Examine the nature of domestic and family violence (DFV) presentations to an ED in the Northern Territory and identify potential gaps in service delivery.
Methods
Prospective descriptive study of DFV presentations in November 2021.
Results
A total of 70 presentations were identified, representing 1.2% of all presentations aged 16 years and older. Disproportionately impacted were First Nations people (90%), women (77.1%) and those aged less than 40 years (67.1%). Most (81.4%) arrived outside of business hours and only 37.1% were assessed by the social worker. Case complexity was increased by high rates of homelessness (30%), concurrent alcohol consumption (44.3%) and pregnancy (11.1% of females). More than a third (37.1%) had attended on one to four occasions in the previous 6 months with a DFV-related injury. Compared to non-DFV attendances, the median ED length of stay was approximately twice as long (456 vs 210 min), admissions rates to the ED short stay unit five times higher (25.7% vs 5.7%; P < 0.01, odds ratio [OR] = 5.7 and 95% confidence interval [CI] = 3.3–9.8) and rates of self-discharge prior to completion of care 9 times higher (12.9% vs 1.5%; P < 0.01, OR = 9.5 and 95% CI = 4.6–19.7).
Conclusion
The data highlights the need for a 24 h trauma-informed, culturally safe and integrated service to support people experiencing DFV. This could be achieved by a specialist unit designed and staffed by First Nations health practitioners.
{"title":"A descriptive study of domestic and family violence presentations to an emergency department in the Northern Territory","authors":"Lucy Owen MBBS, FACEM, Sibella Hare Breidahl MBBS, BMedSci (Hons), Maud Mussared MBBS, Sandra Brownlea BSc, MBBS, FACEM, David Kault MBBS, BSc, PhD","doi":"10.1111/1742-6723.14418","DOIUrl":"10.1111/1742-6723.14418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Examine the nature of domestic and family violence (DFV) presentations to an ED in the Northern Territory and identify potential gaps in service delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective descriptive study of DFV presentations in November 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 70 presentations were identified, representing 1.2% of all presentations aged 16 years and older. Disproportionately impacted were First Nations people (90%), women (77.1%) and those aged less than 40 years (67.1%). Most (81.4%) arrived outside of business hours and only 37.1% were assessed by the social worker. Case complexity was increased by high rates of homelessness (30%), concurrent alcohol consumption (44.3%) and pregnancy (11.1% of females). More than a third (37.1%) had attended on one to four occasions in the previous 6 months with a DFV-related injury. Compared to non-DFV attendances, the median ED length of stay was approximately twice as long (456 <i>vs</i> 210 min), admissions rates to the ED short stay unit five times higher (25.7% <i>vs</i> 5.7%; <i>P</i> < 0.01, odds ratio [OR] = 5.7 and 95% confidence interval [CI] = 3.3–9.8) and rates of self-discharge prior to completion of care 9 times higher (12.9% <i>vs</i> 1.5%; <i>P</i> < 0.01, OR = 9.5 and 95% CI = 4.6–19.7).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The data highlights the need for a 24 h trauma-informed, culturally safe and integrated service to support people experiencing DFV. This could be achieved by a specialist unit designed and staffed by First Nations health practitioners.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140679330","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}
Charlotte Mary Alexander MBBS, Eve Purdy MD, MBA, FRCPC, FACEM, Aoife Reynolds RN, Luc Nguyen M.Sc (Physio), MD, Richard AF Pellatt MBChB, BA[Hons], FACEM, Gerben Keijzers MBBS, MSc, FACEM, PhD
Objective
To understand the reach, adoption and implementation of the evidence that buddy strapping for uncomplicated fifth metacarpal neck fractures is non-inferior to plaster casting.
Methods
Mixed-method study using clinical audit of the years before and after the original randomised controlled study was published (2019) and staff questionnaires/semi-structured interviews.
