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1
Duckett, Stephen, and Amanda Kenny. "Hospital outpatient and emergencyservices in rural Victoria." Australian Health Review 23, no. 4 (2000): 115. http://dx.doi.org/10.1071/ah000115.
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Outpatient and emergency services in rural hospitals have rarely been studied. This paper analyses routinely collecteddata, together with data from a survey of hospitals, to provide a picture of these services in Victorian public hospitals.The larger rural hospitals provide the bulk of rural outpatients and emergency services, particularly so for medicaloutpatients. Cost per service varies with the size of the hospital, possibly reflecting differences in complexity. Fundingpolicies for rural hospital outpatient and emergency services should be sufficiently flexible to take into account thedifferences between rural hospitals.
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Rezaei-Darzi, Ehsan, Janneke Berecki-Gisolf, and Dasamal Tharanga Fernando. "How representative is the Victorian Emergency Minimum Dataset (VEMD) for population-based injury surveillance in Victoria? A retrospective observational study of administrative healthcare data." BMJ Open 12, no. 12 (December 2022): e063115. http://dx.doi.org/10.1136/bmjopen-2022-063115.
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ObjectiveThe Victorian Emergency Minimum Dataset (VEMD) is a key data resource for injury surveillance. The VEMD collects emergency department data from 39 public hospitals across Victoria; however, rural emergency care services are not well captured. The aim of this study is to determine the representativeness of the VEMD for injury surveillance.DesignA retrospective observational study of administrative healthcare data.Setting and participantsInjury admissions in 2014/2015–2018/2019 were extracted from the Victorian Admitted Episodes Dataset (VAED) which captures all Victorian hospital admissions; only cases that arrived through a hospital’s emergency department (ED) were included. Each admission was categorised as taking place in a VEMD-contributing versus a non-VEMD hospital.ResultsThere were 535 477 incident injury admissions in the study period, of which 517 207 (96.6%) were admitted to a VEMD contributing hospital. Male gender (OR 1.13 (95% CI 1.10 to 1.17)) and young age (age 0–14 vs 45–54 years, OR 4.68 (95% CI 3.52 to 6.21)) were associated with VEMD participating (vs non-VEMD-participating) hospitals. Residing in regional/rural areas was negatively associated with VEMD participating (vs non-VEMD participating) hospitals (OR=0.11 (95% CI 0.10 to 0.11)). Intentional injury (assault and self-harm) was also associated with VEMD participation.ConclusionsVEMD representativeness is largely consistent across the whole of Victoria, but varies vastly by region, with substantial under-representation of some areas of Victoria. By comparison, for injury surveillance, regional rates are more reliable when based on the VAED. For local ED-presentation rates, the bias analysis results can be used to create weights, as a temporary solution until rural emergency services injury data is systematically collected and included in state-wide injury surveillance databases.
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Fahey, Kieren P., Ben Gelbart, Felix Oberender, Jenny Thompson, Tom Rozen, Christopher James, Catriona McLaren, Jonathan Sniderman, and Wonie Uahwatanasakul. "Interhospital transport of children with bronchiolitis by a statewide emergency transport service." Critical Care and Resuscitation 23, no. 3 (September 6, 2021): 292–99. http://dx.doi.org/10.51893/2021.3.oa6.
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OBJECTIVE: To investigate the rate of interhospital emergency transport for bronchiolitis and intensive care admission following the introduction of high flow nasal cannula and standardised paediatric observation and response charts. DESIGN: Retrospective cohort study. SETTING: A statewide paediatric intensive care transport service and its two referral paediatric intensive care units (PICUs) in Victoria, Australia. PARTICIPANTS: Children less than 2 years old emergently transported with bronchiolitis during two time periods: 2008–2012 and 2015–2019. MAIN OUTCOME MEASURES: Incidence rates of bronchiolitis transport episodes, PICU admissions and respiratory support. RESULTS: 802 children with bronchiolitis were transported during the study period, 233 in the first period (2008–2012) and 569 in the second period (2015–2019). The rate of interhospital transport for bronchiolitis increased from 32.9 to 71.8 per 100 000 children aged 0–2 years. The population-adjusted rate of PICU admission increased from 16.2 to 36.6 per 100 000 children aged 0–2 years. Metropolitan hospitals were the predominant referral source and this increased from 60.1% of transports to 78.6% (P < 0.001). In children admitted to a PICU, the administration of high flow nasal cannula during transport increased significantly from 1.7% to 75.9% (P < 0.001) and a concomitant reduction in continuous positive airway pressure and mechanical ventilation occurred (40–12.4% and 27–6.9% respectively; P < 0.001). The proportion of mechanical ventilation as well as PICU and hospital length of stay decreased over time. CONCLUSIONS: The population-adjusted rate of interhospital transport and admission to the PICU for bronchiolitis increased over time. This occurred despite a lower rate of non-invasive and invasive mechanical ventilation during transport and in the PICU.
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McDonald, Paul. "From Streets to Sidewalks: Developments in Primary Care Services for Injecting Drug Users." Australian Journal of Primary Health 8, no. 1 (2002): 65. http://dx.doi.org/10.1071/py02010.
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Primary Health Care for the Injecting Drug User (IDU) has been established in Victoria in recognition of the serious health needs of IDUs, which require a relevant and effective response. Research shows the medical consequences that flow from drug abuse, ranging from the onset of blood borne viruses to cardiovascular conditions, and the propensity of drug users to access health services only through accident and emergency areas of hospitals. In 1999, the Victorian government announced the funding of five Local Drug Strategies in five of Melbourne's 'hotspot' street drug areas to address both the needs of users and communities in relation to substance abuse. This funding was an impetus to establish and trial the concept of primary health services, combining both a fixed site and a mobile outreach service. These services are designed to meet the primary health needs of street-based injecting drug users who are at high risk of experiencing overdose or other forms of drug-related harm.
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Boyle, Malcolm J., M. ClinEpi, Erin C. Smith, and Frank L. Archer. "Trauma Incidents Attended by Emergency Medical Services in Victoria, Australia." Prehospital and Disaster Medicine 23, no. 1 (February 2008): 20–28. http://dx.doi.org/10.1017/s1049023x00005501.
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AbstractIntroduction:International literature describing the profile of trauma patients attended by a statewide emergency medical services (EMS) system is lacking. Most literature is limited to descriptions of trauma responses for a single emergency medical service, or to patients transported to a specific Level-1 trauma hospital. There is no Victorian or Australian literature describing the type of trauma patients transported by a state emergency medical service.Purpose:The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS.Methods:A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. Criteria for trauma categories were defined previously, and data were extracted from the PCRs and entered into a secure data repository for descriptive analysis to determine the trauma profile. Ethics committee approval was obtained.Results:There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these, 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459).Conclusions:This is a unique analysis of prehospital trauma. It provides a baseline dataset that may be utilized in future studies of prehospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the prehospital and the hospital assessments.
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Siegloff, L., L. Cusack, P. Arbon, A. Hutton, and L. Mayner. "(A109) Health Workforce and Disaster Preparedness of Rural Hospitals." Prehospital and Disaster Medicine 26, S1 (May 2011): s30—s31. http://dx.doi.org/10.1017/s1049023x11001117.
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Following the devastating March 2009 Victorian bushfire disaster in rural areas of Australia, authorities reviewed strategies designed to protect communities during periods of extreme fire risk. New policy and regulation were introduced and designed to ensure that small rural communities were protected and prepared to confront a wildfire emergency during days of extreme heat or bushfire risk weather. As a result on days of declared ‘catastrophic’ bushfire weather conditions government agencies in South Australia have implemented a policy for schools (including pre-schools) to be temporarily closed. On these days community members are advised to evacuate early to safe regional centres, and to limit travel on country roads. The WADEM Guidelines for Disaster Evaluation and Research demonstrate that Basic Societal Functions (BSFs), such as education, health, transport and others, are interconnected and interdependent. For example in small rural communities in South Australia people may have a number of important roles including being parents, volunteers of emergency services while also being employed as staff of local hospitals. This project reviewed the impact of school closures and other protective measures on the availability of the rural nursing workforce and on rural hospitals. Rural hospitals in Australia are staffed, on average, by 2–8 nurses, service very small communities and are separated by great distances. As a result, small changes in the absentee rate for nurses can have a significant impact on the operation of these hospitals. This paper will argue that policy changes in other sectors, such as education, can impact on societal activities such as childcare, volunteer emergency service work, and hospital staffing, in ways that may not be anticipated unless the impact on all Basic Societal Functions are considered by policymakers.
