Pub Date : 2024-12-02DOI: 10.1016/j.auec.2024.11.004
Loren Barton , Mark Nelson , Kirsten Strudwick , Corey Scholes
Background
There is no published literature on the predictive ability of the Clinical Frailty Scale (CFS) for falls risk specific to the Emergency Department (ED) population. This study aims to develop a prognostic model to determine the predictive ability of the CFS for ED falls’ re-presentation in community-dwelling older people.
Methods
A retrospective observational cohort study was completed from July 2019 to July 2022 on community dwelling people aged 75 years and over who presented to the ED with an extrinsic fall and had a CFS score recorded. The primary outcome was fall-related re-presentation to ED; the secondary outcome was mortality. A flexible parametric survival model was applied with time to falls re-presentation, and post-estimation, used to predict the probability of another fall re-presentation within 6 months. Calibration was assessed and a decision support curve generated.
Results
The model demonstrated reasonable calibration-in-the-large (Slope = 0.999) and fit between CFS and probability of fall re-presentation. The CFS model displayed negligible discriminant ability (C-statistic = 0.534) for identifying older people at risk of falls-related ED re-presentations within 6 months of index presentation.
Conclusions
The CFS cannot be used to prognosticate an individual’s risk of ED re-presentation within 6 months of an index extrinsic fall.
{"title":"The Clinical Frailty Scale offers little utility as part of a prediction model for community-dwelling older fallers at risk of re-presenting to the emergency department.","authors":"Loren Barton , Mark Nelson , Kirsten Strudwick , Corey Scholes","doi":"10.1016/j.auec.2024.11.004","DOIUrl":"10.1016/j.auec.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>There is no published literature on the predictive ability of the Clinical Frailty Scale (CFS) for falls risk specific to the Emergency Department (ED) population. This study aims to develop a prognostic model to determine the predictive ability of the CFS for ED falls’ re-presentation in community-dwelling older people.</div></div><div><h3>Methods</h3><div>A retrospective observational cohort study was completed from July 2019 to July 2022 on community dwelling people aged 75 years and over who presented to the ED with an extrinsic fall and had a CFS score recorded. The primary outcome was fall-related re-presentation to ED; the secondary outcome was mortality. A flexible parametric survival model was applied with time to falls re-presentation, and post-estimation, used to predict the probability of another fall re-presentation within 6 months. Calibration was assessed and a decision support curve generated.</div></div><div><h3>Results</h3><div>The model demonstrated reasonable calibration-in-the-large (Slope = 0.999) and fit between CFS and probability of fall re-presentation. The CFS model displayed negligible discriminant ability (C-statistic = 0.534) for identifying older people at risk of falls-related ED re-presentations within 6 months of index presentation.</div></div><div><h3>Conclusions</h3><div>The CFS cannot be used to prognosticate an individual’s risk of ED re-presentation within 6 months of an index extrinsic fall.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 110-115"},"PeriodicalIF":2.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774992","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}
Pub Date : 2024-11-26DOI: 10.1016/j.auec.2024.10.004
Megan R. Simic , Joanne E. Porter , Blake Peck , Christopher Mesagno
Purpose
In the recovery phase of COVID-19 disaster management, Emergency Department (ED) nurses are attempting to return to normal workforce operations, despite significant impacts on personal and professional lives. This review aims to examine and synthesise current literature for the learnings and recommendations from the lived experiences of ED nurses during the COVID-19 pandemic.
Procedures
Electronic databases CINAHL Complete, Web of Science, Scopus (Elsevier) and PubMed were utilised using a 5-year timeframe that aligned with COVID-19 in Australia. Final date of accepted papers was 28th February 2024. A JBI Mixed Methods Convergent Integrated Approach was used.
Findings
A total of 15 studies were included in the final review, representing seven countries of origin and included 649 ED nurses. Seven major themes related to learnings and recommendations were generated from data synthesis including (1) professional identity, (2) wellbeing support, (3) camaraderie, (4) effective communication, (5) working conditions and professional boundaries, (6) education and training, and (7) external support.
