Pub Date : 2025-02-01Epub Date: 2024-10-07DOI: 10.1111/1742-6723.14507
Baylie Trostian, Andrea McCloughen, Kate Curtis
Objective: To determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care.
Methods: Retrospective cohort review of linked data from five data sets: ED, pathology, radiology, costs and non-admitted/outpatient. Data collected from five EDs between January 2011 and December 2020, across one health district in NSW, Australia, with 150 000 annual ED presentations. Management received by women of reproductive age, with early pregnancy (<20 weeks gestation) bleeding was compared to seven indicators for recommended care. Indicators included blood tests, psychosocial support, administration of Rhesus D immunoglobulin and US. Indicators were determined by a systematic analysis of published primary research, expert consensus clinical practice guidelines and literature reviews on initial assessment, intervention and diagnostics for women with early pregnancy bleeding.
Results: There was no evidence of almost one third of women (n = 3661, 29.4%) receiving any indicators and 54 (0.4%) received five or more indicators of appropriate care. Presentations to rural facility had the lowest number and proportion of indicators being performed (n = 603, 58.0% for no indicators). Cost increased with the number of indicators. Over the study period, the proportion of all indicators being performed increased, and indicator six - psychosocial support referral or care had the biggest growth (almost 500%).
Conclusions: Variation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence-practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population.
{"title":"What proportion of women presenting to the emergency department with early pregnancy bleeding receive appropriate care?","authors":"Baylie Trostian, Andrea McCloughen, Kate Curtis","doi":"10.1111/1742-6723.14507","DOIUrl":"10.1111/1742-6723.14507","url":null,"abstract":"<p><strong>Objective: </strong>To determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care.</p><p><strong>Methods: </strong>Retrospective cohort review of linked data from five data sets: ED, pathology, radiology, costs and non-admitted/outpatient. Data collected from five EDs between January 2011 and December 2020, across one health district in NSW, Australia, with 150 000 annual ED presentations. Management received by women of reproductive age, with early pregnancy (<20 weeks gestation) bleeding was compared to seven indicators for recommended care. Indicators included blood tests, psychosocial support, administration of Rhesus D immunoglobulin and US. Indicators were determined by a systematic analysis of published primary research, expert consensus clinical practice guidelines and literature reviews on initial assessment, intervention and diagnostics for women with early pregnancy bleeding.</p><p><strong>Results: </strong>There was no evidence of almost one third of women (n = 3661, 29.4%) receiving any indicators and 54 (0.4%) received five or more indicators of appropriate care. Presentations to rural facility had the lowest number and proportion of indicators being performed (n = 603, 58.0% for no indicators). Cost increased with the number of indicators. Over the study period, the proportion of all indicators being performed increased, and indicator six - psychosocial support referral or care had the biggest growth (almost 500%).</p><p><strong>Conclusions: </strong>Variation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence-practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":" ","pages":"e14507"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388959","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}
<p>Emergency medicine is sick. Right now, across Australia and Aotearoa New Zealand, EDs are overflowing with patients. Some have received all the care they need from ED staff, but are waiting to see busy inpatient specialists. Others are waiting for beds on wards that are already beyond capacity. Some tried to see their general practitioner when they became unwell a week ago, but there were no available appointments, and their condition worsened, necessitating an ED visit. Many have been assessed by the triage nurse as needing assessment within 30 minutes, but because of overcrowding, they will wait several hours; some will deteriorate before they see a doctor; occasionally, they will die waiting. Increasing numbers of the people waiting in the ED did not decide for themselves to come here: they are residents in understaffed aged care facilities with no after-hours medical care, and have been sent by ambulance after a fall or change in condition. They will spend 12 hours under fluorescent lights being needled by nurses, poked by physicians, missing medications and foregoing food, only to be sent home after a normal CT scan. As the cycle continues, pressure and temperature keep rising in the ED.</p><p>ED doctors want to serve their communities, but many are struggling in these unsustainable conditions.