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McLean, Karen, Harriet Hiscock, Dorothy Scott, and Sharon Goldfeld. "What is the timeliness and extent of health service use of Victorian (Australia) children in the year after entry to out-of-home care? Protocol for a retrospective cohort study using linked administrative data." BMJ Paediatrics Open 3, no. 1 (January 2019): e000400. http://dx.doi.org/10.1136/bmjpo-2018-000400.
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IntroductionChildren entering out-of-home care have high rates of health needs across all domains of health. To identify these needs early and optimise long-term outcomes, routine health assessment on entry to care is recommended by child health experts and included in policy in many jurisdictions. If effective, this ought to lead to high rates of health service use as needs are addressed. Victoria (Australia) has no state-wide approach to deliver routine health assessments and no data to describe the timing and use of health service visits for children in out-of-home care. This retrospective cohort data linkage study aims to describe the extent and timeliness of health service use by Victorian children (aged 0–12 years) who entered out-of-home care for the first time between 1 April 2010 and 31 December 2015, in the first 12 months of care.Methods and analysisThe sample will be identified in the Victorian Child Protection database. Child and placement variables will be extracted. Linked health databases will provide additional data: six state databases that collate data about hospital admissions, emergency department presentations and attendances at dental, mental and community health services and public hospital outpatients. The federal Medicare Benefits Schedule claims dataset will provide information on visits to general practitioners, specialist physicians (including paediatricians), optometrists, audiologists and dentists. The number, type and timing of visits to different health services will be determined and benchmarked to national standards. Multivariable logistic regression will examine the effects of child and system variables on the odds of timely health visits, and proportional-hazards regression will explore the effects on time to first health visits.Ethics and disseminationEthical and data custodian approval has been obtained for this study. Dissemination will include presentation of findings to policy and service stakeholders in addition to scientific papers.
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Eastwood, Kathryn, Stuart Howell, Ziad Nehme, Judith Finn, Karen Smith, Peter Cameron, Dion Stub, and Janet E. Bray. "Impact of a mass media campaign on presentations and ambulance use for acute coronary syndrome." Open Heart 8, no. 2 (October 2021): e001792. http://dx.doi.org/10.1136/openhrt-2021-001792.
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ObjectiveBetween 2009 and 2013, the National Heart Foundation of Australia ran mass media campaigns to improve Australian’s awareness of acute coronary syndrome (ACS) symptoms and the need to call emergency medical services (EMS). This study examined the impact of this campaign on emergency department (ED) presentations and EMS use in Victoria, Australia.MethodsThe Victorian Department of Health and Human Services provided data for adult Victorian patients presenting to public hospitals with an ED diagnosis of ACS or unspecified chest pain (U-CP). We modelled changes in the incidence of ED presentations, and the association between the campaign period and (1) EMS arrival and (2) referred to ED by a general practitioner (GP). Models were adjusted for increasing population size, ACS subtype and demographics.ResultsBetween 2003 and 2015, there were 124 632 eligible ED presentations with ACS and 536 148 with U-CP. In patients with ACS, the campaign period was associated with an increase in ED presentations (incidence rate ratio: 1.11; 95% CI 1.07 to 1.15), a decrease in presentations via a GP (adjusted OR (AOR): 0.77; 95% CI 0.70 to 0.86) and an increase in EMS use (AOR: 1.10; 95% CI 1.05 to 1.17). Similar, but smaller associations were seen in U-CP.ConclusionsThe Warning Signs Campaign was associated with improvements in treatment seeking in patients with ACS—including increased EMS use. The increase in ACS ED presentations corresponds with a decrease in out-of-hospital cardiac arrest over this time. Future education needs to focus on improving EMS use in ACS patient groups where use remains low.
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Joyce, Catherine M., Jo Wainer, Frank Archer, Andrea Wyatt, and Leon Pitermann. "Trends in the paramedic workforce: a profession in transition." Australian Health Review 33, no. 4 (2009): 533. http://dx.doi.org/10.1071/ah090533.
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Ambulance services play a key role in the Australian health system, as the primary providers of pre-hospital clinical care, emergency care and specialised transport.1 Although at present there is a strong focus on broad health system reform, and health workforce reform specifically, little attention has been paid to the place of pre-hospital clinical care and the paramedic workforce that provides these services. Despite their significant role in the health system, there is no strategic national approach by government to the development of ambulance services or the paramedic workforce. In this paper, we review current and emerging trends impacting on the paramedic workforce. We examine changes in patterns of ambulance service provision and the nature of clinical work undertaken by paramedics, as well as developments in education, training and career pathways. We focus on the current situation in Victoria to illustrate and identify a number of important implications of current changes, for the profession, service and training providers, and policy makers.
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Eastwood, Kathryn, Karen Smith, Amee Morgans, and Johannes Stoelwinder. "Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study." BMJ Open 7, no. 10 (October 2017): e016845. http://dx.doi.org/10.1136/bmjopen-2017-016845.
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ObjectiveTo investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage.DesignA pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage.SettingThe secondary telephone triage service, called the Referral Service, and the hospitals were located in metropolitan Melbourne, Australia and operated 24 hours a day, servicing 4.25 million people. The Referral Service provides an in-depth secondary triage of cases classified as low acuity when calling the Australian emergency telephone number.PopulationCases triaged by the Referral Service between September 2009 and June 2012 were linked to ED and hospital admission records (N=44,523). Planned ED presentations were cases referred to the ED following the secondary triage, unplanned ED presentations were cases that presented despite being referred to alternative care pathways.Main outcome measuresAppropriateness was measured using an ED suitability definition and hospital admission rates. These were compared with mean population data which consisted of all of the ED presentations for the state (termed the ‘average Victorian ED presentation’).ResultsPlanned ED presentations were more likely to be ED suitable than unplanned ED presentations (OR 1.62; 95% CI 1.5 to 1.7; p<0.001) and the average Victorian ED presentation (OR 1.85; 95% CI 1.01 to 3.4; p=0.046). They were also more likely to be admitted to the hospital than the unplanned ED presentation (OR 1.5; 95% CI 1.4 to 1.6; p<0.001) and the average Victorian ED presentation (OR 2.3, 95% CI 2.24 to 2.33; p<0.001). Just under 15% of cases diverted away from the emergency care pathways presented in the ED (unplanned ED attendances), and 9.5% of all the alternative care pathway cases were classified as ED suitable and 6.5% were admitted to hospital.ConclusionsSecondary telephone triage was able to appropriately identify many ED suitable cases, and while most cases referred to alternative care pathways did not present in the ED. Further research is required to establish that these were not inappropriately triaged away from the emergency care pathways.
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Eastwood, Kathryn, Dhanya Nambiar, Rosamond Dwyer, Judy A. Lowthian, Peter Cameron, and Karen Smith. "Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study." BMJ Open 10, no. 11 (November 2020): e042351. http://dx.doi.org/10.1136/bmjopen-2020-042351.
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BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.
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Peukert, Thomas. "285 Piloting and implementing an acute neurology service." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 10 (September 13, 2018): A43.2—A43. http://dx.doi.org/10.1136/jnnp-2018-abn.149.
