{"title":"Reducing mechanical restraint in emergency departments: International perspectives and Taiwan's experience","authors":"Chi-Hua Lan, Lien-Chung Wei","doi":"10.1111/1742-6723.14534","DOIUrl":"10.1111/1742-6723.14534","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617062","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}
Amber Shuja MBBS, Fay Balian MBBS, GDPHTM, DipPHRM, FACEM, Michael M Dinh MBBS, MPH, PhD, FACEM, Radhika Seimon PhD, Jameela Truman MSN, Matthew Oliver MBBS, MSc, FACEM
Objective
To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes.
Methods
One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures.
Results
VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = −2.82, −0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury.
Conclusion
Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.
{"title":"Effects of a Virtual Trauma Clinic on admissions and length of stay for minor to moderate trauma","authors":"Amber Shuja MBBS, Fay Balian MBBS, GDPHTM, DipPHRM, FACEM, Michael M Dinh MBBS, MPH, PhD, FACEM, Radhika Seimon PhD, Jameela Truman MSN, Matthew Oliver MBBS, MSc, FACEM","doi":"10.1111/1742-6723.14531","DOIUrl":"10.1111/1742-6723.14531","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = −2.82, −0.79; <i>P</i> = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; <i>P</i> < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (<i>n</i> = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617060","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}
Helena Roennfeldt MSW, Helen Glover MContempLdshp, Calista Castles MPol&Policy, Cath Roper MA (Social Health), Nicole Hill PhD, Louise Byrne PhD, Bridget E Hamilton PhD
The ED is increasingly the first point of contact for people who have no alternative when they are in a mental health crisis. However, there is mounting evidence of inadequate and negative responses to mental health crises in the ED, which has been identified as a ‘human rights flashpoint’. This paper presents the desired crisis support from people who have accessed the ED in a mental health crisis and offers significant opportunities to use lived experience knowledge to reshape crisis care. These key messages arise from a phenomenological analysis of in-depth interviews with 31 users of ED services, a PhD study conducted by a lived experience researcher. The paper concludes with six recommendations that combine collective wished-for responses with tangible examples of how these desired responses can be translated into crisis care practice.
{"title":"We can do better: Recommendations for mental health crisis care from people with lived experience","authors":"Helena Roennfeldt MSW, Helen Glover MContempLdshp, Calista Castles MPol&Policy, Cath Roper MA (Social Health), Nicole Hill PhD, Louise Byrne PhD, Bridget E Hamilton PhD","doi":"10.1111/1742-6723.14528","DOIUrl":"10.1111/1742-6723.14528","url":null,"abstract":"<p>The ED is increasingly the first point of contact for people who have no alternative when they are in a mental health crisis. However, there is mounting evidence of inadequate and negative responses to mental health crises in the ED, which has been identified as a ‘human rights flashpoint’. This paper presents the desired crisis support from people who have accessed the ED in a mental health crisis and offers significant opportunities to use lived experience knowledge to reshape crisis care. These key messages arise from a phenomenological analysis of in-depth interviews with 31 users of ED services, a PhD study conducted by a lived experience researcher. The paper concludes with six recommendations that combine collective wished-for responses with tangible examples of how these desired responses can be translated into crisis care practice.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582518","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}
Jamie Deans MBChB, Brian Burns MBChB, FACEM, William Portas MBChB, Clare Hannah MBChB, Jack Buchanan MBChB, Yasmine Motashar MBChB
Objective
To assess the impact of the AstraZeneca (AZ) vaccine roll-out on an ED. Primary outcomes are ED length of stay (LOS), investigation ordering and costs. Secondary measures are compliance with the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ) Vaccine-Induced Thrombotic Thrombocytopaenia Syndrome (VITT) guidelines.
