Lydia Lozzi, Hatem Alkhouri, Huei-Yang Chen, Symret Singh, Thomas J. Hugh, Mark Gillett
Objective
To examine trends in emergency department (ED) presentations, hospital admissions, and patient outcomes for abdominal pain across New South Wales (NSW) before, during, and after the first COVID-19 lockdown.
Methods
This multi-centre retrospective study analysed de-identified administrative data from NSW public hospitals. ED presentations and hospital admissions for abdominal pain were reviewed across five 31-day periods: pre-pandemic, lockdown, and 3-, 6-, and 12-months post-lockdown.
Results
A total of 35,327 abdominal pain ED presentations were identified. Presentations fell by 31.0%, from 7531 pre-pandemic to 5199 during lockdown, then increased steadily to 7942 (5.5% above baseline) at 12 months. Acuity shifted, with urgent triage cases rising from 57.6% to 61.7%, while semi-urgent cases declined. Ambulance arrivals grew from 23.4% to 28.5% during lockdown, offset by fewer walk-ins. Hospital admissions rose from 2517 at baseline to 2733 at lockdown onset, peaking at 3017 at 3 months later a 19.9% increase (χ2 = 92.28, df = 4, p < 0.0001). Emergency admissions showed a similar pattern (χ2 = 156.81, df = 4, p < 0.0001). Surgical admissions increased from 697 (32.8%) to 840 (38.2%) initially, before declining to 750 (34.2%) at 12 months (p < 0.01). ICU admission rates remained stable, though average ICU hours fluctuated. The mean length of stay for acute overnight admissions shortened from 6.6 days pre-pandemic to 6.0 days during lockdown, returning to 6.5 days by 12 months.
Conclusions
The COVID-19 pandemic substantially altered patterns of abdominal pain presentations and hospital use, with lasting changes in acuity and admission practices.
{"title":"Impact of COVID-19 on Abdominal Pain Presentations and Hospital Outcomes in New South Wales: Findings From the ICON Study","authors":"Lydia Lozzi, Hatem Alkhouri, Huei-Yang Chen, Symret Singh, Thomas J. Hugh, Mark Gillett","doi":"10.1111/1742-6723.70192","DOIUrl":"10.1111/1742-6723.70192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine trends in emergency department (ED) presentations, hospital admissions, and patient outcomes for abdominal pain across New South Wales (NSW) before, during, and after the first COVID-19 lockdown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multi-centre retrospective study analysed de-identified administrative data from NSW public hospitals. ED presentations and hospital admissions for abdominal pain were reviewed across five 31-day periods: pre-pandemic, lockdown, and 3-, 6-, and 12-months post-lockdown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 35,327 abdominal pain ED presentations were identified. Presentations fell by 31.0%, from 7531 pre-pandemic to 5199 during lockdown, then increased steadily to 7942 (5.5% above baseline) at 12 months. Acuity shifted, with urgent triage cases rising from 57.6% to 61.7%, while semi-urgent cases declined. Ambulance arrivals grew from 23.4% to 28.5% during lockdown, offset by fewer walk-ins. Hospital admissions rose from 2517 at baseline to 2733 at lockdown onset, peaking at 3017 at 3 months later a 19.9% increase (<i>χ</i><sup>2</sup> = 92.28, df = 4, <i>p</i> < 0.0001). Emergency admissions showed a similar pattern (<i>χ</i><sup>2</sup> = 156.81, df = 4, <i>p</i> < 0.0001). Surgical admissions increased from 697 (32.8%) to 840 (38.2%) initially, before declining to 750 (34.2%) at 12 months (<i>p</i> < 0.01). ICU admission rates remained stable, though average ICU hours fluctuated. The mean length of stay for acute overnight admissions shortened from 6.6 days pre-pandemic to 6.0 days during lockdown, returning to 6.5 days by 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The COVID-19 pandemic substantially altered patterns of abdominal pain presentations and hospital use, with lasting changes in acuity and admission practices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849013","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}
Benzodiazepines have been established as a safe and efficacious treatment option for Alcohol Withdrawal Syndrome (AWS). The applicability of current evidence for the management of AWS in the acute hospital setting with benzodiazepines is not clear. This review sought to capture efficacy and safety outcomes for benzodiazepine use within acute hospital settings in those experiencing moderate–severe AWS symptoms.