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Over the past decade, the number of patients attending the emergency department (ED) at the Royal Victoria Hospital Belfast, with neurological symptoms, has doubled. Typically, over 50% of these patients would subsequently be admitted to hospital. In 2013, a pilot project was conducted with the aim of evaluating the effectiveness of a rapid access neurology clinic on reducing such admissions.A dedicated neurology clinic was set up offering 12 slots per week. Patients were seen within 10 days of ED staff booking them into the clinics. Early results indicated that within the first month 28 admissions were avoided. As a result rapid access neurology clinics were rolled out. Two acute neurologists were appointed and since 2015, 3 rapid access clinics run per week (15 slots). In addition to the rapid access clinics, the acute neurology team also offer two additional services:Reviewing all patients who have been admitted under the medical take with neurological symptomsPatients who attend ED overnight but require urgent evaluation/tests can be sent home and will be seen the next morning by the acute neurology teamAnalysis indicates approximately 1250 admissions are avoided each year with an estimated cost saving of over £2 million.
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Zhao, Henry, Lauren Pesavento, Edrich Rodrigues, Patrick Salvaris, Karen Smith, Stephen Bernard, Michael Stephenson, et al. "009 The ambulance clinical triage-for acute stroke treatment (ACT-FAST) algorithmic pre-hospital triage tool for endovascular thrombectomy: ongoing paramedic validation." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 6 (May 24, 2018): A5.1—A5. http://dx.doi.org/10.1136/jnnp-2018-anzan.9.
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IntroductionThe ambulance clinical triage-for acute stroke treatment (ACT-FAST) algorithm is a severity based 3-step paramedic triage tool for pre-hospital recognition of large vessel occlusion (LVO), designed to improve specificity and paramedic assessment reliability compared to existing triage scales. ACT-FAST sequentially assesses 1. Unilateral arm fall to stretcher <10 s; 2a. Severe language disturbance (right arm weak), or 2b. Severe gaze deviation/hemi-neglect assessed by shoulder tap (left arm weak); 3. Clinical eligibility questions. We present the results of the ongoing Ambulance Victoria paramedic validation study.MethodsAmbulance Victoria paramedics assessed ACT-FAST in all suspected stroke patients pre-hospital in metropolitan Melbourne, Australia, and in the Royal Melbourne Hospital Emergency Department since July 2017. Algorithm results were validated against a comparator of ICA/M1 occlusion on CT-angiography with NIHSS ≥6 (Class 1 indications for endovascular thrombectomy).ResultsData were available from n=119 assessments (ED n=68, pre-hospital n=51). Patient diagnoses were LVO n=20 (15.6%), non-LVO infarcts n=45 (38.5%), ICH n=10 (8.3%) and no stroke on imaging n=44 (37.6%). ACT-FAST showed 85% sensitivity, 88.9% specificity, 60.7% (72% excluding ICH) positive predictive value and 96.7% negative predictive value for LVO. Of 10 false-positives, 4 received thrombectomy for non-Class 1 indications (basilar/M2 occlusions/cervical dissection), 3 were ICH, and 1 was tumour. Three false-negatives were LVO with milder syndromes.DiscussionThe ongoing ACT-FAST algorithm validation study shows high accuracy for clinical recognition of LVO. The streamlined algorithmic approach with just two examination items provides a more practical option for implementation in large emergency service networks. Accurate pre-hospital recognition of LVO will allow bypass to endovascular centres and early activation of neuro-intervention services to expedite endovascular thrombectomy.
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Hasson, Ruairi, Eoin McDermott, Karena Hanley, Camilla Carroll, and Claire Collins. "Assessing patient satisfaction with a microsuction service in general practice: a comparative study." BJGP Open 3, no. 2 (June 11, 2019): bjgpopen19X101649. http://dx.doi.org/10.3399/bjgpopen19x101649.
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BackgroundIn the UK, about 2.3 million people each year require intervention for wax impaction, while otitis externa accounts for just over 1% of general practice consultations. Aural microsuction of debris from the ear canal is a commonly performed procedure within the ear, nose, and throat (ENT) outpatient clinic. This article examines the patient acceptability of an aural microsuction service delivered in general practice.AimTo determine patient satisfaction following the introduction of a new microsuction service in general practice compared with a hospital-delivered service.Design & settingThis is a prospective comparative study in two rural general practices in Ireland and the emergency department (ED) of the Royal Victoria Eye and Ear Hospital (RVEEH), Dublin.MethodA 3-month period of data collection on usual care of 56 patients in general practice was followed by a 3-month period of GP-intervention data collection on 67 patients. Comparative data were collected on 37 patients who attended the RVEEH for the same intervention procedure. Patients completed a validated patient satisfaction questionnaire (PSQ-18).ResultsBoth general practice groups scored significantly higher in all seven aspects of medical care than the RVEEH cohort. Patients in the GP-intervention group scored significantly higher in terms of satisfaction with procedure technique compared with the usual care GP group.ConclusionThe provision of microsuction as a service in general practice confers as much or more patient satisfaction as the provision of the service in a hospital setting.
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Nehme, Ziad, Steffi Burns, Jocasta Ball, Stephen Bernard, and Karen Smith. "The impact of ventricular fibrillation amplitude on successful cardioversion, resuscitation duration, and survival after out-of-hospital cardiac arrest." Critical Care and Resuscitation 23, no. 2 (June 7, 2021): 202–10. http://dx.doi.org/10.51893/2021.2.oa7.
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OBJECTIVE: We sought to examine the incidence of low amplitude ventricular fibrillation and its impact on successful cardioversion, duration of resuscitation, and survival to hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). DESIGN: Retrospective analysis from a statewide registry. SETTING: Victoria, Australia. PARTICIPANTS: Consecutive initial ventricular fibrillation arrests with an emergency medical service (EMS)-attempted resuscitation between 1 February 2019 and 30 January 2020. MAIN OUTCOME MEASURES: Survival to hospital discharge, successful cardioversion, and duration of resuscitation. RESULTS: Of the 471 initial ventricular fibrillation arrests, 429 (91.1%) had sufficient electrocardiogram data for review. The median initial and final ventricular fibrillation amplitude did not differ (0.3 mV; interquartile range [IQR], 0.2–0.5 mV). The final pre-shock amplitude was ≤ 0.1 mV (very fine) and ≤ 0.2 mV (fine) in 22.8% and 37.5% of cases respectively. In a multivariable analysis, only the time between emergency call and first defibrillation was associated with a low initial ventricular fibrillation amplitude ≤ 0.2 mV (adjusted odds ratio [aOR], 1.07; 95% CI, 1.02–1.13; P = 0.004). After adjustment for arrest factors, every 0.1 mV increase in final amplitude was independently associated with survival to hospital discharge (aOR, 1.26; 95% CI, 1.14–1.39; P < 0.001) and initial cardioversion success (aOR, 1.19; 95% CI, 1.07–1.32; P = 0.001). The duration of resuscitation also increased by 1.7 minutes (95% CI, 1.03–2.36; P < 0.001) for every 0.1 mV increase in final amplitude. CONCLUSION: More than one-third of initial ventricular fibrillation OHCA cases were low in amplitude. Comparative international data are needed to better understand how low amplitude ventricular fibrillation rhythms confound the measurement of OHCA interventions and international benchmarks for survival outcomes.
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Beauchamp, Alison, Jason Talevski, Stephen J. Nicholls, Anna Wong Shee, Catherine Martin, William Van Gaal, Ernesto Oqueli, et al. "Health literacy and long-term health outcomes following myocardial infarction: protocol for a multicentre, prospective cohort study (ENHEARTEN study)." BMJ Open 12, no. 5 (May 2022): e060480. http://dx.doi.org/10.1136/bmjopen-2021-060480.
