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Turner, Valendar F., Peter J. Bentley, Sharon A. Hodgson, Peter J. Collard, Rosalia Drimatis, Catherine Rabune, and Andrew J. Wilson. "Telephone triage in Western Australia." Medical Journal of Australia 176, no. 3 (February 2002): 100–103. http://dx.doi.org/10.5694/j.1326-5377.2002.tb04313.x.
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Douglas, Ned, Jacqueline Leverett, Joseph Paul, Mitchell Gibson, Jessica Pritchard, Kayla Brouwer, Ebony Edwards, et al. "Performance of First Aid Trained Staff using a Modified START Triage Tool at Achieving Appropriate Triage Compared to a Physiology-Based Triage Strategy at Australian Mass Gatherings." Prehospital and Disaster Medicine 35, no. 2 (January 27, 2020): 184–88. http://dx.doi.org/10.1017/s1049023x20000102.
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AbstractIntroduction:Triage at mass gatherings in Australia is commonly performed by staff members with first aid training. There have been no evaluations of the performance of first aid staff with respect to diagnostic accuracy or identification of presentations requiring ambulance transport to hospital.Hypothesis:It was hypothesized that triage decisions by first aid staff would be considered correct in at least 61% of presentations.Methods:A retrospective audit of 1,048 presentations to a single supplier of event health care services in Australia was conducted. The presentations were assessed based on the first measured set of physiological parameters, and the primary triage decision was classified as “expected” if the primary and secondary triage classifications were the same or “not expected” if they differed. The performance of the two triage systems was compared using area under the receiver operating characteristic curve (AUROC) analysis.Results:The expected decision was made by first aid staff in 674 (71%) of presentations. Under-triage occurred in 131 (14%) presentations and over-triage in 142 (15%) presentations. The primary triage strategy had an AUROC of 0.7644, while the secondary triage strategy had an AUROC of 0.6280, which was significantly different (P = .0199).Conclusion:The results support the continued use of first aid trained staff members in triage roles at Australian mass gatherings. Triage tools should be simple, and the addition of physiological variables to improve the sensitivity of triage tools is not recommended because such an approach does not improve the discriminatory capacity of the tools.
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Happell, Brenda, and Monica Summers. "Satisfaction with psychiatric services in the emergency department." International Psychiatry 1, no. 5 (July 2004): 3–4. http://dx.doi.org/10.1192/s1749367600006809.
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The move to provide psychiatric services within the general health care system has resulted in emergency departments becoming the means of access to acute psychiatric care in Australia (Gillette & Bucknell, 1996). Triage within the emergency departments ensures that patients are reviewed and treated in a timely manner, in accordance with the urgency of the presenting problem. The National Triage Scale was developed as a clinical tool for this purpose for use in Australia and New Zealand (Australasian College for Emergency Medicine, 1994). However, this scale tends to attach lower priority to psychiatric issues (Smart et al, 1998).
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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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Brentnall, Edward W. "A history of triage in civilian hospitals in Australia." Emergency Medicine 9, no. 1 (August 26, 2009): 50–54. http://dx.doi.org/10.1111/j.1442-2026.1997.tb00558.x.
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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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Cox, Shelley, Chris Morrison, Peter Cameron, and Karen Smith. "Advancing age and trauma: Triage destination compliance and mortality in Victoria, Australia." Injury 45, no. 9 (September 2014): 1312–19. http://dx.doi.org/10.1016/j.injury.2014.02.028.
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Johnston-Leek, Malcolm, Peter Sprivulis, Julian Stella, and Didier Palmer. "Emergency department triage of indigenous and non-indigenous patients in tropical Australia." Emergency Medicine 13, no. 3 (September 2001): 333–37. http://dx.doi.org/10.1046/j.1035-6851.2001.00237.x.