<span><sup>1</sup></span> They were trained to assess, treat, and disposition undifferentiated patients, resuscitating those who require it. Increasingly, they spend their time scanning a screen of unseen patients for risk of deterioration, debating a difficult disposition with a subspecialist over the phone, and attending to the complex needs of boarding inpatients. Overcrowding forces them to focus on optimising flow through an overwhelmed department, rather than walking with individual patients through their ED journey. It also eats into non-clinical time, at the expense of maintaining their skills as a critical care practitioner. Trainees are thinking about how things will look in 10 years; some are wondering if this is really what they want to do.</p><p>Overcrowding is a syndrome. ACEM has worked hard to diagnose the causes,<span><sup>2, 3</sup></span> but because these almost all originate outside of ED, they are difficult for ACEM and emergency physicians to address directly, requiring action from governments and other parts of the health system. In 2023, the <i>Emergency Medicine – Building our Future Summit</i><span><sup>4</sup></span> saw the coming together of College leaders, fellows and trainees, to discuss a way forward. Changing demographics and the expanding demands placed on us by overcrowding were highlighted. In response to this thin-spreading of our scope, and commensurate with trends elsewhere in medicine, the role of subspecialisation was discussed. In this issue, Metcalfe provides a timely review of the state of emergency medicine subspecialties and special interest pathways.<span><sup>5</sup></span> Protected opportunities to
{"title":"The future of emergency medicine in Australasia","authors":"Joshua I Smith MB ChB(Dist), BSc(Hons), PGCertCPU","doi":"10.1111/1742-6723.14526","DOIUrl":"10.1111/1742-6723.14526","url":null,"abstract":"<p>Emergency medicine is sick. Right now, across Australia and Aotearoa New Zealand, EDs are overflowing with patients. Some have received all the care they need from ED staff, but are waiting to see busy inpatient specialists. Others are waiting for beds on wards that are already beyond capacity. Some tried to see their general practitioner when they became unwell a week ago, but there were no available appointments, and their condition worsened, necessitating an ED visit. Many have been assessed by the triage nurse as needing assessment within 30 minutes, but because of overcrowding, they will wait several hours; some will deteriorate before they see a doctor; occasionally, they will die waiting. Increasing numbers of the people waiting in the ED did not decide for themselves to come here: they are residents in understaffed aged care facilities with no after-hours medical care, and have been sent by ambulance after a fall or change in condition. They will spend 12 hours under fluorescent lights being needled by nurses, poked by physicians, missing medications and foregoing food, only to be sent home after a normal CT scan. As the cycle continues, pressure and temperature keep rising in the ED.</p><p>ED doctors want to serve their communities, but many are struggling in these unsustainable conditions.<span><sup>1</sup></span> They were trained to assess, treat, and disposition undifferentiated patients, resuscitating those who require it. Increasingly, they spend their time scanning a screen of unseen patients for risk of deterioration, debating a difficult disposition with a subspecialist over the phone, and attending to the complex needs of boarding inpatients. Overcrowding forces them to focus on optimising flow through an overwhelmed department, rather than walking with individual patients through their ED journey. It also eats into non-clinical time, at the expense of maintaining their skills as a critical care practitioner. Trainees are thinking about how things will look in 10 years; some are wondering if this is really what they want to do.</p><p>Overcrowding is a syndrome. ACEM has worked hard to diagnose the causes,<span><sup>2, 3</sup></span> but because these almost all originate outside of ED, they are difficult for ACEM and emergency physicians to address directly, requiring action from governments and other parts of the health system. In 2023, the <i>Emergency Medicine – Building our Future Summit</i><span><sup>4</sup></span> saw the coming together of College leaders, fellows and trainees, to discuss a way forward. Changing demographics and the expanding demands placed on us by overcrowding were highlighted. In response to this thin-spreading of our scope, and commensurate with trends elsewhere in medicine, the role of subspecialisation was discussed. In this issue, Metcalfe provides a timely review of the state of emergency medicine subspecialties and special interest pathways.<span><sup>5</sup></span> Protected opportunities to","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"968-969"},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644196","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}