Methods
This retrospective observational study examined a level 5 ED in Sydney, Australia. Triages mentioning the AZ vaccine between 7 July 2021 and 8 November 2021 were reviewed. Cases were limited to a single day of the week. Researchers reviewed clinical notes to identify patients that presented due to AZ vaccine concern and abstracted relevant data. Costings were calculated using an ED activity-based funding algorithm.
Results
One thousand three hundred and fifty cases were identified, with 167 analysed (12%) and 97 presented (7%). Median LOS was 195 min (IQR: 152–232 min, 95% CI [184, 217]). Median age was 43 years (IQR: 35–65 years, 95% CI [44, 51]). Median Australian Triage Category was 4. Ninety-eight percent were discharged directly home. Ninety-four percent underwent pathology and 41% radiology. Compliance with the THANZ guidelines was 16%. No findings were related to VITT. AZ vaccine concern contributed 12% of August ED caseload. Over the 16-week study period a cost of AUD$486 747.99 was extrapolated.
Conclusions
A high number of young, low acuity patients presented to the ED with AZ vaccine concerns and were associated with financial and workload implications. The quantity of ED presentations appears to be associated with vaccine administration rates. There was poor compliance with the THANZ guidelines, and they appear to have contributed to the high volume of investigations.
目的：评估阿斯利康（AZ）疫苗推广对急诊室的影响。主要结果是急诊室的住院时间（LOS）、调查订单和成本。次要指标是对澳大利亚和新西兰血栓与止血学会（THANZ）疫苗诱发血栓性血小板减少综合征（VITT）指南的遵守情况：这项回顾性观察研究检查了澳大利亚悉尼的一家 5 级急诊室。研究回顾了 2021 年 7 月 7 日至 2021 年 11 月 8 日期间提及 AZ 疫苗的分诊情况。病例仅限于一周中的某一天。研究人员查阅了临床记录，以确定因担心接种 AZ 疫苗而就诊的患者，并摘录了相关数据。成本计算采用基于急诊室活动的资金算法：共确定了 1350 个病例，分析了 167 个病例（12%），97 个病例（7%）。住院时间中位数为 195 分钟（IQR：152-232 分钟，95% CI [184, 217]）。中位年龄为 43 岁（IQR：35-65 岁，95% CI [44，51]）。澳大利亚分诊类别中位数为 4。94%的患者接受了病理检查，41%接受了放射检查。符合THANZ指南的比例为16%。没有发现与 VITT 有关的情况。亚利桑那州的疫苗问题占八月份急诊室工作量的 12%。在为期16周的研究期间，推算出的费用为486 747.99澳元：结论：大量年轻、病情较轻的患者因接种 AZ 疫苗而前往急诊室就诊，这对经济和工作量都有影响。急诊室接诊量似乎与疫苗接种率有关。对 THANZ 指南的遵守情况很差，这似乎也是造成大量调查的原因之一。
{"title":"Impact of the Astra Zeneca COVID-19 vaccine on an emergency department","authors":"Jamie Deans MBChB, Brian Burns MBChB, FACEM, William Portas MBChB, Clare Hannah MBChB, Jack Buchanan MBChB, Yasmine Motashar MBChB","doi":"10.1111/1742-6723.14519","DOIUrl":"10.1111/1742-6723.14519","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the impact of the AstraZeneca (AZ) vaccine roll-out on an ED. Primary outcomes are ED length of stay (LOS), investigation ordering and costs. Secondary measures are compliance with the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ) Vaccine-Induced Thrombotic Thrombocytopaenia Syndrome (VITT) guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study examined a level 5 ED in Sydney, Australia. Triages mentioning the AZ vaccine between 7 July 2021 and 8 November 2021 were reviewed. Cases were limited to a single day of the week. Researchers reviewed clinical notes to identify patients that presented due to AZ vaccine concern and abstracted relevant data. Costings were calculated using an ED activity-based funding algorithm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One thousand three hundred and fifty cases were identified, with 167 analysed (12%) and 97 presented (7%). Median LOS was 195 min (IQR: 152–232 min, 95% CI [184, 217]). Median age was 43 years (IQR: 35–65 years, 95% CI [44, 51]). Median Australian Triage Category was 4. Ninety-eight percent were discharged directly home. Ninety-four percent underwent pathology and 41% radiology. Compliance with the THANZ guidelines was 16%. No findings were related to VITT. AZ vaccine concern contributed 12% of August ED caseload. Over the 16-week study period a cost of AUD$486 747.99 was extrapolated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A high number of young, low acuity patients presented to the ED with AZ vaccine concerns and were associated with financial and workload implications. The quantity of ED presentations appears to be associated with vaccine administration rates. There was poor compliance with the THANZ guidelines, and they appear to have contributed to the high volume of investigations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590191","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}
Jordi Shahab MD, BMedSc(Hons), Michael Noonan MBChB(Hons), BPthy(Hons), MMEd, AFRACMA, FACEM, Shelley Cox PhD, GradCert Biostats, BAppSc(Hons), BA, Ziad Nehme PhD, Matthew Shepherd BSC Nursing, GradDip Emergency Nursing, B Paramed, GradDip MICA, GradCert Aero Medical Retrieval, Ben Meadley BAppSci, PhD, FACPara, Biswadev Mitra MBBS, MHlthServMt, PhD, FACEM, Alexander Olaussen MBBS(Hons), BEH BMedSc(Hons), MACPara, FHEA
Objectives
Stress-induced hyperglycaemia (SIH) is an elevated blood glucose level (≥11.1 mmol/L) in patients experiencing physiological stress, in the absence of diabetes mellitus. Although early in-hospital SIH has been associated with worse outcomes following major trauma, the predictive value of SIH in the prehospital setting has not been established. To investigate the role of prehospital SIH as a predictor of in-hospital mortality following major trauma.
Methods
A retrospective cohort study of non-diabetic, adult major trauma patients was undertaken to determine the association between prehospital SIH and in-hospital mortality. Secondary outcomes included ED disposition and ED length of stay.
Results
Of 1179 trauma patients included, 89 (8%) had SIH. Prehospital SIH was associated with higher Injury Severity Scores (median (interquartile range): 25 (17–33) vs 17 (14–25)), lower GCS (GCS 3–7: 48.3% vs 10.9%, P < 0.001), lower systolic BP (mean (SD): 122 (44.0) vs 133 (30.3)), lower oxygen saturations (mean (SD): 88% (16) vs 96% (7)) and abnormal heart and respiratory rate. The in-hospital mortality rate was 9.9% in non-SIH patients and 42.7% among patients with SIH (odds ratio (OR): 6.8; 95% confidence interval (CI): 4.3–10.8, P < 0.001). The area under the receiver operating curve for blood glucose alone in predicting mortality was 0.65 (95% CI: 0.60–0.70). Prehospital blood glucose was an independent predictor of mortality after adjustment for age, sex, GCS and vital signs (adjusted OR = 2.9; 95% CI: 1.5–5.5, P = 0.001).
Conclusion
The present study demonstrated an association between prehospital SIH and in-hospital mortality following major trauma. Further prospective research is warranted to examine the utility and integration of prehospital SIH into predicting models of trauma care.