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Russell, Bethany, Jennifer Philip, Olivia Wawryk, Sara Vogrin, Jodie Burchell, Anna Collins, Brian Le, Caroline Brand, Peter Hudson, and Vijaya Sundararajan. "Validation of the responding to urgency of need in palliative care (RUN-PC) triage tool." Palliative Medicine 35, no. 4 (January 21, 2021): 759–67. http://dx.doi.org/10.1177/0269216320986730.
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Background: The Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool is a novel, evidence-based tool by which specialist palliative care services can manage waiting lists and workflow by prioritising access to care for those patients with the most pressing needs in an equitable, efficient and transparent manner. Aim: This study aimed to establish the intra- and inter-rater reliability, and convergent validity of the RUN-PC Triage Tool and generate recommended response times. Design: An online survey of palliative care intake officers applying the RUN-PC Triage Tool to a series of 49 real clinical vignettes was assessed against a reference standard: a postal survey of expert palliative care clinicians ranking the same vignettes in order of urgency. Setting/Participants: Intake officers ( n = 28) with a minimum of 2 years palliative care experience and expert clinicians ( n = 32) with a minimum of 10 years palliative care experience were recruited from inpatient, hospital consultation and community palliative care services across metropolitan and regional Victoria, Australia. Results: The RUN-PC Triage Tool has good intra- and inter-rater reliability in inpatient, hospital consultation and community palliative care settings (Intraclass Correlation Coefficients ranged from 0.61 to 0.74), and moderate to good correlation to expert opinion used as a reference standard (Kendall’s Tau rank correlation coefficients ranged from 0.68 to 0.83). Conclusion: The RUN-PC Triage Tool appears to be a reliable and valid tool for the prioritisation of patients referred to specialist inpatient, hospital consultation and community palliative care services.
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Grigg, Margaret, Helen Herrman, and Carol Harvey. "What is Duty/Triage? Understanding the Role of Duty/Triage in an Area Mental Health Service." Australian & New Zealand Journal of Psychiatry 36, no. 6 (December 2002): 787–91. http://dx.doi.org/10.1046/j.1440-1614.2002.01088.x.
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Objective: To describe the duty/triage system within one urban area mental health service in Australia and to investigate the factors that affect the decision to organize a comprehensive assessment. Method: Data was collected from 3 months of duty/triage information and key informant interviews. Policies and procedures related to duty/triage were reviewed. Quantitative and qualitative analyses were conducted. Results: Two thousand, six hundred and three contacts with duty/triage occurred over a 3-month period. Half of these were related to patients new to the service. Most contacts were self-referrals or referrals from a carer. Few referrals came through the primary health care sector. New patients were more likely to be assessed if the referral was presented in technical language and if it was initiated by a health professional, particularly a general practitioner, emergency department or other mental health service. Assessment was less likely if the patient or carer initiated the referral, if the problem was presented in vague or non-technical terms, if there was a drug or alcohol problem or if the person refused care. Conclusions: A substantial number of potential patients contact a duty/triage worker every day. However, there is little interaction with the primary care sector, limited documentation of risk and a lack of consistency in the documented reasons for the service response. Further investigation is needed of the conditions conducive to consistent quality decision making at the point of entry to a specialist mental health service.
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Boyle, M. "Proposal for a radical change to prehospital trauma triage guidelines in Victoria, Australia." Injury Extra 40, no. 8 (August 2009): 140. http://dx.doi.org/10.1016/j.injury.2009.03.023.
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Wollaston, Anthony, Paul Fahey, Michelle McKay, Desley Hegney, Peter Miller, and James Wollaston. "Reliability and validity of the Toowoomba adult trauma triage tool: a Queensland, Australia study." Accident and Emergency Nursing 12, no. 4 (October 2004): 230–37. http://dx.doi.org/10.1016/j.aaen.2004.07.003.