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IntroductionLow health literacy is common in people with cardiovascular disease and may be one factor that affects an individual’s ability to maintain secondary prevention health behaviours following myocardial infarction (MI). However, little is known about the association between health literacy and longer-term health outcomes in people with MI. The ENhancing HEAlth literacy in secondary pRevenTion of cardiac evENts (ENHEARTEN) study aims to examine the relationship between health literacy and a number of health outcomes (including healthcare costs) in a cohort of patients following their first MI. Findings may provide evidence for the significance of health literacy as a predictor of long-term cardiac outcomes.Methods and analysisENHEARTEN is a multicentre, prospective observational study in a convenience sample of adults (aged >18 years) with their first MI. A total of 450 patients will be recruited over 2 years across two metropolitan health services and one rural/regional health service in Victoria, Australia. The primary outcome of this study will be all-cause, unplanned hospital admissions within 6 months of index admission. Secondary outcomes include cardiac-related hospital admissions up to 24 months post-MI, emergency department presentations, health-related quality of life, mortality, cardiac rehabilitation attendance and healthcare costs. Health literacy will be observed as a predictor variable and will be determined using the 12-item version of the European Health Literacy Survey (HLS-Q12).Ethics and disseminationEthics approval for this study has been received from the relevant human research ethics committee (HREC) at each of the participating health services (lead site Monash Health HREC; approval number: RES-21-0000-242A) and Services Australia HREC (reference number: RMS1672). Informed written consent will be sought from all participants. Study results will be published in peer-reviewed journals and collated in reports for participating health services and participants.Trial registration numberACTRN12621001224819.
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Campbell, Sharon, Paul Fox-Hughes, Penelope Jones, Tomas Remenyi, Kate Chappell, Christopher White, and Fay Johnston. "Evaluating the Risk of Epidemic Thunderstorm Asthma: Lessons from Australia." International Journal of Environmental Research and Public Health 16, no. 5 (March 7, 2019): 837. http://dx.doi.org/10.3390/ijerph16050837.
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Epidemic thunderstorm asthma (ETA) is an emerging public health threat in Australia, highlighted by the 2016 event in Melbourne, Victoria, that overwhelmed health services and caused loss of life. However, there is limited understanding of the regional variations in risk. We evaluated the public health risk of ETA in the nearby state of Tasmania by quantifying the frequency of potential ETA episodes and applying a standardized natural disaster risk assessment framework. Using a case–control approach, we analyzed emergency presentations in Tasmania’s public hospitals from 2002 to 2017. Cases were defined as days when asthma presentations exceeded four standard deviations from the mean, and controls as days when asthma presentations were less than one standard deviation from the mean. Four controls were randomly selected for each case. Independently, a meteorologist identified the dates of potential high-risk thunderstorm events. No case days coincided with thunderstorms during the study period. ETA was assessed as a very low risk to the Tasmanian population, with these findings informing risk prioritization and resource allocation. This approach may be scaled and applied in other settings to determine local ETA risk. Furthermore, the identification of hazards using this method allows for critical analysis of existing public health systems.
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Considine, Julie, Anastasia F. Hutchison, Helen Rawson, Alison M. Hutchinson, Tracey Bucknall, Trisha Dunning, Mari Botti, Maxine M. Duke, and Maryann Street. "Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services." Australian Health Review 42, no. 4 (2018): 412. http://dx.doi.org/10.1071/ah16265.
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Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.
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McDermott, Francis T., Gregory J. Cooper, Philip L. Hogan, Stephen M. Cordner, and Ann B. Tremayne. "Evaluation of the Prehospital Management of Road Traffic Fatalities in Victoria, Australia." Prehospital and Disaster Medicine 20, no. 4 (August 2005): 219–27. http://dx.doi.org/10.1017/s1049023x00002570.
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AbstractIntroduction:This study was undertaken to identify prehospital system and management deficiencies and preventable deaths between 01 January 1997 and 31 December 1998 in 243 consecutive Victorian road crash victims with fatal outcomes.Methods:The complete prehospital and hospital records, the deposition to the coroner, and autopsy findings were evaluated by computer analysis and peer group review with multidisciplinary discussion.Results:One-hundred eighty-seven (77%) patients had prehospital errors or inadequacies, of which 135 (67%) contributed to death. Three-hundred ninety-four (67%) related to management and 130 (22%) to system deficiencies. Technique errors, diagnosis delays, and errors relatively were infrequent. One of 24 deaths at the crash scene or en route to hospital was considered to be preventable and two potentially preventable.Conclusion:The high prevalence of prehospital deficiencies has been addressed by a Ministerial Task Force on Trauma and Emergency Services and followed by the introduction of a new trauma care system in Victoria.
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Drosdowsky, A., K. Gough, M. Grewal, A. Dabscheck, N. Tebbutt, J. Philip, O. Spruyt, M. Michael, and M. Krishnasamy. "Does Care for Australians With Pancreatic Cancer Compare Favourably to a Consensus-Based Standard of Optimal Care?" Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 82s. http://dx.doi.org/10.1200/jgo.18.58800.
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Background: Pancreatic cancer has one of the lowest survival rates of all cancer types, with an incidence to mortality ratio approaching one. People with pancreatic cancer experience a rapid decline in health characterized by pain, nausea, fatigue and weight loss. For most people, the disease is detected at an advanced stage and the focus of treatment is palliative. In Victoria, Australia, knowledge regarding patterns of care for people with pancreatic cancer is out-of-date, but central to quality improvement initiatives targeting unwarranted variations in care and improvement in supports that are consistent with patient preferences. Aim: Our aim was to compare care received by patients with pancreatic cancer with a consensus-based standard representing optimal care to identify deviations from best practice and highlight processes that may improve the quality and safety of care provided. Methods: Eligible patients included those with pancreatic cancer, first treated in 2015, at one of three tertiary hospitals in Victoria, Australia. Once identified, dates and details of events indicated by the optimal care pathway were extracted from the medical record of each patient. Data were summarized using descriptive statistics and process maps: a visualization method that illuminates gaps, duplication, deviations from best practice and processes that may be amenable to improvement. Results: Thirty-two of 165 care pathways have been mapped to date. The nature and timing of care received appears highly variable. Only nine of 32 patients (28%) received all of their cancer care at a single institution; the remainder (n=23, 72%) received care in multiple tertiary and community facilities. Apart from four (13%) emergency presentations, referrals for specialist care came from general/primary practitioners (n=26, 81%). The timeframe for general/primary practitioner investigations ranged from one to 57 days. Once referred to a tertiary setting, most patients (n=23, 72%) were discussed at a multidisciplinary team meeting and received standard therapies. Only four had resectable disease. Nineteen patients (60%) had documented referrals to hospital- or community-based palliative care services. Where observed, deviations from the consensus-based standard tended to be related to the difficult nature of diagnosing pancreatic cancer, and determining appropriate care for patients with an advanced cancer with nonspecific symptoms. Conclusion: Process mapping provided a useful and efficient means of comparing care received with a consensus-based standard; however, the assessment of adherence to optimal timeframes and specific care events was complicated by missing data. Implications for quality improvement activities will be considered in the context of study limitations. We will also emphasize the importance of engaging patients and carers in setting improvement priorities.
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Kinsella, Rita, Tom Collins, Bridget Shaw, James Sayer, Belinda Cary, Andrew Walby, and Sallie Cowan. "Management of patients brought in by ambulance to the emergency department: role of the Advanced Musculoskeletal Physiotherapist." Australian Health Review 42, no. 3 (2018): 309. http://dx.doi.org/10.1071/ah16094.