{"title":"What can emergency medicine in Australasia learn from the NHS?","authors":"Thomas A G Shanahan BA, MBChB, PGCert, MA, MRCEM","doi":"10.1111/1742-6723.14525","DOIUrl":"10.1111/1742-6723.14525","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"972-974"},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Although Point of care Ultrasound (POCUS) use is widespread in EDs, there are no standardised training standards. A group of Australasian enthusiasts have produced a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs. We publish two papers from the group that describe the processes they followed and the outcomes achieved. Their recommendations have five pillars of Infrastructure, Governance, Administration, Education and Quality. The guidelines are comprehensive and consideration should be given to adopting them as the benchmark for our specialty.</p><p>Joana Manton provides us with a fascinating literature review of the phenomenon of ED autoresuscitation. A systematic search of five databases with the keywords ‘autoresuscitation’, ‘cardiac arrest’ and ‘emergency department’ produced 240 papers and 26 cases. These then provided 26 cases of interest. The majority of people who auto-resuscitated did so within ten minutes of being pronounced dead. Eleven survivors were discharged neurologically intact. Only five patients had a bedside echocardiogram before resuscitation was stopped. Underreporting of autoresuscitation is suspected due to fears of blame. Passive monitoring for 10 min after resuscitation stops is recommended. There is need for more data on this phenomenon.</p><p>In recent years, the landscape of disasters, conflicts, and terror events has become more frequent and complex. Climate change, armed conflicts, terrorism, disinformation, cyber-attacks, inequality, and pandemics now present significant challenges to humanity. Emergency physicians today are likely to encounter ideologically motivated violent extremism or terrorist actions by radicalized lone actors. Terror medicine, distinct from disaster medicine, addresses the unique and severe injuries caused by terrorist incidents, including explosions, gunshots, and chemical agents. Understanding the broader public health implications of these attacks is crucial for emergency physicians to enhance community safety and resilience. We publish an excellent review that offers a comprehensive approach to understanding terror medicine, defining the concept of “terror,” its significance for emergency physicians, and the known health impacts on patients, healthcare workers, and responders.</p><p>Equitable access means that timely, sensitive, and respectful treatment is offered to all people. Adults with disability access ED care more frequently than the general population. However, in Australia and internationally, people with disability experience poorer healthcare access and outcomes than the general population. A team from Macquarie University offers us a systematic review of evaluated strategies implemented to improve care for people with disability in the ED.</p><p>Emergency physicians are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter-profe
{"title":"In this December issue","authors":"Geoff Hughes","doi":"10.1111/1742-6723.14520","DOIUrl":"10.1111/1742-6723.14520","url":null,"abstract":"<p>Although Point of care Ultrasound (POCUS) use is widespread in EDs, there are no standardised training standards. A group of Australasian enthusiasts have produced a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs. We publish two papers from the group that describe the processes they followed and the outcomes achieved. Their recommendations have five pillars of Infrastructure, Governance, Administration, Education and Quality. The guidelines are comprehensive and consideration should be given to adopting them as the benchmark for our specialty.</p><p>Joana Manton provides us with a fascinating literature review of the phenomenon of ED autoresuscitation. A systematic search of five databases with the keywords ‘autoresuscitation’, ‘cardiac arrest’ and ‘emergency department’ produced 240 papers and 26 cases. These then provided 26 cases of interest. The majority of people who auto-resuscitated did so within ten minutes of being pronounced dead. Eleven survivors were discharged neurologically intact. Only five patients had a bedside echocardiogram before resuscitation was stopped. Underreporting of autoresuscitation is suspected due to fears of blame. Passive monitoring for 10 min after resuscitation stops is recommended. There is need for more data on this phenomenon.</p><p>In recent years, the landscape of disasters, conflicts, and terror events has become more frequent and complex. Climate change, armed conflicts, terrorism, disinformation, cyber-attacks, inequality, and pandemics now present significant challenges to humanity. Emergency physicians today are likely to encounter ideologically motivated violent extremism or terrorist actions by radicalized lone actors. Terror medicine, distinct from disaster medicine, addresses the unique and severe injuries caused by terrorist incidents, including explosions, gunshots, and chemical agents. Understanding the broader public health implications of these attacks is crucial for emergency physicians to enhance community safety and resilience. We publish an excellent review that offers a comprehensive approach to understanding terror medicine, defining the concept of “terror,” its significance for emergency physicians, and the known health impacts on patients, healthcare workers, and responders.