Results
Sixty-nine percent of questionnaire respondents were aware of the original study findings (i.e. reach) and 57% had adopted the research findings. The proportion of patients receiving buddy strapping was 6% in 2014–2016 and 28% in 2019–2021 (implementation). Qualitative data provided insight into ongoing barriers to adoption and implementation including fear of reprisal, the need for permission, opinions of senior decision makers, perceptions about patient preferences, and an overall tendency to ‘play it safe’.
Conclusions
Even in a department where primary research is conducted, implementation requires ongoing attention to factors impacting reach and adoption.
{"title":"The Buddy Study: Local reach, adoption and implementation following a randomised controlled trial of conservative management of fifth metacarpal neck fractures","authors":"Charlotte Mary Alexander MBBS, Eve Purdy MD, MBA, FRCPC, FACEM, Aoife Reynolds RN, Luc Nguyen M.Sc (Physio), MD, Richard AF Pellatt MBChB, BA[Hons], FACEM, Gerben Keijzers MBBS, MSc, FACEM, PhD","doi":"10.1111/1742-6723.14412","DOIUrl":"10.1111/1742-6723.14412","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand the <i>reach, adoption and implementation</i> of the evidence that buddy strapping for uncomplicated fifth metacarpal neck fractures is non-inferior to plaster casting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Mixed-method study using clinical audit of the years before and after the original randomised controlled study was published (2019) and staff questionnaires/semi-structured interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-nine percent of questionnaire respondents were aware of the original study findings (i.e. <i>reach</i>) and 57% had <i>adopted</i> the research findings. The proportion of patients receiving buddy strapping was 6% in 2014–2016 and 28% in 2019–2021 (<i>implementation</i>). Qualitative data provided insight into ongoing barriers to adoption and implementation including fear of reprisal, the need for permission, opinions of senior decision makers, perceptions about patient preferences, and an overall tendency to ‘play it safe’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Even in a department where primary research is conducted, implementation requires ongoing attention to factors impacting reach and adoption.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140616103","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}
Michael Eburn PhD, LLM, LLB, Tina Cockburn BCom, LLB(Hons), LLM, Anne-Maree Kelly MD, FACEM, MHealth&MedLaw
Patients leave ED for a variety of reasons and at all stages of care. In Australian law, clinicians and health services owe a duty of care to people presenting to the ED for care, even if they have not yet entered a treatment space. There is also a positive duty to warn patients of material risks associated with their condition, proposed treatment(s), reasonable alternative treatment options and the likely effect of their healthcare decisions, including refusing treatment. This extends to a decision to leave the ED before care is completed. The form of that warning may vary based on what is known about the patient's condition and the associated risks at the time. Specific documentation of warnings given is essential.
{"title":"Review article: Patients who leave before care is completed: What does the legal duty to warn mean for emergency department clinicians?","authors":"Michael Eburn PhD, LLM, LLB, Tina Cockburn BCom, LLB(Hons), LLM, Anne-Maree Kelly MD, FACEM, MHealth&MedLaw","doi":"10.1111/1742-6723.14407","DOIUrl":"10.1111/1742-6723.14407","url":null,"abstract":"<p>Patients leave ED for a variety of reasons and at all stages of care. In Australian law, clinicians and health services owe a duty of care to people presenting to the ED for care, even if they have not yet entered a treatment space. There is also a positive duty to warn patients of material risks associated with their condition, proposed treatment(s), reasonable alternative treatment options and the likely effect of their healthcare decisions, including refusing treatment. This extends to a decision to leave the ED before care is completed. The form of that warning may vary based on what is known about the patient's condition and the associated risks at the time. Specific documentation of warnings given is essential.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140616188","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}
Piers Truter M.Clin PHTY, Pippa Flanagan M. Clin PHTY, Robert Waller PhD, Karen Richards D. Clin PHTY, Marshall Makate PhD, Anthony Johnstone B. PHTY (Hons), Luke Bongiascia MBA, Katrina Spilsbury PhD, Vinicius Cavalheri PhD, Ivan Lin PhD
Objective
Patients with musculoskeletal conditions (MSKCs) are highly prevalent in ED. This project explores the impact of the pilot phase of a ‘diversion pathway’, which directed patients with MSKCs from the ED waiting room to an outpatient clinic led by advanced-scope physiotherapists.