Conclusion
With the likelihood of future epidemic and pandemic events globally, it is vital to explore and collate evidence on the learnings and recommendations from ED during the COVID-19 pandemic to continue to build a sustainable, resilient, and supported workforce.
{"title":"'It’s only a matter of time' - Lessons learnt and recommendations from COVID-19 to inform emergency nursing for future pandemics: An integrated literature review","authors":"Megan R. Simic , Joanne E. Porter , Blake Peck , Christopher Mesagno","doi":"10.1016/j.auec.2024.10.004","DOIUrl":"10.1016/j.auec.2024.10.004","url":null,"abstract":"<div><h3>Purpose</h3><div>In the recovery phase of COVID-19 disaster management, Emergency Department (ED) nurses are attempting to return to normal workforce operations, despite significant impacts on personal and professional lives. This review aims to examine and synthesise current literature for the learnings and recommendations from the lived experiences of ED nurses during the COVID-19 pandemic.</div></div><div><h3>Procedures</h3><div>Electronic databases CINAHL Complete, Web of Science, Scopus (Elsevier) and PubMed were utilised using a 5-year timeframe that aligned with COVID-19 in Australia. Final date of accepted papers was 28th February 2024. A JBI Mixed Methods Convergent Integrated Approach was used.</div></div><div><h3>Findings</h3><div>A total of 15 studies were included in the final review, representing seven countries of origin and included 649 ED nurses. Seven major themes related to learnings and recommendations were generated from data synthesis including (1) professional identity, (2) wellbeing support, (3) camaraderie, (4) effective communication, (5) working conditions and professional boundaries, (6) education and training, and (7) external support.</div></div><div><h3>Conclusion</h3><div>With the likelihood of future epidemic and pandemic events globally, it is vital to explore and collate evidence on the learnings and recommendations from ED during the COVID-19 pandemic to continue to build a sustainable, resilient, and supported workforce.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 76-88"},"PeriodicalIF":2.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741534","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}
Pub Date : 2024-11-21DOI: 10.1016/j.auec.2024.08.001
Robert Waller , Mathew McLaughlin , Sarah King , Jessica Lai , Reuben Holt , Pippa Flanagan , Ivan Lin , Karen Richards , Piers Truter
Background
Low urgency, non-traumatic musculoskeletal presentations are common in emergency departments. Although care is safe, it is expensive, and low priority. Pathways diverting these patients from emergency departments to physiotherapy care may improve hospital outcomes. Identifying the suitable patient profile for these pathways is important.
Methods
A mixed prospective and retrospective, descriptive, cross-sectional study investigated adults aged 18–65 presenting to two emergency departments. Suitable patients were diverted directly to a physiotherapy outpatient diversion pathway. Three groups were compared, diverted patients, patients suitable but not diverted, and patients unsuitable for diversion.
Results
Diverted patients were aged 43 (median, inter-quartile range 34–53.5) years, triaged as low-urgency, self-referred, self-transported, and had few concerning features of serious pathology. Diverted patients had a 113-minute shorter emergency stay at 79 (median) minutes compared to suitable but not diverted patients, and both groups had a similar profile. Most (93.4 %) diverted patients were discharged within 4- hours, compared to suitable but not diverted patients (72.9 %). Key factors preventing diversion were concern for serious pathology or diversion capacity restraints.
Conclusion
A group of patients with non-traumatic musculoskeletal conditions who can be safely diverted to physiotherapy outpatients are described. Diversion impact was high quality care and improved emergency department metrics.
