Australasian Emergency Care最新文献

Background: Emergency Clinical Nurse Specialists (CNS) are experts in treating patients across the lifespan in the dynamic, unpredictable and busy Emergency Department (ED). The aim of this paper was to create a profile of the Emergency CNS role and practice, and assess work satisfaction.

Methods: An online cross-sectional survey based on the College of Emergency Nursing Australasia's Practice Standards for the Specialist Emergency Nurse was conducted in the Australian states of Victoria and New South Wales.

Results: There were 59 survey responses. The domains Lawful Practice, Professional Ethics and Communication were rated as practiced with the greatest frequency, and Lawful Practice and Teamwork were rated very important by respondents. 79 % of CNSs planned to continue working in ED, with all CNSs reporting plans to continue working in healthcare. 77 % of CNSs were satisfied in their current role.

Conclusion: The Practice Standards for the Specialist Emergency Nurse are used regularly and are relevant to CNS practice. CNSs are largely satisfied with their role, which is versatile and multifaceted. However, CNSs face challenges to perform all elements of their role, and reported protected non-clinical time and collaboration with management as enablers to their role.

Objective: The Victorian Virtual Emergency Department (VVED) provides emergency care for patients across Victoria, Australia with non-life-threatening concerns. This study aims to explore subsequent self-referral patterns of patients after initial presentation to the VVED.

Methods: A retrospective cohort study was conducted in 42,921 VVED patients between October 2020 and June 2024. Subsequent self-referral rates among VVED patients who were initially referred through a health care provider (HCP) referral pathway were compared to those who self-referred upon their first presentation. Descriptive statistics and multivariable logistic regression modelling were used.

Results: Patients were more likely to self-refer on their second presentation if they self-referred on their first presentation (88 % vs 40 %; p < 0.001). Multivariable logistic regression analyses showed significantly lower odds of subsequent self-referral in all HCP referral pathways compared to the self-referral group. Patients referred through pathways without an HCP present had higher odds of subsequent self-referral than those referred via pathways with a HCP present (OR=1.19, 95 % CI: 1.10-1.28).

Conclusions: Patients who self-refer to the VVED initially are more likely to continue self-referring to the service. Further research is needed to explore factors that may enhance the likelihood of self-referral to virtual emergency care services.

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.