Methods
A prospective intervention study comparing care outcomes between patients in the ‘diversion pathway’ with usual ED care. The characteristics of patients considered eligible and non-eligible are described.
Results
Between May and December 2022, 1099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95% confidence interval [CI]: 99–120) min and 4 h rule compliance improved by 19.3% compared to usual ED care. There were fewer patients who ‘did not wait’ (DNW) with the diversion pathway. The diverted group was young (median age 22 years and 41% paediatric), mostly low urgency, self-referred and arrived by private transport with minor limb trauma. The diversion pathway triage process appropriately identified 182 patients ineligible for diversion. 96.7% of patients reported satisfaction with care received from the diversion pathway. There was no change in ED representation rates for diverted patients.
Conclusions
A new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 h for diverted patients compared to usual ED care. The pathway increased ED capacity, improved key ED performance metrics and safely expedited care delivery for patients.
{"title":"Short waits, happy patients and expert care, moving basic musculoskeletal care from the emergency department to a physiotherapist-led diversion pathway","authors":"Piers Truter M.Clin PHTY, Pippa Flanagan M. Clin PHTY, Robert Waller PhD, Karen Richards D. Clin PHTY, Marshall Makate PhD, Anthony Johnstone B. PHTY (Hons), Luke Bongiascia MBA, Katrina Spilsbury PhD, Vinicius Cavalheri PhD, Ivan Lin PhD","doi":"10.1111/1742-6723.14416","DOIUrl":"10.1111/1742-6723.14416","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Patients with musculoskeletal conditions (MSKCs) are highly prevalent in ED. This project explores the impact of the pilot phase of a ‘diversion pathway’, which directed patients with MSKCs from the ED waiting room to an outpatient clinic led by advanced-scope physiotherapists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective intervention study comparing care outcomes between patients in the ‘diversion pathway’ with usual ED care. The characteristics of patients considered eligible and non-eligible are described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May and December 2022, 1099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95% confidence interval [CI]: 99–120) min and 4 h rule compliance improved by 19.3% compared to usual ED care. There were fewer patients who ‘did not wait’ (DNW) with the diversion pathway. The diverted group was young (median age 22 years and 41% paediatric), mostly low urgency, self-referred and arrived by private transport with minor limb trauma. The diversion pathway triage process appropriately identified 182 patients ineligible for diversion. 96.7% of patients reported satisfaction with care received from the diversion pathway. There was no change in ED representation rates for diverted patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 h for diverted patients compared to usual ED care. The pathway increased ED capacity, improved key ED performance metrics and safely expedited care delivery for patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140616194","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}
To define the utility of the Triage Revised Trauma Score (TRTS), GCS/Age/arterial Pressure (GAP) score, and shock index (SI) in predicting the need for in-flight blood product administration in civilian trauma patients transported by an aeromedical platform.
Methods
A retrospective chart review of 3582 aeromedical trauma cases was conducted. An initial TRTS, GAP score and SI were calculated for each patient, and the administration of in-flight blood products was also recorded. Receiver operating characteristic (ROC) curves were used to quantify the predictive discrimination of the TRTS, GAP score and SI on the need for in-flight blood product administration.
Results
The SI showed a superior predictive value compared to the TRTS and GAP score. The SI showed an area under the curve on the ROC curve of 0.85 in both primary and inter-hospital transfer cases, indicating reasonable predictive value.
Conclusion
The SI demonstrates favourable test characteristics for predicting the need for in-flight blood product administration. Prospective validation of these results is warranted.