{"title":"Managing non-traumatic musculoskeletal conditions presenting to emergency departments: Do patient profiles vary between a physiotherapy-led 'Diversion' pathway and routine care?","authors":"Robert Waller , Mathew McLaughlin , Sarah King , Jessica Lai , Reuben Holt , Pippa Flanagan , Ivan Lin , Karen Richards , Piers Truter","doi":"10.1016/j.auec.2024.08.001","DOIUrl":"10.1016/j.auec.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Low urgency, non-traumatic musculoskeletal presentations are common in emergency departments. Although care is safe, it is expensive, and low priority. Pathways diverting these patients from emergency departments to physiotherapy care may improve hospital outcomes. Identifying the suitable patient profile for these pathways is important.</div></div><div><h3>Methods</h3><div>A mixed prospective and retrospective, descriptive, cross-sectional study investigated adults aged 18–65 presenting to two emergency departments. Suitable patients were diverted directly to a physiotherapy outpatient diversion pathway. Three groups were compared, diverted patients, patients suitable but not diverted, and patients unsuitable for diversion.</div></div><div><h3>Results</h3><div>Diverted patients were aged 43 (median, inter-quartile range 34–53.5) years, triaged as low-urgency, self-referred, self-transported, and had few concerning features of serious pathology. Diverted patients had a 113-minute shorter emergency stay at 79 (median) minutes compared to suitable but not diverted patients, and both groups had a similar profile. Most (93.4 %) diverted patients were discharged within 4- hours, compared to suitable but not diverted patients (72.9 %). Key factors preventing diversion were concern for serious pathology or diversion capacity restraints.</div></div><div><h3>Conclusion</h3><div>A group of patients with non-traumatic musculoskeletal conditions who can be safely diverted to physiotherapy outpatients are described. Diversion impact was high quality care and improved emergency department metrics.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 1","pages":"Pages 24-30"},"PeriodicalIF":2.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689724","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}
Pub Date : 2024-11-04DOI: 10.1016/j.auec.2024.10.003
Julie Gawthorne , Kate Curtis , Margaret Fry , Andrea Mccloughen , Judith Fethney
Background
Increased demand, wait times and length of stay have seen many emergency departments implement nurse-initiated protocols In New South Wales, Australia, 74 nurse-initiated protocols have been developed for implementation. The aim of this paper is to identify the barriers and enablers to nurses’ use of these protocols to inform and maximise future implementation.
Methods
Data were collected via surveys informed by the theoretical domains' framework and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Descriptive statistics summarised quantitative data and content analysis was performed on qualitative data. Results were integrated and classified as barriers or enablers to nurses’ use of protocols.
Results
The nurses’ response rate was 82 % (n = 76) and doctors 72 % (n = 34) Six categories were generated; one barrier (lack of resources), three enablers (patient and organisational benefits, nurses’ motivation, nurses’ desire to develop their practice) and two were both a barrier and enabler ( nurse confidence and the work environment).
Conclusion
Emergency nurses are highly motivated to use nurse-initiated protocols to positively impact patient outcomes. However, a lack of resources, time, access to education and confidence are barriers to use that need to be addressed when designing implementation.
{"title":"Barriers and enablers to nurse-initiated care in emergency departments: An embedded mixed methods survey study","authors":"Julie Gawthorne , Kate Curtis , Margaret Fry , Andrea Mccloughen , Judith Fethney","doi":"10.1016/j.auec.2024.10.003","DOIUrl":"10.1016/j.auec.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Increased demand, wait times and length of stay have seen many emergency departments implement nurse-initiated protocols In New South Wales, Australia, 74 nurse-initiated protocols have been developed for implementation. The aim of this paper is to identify the barriers and enablers to nurses’ use of these protocols to inform and maximise future implementation.</div></div><div><h3>Methods</h3><div>Data were collected via surveys informed by the theoretical domains' framework and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Descriptive statistics summarised quantitative data and content analysis was performed on qualitative data. Results were integrated and classified as barriers or enablers to nurses’ use of protocols.</div></div><div><h3>Results</h3><div>The nurses’ response rate was 82 % (n = 76) and doctors 72 % (n = 34) Six categories were generated; one barrier (lack of resources), three enablers (patient and organisational benefits, nurses’ motivation, nurses’ desire to develop their practice) and two were both a barrier and enabler ( nurse confidence and the work environment).</div></div><div><h3>Conclusion</h3><div>Emergency nurses are highly motivated to use nurse-initiated protocols to positively impact patient outcomes. However, a lack of resources, time, access to education and confidence are barriers to use that need to be addressed when designing implementation.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 1","pages":"Pages 12-23"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585196","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}
Pub Date : 2024-10-25DOI: 10.1016/j.auec.2024.10.002
Nikita Indrawan , Jason Ellis , Judith Finn , Glenn Arendts
Background
Screening for frailty in the emergency setting may be useful in directing patients to appropriate management pathways. The main aim of this study was to assess the inter-rater reliability of the Clinical Frailty Scale between paramedics and emergency department staff (doctors and allied heath) for patients after a fall. Secondarily, to assess how these scores correlate with patient outcomes.
