Australasian Emergency Care最新文献

Aim: To examine the effect of the HIRAID® emergency nursing framework on clinical handover.

Background: Clinical handover is very frequent in emergency departments and critical for patient safety. Inadequate handovers are associated with up to 80 % of adverse events.

Methods: This modified stepped-wedge cluster randomised control trial was conducted across 29 Australian rural, regional and metropolitan emergency departments between 2020 and 2024. HIRAID® was implemented using a behaviour change theory-informed strategy. Surveys were distributed to eligible staff. Quantitative data were analysed using a multiple regression approach; qualitative data using inductive content analysis.

Results: Surveys were completed by 1205 nurses (671 control, 534 intervention) and 328 medical staff (176 control, 152 intervention). Significant improvements were observed in satisfaction with nurse-to-nurse communication of patient history (t = 5.57, p < 0.001, 95 % C.I. = 0.33-0.69), physical assessment (t = 4.72, p < 0.001, 95 % C.I. = 0.28-0.68), recognition of clinical deterioration (t = 2.58, p = 0.01, 95 % C.I. = 0.06-0.43), information relevance (t = 3.29, p = 0.001, 95 % C.I. = 0.13-0.51) and completeness (t = 3.60, p < 0.001, 95 % C.I. = 0.17-0.56). Qualitative findings supported these results.

Conclusions: Implementing a structured emergency nursing framework improved nurse-to-nurse clinical handover, supporting safer patient care.

Background: Headache is a common emergency department (ED) presentation. We aimed to determine the proportion of patients undergoing Computerised Tomography (CT) for non-traumatic headache and identify factors influencing clinician decision-making.

Methods: We conducted a retrospective chart review of adult ED presentations at the Royal Melbourne Hospital from January to March 2024. Clinical features and CT data were extracted and mapped against SNOOP4 features.

Results: Among 223 patients, 124 (55.6 %) underwent CT, with abnormal findings in 15.3 % (19/124). No patient-reported symptoms increased the likelihood of CT ordering; photophobia was negatively associated (Odds Ratio (OR)= 0.41, 95 % Confidence Interval (CI):0.22-0.79). Examination abnormalities in peripheral sensation (OR=13.04, 95 %CI:1.69-100.59) and strength (OR= 3.62, 95 %CI:1.00-13.09) increased CT use. Patients with > 2 SNOOP4 features had markedly higher odds of receiving CT (OR= 13.5, 95 %CI:3.12-58.34) and of abnormal findings (OR= 5.75, 95 %CI:2.03-16.27).

Conclusions: CT neuroimaging for non-traumatic headache was frequently performed, with a relatively low abnormal yield. While patient-reported symptoms did not influence CT ordering, examination findings and cumulative SNOOP4 features were associated with both imaging decisions and abnormal results. These findings support future studies into red-flag-based pathways to guide purposeful CT use.

Background: To address increasing wait times and length of stay, many emergency departments (EDs) have implemented protocols focused on nurse-initiated care, enabling nurses to commence treatments, investigations or medications under standing orders or protocols. This study provides scientometric analysis and data visualisation of nurse-initiated care research.

Methods: A systematic search of the Web of Sciences Core Collection was conducted from inception to November 2025. Bibliometric and scientometric techniques examined publication trends, journals, authorship, co-citation patterns and keyword co-occurrence. Clinical coding was applied to classify problems, interventions and populations.

Results: A total 126 papers were identified, published between 1971 and 2025 across 64 journals and 23 countries. Publication activity was limited until 2000, until an increase and more marked growth from 2012. Nurse-initiated analgesia and x-rays were most frequently studied. Other studies examined nurse-initiated care for time-sensitive conditions such as pain, musculoskeletal injuries and trauma. Most protocols were for adult populations, though paediatric and older adult cohorts also featured. Keywords consistently included triage, analgesia and emergency care.

Conclusions: Nurse-initiated care in EDs is a growing field, with increasing evidence supporting its relevance to time-critical presentations.