目的：应激性高血糖（SIH）是指患者在没有糖尿病的情况下，因生理应激而导致的血糖水平升高（≥11.1 mmol/L）。虽然院内早期 SIH 与重大创伤后较差的预后有关，但院前 SIH 的预测价值尚未确定。目的：研究院前 SIH 对重大创伤后院内死亡率的预测作用：对非糖尿病成人重大创伤患者进行了一项回顾性队列研究，以确定院前 SIH 与院内死亡率之间的关系。次要结果包括急诊室处置和急诊室住院时间：在纳入的 1179 名创伤患者中，89 人（8%）患有 SIH。院前 SIH 与较高的损伤严重程度评分有关（中位数（四分位间范围）：25（17-33） vs 17（17-33））：25 (17-33) vs 17 (14-25)）、较低的 GCS（GCS 3-7：48.3% vs 10.9%, P 结论：本研究表明，院前 SIH 与重大创伤后的院内死亡率存在关联。有必要进一步开展前瞻性研究，以检查院前 SIH 的效用并将其纳入创伤护理预测模型。
{"title":"The diagnostic utility of prehospital hyperglycaemia in major trauma patients: An observational study","authors":"Jordi Shahab MD, BMedSc(Hons), Michael Noonan MBChB(Hons), BPthy(Hons), MMEd, AFRACMA, FACEM, Shelley Cox PhD, GradCert Biostats, BAppSc(Hons), BA, Ziad Nehme PhD, Matthew Shepherd BSC Nursing, GradDip Emergency Nursing, B Paramed, GradDip MICA, GradCert Aero Medical Retrieval, Ben Meadley BAppSci, PhD, FACPara, Biswadev Mitra MBBS, MHlthServMt, PhD, FACEM, Alexander Olaussen MBBS(Hons), BEH BMedSc(Hons), MACPara, FHEA","doi":"10.1111/1742-6723.14521","DOIUrl":"10.1111/1742-6723.14521","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Stress-induced hyperglycaemia (SIH) is an elevated blood glucose level (≥11.1 mmol/L) in patients experiencing physiological stress, in the absence of diabetes mellitus. Although early in-hospital SIH has been associated with worse outcomes following major trauma, the predictive value of SIH in the prehospital setting has not been established. To investigate the role of prehospital SIH as a predictor of in-hospital mortality following major trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of non-diabetic, adult major trauma patients was undertaken to determine the association between prehospital SIH and in-hospital mortality. Secondary outcomes included ED disposition and ED length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1179 trauma patients included, 89 (8%) had SIH. Prehospital SIH was associated with higher Injury Severity Scores (median (interquartile range): 25 (17–33) <i>vs</i> 17 (14–25)), lower GCS (GCS 3–7: 48.3% <i>vs</i> 10.9%, <i>P</i> < 0.001), lower systolic BP (mean (SD): 122 (44.0) <i>vs</i> 133 (30.3)), lower oxygen saturations (mean (SD): 88% (16) <i>vs</i> 96% (7)) and abnormal heart and respiratory rate. The in-hospital mortality rate was 9.9% in non-SIH patients and 42.7% among patients with SIH (odds ratio (OR): 6.8; 95% confidence interval (CI): 4.3–10.8, <i>P</i> < 0.001). The area under the receiver operating curve for blood glucose alone in predicting mortality was 0.65 (95% CI: 0.60–0.70). Prehospital blood glucose was an independent predictor of mortality after adjustment for age, sex, GCS and vital signs (adjusted OR = 2.9; 95% CI: 1.5–5.5, <i>P</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The present study demonstrated an association between prehospital SIH and in-hospital mortality following major trauma. Further prospective research is warranted to examine the utility and integration of prehospital SIH into predicting models of trauma care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590196","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}
Sophie Walter BMed, MD, BSc(Med)(Hons), Angela L Chiew BSc(Med), MBBS(Hons), FACEM, PhD, Linda K Martin BA, BSc(Med), MBBS(Hons), MMed, FACD
Objectives
The present study aimed to assess self-reported experience, knowledge, practices and attitudes of ED medical staff regarding teledermatology.
Methods
Online questionnaire of ED medical staff at Prince of Wales Hospital (Sydney, Australia).
Results
Seventy-nine staff completed the questionnaire. Photographic technique and compliance with medicolegal policies were variable: 1% obtained written consent and 45.6% documented verbal consent for photography. 54.4% of respondents had concerns about the quality of their photographs.
Conclusions
Skin photography image quality, knowledge and adherence to medicolegal policy were poor among ED medical staff. Education could reduce risk and improve outcomes.