Methods
A prospective study of older patients arriving by ambulance to a single hospital in Western Australia following a fall. The inter-rater reliability was assessed using a weighted Cohen’s κ. The relationship between Clinical Frailty Scale and secondary outcomes were assessed using chi-squared and Kruskal-Wallis tests.
Results
Data from 94 patients were included, the mean age was 82 years and 64 % were female.
The inter-rater reliability between paramedics and emergency department staff using the Clinical Frailty Scale was moderate (κ 0.48 (95 % CI 0.36–0.59)).
Conclusions
There is only moderate agreement between emergency department staff and paramedics when screening for frailty in patients who present after a fall. The findings indicate the need to improve reliability as a pre-requisite to the use of frailty screening in emergency settings.
{"title":"The inter-rater reliability of emergency department and paramedic frailty screening in older patients following a fall","authors":"Nikita Indrawan , Jason Ellis , Judith Finn , Glenn Arendts","doi":"10.1016/j.auec.2024.10.002","DOIUrl":"10.1016/j.auec.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Screening for frailty in the emergency setting may be useful in directing patients to appropriate management pathways. The main aim of this study was to assess the inter-rater reliability of the Clinical Frailty Scale between paramedics and emergency department staff (doctors and allied heath) for patients after a fall. Secondarily, to assess how these scores correlate with patient outcomes.</div></div><div><h3>Methods</h3><div>A prospective study of older patients arriving by ambulance to a single hospital in Western Australia following a fall. The inter-rater reliability was assessed using a weighted Cohen’s κ. The relationship between Clinical Frailty Scale and secondary outcomes were assessed using chi-squared and Kruskal-Wallis tests.</div></div><div><h3>Results</h3><div>Data from 94 patients were included, the mean age was 82 years and 64 % were female.</div><div>The inter-rater reliability between paramedics and emergency department staff using the Clinical Frailty Scale was moderate (κ 0.48 (95 % CI 0.36–0.59)).</div></div><div><h3>Conclusions</h3><div>There is only moderate agreement between emergency department staff and paramedics when screening for frailty in patients who present after a fall. The findings indicate the need to improve reliability as a pre-requisite to the use of frailty screening in emergency settings.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 1","pages":"Pages 63-66"},"PeriodicalIF":2.1,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513558","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}
Pub Date : 2024-10-22DOI: 10.1016/j.auec.2024.10.001
Kimberley Ryan , Lee Jones , Sherry Cass , Jacob Christensen , Mark Appleyard , Anthony FT Brown , Florian Grimpen
Evaluation of the Australian Triage Scale in patients who present to the emergency department with upper gastrointestinal bleeding
Background
Upper gastrointestinal bleeding (UGIB) is a common presentation to the emergency department (ED). Study aims were to evaluate the utility of the Australasian Triage Score (ATS) in patients presenting to the ED with UGIB.
Methods
This retrospective observational study included 356 patients over a 2-year period who presented to a metropolitan hospital ED. The ATS was categorised into three groups, ATS 1/2, ATS 3 and ATS 4/5. Primary outcomes explored the relationship between ATS and haemodynamic parameters. Secondary outcomes evaluated the proportion of patients with suspected variceal bleeding and allocated a non-life-threatening ATS category.
