement and reliability.
Conclusions
In this study, only an abnormal lung examination, a suspicion of pneumonia or of acute pulmonary oedema had perfect inter-rater agreement and reliability. Further research is required on a larger scale to refine and identify the optimal candidate variables for inclusion in a clinical decision rule.
{"title":"Identifying Predictor Variables for a Future Clinical Decision Rule for Ordering of Chest X-Rays (CXR) for Non-Traumatic Chest Pain in Adult Emergency Department (ED) Patients","authors":"Joe Anthony Rotella","doi":"10.1111/1742-6723.70210","DOIUrl":"10.1111/1742-6723.70210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We sought to identify predictor variables for a future clinical decision rule for CXR ordering in non-traumatic chest pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Emergency Medicine Physicians were asked to select variables that would result in a CXR being ordered. Inter-rater reliability (using Fleiss' kappa) was calculated for the most commonly agreed upon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 40 candidate variables, 10 were most agreed upon; however, only three had perfect inter-rater agreement and reliability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this study, only an abnormal lung examination, a suspicion of pneumonia or of acute pulmonary oedema had perfect inter-rater agreement and reliability. Further research is required on a larger scale to refine and identify the optimal candidate variables for inclusion in a clinical decision rule.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917279","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}
Kexun K. Chen, Tina Hardin, Ali Mohtasham, Joseph F. Orlando, Rutger M. J. de Zoete, Anne L. J. Burke
Introduction
Low back pain (LBP) is a leading cause of disability and a common reason for emergency department (ED) presentation. Although clinical guidelines recommend community-based treatment for non-specific LBP, a range of factors drive people to seek hospital-based care in Australia. This study aimed to describe the patient flow, hospital resource utilisation, and economic impact of LBP-related presentations to South Australian public hospital EDs to identify clinical and financial levers to support innovation.
Methods
This retrospective observational study utilised data from public hospitals using the electronic medical record over four fiscal years (FY19/20-FY22/23). Systematised Nomenclature of Medicine-Clinical Terms (SNOMED) diagnosis and International Classification of Disease (ICD) codes were used to identify episodes of care where individuals were assigned a primary diagnostic code of LBP and/or sciatica on admission or discharge. Serious spinal pathologies were excluded. Cost of care was calculated using recognised health system metrics (National Weighted Activity Units (NWAU) calculator, estimated ambulance transfer costs).
Findings
Ambulance transfer, semi-/non-urgent triage and presentation during office hours were common. Imaging and allied health consultations were low. Opioid prescription was the primary treatment identified, and this increased (frequency, potency) over time. Few patients required admission. Average ‘per patient’ costing increased by $426.30/patient over the 4-year period.
Conclusion
ED-based care for non-specific LBP was typically non-urgent care with limited evidence-based components and rising per-patient costs. The elevated prescribing practices, limited access to evidence-based care, and rising per-patient costs highlight an urgent need to reform LBP care pathways to enhance patient outcomes and system performance.