{"title":"Experience, knowledge, practices and attitudes of emergency department medical staff regarding teledermatology","authors":"Sophie Walter BMed, MD, BSc(Med)(Hons), Angela L Chiew BSc(Med), MBBS(Hons), FACEM, PhD, Linda K Martin BA, BSc(Med), MBBS(Hons), MMed, FACD","doi":"10.1111/1742-6723.14530","DOIUrl":"10.1111/1742-6723.14530","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The present study aimed to assess self-reported experience, knowledge, practices and attitudes of ED medical staff regarding teledermatology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Online questionnaire of ED medical staff at Prince of Wales Hospital (Sydney, Australia).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-nine staff completed the questionnaire. Photographic technique and compliance with medicolegal policies were variable: 1% obtained written consent and 45.6% documented verbal consent for photography. 54.4% of respondents had concerns about the quality of their photographs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Skin photography image quality, knowledge and adherence to medicolegal policy were poor among ED medical staff. Education could reduce risk and improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544434","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}
Daniel Brouillard MD, FRCPC, FACEM, Geoffrey Melville PhD, Mary K Lam PhD, MHIM, FAIDH, CHIA, Jessie Woods BNursing, BParamedicSc, MD, James Martoo MD, B.Radiog, Gabrielle Wilkie MD, Hughes Makoni MBChB, FACEM, Ataur Rahman MBBS, MD, AACEM (Advanced), Emezie Odigboh MBBS, MSc, FRCEM, FACEM, Thomas Carrigan MBSS (Syd), FRCS (Ed), A&E, DA (UK), FACEM, Simon Binks BM BS BMedSci FACEM, Naomi Fielding MN(NP), Kate Curtis PhD
Objective
To evaluate the use and impact of pathology tests in patients who present to the ED with mental health-related complaints. The primary objective is to measure the proportion of patients undergoing pathology tests and assess whether these tests trigger a change in management.
Methods
In this retrospective study, we reviewed all recorded mental health presentations to our regional ED between January and June 2021. Patient characteristics, pathology tests, subsequent change in management, treatment costs and time to Emergency Physician and Psychiatrist were extracted. Descriptive statistics and multivariate analysis were used to explore associations between variables of interest, ED length of stay (LOS) and change in management.
Results
Of 37 900 ED visits, 1462 (3.9%) were mental health-related presentations. Pathology tests were conducted in 47.7% of cases, with 3% leading to a change in management. Pathology tests were associated with increased treatment costs (45% increase for blood tests, 17% for urine), and increased ED LOS (48%). Patients with coexisting medical conditions were three times more likely to have a change in management.
Conclusion
Pathology tests should be reserved for patients with high-risk features and based on clinical assessment. Strategic use of pathology tests could avoid unnecessary delays and costs, enhancing patient care in mental health-related ED presentations.