Results
The study population were distributed by ATS 1/2 (28.7 %), ATS 3 (46.6 %) and ATS 4/5 (24.7 %). Over half of patients with some haemodynamic compromise were allocated an ATS 3 or 4/5. Additionally, 56 % with suspected variceal bleeding and 51 % with syncope were also allocated an ATS category (3 or 4/5).
Conclusions
The utility of the ATS recognises most patients presenting with UGIB at high-risk of adverse outcomes. Additional screening at triage maybe beneficial for those patients with a history of cirrhosis or varices, and UGIB-related syncope. Consideration of an ATS category of 2 for these patients may enable them to access earlier time-critical therapies.
{"title":"Evaluation of the Australian Triage Scale in patients who present to the emergency department with upper gastrointestinal bleeding","authors":"Kimberley Ryan , Lee Jones , Sherry Cass , Jacob Christensen , Mark Appleyard , Anthony FT Brown , Florian Grimpen","doi":"10.1016/j.auec.2024.10.001","DOIUrl":"10.1016/j.auec.2024.10.001","url":null,"abstract":"<div><div>Evaluation of the Australian Triage Scale in patients who present to the emergency department with upper gastrointestinal bleeding</div></div><div><h3>Background</h3><div>Upper gastrointestinal bleeding (UGIB) is a common presentation to the emergency department (ED). Study aims were to evaluate the utility of the Australasian Triage Score (ATS) in patients presenting to the ED with UGIB.</div></div><div><h3>Methods</h3><div>This retrospective observational study included 356 patients over a 2-year period who presented to a metropolitan hospital ED. The ATS was categorised into three groups, ATS 1/2, ATS 3 and ATS 4/5. Primary outcomes explored the relationship between ATS and haemodynamic parameters. Secondary outcomes evaluated the proportion of patients with suspected variceal bleeding and allocated a non-life-threatening ATS category.</div></div><div><h3>Results</h3><div>The study population were distributed by ATS 1/2 (28.7 %), ATS 3 (46.6 %) and ATS 4/5 (24.7 %). Over half of patients with some haemodynamic compromise were allocated an ATS 3 or 4/5. Additionally, 56 % with suspected variceal bleeding and 51 % with syncope were also allocated an ATS category (3 or 4/5).</div></div><div><h3>Conclusions</h3><div>The utility of the ATS recognises most patients presenting with UGIB at high-risk of adverse outcomes. Additional screening at triage maybe beneficial for those patients with a history of cirrhosis or varices, and UGIB-related syncope. Consideration of an ATS category of 2 for these patients may enable them to access earlier time-critical therapies.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 1","pages":"Pages 57-62"},"PeriodicalIF":2.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513557","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}
Pub Date : 2024-10-15DOI: 10.1016/j.auec.2024.09.006
Baylie Trostian , Andrea McCloughen , Ramon Z. Shaban , Kate Curtis
Background
Vaginal bleeding is a frequent complication in early pregnancy, care that women receive, or lack thereof, can have immediate and long-term consequences. There is a lack of cogent, synthesised evidence on the assessment, interventions, and diagnostics for the management of early pregnancy bleeding in the emergency department (ED). This paper reports the results of a scoping review that identified that examined the literature to clarify concepts and generate a synthesis of the evidence for the assessment, interventions, diagnostics and management of early pregnancy bleeding in the ED.
Methods
Five databases were searched. Practice guidelines and statements were sourced from professional organisations, and online repositories. Three types of data were included: practice guidelines, reviews, and primary research. Data were extracted and collated, and findings were synthesised into a clinical guideline.
Results
A total 122 (of 3602) papers from database searching, and six (of 46) practice guidelines were included. Seventy-seven publications reported on assessment including performing vital observations. Thirty-six reported on interventions including administration of analgesia, and 114 reported on diagnostics, which most (n = 93) recommended use of ultrasound. Few (12 %) of practice statements and guidelines recommended care not based in current evidence. The study yielded an evidence-based practice guideline to be used for initial management of early pregnancy bleeding.