Methods
Cochrane Registry, Medline, Embase and APA PsycInfo were searched for studies published between 2000 and 2025. Adult patients experiencing at least moderate severity AWS symptoms and treated with benzodiazepines in an acute hospital setting were included. Efficacy and safety outcomes were extracted and subsequently analysed.
Results
There were 603 articles imported for screening, of which 24 met inclusion criteria for data extraction. There was significant heterogeneity between studies. The most common efficacy outcomes assessed were total cumulative benzodiazepine dose (20 studies); length of stay (ED, hospital admission or equivalent) (19 studies) and use of adjunct medication(s) (12 studies). The most common safety outcomes assessed were need for intubation/respiratory failure (12 studies); Occurrence of seizure (11 studies); need for ICU/higher level care (nine studies) and occurrence of delirium/DT (nine studies).
Conclusion
Current evidence lacks uniformity in reported outcomes and inclusion/exclusion criteria such that there is insufficient data to readily apply current evidence to the acute hospital setting for the selected population. Higher level evidence is required for future research. Prospective studies in this area should be in the form of randomised-controlled trials with pre-defined cohorts and treatment parameters.
{"title":"A Scoping Review of Benzodiazepine Dosing Regimens for Adults Experiencing Moderate-to-Severe Alcohol Withdrawal Syndrome in the Acute Hospital Setting","authors":"Scott Dickson, Joe Anthony Rotella","doi":"10.1111/1742-6723.70198","DOIUrl":"10.1111/1742-6723.70198","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aims</h3>\u0000 \u0000 <p>Benzodiazepines have been established as a safe and efficacious treatment option for Alcohol Withdrawal Syndrome (AWS). The applicability of current evidence for the management of AWS in the acute hospital setting with benzodiazepines is not clear. This review sought to capture efficacy and safety outcomes for benzodiazepine use within acute hospital settings in those experiencing moderate–severe AWS symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cochrane Registry, Medline, Embase and APA PsycInfo were searched for studies published between 2000 and 2025. Adult patients experiencing at least moderate severity AWS symptoms and treated with benzodiazepines in an acute hospital setting were included. Efficacy and safety outcomes were extracted and subsequently analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 603 articles imported for screening, of which 24 met inclusion criteria for data extraction. There was significant heterogeneity between studies. The most common efficacy outcomes assessed were total cumulative benzodiazepine dose (20 studies); length of stay (ED, hospital admission or equivalent) (19 studies) and use of adjunct medication(s) (12 studies). The most common safety outcomes assessed were need for intubation/respiratory failure (12 studies); Occurrence of seizure (11 studies); need for ICU/higher level care (nine studies) and occurrence of delirium/DT (nine studies).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current evidence lacks uniformity in reported outcomes and inclusion/exclusion criteria such that there is insufficient data to readily apply current evidence to the acute hospital setting for the selected population. Higher level evidence is required for future research. Prospective studies in this area should be in the form of randomised-controlled trials with pre-defined cohorts and treatment parameters.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"38 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848923","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}
This edition of Trainee Focus is the first to introduce the topic of Clinical Forensic Medicine (CFM). Despite its inclusion in the ACEM curriculum, forensic medicine and the associated medicolegal frameworks remain an unfamiliar and poorly understood area of medicine for most trainees. Laws vary between jurisdictions, limiting the generalisability of training. Interactions with Police officers and the criminal justice system can be nerve-wracking, whether on the floor during a shift or when tasked to give evidence at a later date. Misunderstandings about legal process are common among clinicians, due not only to limited training and exposure, but also inaccurate media depictions, contributing to confusion and apprehension. This edition provides a broad overview of the role of CFM in the ED and in the community and demystifies common legal processes. We hope it will give trainees confidence when caring for forensic patients in the ED, wherever they practice.