{"title":"Non-Specific Low Back Pain in South Australian Public Hospital Emergency Departments: A Retrospective Observational Study","authors":"Kexun K. Chen, Tina Hardin, Ali Mohtasham, Joseph F. Orlando, Rutger M. J. de Zoete, Anne L. J. Burke","doi":"10.1111/1742-6723.70205","DOIUrl":"10.1111/1742-6723.70205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Low back pain (LBP) is a leading cause of disability and a common reason for emergency department (ED) presentation. Although clinical guidelines recommend community-based treatment for non-specific LBP, a range of factors drive people to seek hospital-based care in Australia. This study aimed to describe the patient flow, hospital resource utilisation, and economic impact of LBP-related presentations to South Australian public hospital EDs to identify clinical and financial levers to support innovation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study utilised data from public hospitals using the electronic medical record over four fiscal years (FY19/20-FY22/23). Systematised Nomenclature of Medicine-Clinical Terms (SNOMED) diagnosis and International Classification of Disease (ICD) codes were used to identify episodes of care where individuals were assigned a primary diagnostic code of LBP and/or sciatica on admission or discharge. Serious spinal pathologies were excluded. Cost of care was calculated using recognised health system metrics (National Weighted Activity Units (NWAU) calculator, estimated ambulance transfer costs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Ambulance transfer, semi-/non-urgent triage and presentation during office hours were common. Imaging and allied health consultations were low. Opioid prescription was the primary treatment identified, and this increased (frequency, potency) over time. Few patients required admission. Average ‘per patient’ costing increased by $426.30/patient over the 4-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ED-based care for non-specific LBP was typically non-urgent care with limited evidence-based components and rising per-patient costs. The elevated prescribing practices, limited access to evidence-based care, and rising per-patient costs highlight an urgent need to reform LBP care pathways to enhance patient outcomes and system performance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917272","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}
Geraldine Hancock, Eugenie Batterby, Elliot Dovers, Chris Harrington, Steve Korbel, Adam Hudson, Angela L. Chiew
Background
Point-of-care ultrasound (POCUS) is widely used in emergency departments (ED) and has potential value during cardiac arrest for identifying reversible causes (e.g., pericardial effusion, pneumothorax and pulmonary embolism) and guiding resuscitation. However, its role remains inconsistently applied. This study describes the use of POCUS during ED cardiac arrests, including frequency, association with rhythm type and impact on interventions.
Methods
A retrospective review was conducted across three Sydney EDs from November 2020 to October 2023 (3 years). Patients were included if they received CPR in the ED; those with resuscitation ceased on arrival under an advanced directive were excluded. Data collected included demographics, presenting rhythm, POCUS use, interventions prompted by POCUS findings and outcomes.
Results
Of 528 cardiac arrests, 257 met inclusion criteria. Median age was 66 years (IQR:54–80), with 67% male. Nonshockable rhythms were present in 159 (62%). POCUS was performed in 196 (76%): 76/98 (78%) with shockable rhythms and 119/159 (75%) with nonshockable rhythms. A reversible cause was identified in six: four pericardial effusions (treated with pericardiocentesis) and two suspected pulmonary emboli (treated with thrombolysis). No patient achieved return of spontaneous circulation following intervention. Overall survival to discharge was 12/257 (5%): 7/98 (7%) in shockable rhythms and 5/159 (3%) in nonshockable rhythms.
Conclusions
POCUS was commonly used during cardiac arrest and identified reversible pathology in a small number; however, these findings did not alter outcomes. While POCUS can assist in identifying reversible causes, its use must not disrupt high-quality chest compressions, which remain the cornerstone of cardiac arrest management.
{"title":"Use of Point-of-Care Ultrasound During Cardiac Arrest in the Emergency Department: A Multicentre Retrospective Study","authors":"Geraldine Hancock, Eugenie Batterby, Elliot Dovers, Chris Harrington, Steve Korbel, Adam Hudson, Angela L. Chiew","doi":"10.1111/1742-6723.70209","DOIUrl":"10.1111/1742-6723.70209","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Point-of-care ultrasound (POCUS) is widely used in emergency departments (ED) and has potential value during cardiac arrest for identifying reversible causes (e.g., pericardial effusion, pneumothorax and pulmonary embolism) and guiding resuscitation. However, its role remains inconsistently applied. This study describes the use of POCUS during ED cardiac arrests, including frequency, association with rhythm type and impact on interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted across three Sydney EDs from November 2020 to October 2023 (3 years). Patients