</p><p>Equitable access means that timely, sensitive, and respectful treatment is offered to all people. Adults with disability access ED care more frequently than the general population. However, in Australia and internationally, people with disability experience poorer healthcare access and outcomes than the general population. A team from Macquarie University offers us a systematic review of evaluated strategies implemented to improve care for people with disability in the ED.</p><p>Emergency physicians are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter-profe","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"805"},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644195","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}
Sierra Beck, Bridget Honan, James L Mallows, Joseph Ting
{"title":"From Other Journals","authors":"Sierra Beck, Bridget Honan, James L Mallows, Joseph Ting","doi":"10.1111/1742-6723.14523","DOIUrl":"10.1111/1742-6723.14523","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"995-997"},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644191","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}
{"title":"Divide and conquer? Emergency medicine subspecialties in Australasia","authors":"Ryan D Metcalfe MBChB, PGCertCPU","doi":"10.1111/1742-6723.14527","DOIUrl":"10.1111/1742-6723.14527","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"970-971"},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644181","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}
{"title":"Emergency medicine needs a narrower scope and a broader worldview","authors":"Tom Jerram MBChB, FACEM","doi":"10.1111/1742-6723.14524","DOIUrl":"10.1111/1742-6723.14524","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"975-976"},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644187","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}
Clare A. Skinner BSc, BA(Hons), MBBS, MPH, FACEM, AFRACMA
{"title":"Emergency medicine will stay big and become the acute decision-making nexus of future health systems","authors":"Clare A. Skinner BSc, BA(Hons), MBBS, MPH, FACEM, AFRACMA","doi":"10.1111/1742-6723.14529","DOIUrl":"10.1111/1742-6723.14529","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"977-978"},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica WS Wong, Nicolene Shipton, Matthew Edwards, Kate Bradman
{"title":"Implementing the electronic HEEADSSS screening tool in a paediatric emergency department","authors":"Jessica WS Wong, Nicolene Shipton, Matthew Edwards, Kate Bradman","doi":"10.1111/1742-6723.14509","DOIUrl":"10.1111/1742-6723.14509","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"993-994"},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sharon O'Brien BN, PhD, Catherine Wilson MPH, Ms, Megan Duck BN, GDipHlthRes, Gaby Nieva BNurs, GradDipNurs, Medhawani P Rao BHSc (Nsg) and PGDip AdvNsg, Libby Haskell NP, PhD
Conducting research in ED is important and necessary to improve emergency care. Effective recruitment is an essential ingredient for the success of a research project and must be carefully monitored. Research coordinators are focused on optimising recruitment to research studies while also ensuring that the needs of participants and their families are met, and the research is acceptable to ED staff. In this paper, a group of experienced research coordinators from Australia and New Zealand have shared their strategies to engage staff and enhance recruitment of participants in emergency research. Although this paper is from a paediatric research network, the findings are applicable for EDs in general, both in Australasia and elsewhere.
{"title":"Review article: A primer for clinical researchers in the emergency department: Part XIII. Strategies to engage staff and enhance participant recruitment in emergency department research","authors":"Sharon O'Brien BN, PhD, Catherine Wilson MPH, Ms, Megan Duck BN, GDipHlthRes, Gaby Nieva BNurs, GradDipNurs, Medhawani P Rao BHSc (Nsg) and PGDip AdvNsg, Libby Haskell NP, PhD","doi":"10.1111/1742-6723.14505","DOIUrl":"10.1111/1742-6723.14505","url":null,"abstract":"<p>Conducting research in ED is important and necessary to improve emergency care. Effective recruitment is an essential ingredient for the success of a research project and must be carefully monitored. Research coordinators are focused on optimising recruitment to research studies while also ensuring that the needs of participants and their families are met, and the research is acceptable to ED staff. In this paper, a group of experienced research coordinators from Australia and New Zealand have shared their strategies to engage staff and enhance recruitment of participants in emergency research. Although this paper is from a paediatric research network, the findings are applicable for EDs in general, both in Australasia and elsewhere.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"36 6","pages":"834-840"},"PeriodicalIF":1.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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