{"title":"The shock index predicts in-flight blood transfusion in aeromedical trauma patients","authors":"Benjamin Powell BSc, PGDipHSM, MBBS, GCertTM, MPH, DipPHRM, FACEM, Susanna Cramb PhD","doi":"10.1111/1742-6723.14413","DOIUrl":"10.1111/1742-6723.14413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To define the utility of the Triage Revised Trauma Score (TRTS), GCS/Age/arterial Pressure (GAP) score, and shock index (SI) in predicting the need for in-flight blood product administration in civilian trauma patients transported by an aeromedical platform.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective chart review of 3582 aeromedical trauma cases was conducted. An initial TRTS, GAP score and SI were calculated for each patient, and the administration of in-flight blood products was also recorded. Receiver operating characteristic (ROC) curves were used to quantify the predictive discrimination of the TRTS, GAP score and SI on the need for in-flight blood product administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The SI showed a superior predictive value compared to the TRTS and GAP score. The SI showed an area under the curve on the ROC curve of 0.85 in both primary and inter-hospital transfer cases, indicating reasonable predictive value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The SI demonstrates favourable test characteristics for predicting the need for in-flight blood product administration. Prospective validation of these results is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561626","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}
Elliot Long BSc, BMBS, FRACP, PhD, Andrew Davidson MBBS, MD, FANZCA, FAHMS, Katherine J Lee BSc, MSc, PhD, Franz E Babl MD, MPH, DMedSc, FRACP, FAAP, FACEP, Shane George BSc, MBBS, MPH, FACEM, FCICM
Adaptive platform trials (APTs) offer a promising alternative to traditional randomised controlled trials for evaluating treatments for paediatric sepsis. Randomised controlled trials, despite being the gold standard for establishing causality between interventions and outcomes, make many assumptions about disease prevalence, severity and intervention effects, which are often incorrect. As a result, the evidence for most treatments for paediatric sepsis are based on low-quality evidence. APTs use accrued data rather than assumptions to power trial adaptations. They can assess multiple treatments simultaneously with shared research infrastructure. As such, APTs offer a more efficient, flexible and more effective way to identify optimal treatments. The proposed Paediatric Adaptive Sepsis Platform Trial, leveraging the Paediatric Research in Emergency Departments International Collaborative network's infrastructure, will evaluate resuscitation fluids, vasoactive medications, corticosteroids and antimicrobials. This trial has the potential to substantially impact clinical practice and reduce global sepsis mortality in children.
{"title":"Adaptive platform trials rather than randomised controlled trials for paediatric sepsis","authors":"Elliot Long BSc, BMBS, FRACP, PhD, Andrew Davidson MBBS, MD, FANZCA, FAHMS, Katherine J Lee BSc, MSc, PhD, Franz E Babl MD, MPH, DMedSc, FRACP, FAAP, FACEP, Shane George BSc, MBBS, MPH, FACEM, FCICM","doi":"10.1111/1742-6723.14409","DOIUrl":"10.1111/1742-6723.14409","url":null,"abstract":"<p>Adaptive platform trials (APTs) offer a promising alternative to traditional randomised controlled trials for evaluating treatments for paediatric sepsis. Randomised controlled trials, despite being the gold standard for establishing causality between interventions and outcomes, make many assumptions about disease prevalence, severity and intervention effects, which are often incorrect. As a result, the evidence for most treatments for paediatric sepsis are based on low-quality evidence. APTs use accrued data rather than assumptions to power trial adaptations. They can assess multiple treatments simultaneously with shared research infrastructure. As such, APTs offer a more efficient, flexible and more effective way to identify optimal treatments. The proposed Paediatric Adaptive Sepsis Platform Trial, leveraging the Paediatric Research in Emergency Departments International Collaborative network's infrastructure, will evaluate resuscitation fluids, vasoactive medications, corticosteroids and antimicrobials. This trial has the potential to substantially impact clinical practice and reduce global sepsis mortality in children.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561412","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}
Oliver Harris, Krista J Siefried RN, BScN, GradDipCardio, PhD, Angela Chiew BMedSci, MBBS(Hons), PhD, Nazila Jamshidi B.Pharm (Hons), PhD, MBBS, FRACP, FAChAM, Daniel T Chung, Nicholas Moore MBBS, MPH, FACEM, Una Nic Ionmhain MB BCh, BAO FACEM, MSc (clin tox cardiff), Darren M Roberts PhD, FRACP, FAChAM, Nadine Ezard MBBS, BA, MPH, PhD, FAChAM, Jonathan Brett MBBS (Hons), BMedSci (Hons), FAChAM, FRACP, GradDipTox, PhD
Objectives
In overdose, gamma-hydroxybutyrate (GHB) and its precursors can cause decreased levels of consciousness, coma and death. Here, we aim to describe reported exposure to GHB at four EDs in Sydney, New South Wales (NSW), Australia.