were included if they received CPR in the ED; those with resuscitation ceased on arrival under an advanced directive were excluded. Data collected included demographics, presenting rhythm, POCUS use, interventions prompted by POCUS findings and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 528 cardiac arrests, 257 met inclusion criteria. Median age was 66 years (IQR:54–80), with 67% male. Nonshockable rhythms were present in 159 (62%). POCUS was performed in 196 (76%): 76/98 (78%) with shockable rhythms and 119/159 (75%) with nonshockable rhythms. A reversible cause was identified in six: four pericardial effusions (treated with pericardiocentesis) and two suspected pulmonary emboli (treated with thrombolysis). No patient achieved return of spontaneous circulation following intervention. Overall survival to discharge was 12/257 (5%): 7/98 (7%) in shockable rhythms and 5/159 (3%) in nonshockable rhythms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>POCUS was commonly used during cardiac arrest and identified reversible pathology in a small number; however, these findings did not alter outcomes. While POCUS can assist in identifying reversible causes, its use must not disrupt high-quality chest compressions, which remain the cornerstone of cardiac arrest management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910963","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}
Abdi D. Osman, Jahar Bhowmik, Robert Millar, Negar Mansouri, Hans Goh-Davis, Daryl Yeak, Michael Ben-Meir, George Braitberg
Introduction
Understanding the factors that lead patients to leave the Emergency Department (ED) before treatment begins, and their subsequent health-seeking behaviours, is essential. This study explores the patient perspective on decisions not to wait (DNW) and documents patterns of care utilisation after leaving the ED.
Method
This study employed a cross-sectional survey that was specifically designed and tested for this research. The survey was distributed to patients via an automated messaging platform-MessageMedia linked to a REDCap database. During 5 months of data collection there were 37,303 patients' presentations to the ED of which 1282 participants of all ages were identified within the DNW cohort who were invited to participate in a follow-up survey which yielded 246 responses, 41 of whom were under the age of 18 years.
Results
Participants had a mean age of 44.3 years (SD = 19.4), spent an average of 207.3 min (SD = 145.5) in the ED and the majority were female (67.1%). Receiving advice on what to do if their condition worsened was significantly associated with the length of time participants were prepared to wait (χ2 (2) = 8.97, p = 0.011). Among those who received advice, 59.6% left due to long waits compared with 73.2% of those who did not receive such advice and 53.8% were either triage category 2 or 3 indicating that more than half of the participants were acutely unwell.
Conclusion
Providing clinical advice and waiting time estimates may help reduce the rate of DNW given its significance in patient safety.
{"title":"Why I Left the Emergency Department Before Receiving Care (Did Not Wait): A Cross-Sectional Study","authors":"Abdi D. Osman, Jahar Bhowmik, Robert Millar, Negar Mansouri, Hans Goh-Davis, Daryl Yeak, Michael Ben-Meir, George Braitberg","doi":"10.1111/1742-6723.70206","DOIUrl":"10.1111/1742-6723.70206","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Understanding the factors that lead patients to leave the Emergency Department (ED) before treatment begins, and their subsequent health-seeking behaviours, is essential. This study explores the patient perspective on decisions not to wait (DNW) and documents patterns of care utilisation after leaving the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study employed a cross-sectional survey that was specifically designed and tested for this research. The survey was distributed to patients via an automated messaging platform-<i>MessageMedia</i> linked to a REDCap database. During 5 months of data collection there were 37,303 patients' presentations to the ED of which 1282 participants of all ages were identified within the DNW cohort who were invited to participate in a follow-up survey which yielded 246 responses, 41 of whom were under the age of 18 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants had a mean age of 44.3 years (SD = 19.4), spent an average of 207.3 min (SD = 145.5) in the ED and the majority were female (67.1%). Receiving advice on what to do if their condition worsened was significantly associated with the length of time participants were prepared to wait (<i>χ</i><sup>2</sup> (2) = 8.97, <i>p</i> = 0.011). Among those who received advice, 59.6% left due to long waits compared with 73.2% of those who did not receive such advice and 53.8% were either triage category 2 or 3 indicating that more than half of the participants were acutely unwell.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Providing clinical advice and waiting time estimates may help reduce the rate of DNW given its significance in patient safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910949","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}
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