{"title":"Clinical Forensic Medicine: Essentials for Emergency Medicine Trainees","authors":"Daphne Cohen, Brittany Hulbert","doi":"10.1111/1742-6723.70194","DOIUrl":"10.1111/1742-6723.70194","url":null,"abstract":"<div>\u0000 \u0000 <p>This edition of <i>Trainee Focus</i> is the first to introduce the topic of Clinical Forensic Medicine (CFM). Despite its inclusion in the ACEM curriculum, forensic medicine and the associated medicolegal frameworks remain an unfamiliar and poorly understood area of medicine for most trainees. Laws vary between jurisdictions, limiting the generalisability of training. Interactions with Police officers and the criminal justice system can be nerve-wracking, whether on the floor during a shift or when tasked to give evidence at a later date. Misunderstandings about legal process are common among clinicians, due not only to limited training and exposure, but also inaccurate media depictions, contributing to confusion and apprehension. This edition provides a broad overview of the role of CFM in the ED and in the community and demystifies common legal processes. We hope it will give trainees confidence when caring for forensic patients in the ED, wherever they practice.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809806","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}
Forensic medical services vary in structure and practice between metropolitan and rural centres in Australia. Limited access to trained forensic clinicians, resource constraints, and geographical isolation create challenges for rural clinicians—particularly trainees. The ACEM policy outlines the ED's dual role in managing medical needs and ensuring timely evidence collection and reporting. In rural settings, it's not always possible for a forensic medical officer to assess patients on site. Early evidence kits (EEKs) can preserve the chain of evidence by enabling the patient to self-collect. Emphasising continuing education, forensic management protocols, and incorporating EEK training into staff induction can improve clinician awareness in forensic cases.
{"title":"Forensic Medicine in Rural Australia","authors":"Ami Clubb, Brittany Hulbert","doi":"10.1111/1742-6723.70193","DOIUrl":"10.1111/1742-6723.70193","url":null,"abstract":"<div>\u0000 \u0000 <p>Forensic medical services vary in structure and practice between metropolitan and rural centres in Australia. Limited access to trained forensic clinicians, resource constraints, and geographical isolation create challenges for rural clinicians—particularly trainees. The ACEM policy outlines the ED's dual role in managing medical needs and ensuring timely evidence collection and reporting. In rural settings, it's not always possible for a forensic medical officer to assess patients on site. Early evidence kits (EEKs) can preserve the chain of evidence by enabling the patient to self-collect. Emphasising continuing education, forensic management protocols, and incorporating EEK training into staff induction can improve clinician awareness in forensic cases.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809832","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}
Timothy J. Schultz, Paul Tait, Brendan Major, Andrew Partington, Darren Daff, Pamela Everingham, Rebecca Perry, Jackie Davidson, Jonathan Karnon
Objective
We measured multidisciplinary staff perceptions of the working environment, attitudes to telemedicine and the experience of working in a virtual emergency department (ED) to permit comparison with studies of physical EDs.
Methods
In September 2024, we conducted an online survey of 63 staff in a South Australian virtual ED. The survey comprised the Working Environment Scale (WES-10) and questions assessing attitudes to telemedicine and open-ended questions on attractors and challenges to work. Descriptive statistics and non-parametric inferential statistics were used to compare responses between professions; content analysis was conducted on open-ended data.
Results
The response rate was 52% (n = 33, comprising 5 clerical, 16 doctors, 11 nurses and 1 paramedic). The WES-10 scores were (median, interquartile range): Self-realisation (3.6, 3.2–4.3), Workload (3.0, 2.4–3.0), Conflict (1.5, 1.0–2.0) and Nervousness (1.5, 1.0–2.0). We identified inconsistencies in the scoring of previous studies of the physical ED working environment that complicate comparison, although the results suggest that the virtual ED is viewed at least as positively as the physical ED, particularly for Self-realisation. Staff had generally very positive attitudes towards telemedicine, except for future plans for professional development and preference for virtual care. Delivering novel care and having a positive workplace culture were the main attractions to working at the virtual ED, whereas limitations in assessing patients were the main challenge.
Conclusions
Virtual ED staff viewed their workplaces and telemedicine positively and were attracted to the delivery of a novel form of healthcare. Greater consistency of WES-10 measurement is necessary.