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Alfano, Catherine M., Michael Jefford, Jane Maher, Sarah A. Birken, and Deborah K. Mayer. "Building Personalized Cancer Follow-up Care Pathways in the United States: Lessons Learned From Implementation in England, Northern Ireland, and Australia." American Society of Clinical Oncology Educational Book, no. 39 (May 2019): 625–39. http://dx.doi.org/10.1200/edbk_238267.
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There is a global need to transform cancer follow-up care to address the needs of cancer survivors while efficiently using the health care system to limit the effects of provider shortages, gaps in provider knowledge, and already overburdened clinics; improve the mental health of clinicians; and limit costs to health care systems and patients. England, Northern Ireland, and Australia are implementing an approach that triages patients to personalized follow-up care pathways depending on the types and levels of resources needed for patients’ long-term care that has been shown to meet patients’ needs, more efficiently use the health care system, and reduce costs. This article discusses lessons learned from these implementation efforts, identifying the necessary components of these care models and barriers and facilitators to implementation of this care. Specifically, the United States and other countries looking to transform follow-up care should consider how to develop six key principles of this care: algorithms to triage patients to pathways; methods to assess patient issues to guide care; remote monitoring systems; methods to support patients in self-management; ways to coordinate care and information exchange between oncology, primary care, specialists, and patients; and methods to engage all stakeholders and secure their ongoing buy-in. Next steps to advance this work in the United States are discussed.
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Ebker-White, Anja, Kendall J. Bein, and Michael M. Dinh. "Extending the Sydney Triage to Admission Risk Tool (START+) to predict discharges and short stay admissions." Emergency Medicine Journal 35, no. 8 (June 18, 2018): 471–76. http://dx.doi.org/10.1136/emermed-2017-207227.
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ObjectiveThis study aims to validate previously reported triage tool titled Sydney Triage to Admission Risk Tool (START+) and investigate whether an extended version of the tool could be used to identify and stream appropriate short stay admissions to ED observation units or specialised short stay inpatient wards.MethodsThis was a prospective study at two metropolitan EDs in Sydney, Australia. Consecutive triage encounters were observed by a trained researcher and START scores calculated. The primary outcome was length of stay <48 hours. Multivariable logistic regression was used to estimate area under curve of receiver operator characteristic (AUROC) for START scores. The original START tool was then extended to include frailty and multiple or major comorbidities as additional variables to assess for further predictive accuracy.ResultsThere were 894 patients analysed during the study period. Of the 894 patients, there were 732 patients who were either discharged from ED or admitted for <2 days. The AUROC for the original START+ tool was 0.80 (95% CI 0.77 to 0.83). The presence of frailty was found to add a further five points and multiple comorbidities added another four points on top of the START score, and the AUROC for the extended START score 0.84 (95% CI 0.81 to 0.88).ConclusionThe overall performance of the extended ED disposition prediction tool that included frailty and multiple medical comorbidities significantly improved the ability of the START tool to identify patients likely to be discharged from ED or require short stay admission <2 days.Trial registration numberACTRN12618000426280
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Taylor, Kathryn A., David N. Durrheim, Tony Merritt, Peter Massey, John Ferguson, Nick Ryan, and Carolyn Hullick. "Multidisciplinary analysis of invasive meningococcal disease as a framework for continuous quality and safety improvement in regional Australia." BMJ Open Quality 7, no. 1 (February 2018): e000077. http://dx.doi.org/10.1136/bmjoq-2017-000077.