Methods
We searched the ED databases of four Sydney metropolitan hospitals for presentations relating to GHB exposure between 2012 and 2021. We calculated annual number of presentations stratified by hospital, age, sex, mode of arrival and triage category.
Results
A total of 3510 GHB-related presentations to ED were recorded across the four hospitals. Data for all hospitals were only available from 2015 onwards and between 2015 and 2021; there was a 114% increase in annual presentations (from 228 to 487). Males represented 68.7% of all presentations and the median age was 31 years (range 16–74 years). There was an increase in the proportion of female presentations between 2012 and 2021 (from 27.9% to 37.9%) along with the severity of presentation over the same period, with the proportion of presentations with a triage category 1 increasing from 19.7% to 34.5%.
Conclusions
Increases in recorded absolute number and severity of GHB-related presentations to Sydney EDs are a major public health concern. There may also be shifts in the demographics of those with GHB-related presentations. Renewed efforts are required to understand the drivers of these increases to optimally target harm reduction approaches.
{"title":"Trends in reported GHB-related presentations to Sydney emergency departments between 2012 and 2021","authors":"Oliver Harris, Krista J Siefried RN, BScN, GradDipCardio, PhD, Angela Chiew BMedSci, MBBS(Hons), PhD, Nazila Jamshidi B.Pharm (Hons), PhD, MBBS, FRACP, FAChAM, Daniel T Chung, Nicholas Moore MBBS, MPH, FACEM, Una Nic Ionmhain MB BCh, BAO FACEM, MSc (clin tox cardiff), Darren M Roberts PhD, FRACP, FAChAM, Nadine Ezard MBBS, BA, MPH, PhD, FAChAM, Jonathan Brett MBBS (Hons), BMedSci (Hons), FAChAM, FRACP, GradDipTox, PhD","doi":"10.1111/1742-6723.14402","DOIUrl":"10.1111/1742-6723.14402","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In overdose, gamma-hydroxybutyrate (GHB) and its precursors can cause decreased levels of consciousness, coma and death. Here, we aim to describe reported exposure to GHB at four EDs in Sydney, New South Wales (NSW), Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the ED databases of four Sydney metropolitan hospitals for presentations relating to GHB exposure between 2012 and 2021. We calculated annual number of presentations stratified by hospital, age, sex, mode of arrival and triage category.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 3510 GHB-related presentations to ED were recorded across the four hospitals. Data for all hospitals were only available from 2015 onwards and between 2015 and 2021; there was a 114% increase in annual presentations (from 228 to 487). Males represented 68.7% of all presentations and the median age was 31 years (range 16–74 years). There was an increase in the proportion of female presentations between 2012 and 2021 (from 27.9% to 37.9%) along with the severity of presentation over the same period, with the proportion of presentations with a triage category 1 increasing from 19.7% to 34.5%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Increases in recorded absolute number and severity of GHB-related presentations to Sydney EDs are a major public health concern. There may also be shifts in the demographics of those with GHB-related presentations. Renewed efforts are required to understand the drivers of these increases to optimally target harm reduction approaches.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335174","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}
Emily Nehme MBiostats, Karen Smith PhD, Colin Jones GDipHlthSci(MICA), Shelley Cox PhD, Peter Cameron MBBS MD, Ziad Nehme PhD
Objective
The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low-acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations.