{"title":"Working Environment in a Virtual Emergency Department: A Cross-Sectional Study","authors":"Timothy J. Schultz, Paul Tait, Brendan Major, Andrew Partington, Darren Daff, Pamela Everingham, Rebecca Perry, Jackie Davidson, Jonathan Karnon","doi":"10.1111/1742-6723.70191","DOIUrl":"10.1111/1742-6723.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We measured multidisciplinary staff perceptions of the working environment, attitudes to telemedicine and the experience of working in a virtual emergency department (ED) to permit comparison with studies of physical EDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In September 2024, we conducted an online survey of 63 staff in a South Australian virtual ED. The survey comprised the Working Environment Scale (WES-10) and questions assessing attitudes to telemedicine and open-ended questions on attractors and challenges to work. Descriptive statistics and non-parametric inferential statistics were used to compare responses between professions; content analysis was conducted on open-ended data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The response rate was 52% (<i>n</i> = 33, comprising 5 clerical, 16 doctors, 11 nurses and 1 paramedic). The WES-10 scores were (median, interquartile range): Self-realisation (3.6, 3.2–4.3), Workload (3.0, 2.4–3.0), Conflict (1.5, 1.0–2.0) and Nervousness (1.5, 1.0–2.0). We identified inconsistencies in the scoring of previous studies of the physical ED working environment that complicate comparison, although the results suggest that the virtual ED is viewed at least as positively as the physical ED, particularly for Self-realisation. Staff had generally very positive attitudes towards telemedicine, except for future plans for professional development and preference for virtual care. Delivering novel care and having a positive workplace culture were the main attractions to working at the virtual ED, whereas limitations in assessing patients were the main challenge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Virtual ED staff viewed their workplaces and telemedicine positively and were attracted to the delivery of a novel form of healthcare. Greater consistency of WES-10 measurement is necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793537","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}
Yuta Tamberg, Melyssa Roy, Waldir Rodrigues de Souza Jr., John Eastwood
Objective
To compare patterns and characteristics of emergency department visits initiated by frequent presenters and other ED attenders.
Methods
We performed a quantitative retrospective data analysis of routinely collected ED data across three public hospitals within New Zealand's Southern district. The study population comprised: (1) frequent presenters (i.e., patients who visited any of the EDs on 10 or more occasions in any continuous 365-day period between 01/01/2018 and 31/12/2022) and (2) all other ED presenters during the same period. We compared visit-based and per-person metrics characterising presentation flow, utilisation patterns and demographics.
Results
Frequent presenters constituted 0.6% of all ED attenders (1259 out of 196,136) and initiated 6.8% of all ED visits (32,541 out of 479,975). Visits by frequent presenters showed no seasonality or day-of-the-week patterns and occurred mostly during daylight hours. Frequent presenters differed from non-frequent presenters by having more clustered visits, shorter intervals between presentations, higher presentation severity (more visits were triaged urgent and above), more arrivals by ambulance and police, a higher incomplete treatment rate, more referrals and short stay admissions.
Conclusion
Frequent presenters make a sizeable contribution to ED load in terms of visit numbers and urgency. The nature of differences between frequent and non-frequent presenters indicates greater and more complex health needs in the former cohort. At the same time the diversity of visits in the frequent presenters' histories shows potential for redirecting some patients and/or presentations to other care providers.
{"title":"Frequent Presenters to Southern New Zealand Emergency Departments Differ From Other ED Attenders","authors":"Yuta Tamberg, Melyssa Roy, Waldir Rodrigues de Souza Jr., John Eastwood","doi":"10.1111/1742-6723.70185","DOIUrl":"10.1111/1742-6723.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare patterns and characteristics of emergency department visits initiated by frequent presenters and other ED attenders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a quantitative retrospective data analysis of routinely collected ED data across three public hospitals within New Zealand's Southern district. The study population comprised: (1) frequent presenters (i.e., patients who visited any of the EDs on 10 or more occasions in any continuous 365-day period between 01/01/2018 and 31/12/2022) and (2) all other ED presenters during the same period. We compared visit-based and per-person metrics characterising presentation flow, utilisation patterns and demographics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Frequent presenters constituted 0.6% of all ED attenders (1259 out of 196,136) and initiated 6.8% of all ED visits (32,541 out of 479,975). Visits by frequent presenters showed no seasonality or day-of-the-week patterns and occurred mostly during daylight hours. Frequent presenters differed from non-frequent presenters by having more clustered visits, shorter intervals between presentations, higher presentation severity (more visits were triaged urgent and above), more arrivals by ambulance and police, a higher incomplete treatment rate, more referrals and short stay admissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Frequent presenters make a sizeable contribution to ED load in terms of visit numbers and urgency. The nature of differences between frequent and non-frequent presenters indicates greater and more complex health needs in the former cohort. At the same time the diversity of visits in the frequent presenters' histories shows potential for redirecting some patients and/or presentations to other care providers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767440","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}
Danlu Liang, Paul Buntine, Louise Roberts, Liam Hackett, Joseph Miller, Patrick J. Owen, Andrew W. Teh
Objective
Recent onset atrial fibrillation is common in emergency departments and treated with resource- and time-intensive electrical cardioversion despite most patients spontaneously reverting to sinus rhythm within 48 h. We investigated whether discharging patients with a portable electrocardiograph to monitor rhythm was feasible and could improve emergency department workflow.