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Objective The aim of the present study was to evaluate the role of the Advanced Musculoskeletal Physiotherapist (AMP) in managing patients brought in by ambulance to the emergency department (ED). Methods This study was a dual-centre observational study. Patients brought in by ambulance to two Melbourne hospitals over a 12-month period and seen by an AMP were compared with a matched group seen by other ED staff. Primary outcome measures were wait time and length of stay (LOS) in the ED. Results Data from 1441 patients within the Australasian Triage Scale (ATS) Categories 3–5 with musculoskeletal complaints were included in the analysis. Subgroup analysis of 825 patients aged ≤65 years demonstrated that for Category 4 (semi-urgent) patients, the median wait time to see the AMP was 9.5 min (interquartile range (IQR) 3.25–18.00 min) compared with 25 min (IQR 10.00–56.00 min) to see other ED staff (P ≤ 0.05). LOS analysis was undertaken on patients discharged home and demonstrated that there was a 1.20 greater probability (95% confidence interval 1.07–1.35) that ATS Category 4 patients managed by the AMP were discharged within the 4-hour public hospital target compared with patients managed by other ED staff: 87.04% (94/108) of patients managed by the AMPs met this standard compared with 72.35% (123/170) of patients managed by other ED staff (P = 0.002). Conclusions Patients aged ≤65 years with musculoskeletal complaints brought in by ambulance to the ED and triaged to ATS Category 4 are likely to wait less time to be seen and are discharged home more quickly when managed by an AMP. This study has added to the evidence that AMPs improve patient flow in the ED, freeing up time for other ED staff to see higher-acuity, more complex patients. What is known about the topic? There is a growing body of evidence establishing that AMPs improve the flow of patients presenting with musculoskeletal conditions to the ED through reduced wait times and LOS and, at the same time, providing good-quality care and enhanced patient satisfaction. What does this paper add? Within their primary contact capacity, AMPs also manage patients who are brought in by ambulance presenting with musculoskeletal conditions. To the authors’ knowledge, there is currently no available literature documenting the performance of AMPs in the management of this cohort of patients. What are the implications for practitioners? This study has added to the body of evidence that AMPs improve patient flow in the ED and illustrates that AMPs, by seeing patients brought in by ambulance, are able to have a positive impact on the pressures increasingly facing the Victorian Ambulance Service and emergency hospital care.
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Dennett, Amy M., Katherine E. Harding, Casey L. Peiris, Nora Shields, Christian Barton, Lauren Lynch, Phillip Parente, David Lim, and Nicholas F. Taylor. "Efficacy of Group Exercise–Based Cancer Rehabilitation Delivered via Telehealth (TeleCaRe): Protocol for a Randomized Controlled Trial." JMIR Research Protocols 11, no. 7 (July 18, 2022): e38553. http://dx.doi.org/10.2196/38553.
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Background Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise–based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. Objective We aimed to evaluate the efficacy of a group exercise–based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. Methods A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. Results The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. Conclusions This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr International Registered Report Identifier (IRRID) PRR1-10.2196/38553
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Cox, Shelley, Rohan Martin, Piyali Somaia, and Karen Smith. "The development of a data-matching algorithm to define the ‘case patient’." Australian Health Review 37, no. 1 (2013): 54. http://dx.doi.org/10.1071/ah11161.
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Objectives. To describe a model that matches electronic patient care records within a given case to one or more patients within that case. Method. This retrospective study included data from all metropolitan Ambulance Victoria electronic patient care records (n = 445 576) for the time period 1 January 2009–31 May 2010. Data were captured via VACIS (Ambulance Victoria, Melbourne, Vic., Australia), an in-field electronic data capture system linked to an integrated data warehouse database. The case patient algorithm included ‘Jaro–Winkler’, ‘Soundex’ and ‘weight matching’ conditions. Results. The case patient matching algorithm has a sensitivity of 99.98%, a specificity of 99.91% and an overall accuracy of 99.98%. Conclusions. The case patient algorithm provides Ambulance Victoria with a sophisticated, efficient and highly accurate method of matching patient records within a given case. This method has applicability to other emergency services where unique identifiers are case based rather than patient based. What is known about the topic? Accurate pre-hospital data that can be linked to patient outcomes is widely accepted as critical to support pre-hospital patient care and system performance. What does this paper add? There is a paucity of literature describing electronic matching of patient care records at the patient level rather than the case level. Ambulance Victoria has developed a complex yet efficient and highly accurate method for electronically matching patient records, in the absence of a patient-specific unique identifier. Linkage of patient information from multiple patient care records to determine if the records are for the same individual defines the ‘case patient’. What are the implications for practitioners? This paper describes a model of record linkage where patients are matched within a given case at the patient level as opposed to the case level. This methodology is applicable to other emergency services where unique identifiers are case based.
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McMillan, Alison. "Epidemic Thunderstorm Asthma." Prehospital and Disaster Medicine 34, s1 (May 2019): s7. http://dx.doi.org/10.1017/s1049023x19000335.
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Introduction:On November 21 and 22 of 2016, Victoria witnessed an unprecedented epidemic thunderstorm asthma emergency event in size acuity and impact. This scenario was never exercised nor contemplated. The event resulted in a 73% increase in calls to the Emergency Services Telecommunications Authority and 814 ambulance cases in the six hours from 6 pm on November 21, 2016. A 58% increase in people presented to public hospital emergency departments in Melbourne and Geelong on November 21 and 22, 2016 (based on the three-year average). 313 calls were made to the nurse on call from people with breathing, respiratory, and allergy problems (compared to an average of 63 calls for the previous month). Tragically, ten deaths are linked to this event.Methods:A substantial amount of work has been completed, much of which goes towards addressing the Inspector-General for Emergency Management recommendations following a review of the event, including: Release of an epidemic thunderstorm asthma campaign and education programs which were rolled out across Victoria for the community and health professionals from September through November 2017;Development of a new epidemic thunderstorm asthma forecasting system on 1 October 2017 and updated warning protocols during the 2017 grass pollen season;Implementation of a Real-time Health Emergency Monitoring System to alert the department of demands on public hospital emergency departments on the system; andIntroduction of a new State Health Emergency Response Plan in October 2017 to improve coordination and communications before and during a health emergency.Discussion:The presentation will concentrate on the lessons learned more than two years down the track from the event in November 2016.
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Stanton, Pauline. "Employment relationships in Victorian public hospitals: the Kennett years." Australian Health Review 23, no. 3 (2000): 193. http://dx.doi.org/10.1071/ah000193a.
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From 1992 to 1999, the Kennett government in Victoria moved to competitive market models of service delivery andthe measurement of service provision through casemix funding. Public hospital managers were given greateraccountability for the costs and provision of service delivery and a new range of service providers, many from theprivate sector, entered the public health market. The decentralisation of the industrial relations system led to newdevelopments in bargaining that brought both opportunities and problems. In the Victorian public health system therewas an increasing emphasis on decentralisation in both service provision and employment relations. In this paper Isuggest that there were contradictions in these developments for government, and new challenges and difficulties foremployers, employees and trade unions.
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Thompson, J., C. Batey, S. Borrell, L. Houston, G. Land, P. Bass, A. Lickliter, K. Watson, C. Stansfield, and G. Harrington. "The Alfred Hospitals Emergency Department response as H1N1 (Swine flu) griped Victoria." Australasian Emergency Nursing Journal 12, no. 4 (November 2009): 166. http://dx.doi.org/10.1016/j.aenj.2009.08.051.
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Bergin, Anne, Sandra G. Leggat, David Webb, and Koh Ai Lane. "A case study on easing an institutional bottleneck in aged care." Australian Health Review 29, no. 3 (2005): 327. http://dx.doi.org/10.1071/ah050327.
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This is a case study about a cross-sector Interim Health Care Strategy (IHCS) developed by a Victorian metropolitan health service in partnership with a private residential facility and a community agency to provide a range of transitional or interim care initiatives for public hospital patients awaiting permanent residential care after completing acute or subacute treatment. The aims were to improve access to emergency and acute inpatient services, while meeting the needs of residential care clients in the metropolitan suburbs. The components included care within a residential care facility, communitybased interim care and a subsequent Extended Rehabilitation Program. This IHCS has shown how a cross-sector initiative can improve care and outcomes of patients awaiting residential care placement. The case study shows how a multifaceted strategy that built upon existing relationships with strong planning, organisational commitment and a facilitating structure was successful in improving care integration.
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Mercier, E., E. Andrew, Z. Nehme, M. Lijovic, S. Bernard, and K. Smith. "LO73: Long-term functional outcome and health-related quality of life of elderly out-of-hospital cardiac arrest survivors." CJEM 19, S1 (May 2017): S53. http://dx.doi.org/10.1017/cem.2017.135.