Conclusions
The practice guideline generated by this examination and synthesis of the evidence offers comprehensive, evidence informed recommendations for the initial management of early pregnancy bleeding. Continued research and knowledge translation for initial management of early pregnancy bleeding is needed to reduce variation in emergency care and improve outcomes for women.
{"title":"What assessment, intervention and diagnostics should women with early pregnancy bleeding receive in the emergency department and when? A scoping review and synthesis of evidence","authors":"Baylie Trostian , Andrea McCloughen , Ramon Z. Shaban , Kate Curtis","doi":"10.1016/j.auec.2024.09.006","DOIUrl":"10.1016/j.auec.2024.09.006","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal bleeding is a frequent complication in early pregnancy, care that women receive, or lack thereof, can have immediate and long-term consequences. There is a lack of cogent, synthesised evidence on the assessment, interventions, and diagnostics for the management of early pregnancy bleeding in the emergency department (ED). This paper reports the results of a scoping review that identified that examined the literature to clarify concepts and generate a synthesis of the evidence for the assessment, interventions, diagnostics and management of early pregnancy bleeding in the ED.</div></div><div><h3>Methods</h3><div>Five databases were searched. Practice guidelines and statements were sourced from professional organisations, and online repositories. Three types of data were included: practice guidelines, reviews, and primary research. Data were extracted and collated, and findings were synthesised into a clinical guideline.</div></div><div><h3>Results</h3><div>A total 122 (of 3602) papers from database searching, and six (of 46) practice guidelines were included. Seventy-seven publications reported on assessment including performing vital observations. Thirty-six reported on interventions including administration of analgesia, and 114 reported on diagnostics, which most (n = 93) recommended use of ultrasound. Few (12 %) of practice statements and guidelines recommended care not based in current evidence. The study yielded an evidence-based practice guideline to be used for initial management of early pregnancy bleeding.</div></div><div><h3>Conclusions</h3><div>The practice guideline generated by this examination and synthesis of the evidence offers comprehensive, evidence informed recommendations for the initial management of early pregnancy bleeding. Continued research and knowledge translation for initial management of early pregnancy bleeding is needed to reduce variation in emergency care and improve outcomes for women.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 1","pages":"Pages 1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481785","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}
Pub Date : 2024-10-05DOI: 10.1016/j.auec.2024.09.005
Elisha Deegan, Peter Lewis, Laynie H. Pullin, Nathan J. Wilson
Aim
To explore evidence that informs new or non-standard methods for delivery of cardiopulmonary resuscitation (CPR) and basic life support (BLS) that may be used by carers of wheelchair users and assist in the development of an educational intervention.
Material and methods
A scoping review was conducted. Keywords used included cardiac arrest, cardiopulmonary, resuscitation, “basic life support”, and special circumstances. In total, 3581 papers were retrieved and 72 full text articles were reviewed with 14 papers meeting the inclusion criteria.
Results
Nine intervention studies, three systematic reviews and two expert opinion papers were included and divided into four broad categories pertaining to how they differed from standard CPR guidelines. The four categories were nontraditional compression techniques, CPR not delivered in a flat position, CPR not delivered on a hard surface and CPR not delivered at floor level.
Conclusion
The scoping review has identified techniques for delivery of CPR and BLS that may be beneficial to wheelchair users. Further research is required to determine applicability and effectiveness.