Methods
A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018. Ambulance data were linked with ED presentations occurring up to 48 h after contact. Interrupted time series analyses were used to evaluate the impact of the revised CRM.
Results
A total of 2 365 529 calls were included. The proportion allocated a Code 1 (time-critical, lights/sirens) dispatch decreased from 56.6 to 41.0% after implementation of the revised CRM. The proportion of calls not receiving an emergency ambulance increased from 10.4 to 19.6%. Interrupted time series analyses demonstrated an improvement in Code 1 cases attended within 15 min (Key Performance Indicator). However, for patients with out-of-hospital cardiac arrest or requiring lights and sirens transport to hospital, there was no improvement in response time performance. By the end of the study period, there was also no difference in the proportion of callers presenting to ED when compared with the estimated proportion assuming the revised CRM had not been implemented.
Conclusion
The revised CRM was associated with improved Code 1 response time performance. However, there was no improvement in response times for high acuity patients, and no change in the proportion of callers presenting to ED.
{"title":"Refining ambulance clinical response models: The impact on ambulance response and emergency department presentations","authors":"Emily Nehme MBiostats, Karen Smith PhD, Colin Jones GDipHlthSci(MICA), Shelley Cox PhD, Peter Cameron MBBS MD, Ziad Nehme PhD","doi":"10.1111/1742-6723.14406","DOIUrl":"10.1111/1742-6723.14406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low-acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018. Ambulance data were linked with ED presentations occurring up to 48 h after contact. Interrupted time series analyses were used to evaluate the impact of the revised CRM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2 365 529 calls were included. The proportion allocated a Code 1 (time-critical, lights/sirens) dispatch decreased from 56.6 to 41.0% after implementation of the revised CRM. The proportion of calls not receiving an emergency ambulance increased from 10.4 to 19.6%. Interrupted time series analyses demonstrated an improvement in Code 1 cases attended within 15 min (Key Performance Indicator). However, for patients with out-of-hospital cardiac arrest or requiring lights and sirens transport to hospital, there was no improvement in response time performance. By the end of the study period, there was also no difference in the proportion of callers presenting to ED when compared with the estimated proportion assuming the revised CRM had not been implemented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The revised CRM was associated with improved Code 1 response time performance. However, there was no improvement in response times for high acuity patients, and no change in the proportion of callers presenting to ED.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335173","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}
Michelle Davison MBBS FACEM, Jason Chan MBBS, FACEM, Meg Clarke BNurs, Caroline Mitchell RN, MNP, Alan Yan BM, FACEM, MHA, Emma Ballard BAppSc(Hons), M Biostatistics (PHD), Elwyn Henaway
Objective
The ‘Deadly RED’ project primarily aimed to improve culturally competent care to reduce the number of First Nations patients presenting to a Queensland ED who ‘Take own leave’ (TOL). The secondary aim was to evaluate the implementation project.
Methods
A pre/post-test quasi experimental study design using mixed methods was co-designed with adherence to Indigenous research considerations. Quantitative analysis of First Nations presentations before and after Deadly RED implementation was performed using SPSS. Qualitative analysis of transcribed research yarns in NVIVO was coded and themed for analysis. Staff experiences and perspectives were collated using electronically distributed surveys and process audits were performed.
Results
A total of 1096 First Nations presentations June to August 2021 and 1167 in the matched 2022 post-implementation period were analysed. Significantly more patients were recorded as TOL post-implementation (13.0% pre vs 21.3% post) and representations rates were unchanged. Forty-six staff surveyed identified improvements in all parameters including cultural appropriateness and quality of care. Qualitative analysis of 85 research yarns revealed themes migrated to increasingly acceptable, accessible, and usable care. Notably, 45% of the First Nation's patients recorded as TOL self-reported that their treatment was complete. The study was feasible as 80% of packs distributed and 73% follow-up screening after TOL.