{"title":"The use and impact of pathology tests in emergency department patients with mental health-related complaints: A cross sectional study","authors":"Daniel Brouillard MD, FRCPC, FACEM, Geoffrey Melville PhD, Mary K Lam PhD, MHIM, FAIDH, CHIA, Jessie Woods BNursing, BParamedicSc, MD, James Martoo MD, B.Radiog, Gabrielle Wilkie MD, Hughes Makoni MBChB, FACEM, Ataur Rahman MBBS, MD, AACEM (Advanced), Emezie Odigboh MBBS, MSc, FRCEM, FACEM, Thomas Carrigan MBSS (Syd), FRCS (Ed), A&E, DA (UK), FACEM, Simon Binks BM BS BMedSci FACEM, Naomi Fielding MN(NP), Kate Curtis PhD","doi":"10.1111/1742-6723.14516","DOIUrl":"10.1111/1742-6723.14516","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the use and impact of pathology tests in patients who present to the ED with mental health-related complaints. The primary objective is to measure the proportion of patients undergoing pathology tests and assess whether these tests trigger a change in management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective study, we reviewed all recorded mental health presentations to our regional ED between January and June 2021. Patient characteristics, pathology tests, subsequent change in management, treatment costs and time to Emergency Physician and Psychiatrist were extracted. Descriptive statistics and multivariate analysis were used to explore associations between variables of interest, ED length of stay (LOS) and change in management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 37 900 ED visits, 1462 (3.9%) were mental health-related presentations. Pathology tests were conducted in 47.7% of cases, with 3% leading to a change in management. Pathology tests were associated with increased treatment costs (45% increase for blood tests, 17% for urine), and increased ED LOS (48%). Patients with coexisting medical conditions were three times more likely to have a change in management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pathology tests should be reserved for patients with high-risk features and based on clinical assessment. Strategic use of pathology tests could avoid unnecessary delays and costs, enhancing patient care in mental health-related ED presentations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497212","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}
Emma Bourke-Matas PhD, Tan Doan PhD, Kelly-Ann Bowles PhD, Emma Bosley PhD
Objective
Improved understanding of the deteriorating patient in the pre-hospital setting may result in earlier recognition and response. Considering the effects of undetected deterioration are profound, it is fundamental to report the prevalence of pre-hospital clinical deterioration to advance our understanding. The present study investigated the prevalence of pre-hospital clinical deterioration and adverse events (AEs) within 3 days of the pre-hospital episode of care.
Methods
This retrospective cohort study was based on pre-hospital incidents involving adult patients attended by Queensland Ambulance Service between 1 January 2018 and 31 December 2020. Due to lacking a standardised definition of pre-hospital clinical deterioration, established early warning scores (NEWS, MEWS and Q-ADDS) were calculated from pre-hospital vital signs to identify clinical deterioration. Linked hospital data were used to identify the occurrence of an AE.
Results
Some degree of physiological derangement was initially observed in over half of the patients, and pre-hospital clinical deterioration was seen in 2.7%–4% of patients. The prevalence of AEs was 3.2%. Patients that experienced an AE were more likely to be male, elderly, suffering from a medical (non-trauma) condition, and had a greater burden of disease. Concerningly, almost 50% of patients that suffered an AE did not meet escalation thresholds of NEWS, MEWS or Q-ADDS.
Conclusions
The present study found the prevalence of pre-hospital clinical deterioration and AEs subsequent to pre-hospital episodes of care to be low. Future research should prioritise using standardised criteria to define pre-hospital clinical deterioration and evaluate the performance of early warning scores.
{"title":"Prevalence of clinical deterioration in the pre-hospital setting","authors":"Emma Bourke-Matas PhD, Tan Doan PhD, Kelly-Ann Bowles PhD, Emma Bosley PhD","doi":"10.1111/1742-6723.14511","DOIUrl":"10.1111/1742-6723.14511","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Improved understanding of the deteriorating patient in the pre-hospital setting may result in earlier recognition and response. Considering the effects of undetected deterioration are profound, it is fundamental to report the prevalence of pre-hospital clinical deterioration to advance our understanding. The present study investigated the prevalence of pre-hospital clinical deterioration and adverse events (AEs) within 3 days of the pre-hospital episode of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study was based on pre-hospital incidents involving adult patients attended by Queensland Ambulance Service between 1 January 2018 and 31 December 2020. Due to lacking a standardised definition of pre-hospital clinical deterioration, established early warning scores (NEWS, MEWS and Q-ADDS) were calculated from pre-hospital vital signs to identify clinical deterioration. Linked hospital data were used to identify the occurrence of an AE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Some degree of physiological derangement was initially observed in over half of the patients, and pre-hospital clinical deterioration was seen in 2.7%–4% of patients. The prevalence of AEs was 3.2%. Patients that experienced an AE were more likely to be male, elderly, suffering from a medical (non-trauma) condition, and had a greater burden of disease. Concerningly, almost 50% of patients that suffered an AE did not meet escalation thresholds of NEWS, MEWS or Q-ADDS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The present study found the prevalence of pre-hospital clinical deterioration and AEs subsequent to pre-hospital episodes of care to be low. Future research should prioritise using standardised criteria to define pre-hospital clinical deterioration and evaluate the performance of early warning scores.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497211","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}
