Australasian Emergency Care最新文献

Background: Triage nurses have under five minutes to assess patients; prioritise urgency and assign wait times. Triage accuracy is vital for patient safety and Emergency Department (ED) efficiency. Guidelines for triage nurse refresher training are unclear. This review aimed to describe the evidence on ED triage nurse refresher training.

Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), searching Medline, Embase and CINAHL databases from 2007 to 2024.

Results: Eighteen studies were included. Problem-based learning, lectures, simulation, and project learning were identified as effective education strategies, with multiple teaching methods frequently used. Cost and delivery mode affected refresher training. Tiredness, patient context, and nurses' forming personal rules over time negatively impacted accuracy, while clear guidelines and flowcharts helped maintain it.

Conclusions: Triage refresher training enhances nurses' accuracy. Clear guidance on minimum standards along with visible resources, guidelines and flowcharts further improve triage accuracy. Further research is needed to understand the long-term effects on patient safety and ED patient flow.

Background and aim: Screening of traumatic brain injuries (TBI) using different clinical assessment tools would facilitate diagnosis and effective inpatient follow-up. We aimed to describe rates of diagnosis, classification, documentation, and referral practices for TBI inpatients.

Material and methods: In a retrospective cohort study, we reviewed electronic clinical records of adult patients admitted to a hospital ward with head trauma from an emergency department (ED) in 2021. Data included demographics, injury, TBI diagnoses, and referral to concussion services. Factors predicting ED physician documentation and referral to concussion services were identified.

Results: Of approximately 34,000 adults admitted from the ED, 1059 presented with head trauma, and 609 (57.5 %) were diagnosed with TBI. There were 553 mild/moderate TBI cases with an incidence rate of 103.4 per 100,000 adult population in Canterbury. 14 % (n = 77) were referred to a concussion service. Predictors of ED-documented TBI included non-isolated head injury (OR:0.60), head CT request (OR:9.12), injured in street/public areas (OR:2.03). Older age and non-isolated head injury decreased odds of concussion service referral (0.96 and 0.46, respectively), while female and ED-documented TBI increased odds of referral (5.8 and 28, respectively).

Conclusion: Better documentation of mild/moderate TBI might facilitate health care access, with efficient clinical decision making.

Background: The representation of healthcare professionals in television has been subject to critique due to the depictions of stereotypical tropes between professional disciplines. Production of factual television programs requires healthcare professionals to perform their roles for a diverse audience, and ideally presents an accurate portrayal of patient care.

Methods: We used an anonymous mixed-method survey framed by symbolic interactionism and Goffman's theory of presentation of self to explore how staff negotiate representation during the filming of an observational documentary in an Emergency Department. Quantitative data were analysed using descriptive statistics and qualitative data using thematic analysis.

Results: In total 105 staff completed the survey, predominantly nurses and physicians. They reported mixed responses to the impact of filming on professional performance and clinical care. Two themes from the qualitative data revealed that staff sought ideal representation through television production, while also being required to engage in additional work to adjust to the filming team, manage team dynamics, and provide appropriate patient care.

Conclusion: Filming of documentaries provides the opportunity for healthcare professionals to engage in representation. However, there is a need to challenge dominant depictions of medical-nursing hierarchies, and present a broader variety of clinical presentations.

Background: The most commonly reported side effect of intramuscular injection is pain. Cold needles and ShotBlocker can be used as non-pharmacological methods for pain relief. This study aims to determine the effect of cold needle and ShotBlocker on pain and satisfaction in intramuscular injection pain.

Methods: This is a triple-blind, randomized controlled study. The study was conducted on 120 patients (40: control, 40: cold needle, 40: ShotBlocker) who presented to the emergency department of a university hospital in Turkey for cyanocobalamin injection in July-August 2024. Data were collected using a patient identification form, visual pain scale (VPS), and injection satisfaction scale. SPSS statistical package (version 22.0; SPSS, Inc., USA) was used to analyze the data.

Results: In the study, the groups were found to be similar except for age and continuous drug use. The pain scores of the control group were significantly higher than those of the cold needle and ShotBlocker groups. Injection satisfaction was significantly higher in the cold needle and ShotBlocker groups than in the control group.

Conclusion: Both the Cold Needle and the ShotBlocker can be used as effective methods to reduce pain associated with intramuscular injections and improve injection satisfaction. Both methods are non-pharmacological, inexpensive, and easy to use, and they can be used safely and effectively in all clinical settings.

Background: The impact of Emergency Medical Service (EMS) stroke performance indicators on patient outcomes is unclear. We aimed to evaluate adherence to EMS indicators (15 minutes response, 60 minutes transport to a stroke centre or both) and associations with treatment access and patient outcomes.

Method: Retrospective cohort study using data from the Australian Stroke Clinical Registry and ambulance records from Victoria (2015-2017) for patients (≥18 years) with stroke transported by ambulance. Multivariable regression models were used to evaluate EMS adherence to performance indicators and outcomes of interest.

Results: Among 4206 patients (72 years; 42 % female), EMS indicators were less frequently met for patients in regional areas (aOR: 0.27; 95 % CI: 0.17, 0.43). Socio-economic disparities were observed, with patients in advantaged areas less likely to receive an ambulance response within 15 minutes. Adherence to EMS performance indicators was associated with shorter off-stretcher time and increased thrombolytic therapy use (aOR: 1.62; 95 % CI: 1.24, 2.11). EMS adherence to performance indicators did not significantly impact functional independence, or health-related quality of life.