{"title":"Nonstandard cardiopulmonary resuscitation and basic life support: A scoping review of techniques applicable to wheelchair users","authors":"Elisha Deegan, Peter Lewis, Laynie H. Pullin, Nathan J. Wilson","doi":"10.1016/j.auec.2024.09.005","DOIUrl":"10.1016/j.auec.2024.09.005","url":null,"abstract":"<div><h3>Aim</h3><div>To explore evidence that informs new or non-standard methods for delivery of cardiopulmonary resuscitation (CPR) and basic life support (BLS) that may be used by carers of wheelchair users and assist in the development of an educational intervention.</div></div><div><h3>Material and methods</h3><div>A scoping review was conducted. Keywords used included cardiac arrest, cardiopulmonary, resuscitation, “basic life support”, and special circumstances. In total, 3581 papers were retrieved and 72 full text articles were reviewed with 14 papers meeting the inclusion criteria.</div></div><div><h3>Results</h3><div>Nine intervention studies, three systematic reviews and two expert opinion papers were included and divided into four broad categories pertaining to how they differed from standard CPR guidelines. The four categories were nontraditional compression techniques, CPR not delivered in a flat position, CPR not delivered on a hard surface and CPR not delivered at floor level.</div></div><div><h3>Conclusion</h3><div>The scoping review has identified techniques for delivery of CPR and BLS that may be beneficial to wheelchair users. Further research is required to determine applicability and effectiveness.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 1","pages":"Pages 48-56"},"PeriodicalIF":2.1,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378598","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}
Pub Date : 2024-10-02DOI: 10.1016/j.auec.2024.09.003
Jamie Ranse , Benjamin Mackie , Julia Crilly , David Heslop , Bridget Wilson , Marion Mitchell , Sarah Weber , Nathan Watkins , Joseph Sharpe , Michael Handy , Attila Hertelendy , Jane Currie , Karen Hammad
Introduction
Natural hazards resulting in disasters are increasing globally, impacting communities and disrupting industries. In addition to planning for these natural hazard disasters, emergency departments (EDs) should prepare for chemical, biological, radiological, and nuclear (CBRN) incidents that result in surges of patient presentations. Chemical, biological, radiological, and nuclear incidents differ in preparedness to natural hazards, requiring an understanding of patient management and health system-related challenges.
Methods
This scoping review used the Arksey and O’Malley five-step framework. Manuscripts were retrieved from four databases and search engines using keywords relating to impacts on the ED from real world CBRN event(s). Analysis focused on the characteristics of CBRN event, ED impact, and lessons learnt against four surge capacity domains that including staff, stuff, space, and systems.
Results
A total of 44 paper were included in this review. Most of the incidents were chemical in nature (n = 36/44, 81.8 %). The majority of CBRN incidents were accidental (n = 34/44, 77.3 %). Between 1 and 1470 people (Mdn=56, IQR: 18–228) presented to an ED from each event. Most patients were discharged from the ED, but this was variably reported. Some key lessons related to secondary exposure to ED staff, repurposing spaces, and coordination of CBRN incidents.
Conclusion
With the increasing number of CBRN incidents, strategies to strengthen EDs and limit the impact from a surge in patient presentations are paramount. An understanding of local CBRN risk to inform a top-hazards approach to CBRN preparedness, and the implementation of pre-emptive CBRN clinical pathways is recommended. Additionally, strategies should be implemented to protect staff from the risk of secondary exposure to a CBRN event. These strategies may include adequate education, training, and personal protective equipment for staff.