Conclusions
The Deadly RED evaluation revealed significant discrepancies in the reported data points of TOL and the ‘story’ of the First Nations persons experience of appropriate and completed care. Staff awareness and cultural capability improved significantly, and yarning allowed knowledge translation and improvements in communication which contributed to a better healthcare experience for First Nations patients attending our ED.
目标：Deadly RED "项目的主要目的是改善文化适宜性护理，以减少昆士兰州急诊室的原住民患者 "自行离院"（TOL）的人数。次要目的是评估项目的实施情况：方法：采用混合方法共同设计了一项前/后测试准实验研究设计，并考虑到了土著研究因素。使用 SPSS 对 "致命 RED "实施前后原住民的发言进行了定量分析。对 NVIVO 中转录的研究报告进行了定性分析，并进行了编码和主题分析。使用电子分发的调查问卷整理了员工的经验和观点，并进行了流程审计：对 2021 年 6 月至 8 月的 1096 例原住民病例和 2022 年实施后的 1167 例原住民病例进行了分析。实施后被记录为TOL的患者明显增多（实施前为13.0%，实施后为21.3%），陈述率保持不变。接受调查的 46 名员工认为所有参数都有所改善，包括文化适宜性和护理质量。对 85 项研究成果进行的定性分析显示，研究主题已转移到可接受性、可访问性和可用性越来越高的护理方面。值得注意的是，原住民中 45% 被记录为 TOL 的患者自我报告说他们的治疗已经完成。这项研究是可行的，因为在 TOL 之后，80% 发放的药包和 73% 的后续筛查都是可行的：Deadly RED 评估显示，报告的 TOL 数据点与原住民获得适当和完整护理的 "故事 "存在重大差异。工作人员的意识和文化能力都有了显著提高，通过学习实现了知识转化并改善了沟通，从而为到我们急诊室就诊的原住民患者带来了更好的医疗体验。
{"title":"Evaluation of a pathway to address take own leave events for First Nations peoples presenting for emergency care: The Deadly RED project","authors":"Michelle Davison MBBS FACEM, Jason Chan MBBS, FACEM, Meg Clarke BNurs, Caroline Mitchell RN, MNP, Alan Yan BM, FACEM, MHA, Emma Ballard BAppSc(Hons), M Biostatistics (PHD), Elwyn Henaway","doi":"10.1111/1742-6723.14397","DOIUrl":"10.1111/1742-6723.14397","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The ‘Deadly RED’ project primarily aimed to improve culturally competent care to reduce the number of First Nations patients presenting to a Queensland ED who ‘Take own leave’ (TOL). The secondary aim was to evaluate the implementation project.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A pre/post-test quasi experimental study design using mixed methods was co-designed with adherence to Indigenous research considerations. Quantitative analysis of First Nations presentations before and after Deadly RED implementation was performed using SPSS. Qualitative analysis of transcribed research yarns in NVIVO was coded and themed for analysis. Staff experiences and perspectives were collated using electronically distributed surveys and process audits were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1096 First Nations presentations June to August 2021 and 1167 in the matched 2022 post-implementation period were analysed. Significantly more patients were recorded as TOL post-implementation (13.0% pre <i>vs</i> 21.3% post) and representations rates were unchanged. Forty-six staff surveyed identified improvements in all parameters including cultural appropriateness and quality of care. Qualitative analysis of 85 research yarns revealed themes migrated to increasingly acceptable, accessible, and usable care. Notably, 45% of the First Nation's patients recorded as TOL self-reported that their treatment was complete. The study was feasible as 80% of packs distributed and 73% follow-up screening after TOL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Deadly RED evaluation revealed significant discrepancies in the reported data points of TOL and the ‘story’ of the First Nations persons experience of appropriate and completed care. Staff awareness and cultural capability improved significantly, and yarning allowed knowledge translation and improvements in communication which contributed to a better healthcare experience for First Nations patients attending our ED.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140331605","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}
Michaela J Ryan MD, BMedSc (Hons), Andis Graudins MBBS, PHD, Nicole O'Shea Bachelor of pharmacy, Firouzeh Noghrehchi PHD, Anselm Wong MBBS, PHD
Objectives
In June 2020, modified-release paracetamol (paracetamol-MR) preparations were up-scheduled from schedule-2 (available in pharmacy) to schedule-3 (available by request to a pharmacist only). The present study aims to ascertain whether up-scheduling affected the frequency of paracetamol-MR overdoses.