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Introduction: This study aims to describe the long-term functional outcome and health-related quality of life of elderly (≥65 years old) out-of-hospital cardiac arrest (OHCA) survivors in Victoria, Australia. Methods: Elderly OHCA patients who arrested between January 1st, 2010 and December 31st, 2014 were identified from the Victorian Ambulance Cardiac Arrest Registry (VACAR). Living status, Glasgow Outcome Scale-Extended (GOS-E), Euro-QoL (EQ-5D) and Twelve-item Short Form (SF-12) Health Survey were collected by telephone 12 months following the OHCA. Results: Emergency medical services attended on 14,678 elderly OHCA during the study period, 6,851 (46.7%) of which received a resuscitation attempt. Of these, 668 patients (9.8%) survived to hospital discharge. The mean age of the survivors was 75 (standard deviation (SD) 7.4) years and 504 (75.4%) were male. Eighty-five patients subsequently died within 12 months of their OHCA. A total of 483 patients were interviewed (response rate 82.9%). At 12 months, 313 responders (64.9%) were living at home without care. Most responders (n=324 (67.2%)) had a good long-term functional recovery with a GOS-E ≥7. The proportion of patients with a GOS-E≥7 progressively decreased with increasing age (65-74 years: 66.1%, 75-84 years: 53.0%,≥85 years: 27.3%). On the EQ-5D, the majority of survivors reported no problem with mobility (n=266 (55.1%)), self-care (n=403 (83.4%)), activity (n=293 (60.6%)), pain (n=335 (69.3%)) and anxiety (n=358 (74.1%)). On the SF-12, the mean mental component summary was 56.3 (SD 6.6) while the mean physical component summary was 44.7 (SD 11.4) (both measures range from 0-100). Among the 1,951 patients who arrested in a supported accommodation, 849 (43.5%) had a resuscitation attempt, and of these, 21 survived to hospital discharge (2.5%). Only eight (1.0%) of these patients were still alive 12 months after the OHCA and one survivor (0.12%) had a good functional outcome (GOS-E≥7). Conclusion: Most elderly OHCA survivors have an adequate long-term functional status and health-related quality of life. However, the likelihood of having a good functional recovery decreases with increasing age, and is rare for patients arresting in a supported accommodation.
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Cameron, Peter A., Marcus P. Kennedy, and John J. McNeil. "The effects of bonus payments on emergency service performance in Victoria." Medical Journal of Australia 171, no. 5 (September 1999): 243–46. http://dx.doi.org/10.5694/j.1326-5377.1999.tb123630.x.
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Glaser, William F., Peter A. Cameron, Marcus P. Kennedy, and John J. McNeil. "The effects of bonus payments on emergency service performance in Victoria." Medical Journal of Australia 172, no. 2 (January 2000): 92–93. http://dx.doi.org/10.5694/j.1326-5377.2000.tb139213.x.
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Gleeson, Patrick, and Stephen Duckett. "Modeling the Emergency Ambulance Pass-By of Small Rural Hospitals in Victoria, Australia." Journal of Rural Health 21, no. 4 (October 2005): 367–71. http://dx.doi.org/10.1111/j.1748-0361.2005.tb00109.x.
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Gao, Crystal, Zheng Jie Lim, Sabrina Yeh, Scott Santinon, Scott De Haas, and Kristy Austin. "Assessing the Efficacy of a One-day Structured Induction Program in Orienting Clinical Staff to a Novel Prehospital Medical Deployment Model." Prehospital and Disaster Medicine 34, s1 (May 2019): s102—s103. http://dx.doi.org/10.1017/s1049023x19002127.
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Introduction:St. John Ambulance Victoria provides first aid and medical services at a variety of mass gathering events (MGEs) throughout Victoria. Volunteer healthcare professionals and students (termed “volunteers”) form Medical Assistance Teams (MAT) at these MGEs. MAT deployments manage a variety of patient presentations which include critically ill patients. This reduces high acuity patient transfers to the hospital and, where possible, avoid ambulance and hospital utilization.Aim:To determine the effectiveness of interdisciplinary prehospital simulation workshops in preparing volunteers for MAT deployment at MGEs.Methods:A one-day, simulation-based training session within the MAT environment was implemented to introduce volunteers to the management of various scenarios faced at MGEs. All volunteers were provided an orientation to the equipment and setting up MAT deployments at MGEs. Volunteers then participated in interdisciplinary group-based scenarios such as cardiac arrest management, drug intoxication, spinal injuries, agitated patients, and airway management. To determine the effectiveness of this training session, volunteers were invited to participate in a post-training survey, comprising of Likert scores and open-ended responses.Results:Seventeen volunteers attended the training session with 10 (58.8%) completing the post-training survey. Volunteers were satisfied with environment familiarization in the MAT (Average 4.47/5.00) and found the simulation-based training helpful (Average 3.67/4.00). The induction overall was well-received (4.60/5.00) with volunteers feeling more confident in being deployed at MGEs (4.20/5.00).Discussion:The results of the simulation-based training session were positive with volunteers receptive to the need for a training day prior to MAT deployment at MGEs. The simulation session enables volunteers to be comfortable with working in MAT and managing a diverse range of patients at MGEs. This session is likely to improve interdisciplinary communication and teamwork in the MAT. Future research is aimed at following these volunteers after several MAT deployments to improve the training session for future participants.
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Durmuş, Ensar, and Fatih Güneysu. "Do we need to enlarge emergency services or new emergency hospitals?" Medical Science and Discovery 8, no. 5 (May 15, 2021): 329–33. http://dx.doi.org/10.36472/msd.v8i5.543.
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Objective: It was aimed to obtain a notion about the needed hospital bed capacity by analyzing the number of hospitalizations and referrals from the ER in this study.
Material and Method: This study is a retrospective, analytical cross-sectional research. Patients admitted to a tertiary hospital’s adult emergency service in 2018-2019, hospitalized, or referred to another hospital were analyzed.
Results: Of the patients, 28036 were hospitalized; furthermore, this number corresponded to 38.4 patients per day. Of these cases, 15303 (54.6%) were male, and the mean age was 57.89 (±19.5); 8438 cases (30.1%) were admitted to the intensive care unit. The department with the most hospitalizations was internal medicine with 6105 patients (21.78%) and cardiology, with 4822 hospitalized, the most intensive care patients; moreover, psychiatry had the most prolonged length of stay service average of 28 days. The number of patients required to be hospitalized from the emergency room was an average of 48.5 patients per day. The average hospital stay was seven days.
Conclusion: Mainly in regions with several emergency admissions, it can be considered to establish emergency hospitals that serve particularly emergency cases to engage the number of patients to be hospitalized from the emergency room.
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Wilson, Beth. "Issues in Service Delivery for Women Statewide: The Consumer Context." Australian Journal of Primary Health 4, no. 3 (1998): 72. http://dx.doi.org/10.1071/py98032.
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This article presents data from two sources. The first set of data comes from complaints received by the Health Services Commissioner (Health Ombudsman) in Victoria from Consumers of Health Services about health service providers. The second set of data has been provided by 92 public hospitals using the health complaints information program. The Health Complaints Resolution Process is described and the data are presented in the hope that they may assist in formulating policies for women's health.
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Strømme, J. H., and P. Frederichsen. "Characteristics of Emergency Clinical Chemistry Service in Nordic General Hospitals." Scandinavian Journal of Clinical and Laboratory Investigation 48 (1988): 66–67. http://dx.doi.org/10.3109/00365518809168508.
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Strømme, J. H., and P. Frederichsen. "Characteristics of Emergency Clinical Chemistry Service in Nordic General Hospitals." Scandinavian Journal of Clinical and Laboratory Investigation 48, sup190 (January 1988): 66–67. http://dx.doi.org/10.1080/00365518809168508.