{"title":"Strengthening emergency department response to chemical, biological, radiological, and nuclear disasters: A scoping review","authors":"Jamie Ranse , Benjamin Mackie , Julia Crilly , David Heslop , Bridget Wilson , Marion Mitchell , Sarah Weber , Nathan Watkins , Joseph Sharpe , Michael Handy , Attila Hertelendy , Jane Currie , Karen Hammad","doi":"10.1016/j.auec.2024.09.003","DOIUrl":"10.1016/j.auec.2024.09.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Natural hazards resulting in disasters are increasing globally, impacting communities and disrupting industries. In addition to planning for these natural hazard disasters, emergency departments (EDs) should prepare for chemical, biological, radiological, and nuclear (CBRN) incidents that result in surges of patient presentations. Chemical, biological, radiological, and nuclear incidents differ in preparedness to natural hazards, requiring an understanding of patient management and health system-related challenges.</div></div><div><h3>Methods</h3><div>This scoping review used the Arksey and O’Malley five-step framework. Manuscripts were retrieved from four databases and search engines using keywords relating to impacts on the ED from real world CBRN event(s). Analysis focused on the characteristics of CBRN event, ED impact, and lessons learnt against four surge capacity domains that including staff, stuff, space, and systems.</div></div><div><h3>Results</h3><div>A total of 44 paper were included in this review. Most of the incidents were chemical in nature (n = 36/44, 81.8 %). The majority of CBRN incidents were accidental (n = 34/44, 77.3 %). Between 1 and 1470 people (Mdn=56, IQR: 18–228) presented to an ED from each event. Most patients were discharged from the ED, but this was variably reported. Some key lessons related to secondary exposure to ED staff, repurposing spaces, and coordination of CBRN incidents.</div></div><div><h3>Conclusion</h3><div>With the increasing number of CBRN incidents, strategies to strengthen EDs and limit the impact from a surge in patient presentations are paramount. An understanding of local CBRN risk to inform a top-hazards approach to CBRN preparedness, and the implementation of pre-emptive CBRN clinical pathways is recommended. Additionally, strategies should be implemented to protect staff from the risk of secondary exposure to a CBRN event. These strategies may include adequate education, training, and personal protective equipment for staff.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 1","pages":"Pages 37-47"},"PeriodicalIF":2.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367650","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}
Pub Date : 2024-09-27DOI: 10.1016/j.auec.2024.09.004
Rebecca Ilona Peisah , Kevin Ostrowski
Background
Orbital compartment syndrome (OCS) is considered a time critical condition that requires urgent surgical decompression to preserve vision. This study aims to evaluate the current clinical criteria for performing a lateral canthotomy and cantholysis (LCC) in the emergency management of suspected traumatic OCS.
Methods
A retrospective audit of patients with suspected traumatic OCS presenting to an adult major trauma centre between January 1, 2017, and August 1, 2022, was performed.
Results
20 patients with traumatic OCS treated with a LCC were identified. Five patients satisfied the definitive clinical criteria for LCC. The remaining 15 patients received LCC based on secondary clinical findings, or computed tomography (CT) findings suggestive of OCS. 17 patients received non-contrast CT scanning prior to LCC. Of the nine patients noted to regain baseline or close to baseline vision, only one was decompressed within two hours of injury.
Conclusion
Despite OCS being a clinical diagnosis, the signs and symptoms associated with OCS are difficult to elicit on presentation. Seeking imaging should not delay time to decompression when clinical diagnostic criteria are present. However, imaging may have a role in determining the need for orbital decompression where the absolute indications for LCC cannot be adequately assessed.
{"title":"Emergency management of orbital compartment syndrome: Lateral canthotomy and cantholysis case series","authors":"Rebecca Ilona Peisah , Kevin Ostrowski","doi":"10.1016/j.auec.2024.09.004","DOIUrl":"10.1016/j.auec.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Orbital compartment syndrome (OCS) is considered a time critical condition that requires urgent surgical decompression to preserve vision. This study aims to evaluate the current clinical criteria for performing a lateral canthotomy and cantholysis (LCC) in the emergency management of suspected traumatic OCS.</div></div><div><h3>Methods</h3><div>A retrospective audit of patients with suspected traumatic OCS presenting to an adult major trauma centre between January 1, 2017, and August 1, 2022, was performed.</div></div><div><h3>Results</h3><div>20 patients with traumatic OCS treated with a LCC were identified. Five patients satisfied the definitive clinical criteria for LCC. The remaining 15 patients received LCC based on secondary clinical findings, or computed tomography (CT) findings suggestive of OCS. 17 patients received non-contrast CT scanning prior to LCC. Of the nine patients noted to regain baseline or close to baseline vision, only one was decompressed within two hours of injury.</div></div><div><h3>Conclusion</h3><div>Despite OCS being a clinical diagnosis, the signs and symptoms associated with OCS are difficult to elicit on presentation. Seeking imaging should not delay time to decompression when clinical diagnostic criteria are present. However, imaging may have a role in determining the need for orbital decompression where the absolute indications for LCC cannot be adequately assessed.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 1","pages":"Pages 67-71"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333080","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}
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