Methods
This single-centre proof-of-concept study recruited adults presenting to the emergency department with recent onset, haemodynamically stable, sustained atrial fibrillation, with a clear onset time within 24 h and who owned a smartphone able to pair with the AliveCor single-lead electrocardiograph. Patients were discharged on rate-control and anticoagulant medication where appropriate. Portable electrocardiograph transmissions were sent six-hourly to assess spontaneous reversion to sinus rhythm. If patients remained in atrial fibrillation by 48 h, they represented to the emergency department for direct current cardioversion. Patients continued to send electrocardiograph transmissions for 4 weeks to monitor rhythm.
Results
Most (91%; n = 21/23) patients spontaneously reverted from atrial fibrillation to sinus rhythm within 48 h of symptom-onset, with only two patients returning for direct current cardioversion. All patients remained in sinus rhythm at 4-week follow-up. Patients found the device easy to use and appreciated not returning for cardioversion.
Conclusions
Selected patients presenting to emergency departments with recent onset atrial fibrillation can be discharged home with an expectation that they will revert spontaneously to sinus rhythm, potentially reducing unnecessary electrical cardioversion. Remote electrocardiograph monitoring was feasible for identifying patients who failed to revert to sinus rhythm, allowing timely recall to the emergency department for scheduled cardioversion.
{"title":"Use of Single Lead ECG to Assist Cardioversion in Atrial Fibrillation in the Emergency Department (SELECTED): Proof of Concept Study","authors":"Danlu Liang, Paul Buntine, Louise Roberts, Liam Hackett, Joseph Miller, Patrick J. Owen, Andrew W. Teh","doi":"10.1111/1742-6723.70190","DOIUrl":"10.1111/1742-6723.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Recent onset atrial fibrillation is common in emergency departments and treated with resource- and time-intensive electrical cardioversion despite most patients spontaneously reverting to sinus rhythm within 48 h. We investigated whether discharging patients with a portable electrocardiograph to monitor rhythm was feasible and could improve emergency department workflow.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-centre proof-of-concept study recruited adults presenting to the emergency department with recent onset, haemodynamically stable, sustained atrial fibrillation, with a clear onset time within 24 h and who owned a smartphone able to pair with the AliveCor single-lead electrocardiograph. Patients were discharged on rate-control and anticoagulant medication where appropriate. Portable electrocardiograph transmissions were sent six-hourly to assess spontaneous reversion to sinus rhythm. If patients remained in atrial fibrillation by 48 h, they represented to the emergency department for direct current cardioversion. Patients continued to send electrocardiograph transmissions for 4 weeks to monitor rhythm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most (91%; <i>n</i> = 21/23) patients spontaneously reverted from atrial fibrillation to sinus rhythm within 48 h of symptom-onset, with only two patients returning for direct current cardioversion. All patients remained in sinus rhythm at 4-week follow-up. Patients found the device easy to use and appreciated not returning for cardioversion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Selected patients presenting to emergency departments with recent onset atrial fibrillation can be discharged home with an expectation that they will revert spontaneously to sinus rhythm, potentially reducing unnecessary electrical cardioversion. Remote electrocardiograph monitoring was feasible for identifying patients who failed to revert to sinus rhythm, allowing timely recall to the emergency department for scheduled cardioversion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755735","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}
To evaluate the clinical effectiveness and cost-effectiveness of the integrated Geriatric Emergency Medicine (iGEM) Short Stay Unit (SSU) model in the management of patients presenting from residential aged care facilities (RACF) to the Emergency Department (ED).
Methods
This is a retrospective cohort study comparing patients admitted to the iGEM SSU in July 2024 (Cohort Ia) with matched contemporaneous (Cohort Ib) and historical (May 2024, July 2023) controls who met iGEM criteria but were managed under standard ED pathways. Inclusion criteria comprised geriatric RACF patients presenting with stable, low-acuity conditions such as uncomplicated infections, minor trauma, dehydration, or requiring transfusions suitable for short-stay management.