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Champion, Robert, Leigh D. Kinsman, Geraldine A. Lee, Kevin A. Masman, Elizabeth A. May, Terence M. Mills, Michael D. Taylor, Paulett R. Thomas, and Ruth J. Williams. "Forecasting emergency department presentations." Australian Health Review 31, no. 1 (2007): 83. http://dx.doi.org/10.1071/ah070083.
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Objective: To forecast the number of patients who will present each month at the emergency department of a hospital in regional Victoria. Methods: The data on which the forecasts are based are the number of presentations in the emergency department for each month from 2000 to 2005. The statistical forecasting methods used are exponential smoothing and Box?Jenkins methods as implemented in the software package SPSS version 14.0 (SPSS Inc, Chicago, Ill, USA). Results: For the particular time series, of the available models, a simple seasonal exponential smoothing model provides optimal forecasting performance. Forecasts for the first five months in 2006 compare well with the observed attendance data. Conclusions: Time series analysis is shown to provide a useful, readily available tool for predicting emergency department demand. The approach and lessons from this experience may assist other hospitals and emergency departments to conduct their own analysis to aid planning.
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Naccarella, Lucio, Michelle Raggatt, and Bernice Redley. "The Influence of Spatial Design on Team Communication in Hospital Emergency Departments." HERD: Health Environments Research & Design Journal 12, no. 2 (September 20, 2018): 100–115. http://dx.doi.org/10.1177/1937586718800481.
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Objective: To identify spatial design factors that influence informal interprofessional team-based communication within hospital emergency departments (EDs). Background: Effective team communication in EDs is critical for interprofessional collaborative care and prevention of serious errors due to miscommunication. Limited evidence exists about how informal communication in EDs is shaped by the physical workspace and how workplace design principles can improve the quality of ED team communication. Method: Two health services with four hospital sites in Victoria, Australia, participated. A multistage mixed-methods approach used (1) an anonymous online communication network survey ( N = 103) to collect data on patterns and locations of informal interprofessional team communication among ED staff, (2) focus groups ( N = 37) and interviews ( N = 3) using photoelicitation to understand the perspectives of ED staff about how spatial design influences team communication, and (3) validity testing of preliminary findings with executives and ED managers at the participating sites. Results: Informal communication with peers and within discipline groups on nonspecific areas of the ED was most common. Three key factors influenced the extent to which ED workspaces facilitated informal communication: (1) staff perceptions of privacy, (2) staff perceptions of safety, and (3) staff perceptions of connectedness to ED activity. Conclusion: Our research supports the proposition that ED physical environments influence informal team communication patterns. To facilitate effective team communication, ED workspace spatial designs need to provide visibility and connectedness, support and capture “case talk,” enable privacy for “comfort talk,” and optimize proximity to patients without compromising safety.
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Kiteng’u, Petronella Mueni, Lillian Muiruri, and Oluoch Musa. "The Influence of Staffs’ Knowledge on Preparedness of Catholic Mission Hospitals for Health Service Delivery during Emergency Inflow of Patients in Nairobi County, Kenya." American Journal of Health, Medicine and Nursing Practice 7, no. 9 (July 21, 2022): 25–35. http://dx.doi.org/10.47672/ajhmn.1131.
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Purpose: To determine the influence of staffs’ knowledge on preparedness of catholic mission hospitals for health service delivery during emergency inflow of patients in Nairobi County, Kenya.
Methodology: A cross sectional descriptive study design was used with quantitative approach for data collection and analysis. Four tier-3 Catholic Mission Hospitals were purposively selected and a stratified random sample of 647 members of staff from different cadres was taken. A structured questionnaire was used to collect data. Data was analyzed using STATA software v.16, where descriptive statistics were presented using frequencies and percentages whereas inferential statistics were presented using correlation and regression analysis.
Findings: The study found out that staff training and exercises for knowledge and skills influenced preparedness of Catholic Mission Hospitals for health service delivery during emergency influx of patients. A positive and significant relationship was found at (r=0.211; p<0.01). This means that the hospitals are perceived as prepared for health service delivery during emergency influx of patients. However, staff drills (staff exercises) at (r = -0.147; p<0.05) were found insignificantly influencing services delivery. This means that the hospitals would be unprepared even if staff drills were in place.
Recommendations: The study recommends that the managers of catholic hospitals should have scheduled staff trainings and drills for efficient and timely response in times of need for emergency service deliver. Policy guidelines on skills acquisition for the staff in the health institutions need to be developed to guide the trainings and frequent drills to sharpen the theory and practice of the healthcare team.
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Said, S. "The State of Emergency Radiology Service among Public Hospitals in Tanzania." Prehospital and Disaster Medicine 32, S1 (April 2017): S43. http://dx.doi.org/10.1017/s1049023x17001285.
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Schull, Michael J., and Marian Vermeulen. "Ontario's alternate funding arrangements for emergency departments: the impact on the emergency physician workforce." CJEM 7, no. 02 (March 2005): 100–106. http://dx.doi.org/10.1017/s1481803500013051.
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ABSTRACT Background: Difficulty maintaining physician staffing in emergency departments (EDs) prompted the government of Ontario to offer alternate funding arrangements (AFAs) to replace fee-for-service remuneration for physicians working in EDs. Objective: To analyze the effect of AFAs on physician staffing and practice patterns. Methods: We obtained Ontario Health Insurance Program fee-for-service and shadow-billing records for all physician services provided in EDs one year before and one year after implementation of an ED AFA. Only sites with reliable billing data were retained. Physicians were assigned to small/rural, community or teaching hospital groups based on their billing claims. For each hospital type, and all hospitals combined, we compared the pre- and post-AFA periods in terms of the number of physicians working regularly in the ED and their workload. As a possible unintended consequence of AFAs, we also compared physicians' involvement in primary care. Results: Overall, 76.2% of eligible hospitals adopted an ED AFA, of which 49 (42.6%) were included in our study (16 small/rural, 27 community and 6 teaching hospitals). In the post-AFA period, the number of physicians working in EDs increased by 7, from 674 to 681, representing a 1.0% increase overall in the workforce (p = 0.84). The change varied by hospital type, from a 5.8% increase in teaching hospitals to a 2.2% decrease in community hospitals, though none was significant. In the post-AFA period, the number of physicians working a moderate number of days per month increased from 190 to 214, representing a 3.2% absolute increase (p = 0.39), and the number working few (<5) or many (>10) days per month decreased. Post-AFA, the number of physicians working in EDs who also provided primary care services decreased by 1.7%, from 544 to 535 (p = 0.10). Conclusion: Emergency department AFAs have been widely adopted in Ontario, but have not been associated with substantial changes in the overall physician workforce in EDs. However, trends toward increased physician numbers were seen in small/rural and teaching hospitals. There was little evidence of any adverse effects on the provision of primary care services by physicians.
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Karakaya, A., and N. Vural. "Acute Poisoning Admissions in one of the Hospitals in Ankara." Human Toxicology 4, no. 3 (May 1985): 323–26. http://dx.doi.org/10.1177/096032718500400314.
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Sreemongkol, Kiatirat, Manoj Lohatepanont, Pannee Cheewinsiriwat, Tanyaluk O. Bunlikitkul, and Jirapong Supasaovapak. "GIS Mapping Evaluation of Stroke Service Areas in Bangkok Using Emergency Medical Services." ISPRS International Journal of Geo-Information 10, no. 10 (September 27, 2021): 651. http://dx.doi.org/10.3390/ijgi10100651.