Conclusions: EMS adherence to performance indicators improved off-stretcher time and thrombolytic therapy use but was influenced by geographic and socio-economic status. Refining EMS performance targets and tailoring public and EMS education on stroke is needed.

Background: Falls are a source of harm, repeat emergency department visits and hospital admission for older adults. Undertaking a comprehensive geriatric screening including falls-risk is recommended in guidelines for optimal older adult emergency department care.

Methods: A pragmatic prospective cohort study was undertaken to evaluate use of further falls-risk screening in older adults in a large tertiary Australian hospital emergency department. Primary outcome measures of interest were length of stay; discharge destination; 30-day and 90-day re-presentations.

Results: Of 651 eligible cases, 320 were randomly recruited for further screening following consent. The implementation cohort spent an average 45 m longer in the emergency department with a greater proportion admitted to the short stay unit, staying there longer than a comparison cohort. There were significantly fewer 30-day fall-related representations (2.9 %) in the implementation cohort.

Conclusions: Despite a small reduction in emergency department re-presentation within 30 days in the implementation cohort, hospital admission was not reduced. Further research is needed to examine any cost-benefit ratio of additional falls-risk screening and intervention in emergency departments.

Background: The water-based environment presents challenges to emergency services responding to medical emergencies. These include logistical difficulties, interagency response requirements, and knowledge of unique clinical conditions. Understanding which water-based incidents need emergency response, their locations, and resource needs is essential for preparing paramedics and other emergency service personnel.

Objective: To describe the existing literature examining the prehospital response and management of patients who experience an emergency in a water-based environment.

Review methods: This review used a scoping review methodology following JBI guidance. Five databases were searched: Ovid Medline, EMCARE, CINAHL, SPORTDiscus, and Web of Science. Two independent reviewers screened articles against predefined inclusion criteria. Data were extracted using a structured form, in accordance with JBI guidance.

Results: The search identified 6122 articles, of which 101 were included in the review. Eight emergency service types were described. A broad range of medical emergencies were reported, although most studies focused on fatal drowning. Research on non-fatal drowning and interagency coordination was limited, and reported outcome varied considerably across studies.

Conclusions: Much of the prehospital research on water-based emergencies reports only on fatal drowning, with limited attention to other incident types or agency interoperability. Further research is needed to improve understanding of emergency response, patient outcomes, and interoperability of emergency services in the context of water-based emergencies.

Background: Postgraduate education in health sciences requires practical and interprofessional training. In prehospital emergency medical services, clinical educators play a key role in integrating theoretical and practical knowledge. However, there is a gap in the literature regarding the perceptions of both clinical educators and postgraduate students on out-of-hospital clinical placements METHODS: a descriptive phenomenological approach was used. Semi-structured interviews were conducted with 14 students and 12 clinical educators in the field of prehospital emergency medicine. The interviews were analysed using the Colaizzi method.

Results: Four main themes were identified: the challenges faced at the start of prehospital emergency clinical placements; the heterogeneity of teaching methods used by clinical educators; students' attitudes and levels of preparedness for the prehospital environment; and the development of technical and non-technical skills.

Conclusions: This study highlights the importance of a standardised initial orientation to help students integrate into this environment and to align their expectations. It also emphasises the need to standardise teaching practices, provide support for students' insecurities, and ensure that students have a proactive attitude and a broad knowledge base to help them adapt. Finally, it emphasises the importance of students learning both technical and non-technical skills.

Objective: This study aimed to explore the in-service training needs and expectations of junior nurses in Chinese emergency departments, using the Capability-Opportunity-Motivation-Behaviour (COM-B) model to inform the development of targeted training strategies.

Methods: A qualitative descriptive design and inductive thematic analysis were used. Semi-structured face-to-face interviews were conducted with 16 emergency department (ED) staff between January and February 2025.

Results: The training needs and expectations of junior ED nurses can be summarised into four themes: capability, the depth of mental and physical needs; opportunity, the two-way construction of physical and social opportunities; motivation, the synergy of self-motivation and reflective motivation; and training management: diversified training forms, scientifically reasonable training time, composite team of lecturers, and multidimensional assessment and evaluation.

Conclusion: In developing in-service training program, nursing managers should pay attention to the needs of nurses in terms of competence, motivation, opportunity and training management, and design training content and forms that meet actual needs, in order to enhance the professionalism and clinical competence of junior ED nurses, strengthen professional identity and work motivation, reduce the willingness to leave, and promote sustainable development.

Background: Family presence during critical paediatric emergencies is increasingly accepted practice in paediatric emergency departments, within Australia and internationally. However, limited research explores parent experiences in high-acuity, resuscitation-level presentations.

Methods: This qualitative study used Attride-Stirling's thematic network analysis methodology to identify key themes. Semi-structured telephone interviews were undertaken with 20 parents whose child received care during a critical paediatric emergency at the Emergency Department of The Royal Children's Hospital, Melbourne, Australia.

Results: Thematic network analysis identified 136 unique themes relating to parent experiences and self-identified psychosocial care needs, resulting in the two organising themes of 'Parent perspectives' and 'Emergency system interventions', and the global theme of 'Family responsive service protocols'. These findings highlight the value of family-centred care approaches in paediatric emergency settings, emphasising the importance of staff communication skills and peri-event psychosocial support throughout the episode of care.

Conclusions: Recommendations for practice include enhancing communication strategies, improving pre-arrival preparation, optimising the physical environment, and implementing dedicated family support roles.