Results
A total of 531 geriatric patients from RACFs were included. A progressive improvement in service efficiency was observed with the iGEM SSU model. The average ED length of stay decreased from 18.3 h in July 2023 (Cohort III) to 6.5 h in July 2024 (Cohort Ia), accompanied by a reduction in inpatient admission rates (51% to 5.3%) and overall hospital LOS (8.1 days to 1.7 days). Quality outcomes also improved, with lower readmission and complication rates observed in cohort Ia compared with earlier standard-care cohorts, supporting the model's clinical efficiency.
Conclusions
The iGEM SSU model was associated with greater efficiency, reduced inpatient admissions, shorter hospital length of stay, and potential cost savings compared to standard geriatric emergency care in this retrospective case–control study. These findings suggest that iGEM may help to alleviate ED pressures and optimise hospital resource utilisation without compromising patient safety.
{"title":"Evaluating the Effectiveness of the Integrated Geriatric Emergency Medicine Short Stay Unit Model of Care: A Retrospective Cohort Study","authors":"Karina Hochholzer, Caroline O'Donnell, Daya Jeganathan, Dmitrii Shek, Joanne Medlin, Golo Ahlenstiel","doi":"10.1111/1742-6723.70189","DOIUrl":"10.1111/1742-6723.70189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the clinical effectiveness and cost-effectiveness of the integrated Geriatric Emergency Medicine (iGEM) Short Stay Unit (SSU) model in the management of patients presenting from residential aged care facilities (RACF) to the Emergency Department (ED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective cohort study comparing patients admitted to the iGEM SSU in July 2024 (Cohort Ia) with matched contemporaneous (Cohort Ib) and historical (May 2024, July 2023) controls who met iGEM criteria but were managed under standard ED pathways. Inclusion criteria comprised geriatric RACF patients presenting with stable, low-acuity conditions such as uncomplicated infections, minor trauma, dehydration, or requiring transfusions suitable for short-stay management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 531 geriatric patients from RACFs were included. A progressive improvement in service efficiency was observed with the iGEM SSU model. The average ED length of stay decreased from 18.3 h in July 2023 (Cohort III) to 6.5 h in July 2024 (Cohort Ia), accompanied by a reduction in inpatient admission rates (51% to 5.3%) and overall hospital LOS (8.1 days to 1.7 days). Quality outcomes also improved, with lower readmission and complication rates observed in cohort Ia compared with earlier standard-care cohorts, supporting the model's clinical efficiency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The iGEM SSU model was associated with greater efficiency, reduced inpatient admissions, shorter hospital length of stay, and potential cost savings compared to standard geriatric emergency care in this retrospective case–control study. These findings suggest that iGEM may help to alleviate ED pressures and optimise hospital resource utilisation without compromising patient safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721800","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}
Emily Nehme, Karen Smith, Colin Jones, Peter Cameron, Ziad Nehme
Objective
To examine the impact of a revised ambulance clinical response model (CRM) on 24- and 72-h patient outcomes and triage accuracy.
Methods
Retrospective study of consecutive ambulance calls in Victoria, Australia between 01/01/2015 and 31/12/2018 linked with hospital and death records. Negative binomial interrupted time series analyses were used.
Results
Among callers referred away from emergency ambulance dispatch, the revised CRM was not associated with any change in mortality; although there was an increasing trend in recontacts. Among all callers, triage accuracy improved; however under-triage was more common.
Conclusion
Ongoing CRM reforms should be informed by patient safety outcomes.
{"title":"Revising the Ambulance Clinical Response Model in Victoria, Australia: The Impact on Patient Safety","authors":"Emily Nehme, Karen Smith, Colin Jones, Peter Cameron, Ziad Nehme","doi":"10.1111/1742-6723.70188","DOIUrl":"10.1111/1742-6723.70188","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the impact of a revised ambulance clinical response model (CRM) on 24- and 72-h patient outcomes and triage accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective study of consecutive ambulance calls in Victoria, Australia between 01/01/2015 and 31/12/2018 linked with hospital and death records. Negative binomial interrupted time series analyses were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among callers referred away from emergency ambulance dispatch, the revised CRM was not associated with any change in mortality; although there was an increasing trend in recontacts. Among all callers, triage accuracy improved; however under-triage was more common.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ongoing CRM reforms should be informed by patient safety outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707935","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}
Lu Bai, Shijia Gao, Frada Burstein, Jithin Sajeev, Simon Craig, Diana Egerton-Warburton, Gerard O'Reilly, Peter Cameron, Gabriel Blecher, Liam Hackett, Joseph Miller, Emily Schembri, Patrick J. Owen, Paul Buntine
Background
Diagnostic testing is overused in emergency departments, and clinical decision support may reduce unnecessary ordering. We examined the effects of nudge-based clinical decision support interventions on test ordering among emergency department clinicians.