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Stroke is a major cause of death in Thailand. It requires a specific time period of 4.5 h from onset to treatment to increase recovery rates, and therefore, it can be categorized as a time-sensitive disease. The objective of this research is to identify whether the service areas of the main existing Emergency Medical Services (EMS) prehospital stroke practices cover all areas in Bangkok. This is determined by using GIS mapping. After verifying the current EMS delivery models, comparisons are drawn to find the travelling time of each model. The conditioning factors for GIS mapping were collected and verified, including the traffic speed and duration spent in each mode of the prehospital stroke process. After inputting all of the data into GIS, the service areas were visualized to show the area serviced in each delivery model. The results also show the different hospital groups, including the service areas for (1) non-network hospitals and (2) hospitals with stroke networks. Suggestions for re-networking and adding more hospitals to the existing networks were also identified using GIS. Regularly updating the service area with up-to-date data in GIS is key to improving stroke service areas.
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S. Udoh, Nse, and Idorenyin A. Etukudo. "Minimal cost service rate in priority queuing models for emergency cases in hospitals." International Journal of Advanced Statistics and Probability 6, no. 2 (August 10, 2018): 50. http://dx.doi.org/10.14419/ijasp.v6i2.12332.
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Performance measures and waiting time cost for higher priority patients with severe cases over lower priority patients with stable cases using preemptive priority queuing model were obtained. Also, a total expected waiting time cost per unit time for service and the expected service cost per unit time for priority queuing models: M/M/2: ∞/NPP and M/M/2: ∞/PP were respectively formulated and optimized to obtain optimum cost service rate that minimizes the total cost. The results were applied to obtain optimum service rate that minimizes the total cost of providing and waiting for service at the emergency consulting unit of hospital.
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Donlon, M., and JC Cooper. "Re-designing emergency services: the 'EGS' system." Bulletin of the Royal College of Surgeons of England 88, no. 5 (May 1, 2006): 166–70. http://dx.doi.org/10.1308/147363506x106170.
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The emergency general surgical workload is a major component of hospital service involving over a million admissions and 300,000 emergency operations per year in the UK. Providing appropriate management and continuity of care to these patients is placing an increasing strain on hospitals.
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Suroso, Jebul, Yuliarti Yuliarti, and Eko Mardiyaningsih. "Caring Environment Model in Emergency Services of Hospitals by Banyumas Public Perception." Jurnal Kesehatan Masyarakat 13, no. 1 (July 28, 2017): 88–95. http://dx.doi.org/10.15294/kemas.v13i1.8655.
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Caring environment for providing service in the emergency departmentof the hospital becomes the need of the society. Caring environment has impact on the satisfaction, safety, and potential success of the services for the patients. The research aims at identifying the perception of society on caring environment as well as confirming the model of caring environment for providing emergency service in the hospital. This research employs descriptive exploration, involving 300 patients of emergency department from three hospitals in Banyumas. The analysis of decriptive data is conducted to categorize the perception of society on caring environment. The construct validity of caring environment is tested using confirmatory factor analysis. The result shows that the perceptions of society on caring environment in emergency department are good (86.3%) and fair (13,7 %). As the construct used to shape the model of caring environment has met the criteria of goodness of fit, involving: GFI; 0.96, RMSEA; 0.031, AGFI; 0,94; NFI;0,98; CFI;1, so it is revealed that the measurement model of caring environment for providing emergency service is fit. Moreover, all indicators are able to explain and support the model of caring environment for providing emergency services, involves; clean and comfortable room, complete facilities and equipments, and room safety. This finding could be the foundation for formulating the policy of caring quality improvement related to the aspect of caring environment for providing emergency services.
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Kozhimannil, Katy B., Julia D. Interrante, Mariana S. Tuttle, Carrie Henning-Smith, and Lindsay Admon. "Characteristics of US Rural Hospitals by Obstetric Service Availability, 2017." American Journal of Public Health 110, no. 9 (September 2020): 1315–17. http://dx.doi.org/10.2105/ajph.2020.305695.
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Objectives. To describe characteristics of rural hospitals in the United States by whether they provide labor and delivery (obstetric) care for pregnant patients. Methods. We used the 2017 American Hospital Association Annual Survey to identify rural hospitals and describe their characteristics based on the lack or provision of obstetric services. Results. Among the 2019 rural hospitals in the United States, 51% (n = 1032) of rural hospitals did not provide obstetric care. These hospitals were more often located in rural noncore counties (counties with no town of more than 10 000 residents). Rural hospitals without obstetrics also had lower average daily censuses, were more likely to be government owned or for profit compared with nonprofit ownership, and were more likely to not have an emergency department compared with hospitals providing obstetric care (P for all comparisons < .001). Conclusions. Rural US hospitals that do not provide obstetric care are located in more sparsely populated rural locations and are smaller than hospitals providing obstetric care. Public Health Implications. Understanding the characteristics of rural hospitals by lack or provision of obstetric services is important to clinical and policy efforts to ensure safe maternity care for rural residents.
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Leggat, Sandra G. "Hospital Planning: The Risks of Basing the Future on Past Data." Health Information Management Journal 37, no. 3 (October 2008): 6–14. http://dx.doi.org/10.1177/183335830803700302.
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Planning for capital development of public hospitals in Victoria is guided by a multi-stage process with comprehensive data analysis and thorough approval processes at each of the stages. The long development timeframes and the limitations in the data available to project service utilisation may negatively impact upon the service planning processes, and in some cases newly developed hospitals have not been sufficiently planned to meet community needs. This paper suggests that service utilisation forecasts derived from administrative databases require a more detailed verification process than currently exists. The process requires consideration of the drivers of demand to document the core assumptions about the future drivers, benchmarks with other jurisdictions, epidemiological, comparative and corporate needs assessment to explain the differences in utilisation rates, and sensitivity analysis. Given the cost of hospital construction and the rate of change in the healthcare sector, it is important that future hospital planning processes do not accept current utilisation trends as valid for future planning without this level of verification.
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Cartledge, S., J. Bray, D. Stub, P. Ngu, L. Straney, M. Stewart, W. Keech, H. Patsamanis, J. Shaw, and J. Finn. "Factors Associated with Emergency Medical Service Use for Acute Coronary Syndrome Patients in Victoria." Heart, Lung and Circulation 25 (August 2016): S45. http://dx.doi.org/10.1016/j.hlc.2016.06.103.
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Walker, Andrew, Jessica Rose Barrett, William Lee, Robert M. West, Elspeth Guthrie, Peter Trigwell, Alan Quirk, Mike J. Crawford, and Allan House. "Organisation and delivery of liaison psychiatry services in general hospitals in England: results of a national survey." BMJ Open 8, no. 8 (August 2018): e023091. http://dx.doi.org/10.1136/bmjopen-2018-023091.
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ObjectivesTo describe the current provision of hospital-based liaison psychiatry services in England, and to determine different models of liaison service that are currently operating in England.DesignCross-sectional observational study comprising an electronic survey followed by targeted telephone interviews.SettingAll 179 acute hospitals with an emergency department in England.Participants168 hospitals that had a liaison psychiatry service completed an electronic survey. Telephone interviews were conducted for 57 hospitals that reported specialist liaison services additional to provision for acute care.MeasuresData included the location, service structures and staffing, working practices, relations with other mental health service providers, policies such as response times and funding. Model 2-based clustering was used to characterise the services. Telephone interviews identified the range of additional liaison psychiatry services provided.ResultsMost hospitals (141, 79%) reported a 7-day service responding to acute referrals from the emergency department and wards. However, under half of hospitals had 24 hours access to the service (78, 44%). One-third of hospitals (57, 32%) provided non-acute liaison work including outpatient clinics and links to specialist hospital services. 156 hospitals (87%) had a multidisciplinary service including a psychiatrist and mental health nurses. We derived a four-cluster model of liaison psychiatry using variables resulting from the electronic survey; the salient features of clusters were staffing numbers, especially nursing; provision of rapid response 24 hours 7-day acute services; offering outpatient and other non-acute work, and containing age-specific teams for older adults.ConclusionsThis is the most comprehensive study to date of liaison psychiatry in England and demonstrates the wide availability of such services nationally. Although all services provide an acute assessment function, there is no uniformity about hours of coverage or expectation of response times. Most services were better characterised by the model we developed than by current classification systems for liaison psychiatry.