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BackgroundSystem factors in a regional Australian health district contributed to avoidable care deviations from invasive meningococcal disease (IMD) management guidelines. Traditional root cause analysis (RCA) is not well-suited to IMD, focusing on individual cases rather than system improvements. As IMD requires complex care across healthcare silos, it presents an opportunity to explore and address system-based patient safety issues.ContextBaseline assessment of IMD cases (2005–2006) identified inadequate triage, lack of senior clinician review, inconsistent vital sign recording and laboratory delays as common issues, resulting in antibiotic administration delays and inappropriate or premature discharge.MethodsClinical governance, in partnership with clinical and public health services, established a multidisciplinary Meningococcal Reference Group (MRG) to routinely review management of all IMD cases. The MRG comprised representatives from primary care, acute care, public health, laboratory medicine and clinical governance. Baseline data were compared with two subsequent evaluation points (2011–2012 and 2013–2015).InterventionsPhase I involved multidisciplinary process mapping and development of a standardised audit tool from national IMD management guidelines. Phase II involved formalisation of group processes and advocacy for operational change. Phase III focused on dissemination of findings to clinicians and managers.ResultsGreatest care improvements were observed in the final evaluation. Median antibiotic delay decreased from 72 to 42 min and proportion of cases triaged appropriately improved from 38% to 75% between 2013 and 2015. Increasing fatal outcomes were attributed to the emergence of more virulent meningococcal serotypes.ConclusionsThe MRG was a key mechanism for identifying system gaps, advocating for change and enhancing communication and coordination across services. Employing IMD case review as a focus for district-level process reflection presents an innovative patient safety approach, combining the strengths of prospective hazard analysis with more traditional RCA methodologies.
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Hill, Michella G., Moira Sim, and Brennen Mills. "The quality of diagnosis and triage advice provided by free online symptom checkers and apps in Australia." Medical Journal of Australia 214, no. 3 (January 9, 2021): 143. http://dx.doi.org/10.5694/mja2.50923.
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Gilbert, Stephen, Paul Wicks, and Claire Novorol. "The quality of diagnosis and triage advice provided by free online symptom checkers and apps in Australia." Medical Journal of Australia 214, no. 3 (January 9, 2021): 143. http://dx.doi.org/10.5694/mja2.50917.
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Hill, Michella G., Moira Sim, and Brennen Mills. "The quality of diagnosis and triage advice provided by free online symptom checkers and apps in Australia." Medical Journal of Australia 212, no. 11 (May 11, 2020): 514–19. http://dx.doi.org/10.5694/mja2.50600.
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Owens, A., B. Holroyd, and P. McLane. "P090: A scoping review on patient race, ethnicity, and care in the emergency department." CJEM 21, S1 (May 2019): S96. http://dx.doi.org/10.1017/cem.2019.281.
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Introduction: Health disparities between racial and ethnic groups have been well documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there is a lack of scientific reviews in this important area. The objective of this review is to provide an overview of the literature on the impact of patient race and ethnicity on ED care. Methods: A scoping review guided by the framework described by Arksey and O'Malley was undertaken. This approach was taken because it was best suited to the goal of providing an overview of all of the literature, given the broad nature of the topic. All studies with primary outcomes considering the impact of patient race and ethnicity on “throughput” factors in the ED as defined by Asplin et al., were considered. Outcomes considered included triage scores, wait times, analgesia, diagnostic testing, treatment, leaving without being seen, and patient experiences. Literature from Canada, the United States, Australia, and New Zealand was considered. A database search protocol was developed iteratively as familiarity with the literature developed. Inclusion and exclusion decisions were made using an established model. Results: The original search yielded 1157 citations, reduced to 453 after duplicate removal. 153 full texts were included for screening, of which 85 were included for final data extraction. Results indicate there is evidence that minority racial and ethnic groups experience disparities in triage scores, wait times, analgesia, treatment, diagnostic testing, leaving without being seen, and subjective experiences. Authors’ suggested explanations for these disparities can be placed in the following categories: (1) communication differences; (2) conscious or unconscious bias; (3) facility and resource factors in hospitals with higher minority presentation rates; and (4) differences in clinical presentations. Conclusion: This scoping review provides an overview of the literature on the impacts of race and ethnicity on ED care. As disparities have been shown to exist in numerous contexts, further research on the impact of race and ethnicity in ED care is warranted, especially in the Canadian literature. Such explorations could aid in the informing and creation of policy, and guide practice.