Matthew Woliansky MD, BDS GDip, MPhil, Kai Lee BDSc, MBBS, MMedSci, FRACDS (OMS) Unit, Santosh Tadakamadla BDS, MDS, PGD-HP, GCert Uni Learn Teach, PhD, FHEA, MRACDS (DPH)
This systematic review and meta-analysis aimed to evaluate the effectiveness of Electronic Screening and Brief Intervention (e-SBI) in changing or reducing alcohol consumption and/or related risk behaviours among trauma patients compared to standard of care. Following Cochrane Collaboration's guidelines and PRISMA recommendations, a search of electronic databases (MEDLINE via PubMed, CINAHL, Scopus and Web of Science) and grey literature (Google Scholar) was conducted. Randomised controlled trials (RCTs) from 1995 to 2023 were included, focusing on e-SBI for alcohol misuse in trauma patients. Quality assessment utilised the Cochrane risk of bias tool. Bayesian meta-analysis was employed for synthesising outcomes. Four RCTs, totalling 2641 participants, were included. While e-SBI demonstrated a significant reduction in problematic alcohol consumption up to 6 months post-implementation, uncertainties were noted in risk behaviours determined by: average alcohol consumption, binge drinking and alcohol-related consequences. Heterogeneity in measurements and population variations contributed to the nuanced findings. The review suggests that e-SBI may be effective in reducing problematic alcohol consumption in the short term among alcohol-related trauma patients. However, uncertainties and methodological variations highlight the need for standardised outcome measurements, consistent reporting and further exploration of e-SBI's long-term impact. Relevance to health promotion: Understanding the effectiveness of e-SBI in managing alcohol-related issues among trauma patients is crucial for health promotion. Despite uncertainties, the findings underscore the potential of e-SBI as a scalable and accessible intervention. e-SBI in the setting of the present study, emphasises the importance of tailored approaches in public health strategies.
{"title":"Review article: Electronic screening and brief intervention for alcohol-related trauma: A systematic review and meta-analysis","authors":"Matthew Woliansky MD, BDS GDip, MPhil, Kai Lee BDSc, MBBS, MMedSci, FRACDS (OMS) Unit, Santosh Tadakamadla BDS, MDS, PGD-HP, GCert Uni Learn Teach, PhD, FHEA, MRACDS (DPH)","doi":"10.1111/1742-6723.14506","DOIUrl":"10.1111/1742-6723.14506","url":null,"abstract":"<p>This systematic review and meta-analysis aimed to evaluate the effectiveness of Electronic Screening and Brief Intervention (e-SBI) in changing or reducing alcohol consumption and/or related risk behaviours among trauma patients compared to standard of care. Following Cochrane Collaboration's guidelines and PRISMA recommendations, a search of electronic databases (MEDLINE via PubMed, CINAHL, Scopus and Web of Science) and grey literature (Google Scholar) was conducted. Randomised controlled trials (RCTs) from 1995 to 2023 were included, focusing on e-SBI for alcohol misuse in trauma patients. Quality assessment utilised the Cochrane risk of bias tool. Bayesian meta-analysis was employed for synthesising outcomes. Four RCTs, totalling 2641 participants, were included. While e-SBI demonstrated a significant reduction in problematic alcohol consumption up to 6 months post-implementation, uncertainties were noted in risk behaviours determined by: average alcohol consumption, binge drinking and alcohol-related consequences. Heterogeneity in measurements and population variations contributed to the nuanced findings. The review suggests that e-SBI may be effective in reducing problematic alcohol consumption in the short term among alcohol-related trauma patients. However, uncertainties and methodological variations highlight the need for standardised outcome measurements, consistent reporting and further exploration of e-SBI's long-term impact. Relevance to health promotion: Understanding the effectiveness of e-SBI in managing alcohol-related issues among trauma patients is crucial for health promotion. Despite uncertainties, the findings underscore the potential of e-SBI as a scalable and accessible intervention. e-SBI in the setting of the present study, emphasises the importance of tailored approaches in public health strategies.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460750","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}
Scott McNeil MD, Nikita Goyal MD, Mandy Parr MBBS, FRACP, John Cheek MBBS, FACEM, Gary Freed MD, MPH, Alastair Meyer BSc (Hons), BMedSci, MBBS, FACEM, FRCEM (Lond), FRCP (Edin), FRACGP, Adam West MBBS (Hons), DRANZCOG, FACEM, MHSM, Simon Craig MBBS (Hons), FACEM, MHPE, MPH, PhD
Aim
To describe sources of advice and the recommendations given to parents/guardians prior to attending ED with their child.