Background: Older adults with cognitive impairment frequently present to emergency departments and often experience poor pain management. Patients' impaired self-reporting, limited clinician training, inconsistent use of behavioural tools, and environmental pressures have been reported challenges. This study examined emergency clinicians' knowledge and practices in assessing pain for this population.

Methods: A descriptive cross-sectional survey was conducted across two emergency departments in Australia. An 86-item survey collected clinicians' pain assessment knowledge and practices. Quantitative data were analysed using descriptive statistics, and qualitative responses were thematically analysed.

Results: 148 clinicians (110 nurses, 21 doctors, 17 allied health staff) responded to the survey (response rate =13.9 %). Whilst 80.9 % of respondents agreed observational tools were important, 44.6 % routinely used observational tools and perceived importance of these varied across clinical groups (p = 0.001). A self-report tool, the Numerical Rating Scale, was most used (78.3 %). The top barrier for pain assessment was patients' inability to communicate and top enabler was viewing pain as a priority.

Conclusions: Clinicians recognised the importance of assessing pain in cognitively impaired older adults, yet practice was inconsistent and often relied on self-report and subjective observation. Targeted training, accessible observational assessment tools, and clear guidelines are needed to improve pain assessment and management.

Background: Linking routinely collected patient-level health data supports service planning and research while protecting privacy, though it poses several challenges. This paper demonstrates the process used to produce high-quality linked data for early pregnancy complication care for patients presenting to the Emergency Department (ED).

Methods: Ten years of regional health data were merged using deterministic linkage in five steps: 1) applying strict inclusion/ exclusion criteria via extraction code, 2) collecting data, 3) refining and pre-processing, 4) preparing datasets, and 5) linking to create the final dataset. Many challenges arose throughout this process, and pragmatic solutions were co-developed with the research team and data custodian.

Results: Challenges included handling multi-supply of encrypted, complex datasets; inconsistent health data systems; limited formal support for data interpretation; incomplete and conflicting records; and misalignment between data and research questions. Solutions involved automated data management, clinically guided extraction and exclusions, and a time-based grouping method to improve linkage yield, address missing data and absent linking terms.

Conclusion: Using an exemplar, methods of data collection, pre-processing and linking have been described. A transferable multi-step process and key lessons support efficient use of health data and data driven local policy decisions for the care of patients presenting with early pregnancy complications to the ED.

Background: For over 30 years ambulance services have used the community paramedic (CP) model, in which paramedics receive additional education and deliver specialist interventions to manage non-emergency patients. This study empirically quantifies their actions with patients.

Methods: An independent observer conducted continuous time-and-motion workflow observations of CPs over 22 consecutive days. Results were bootstrapped, descriptive and inferential statistics reported, and the structure of the standard case mapped.

Results: A total of 77 patients were observed for 5496 minutes. Mean on-scene time was 55 min (range 20-98, 95 %CI 54-56). Time was 56 % spent either completing paperwork or transporting, 28 % gathering data, 9 % discussing options, and 7 % providing interventions. The most common vital signs were heart rate/Sp0₂ (96 %), blood pressure (90 %), and temperature (81 %); others were measured in under 40 % of patients. Specialist scope was utilised in 16 % of patients, involving 8 of 24 available interventions. Overall, 57 % of patients were transported (51 % ED, 6 % urgent care), and 13 % were referred onwards.

Conclusions: This study provides insight into how CPs spend their time with patients. Results suggest that interactions focus on assessment and decision-making rather than specialist interventions; that this is a 'thinking' rather than a 'doing' role.

Background: To better align with the evolving needs of the community, Australian ambulance services are increasingly required to develop innovative care models. The dual-qualified emergency nurse-paramedic has skills and knowledge that align with these models yet is underutilised as a flexible workforce group available to meet specific needs. This research explored the lived experience of dual-qualified emergency nurse-paramedics working for Australian jurisdictional ambulance services to gain their perspectives.