Methods
This triple-blind four-arm parallel (1:1:1:1) individually randomised vignette-based experiment included 243 clinicians (male: 54%) from eight emergency departments. Clinicians were presented with a case study (81-year-old woman, simple syncopal event, no injury) and randomised to Nudge #1 (large range of tests and free text), Nudge #2 (Nudge #1 with inline evidence-based advice), Nudge #3 (limited range of tests and free text), or control (free text only). The primary outcome was between-group differences in total tests ordered. Secondary outcomes excluded the most common tests (full blood examination and urea/electrolytes) and were stratified by clinical experience (< 10 or ≥ 10 years).
Results
There were no differences in total tests ordered compared to control for Nudge #1 (incident-rate ratio [95% CI]: 1.05 [0.83, 1.32], p = 0.691), Nudge #2 (0.85 [0.67, 1.08], p = 0.189), or Nudge #3 (0.90 [0.71, 1.14], p = 0.378). When FBE and U&E were excluded, total tests ordered compared to control were lower for Nudge #2 (0.58 [0.39, 0.86], p = 0.007), and Nudge #3 (0.50 [0.33, 0.76], p = 0.001). Secondary analyses revealed effects for clinicians with < 10 years of experience only.
Conclusion
While potentially of limited value for reducing the total number of tests ordered, nudge-based clinical decision support interventions that manipulate decision structure and employ decision assistance may reduce tests other than FBE and U&E in emergency departments, especially among less experienced clinicians.
{"title":"Nudging Emergency Department Clinicians to Reduce Unnecessary Diagnostic Test Ordering: A Multi-Arm Vignette-Based Experiment","authors":"Lu Bai, Shijia Gao, Frada Burstein, Jithin Sajeev, Simon Craig, Diana Egerton-Warburton, Gerard O'Reilly, Peter Cameron, Gabriel Blecher, Liam Hackett, Joseph Miller, Emily Schembri, Patrick J. Owen, Paul Buntine","doi":"10.1111/1742-6723.70187","DOIUrl":"10.1111/1742-6723.70187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diagnostic testing is overused in emergency departments, and clinical decision support may reduce unnecessary ordering. We examined the effects of nudge-based clinical decision support interventions on test ordering among emergency department clinicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This triple-blind four-arm parallel (1:1:1:1) individually randomised vignette-based experiment included 243 clinicians (male: 54%) from eight emergency departments. Clinicians were presented with a case study (81-year-old woman, simple syncopal event, no injury) and randomised to Nudge #1 (large range of tests and free text), Nudge #2 (Nudge #1 with inline evidence-based advice), Nudge #3 (limited range of tests and free text), or control (free text only). The primary outcome was between-group differences in total tests ordered. Secondary outcomes excluded the most common tests (full blood examination and urea/electrolytes) and were stratified by clinical experience (< 10 or ≥ 10 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no differences in total tests ordered compared to control for Nudge #1 (incident-rate ratio [95% CI]: 1.05 [0.83, 1.32], <i>p</i> = 0.691), Nudge #2 (0.85 [0.67, 1.08], <i>p</i> = 0.189), or Nudge #3 (0.90 [0.71, 1.14], <i>p</i> = 0.378). When FBE and U&E were excluded, total tests ordered compared to control were lower for Nudge #2 (0.58 [0.39, 0.86], <i>p</i> = 0.007), and Nudge #3 (0.50 [0.33, 0.76], <i>p</i> = 0.001). Secondary analyses revealed effects for clinicians with < 10 years of experience only.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While potentially of limited value for reducing the total number of tests ordered, nudge-based clinical decision support interventions that manipulate decision structure and employ decision assistance may reduce tests other than FBE and U&E in emergency departments, especially among less experienced clinicians.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707906","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号