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Russell, Grant, Riki Lane, Jennifer Neil, Jenny Advocat, Elizabeth Ann Sturgiss, Timothy Staunton Smith, Karyn Alexander, Simon Hattle, Benjamin F. Crabtree, and William L. Miller. "At the edge of chaos: a prospective multiple case study in Australian general practices adapting to COVID-19." BMJ Open 13, no. 1 (January 2023): e064266. http://dx.doi.org/10.1136/bmjopen-2022-064266.
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ObjectivesThe rapid onset and progressive course of the COVID-19 pandemic challenged primary care practices to generate rapid solutions to unique circumstances, creating a natural experiment of effectiveness, resilience, financial stability and governance across primary care models. We aimed to characterise how practices in Melbourne, Australia modified clinical and organisational routines in response to the pandemic in 2020–2021 and identify factors that influenced these changes.DesignProspective, qualitative, participatory case study design using constant comparative data analysis, conducted between April 2020 and February 2021. Participant general practitioner (GP) investigators were involved in study design, recruitment of other participants, data collection and analysis. Data analysis included investigator diaries, structured practice observation, documents and interviews.SettingThe cases were six Melbourne practices of varying size and organisational model.ParticipantsGP investigators approached potential participants. Practice healthcare workers were interviewed by social scientists on three occasions, and provided feedback on presentations of preliminary findings.ResultsWe conducted 58 interviews with 26 practice healthcare workers including practice owners, practice managers, GPs, receptionists and nurses; and six interviews with GP investigators. Data saturation was achieved within each practice and across the sample. The pandemic generated changes to triage, clinical care, infection control and organisational routines, particularly around telehealth. While collaboration and trust increased within several practices, others fragmented, leaving staff isolated and demoralised. Financial and organisational stability, collaborative problem solving, creative leadership and communication (internally and within the broader healthcare sector) were major influences on practice ability to negotiate the pandemic.ConclusionsThis study demonstrates the complex influences on primary care practices, and reinforces the strengths of clinician participation in research design, conduct and analysis. Two implications are: telehealth, triage and infection management innovations are likely to continue; the existing payment system provides inadequate support to primary care in a global pandemic.
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Mnatzaganian, George, Janet E. Hiller, George Braitberg, Michael Kingsley, Mark Putland, Melanie Bish, Kathleen Tori, and Rachel Huxley. "Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments." Heart 106, no. 2 (September 25, 2019): 111–18. http://dx.doi.org/10.1136/heartjnl-2019-315667.
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ObjectiveTo determine whether sex differences exist in the triage, management and outcomes associated with non-traumatic chest pain presentations in the emergency department (ED).MethodsAll adults (≥18 years) with non-traumatic chest pain presentations to three EDs in Melbourne, Australia between 2009 and 2013 were retrospectively analysed. Data sources included routinely collected hospital databases. Triage scoring of the urgency of presentation, time to medical examination, cardiac troponin testing, admission to specialised care units, and in-ED and in-hospital mortality were each modelled using the generalised estimating equations approach.ResultsOverall 54 138 patients (48.7% women) presented with chest pain, contributing to 76 216 presentations, of which 26 282 (34.5%) were cardiac. In multivariable analyses, compared with men, women were 18% less likely to be allocated an urgency of ‘immediate review’ or ‘within 10 min review’ (OR=0.82, 95% CI 0.79 to 0.85), 16% less likely to be examined within the first hour of arrival to the ED by an emergency physician (0.84, 0.81 to 0.87), 20% less likely to have a troponin test performed (0.80, 0.77 to 0.83), 36% less likely to be admitted to a specialised care unit (0.64, 0.61 to 0.68), and 35% (p=0.039) and 36% (p=0.002) more likely to die in the ED and in the hospital, respectively.ConclusionsIn the ED, systemic sex bias, to the detriment of women, exists in the early management and treatment of non-traumatic chest pain. Future studies that identify the drivers explaining why women presenting with chest pain are disadvantaged in terms of care, relative to men, are warranted.