Method: A descriptive phenomenological approach, informed by the works of Husserl was adopted for this study. Individual interviews were conducted with dual-qualified emergency nurse-paramedics (N = 13). Data was analysed according to Colaizzi.

Results: Participants described frustration with the current lack of acknowledgement of, and potential to therefore apply their knowledge, skills and experience. They voiced a desire for dual regulatory support and for an emergency nurse-paramedic role to be established. Beneficiaries of such a role were perceived to include the health system, ambulance services, the community, and the individual practitioner, whilst barriers included regulatory and organisational challenges.

Conclusion: The introduction of an emergency nurse-paramedic role in Australian jurisdictional ambulance services is timely and could contribute to improving care and health service delivery.

Oleander is an imported ornamental shrub occurring across the majority Australia with two main species Nerium oleander (common or pink oleander) and Cascabela thevetia (yellow oleander) seen. Oleander is a highly toxic plant containing cardiac glycosides that can lead to life-threatening cardiac and gastrointestinal complications. All parts of the plant are toxic. Accidental and intentional ingestion of the plant is reported throughout the world involving both humans and animals. Published case reports from Australia are historical and do not reflect current conventional management. This case report details the intentional ingestion of oleander leaves as a food source and the differing presentations of two family members. The report describes the presentation, diagnosis, and successful management of both patients. This report aims to enhance awareness among healthcare professionals regarding the clinical features, diagnosis, and current treatment of oleander toxicity especially in the pre-hospital and emergency settings.

Background: The implementation of palliative care nursing (PCN) in emergency departments (ED) is challenging, particularly in developing countries. There were several barriers faced by ED nurses. However, the specific barriers to the provision of PCN in the ED of developing countries' hospitals remained unclear. This scoping review aimed to explore the barriers to the provision of palliative nursing care in the ED of developing countries' hospitals.

Methods: This scoping review utilized five databases: Scopus, PubMed, ScienceDirect, Medline, and ProQuest, in addition to a Google Scholar search and backward and forward citation tracking. The articles included must have been published between 2014 and 2025, be available as full text, and be written in English. Two authors independently performed the article selection process, adhering to the PRISMA protocol.

Results: We included eight articles from six developing countries: China, Brazil, Uganda, Thailand, Indonesia, and Ghana. We identified and classified barriers to the provision of PCN in the ED in developing countries into several themes, including lack of knowledge and skills, lack of health facilities, practical issues, ethical issues, and family boundaries.

Conclusions: Understanding the barriers to the provision of PCN is expected to provide a foundation for evaluating and enhancing its implementation in the ED, particularly in developing countries' hospitals.

Background: First-line pharmacological management of acute renal colic pain may vary influenced by preference, structural and staffing issues with emergency departments. The aim of this study was to explore the variation in renal colic pain management and contributing factors within emergency departments in Australia METHODS: A specifically designed survey was sent to relevant national professional colleges and organisations for distribution. The survey presented respondents with four acute renal colic scenarios. Descriptive statistics summarised quantitative data, while free text responses were explored using content analysis.

Results: Responses from 180 nurses, paramedics and medical doctors were analysed. Opioids were the most commonly prescribed analgesia (4 scenarios) in combination with either paracetamol (3 scenarios) or rectal NSAIDs (1 scenario). Free text responses provided context to the preference of opioids and identified workload, clinician availability and scope of practice limitations to timely analgesia provision. Most respondents (91.2 %) would support research into non-pharmacological alternatives to opioids.

Conclusion: Opioids remain the first line preference for many clinicians in managing acute renal colic pain despite current guideline recommendations for NSAIDs. Departmental and clinician capacity, and practice limitations contribute to delays in providing analgesia. Greater consistency and predictability in prescribing, review of limitations on nurse prescribing and exploring novel low risk first line non-pharmacological analgesics may improve management of acute renal colic.