Methods
This was a prospective observational study of patients presenting to two EDs of a multi-centre Victorian Health service in June 2016. Data collection involved surveying all parents/guardians attending paediatric ED during a 1-week period by trained research assistants. We determined the proportion of eligible respondents who sought advice before attending ED, the source of advice, and the type of advice provided.
Results
One thousand sixty-nine patients presented to ED over the 1-week period. There were 730 responses to the survey, of which 65% (477/730) had received a total of 620 recommendations prior to ED attendance. Seventy-six per cent (362/477) had received advice from a single source, 19% (90/477) had received advice from 2 sources, and 5% (25/477) from 3 or more sources. The most common sources of advice were general practice consultations (49%), friends/family (13.5%), and NURSE-ON-CALL (11%). Fifty-four per cent (335/620) of the recommendations were to attend ED immediately and 12% (77/620) were to attend if their child was getting worse.
Conclusions
Most parents and guardians sought advice from a single source prior to attending an ED. The most common source of advice was consultation with a general practitioner and the most common recommendation was to attend ED immediately, or if their child's condition worsened.
{"title":"Sources and content of advice sought by parents/guardians prior to emergency department attendance","authors":"Scott McNeil MD, Nikita Goyal MD, Mandy Parr MBBS, FRACP, John Cheek MBBS, FACEM, Gary Freed MD, MPH, Alastair Meyer BSc (Hons), BMedSci, MBBS, FACEM, FRCEM (Lond), FRCP (Edin), FRACGP, Adam West MBBS (Hons), DRANZCOG, FACEM, MHSM, Simon Craig MBBS (Hons), FACEM, MHPE, MPH, PhD","doi":"10.1111/1742-6723.14514","DOIUrl":"10.1111/1742-6723.14514","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe sources of advice and the recommendations given to parents/guardians prior to attending ED with their child.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective observational study of patients presenting to two EDs of a multi-centre Victorian Health service in June 2016. Data collection involved surveying all parents/guardians attending paediatric ED during a 1-week period by trained research assistants. We determined the proportion of eligible respondents who sought advice before attending ED, the source of advice, and the type of advice provided.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One thousand sixty-nine patients presented to ED over the 1-week period. There were 730 responses to the survey, of which 65% (477/730) had received a total of 620 recommendations prior to ED attendance. Seventy-six per cent (362/477) had received advice from a single source, 19% (90/477) had received advice from 2 sources, and 5% (25/477) from 3 or more sources. The most common sources of advice were general practice consultations (49%), friends/family (13.5%), and NURSE-ON-CALL (11%). Fifty-four per cent (335/620) of the recommendations were to attend ED immediately and 12% (77/620) were to attend if their child was getting worse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most parents and guardians sought advice from a single source prior to attending an ED. The most common source of advice was consultation with a general practitioner and the most common recommendation was to attend ED immediately, or if their child's condition worsened.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460751","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}
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