Methods
This is a retrospective cohort study of two data sets from 1 June 2017 to 31 May 2022. Monash Health data were extracted using the diagnosis of paracetamol overdose coding and electronic medical records data. Calls regarding paracetamol-MR overdoses to Victorian Poisons Information Centre (VPIC) were extracted from the Poisons centre call database. We used a quasi-experimental research design with interrupted time series analysis to evaluate the immediate impact and change in trend of poisoning-related calls and ED presentations before and after June 2020. The change in proportion of paracetamol-MR cases in both databases was analysed using the Χ2 test.
Results
The proportion of paracetamol-MR cases in both data sets did not change. From Monash Health, there was no level change in monthly paracetamol-MR overdose-related presentations following re-scheduling (rate ratio [RR] = 1.08, 95% confidence interval [CI] = 0.57–2.01). There was no change in monthly paracetamol-MR overdose-related calls to VPIC following re-scheduling (RR = 1.05, 95% CI = 0.96–1.14).
Conclusion
The proportion of paracetamol-MR overdoses did not decrease after the up-scheduling to S3. Similarly, the frequency of overdoses by month remained similar. Further limitations on access to paracetamol products may need to be considered.
{"title":"Has the rescheduling of modified-release paracetamol in Australia affected the frequency of overdoses?","authors":"Michaela J Ryan MD, BMedSc (Hons), Andis Graudins MBBS, PHD, Nicole O'Shea Bachelor of pharmacy, Firouzeh Noghrehchi PHD, Anselm Wong MBBS, PHD","doi":"10.1111/1742-6723.14403","DOIUrl":"10.1111/1742-6723.14403","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In June 2020, modified-release paracetamol (paracetamol-MR) preparations were up-scheduled from schedule-2 (available in pharmacy) to schedule-3 (available by request to a pharmacist only). The present study aims to ascertain whether up-scheduling affected the frequency of paracetamol-MR overdoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective cohort study of two data sets from 1 June 2017 to 31 May 2022. Monash Health data were extracted using the diagnosis of paracetamol overdose coding and electronic medical records data. Calls regarding paracetamol-MR overdoses to Victorian Poisons Information Centre (VPIC) were extracted from the Poisons centre call database. We used a quasi-experimental research design with interrupted time series analysis to evaluate the immediate impact and change in trend of poisoning-related calls and ED presentations before and after June 2020. The change in proportion of paracetamol-MR cases in both databases was analysed using the <i>Χ</i><sup>2</sup> test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of paracetamol-MR cases in both data sets did not change. From Monash Health, there was no level change in monthly paracetamol-MR overdose-related presentations following re-scheduling (rate ratio [RR] = 1.08, 95% confidence interval [CI] = 0.57–2.01). There was no change in monthly paracetamol-MR overdose-related calls to VPIC following re-scheduling (RR = 1.05, 95% CI = 0.96–1.14).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The proportion of paracetamol-MR overdoses did not decrease after the up-scheduling to S3. Similarly, the frequency of overdoses by month remained similar. Further limitations on access to paracetamol products may need to be considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287182","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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