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Roberts, D. M., J. F. Fraser, N. A. Buckley, and B. Venkatesh. "Experiences of Anticholinesterase Pesticide Poisonings in an Australian Tertiary Hospital." Anaesthesia and Intensive Care 33, no. 4 (August 2005): 469–76. http://dx.doi.org/10.1177/0310057x0503300408.
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There is limited information regarding the management and outcomes of patients presenting with anticholinesterase pesticide poisoning in Australia. Patients presenting to a tertiary referral hospital with anticholinesterase exposures were identified by discharge coding. The medical records of each patient were retrospectively reviewed. Based on clinical outcome, patients were classified as severe or non-severe poisonings. Forty-one presentations were noted between 1990 and 2003. Eight patients (20%) had severe poisoning of which tachycardia, fasciculations with weakness and metabolic acidosis were common manifestations. The diagnosis was delayed in four patients due to the absence of a clear history, which did not influence patient outcomes or put hospital staff at risk of nosocomial poisoning. The median length of hospital stay was prolonged in severe poisonings (20 days) compared to 12 hours in other patients. Two cases of intermediate syndrome were attributed to fenthion and diazinon, and one case of delayed polyneuropathy to trichlorfon. Cholinesterase activities were performed in only 49% of presentations. The overall mortality was 2.4% (1 death) and the mortality in patients with severe poisoning was 12.5%. The incidence of anticholinesterase poisoning in Australia is low. These outcomes were favourable and comparable with other published data. Measures to enhance the knowledge of medical staff supplemented by validated treatment protocols should be developed. For less significant exposures, an emphasis on adequate documentation of cholinergic signs and cholinesterase activities is necessary for rapid triage and may also have potential forensic implications if not performed.
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Jessup, Rebecca Leigh, C. Bramston, A. Beauchamp, A. Gust, N. Cvetanovska, Y. Cao, C. Haywood, et al. "Impact of COVID-19 on emergency department attendance in an Australia hospital: a parallel convergent mixed methods study." BMJ Open 11, no. 12 (December 2021): e049222. http://dx.doi.org/10.1136/bmjopen-2021-049222.
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ObjectivesThe COVID-19 pandemic has changed the way people are accessing healthcare. The aim of this study was to examine the impact of COVID-19 on emergency department (ED) attendance for frequent attenders and to explore potential reasons for changes in attendance.DesignThis convergent parallel mixed methods study comprised two parts.SettingAn interrupted time-series analysis evaluated changes in ED presentation rates; interviews investigated reasons for changes for frequent ED users in a culturally and linguistically diverse setting.ParticipantsA total of 4868 patients were included in the time series. A subgroup of 200 patients were interviewed, mean age 66 years (range 23–99).ResultsInterrupted time-series analysis from 4868 eligible participants showed an instantaneous decrease in weekly ED presentations by 36% (p<0.001), with reduction between 45% and 67% across emergency triage categories. 32% did not know they could leave home to seek care with differences seen in English versus non-English speakers (p<0.001). 35% reported postponing medical care. There was a high fear about the health system becoming overloaded (mean 4.2 (±2) on 6-point scale). Four key themes emerged influencing health-seeking behaviour: fear and/or avoidance of hospital care; use of telehealth for remote assessment; no fear or avoidance of hospital care; not leaving the house for any reason.ConclusionsThis study demonstrated reduced ED use by a vulnerable population of previously frequent attenders. COVID-19 has resulted in some fear and avoidance of hospitals, but has also offered new opportunity for alternative care through telehealth.
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Lystad, Reidar P., Andrew Fyffe, Rhonda Orr, and Gary Browne. "Incidence, Trends, and Seasonality of Paediatric Injury-Related Emergency Department Presentations at a Large Level 1 Paediatric Trauma Centre in Australia." Trauma Care 2, no. 3 (July 21, 2022): 408–17. http://dx.doi.org/10.3390/traumacare2030033.
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This retrospective cohort study aimed to examine the characteristics, incidence, temporal trends, and seasonality of paediatric injury-related Emergency Department (ED) presentations at a large metropolitan paediatric hospital. It included children aged ≤15 years who presented to the ED at The Children’s Hospital at Westmead, Sydney Australia, with a principal diagnosis of injury during the ten-year period from 1 January 2010 to 31 December 2019. Descriptive statistics were used to describe the characteristics of the cohort and the distribution of ED presentations by mode of arrival, triage category, discharge status, injury diagnosis. Negative binomial regression was used to examine percentage change in annual incidence. Seasonality was examined with Seasonal and Trend decomposition using Loess (STL). There were 134,484 (59.7% male children) paediatric injury-related ED presentations during the ten-year period, of which 23,224 (17.3%) were admitted to hospital. Head injury accounted for more than one-quarter (26.8%) of ED presentations. The average annual increase in incidence was more pronounced during the first five years (5.6% [95%CI 4.1% to 7.1%]) than in the last five years (0.8% [95%CI 0.2% to 1.5%]). The monthly incidence of ED presentations had a bimodal distribution with peaks during autumn (March–May) and spring (October–November) seasons. The mean number of ED presentations per day was higher on weekends (40.8 ± 0.3) than weekdays (35.3 ± 0.8). During 2010 to 2019, there was a significant increase in the annual incidence of injury-related ED presentations for children aged ≤15 years, with head injury accounting for more than one-quarter of the ED presentations. The incidence of paediatric injury-related ED presentations was higher during autumn and spring seasons and at weekends. These data will inform health resource planning and priority-setting and advocacy for child injury prevention strategies in Australia.
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Spaeth, Brooke, Mark Shephard, Rana Kokcinar, Lauren Duckworth, and Rodney Omond. "Impact of point-of-care testing for white blood cell count on triage of patients with infection in the remote Northern Territory of Australia." Pathology 51, no. 5 (August 2019): 512–17. http://dx.doi.org/10.1016/j.pathol.2019.04.003.
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Maxwell, Susannah, Ninh Thi Ha, Max K. Bulsara, Jenny Doust, Donald Mcrobbie, Peter O’Leary, John Slavotinek, and Rachael Moorin. "Increasing use of CT requested by emergency department physicians in tertiary hospitals in Western Australia 2003–2015: an analysis of linked administrative data." BMJ Open 11, no. 3 (March 2021): e043315. http://dx.doi.org/10.1136/bmjopen-2020-043315.
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ObjectiveThis study aimed to examine trends in number of CT scans requested by tertiary emergency department (ED) physicians in Western Australia (WA) from 2003 to 2015 across broad demographic and presentation characteristics, anatomical areas and presented symptoms.DesignAn observational cross-sectional study over study period from 2003 to 2015.SettingLinked administrative health service data at individual level from WA.ParticipantsA total of 1 666 884 tertiary hospital ED presentations of people aged 18 years or older were included in this studyMain outcome measureNumber of CT scans requested by tertiary ED physicians in an ED presentation.MethodsPoisson regression models were used to assess variation and trends in number of CT scans requested by ED physicians across demographic characteristics, clinical presentation characteristics and anatomical areas.ResultsOver the entire study duration, 71 per 1000 ED episodes had a CT requested by tertiary ED physicians. Between 2003 and 2015, the rate of CT scanning almost doubled from 58 to 105 per 1000 ED presentations. After adjusted for all observed characteristics, the rate of CT scans showed a downward trend from 2009 to 2011 and subsequent increase. Males, older individuals, those attending ED as a result of pain, those with neurological symptoms or injury or with higher priority triage code were the most likely to have CT requested by tertiary ED physicians.ConclusionsNoticeable changes in the number of CTs requested by tertiary ED physicians corresponded to the time frame of major health reforms happening within WA and nationally.
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Lam, Tina, Jane Hayman, Janneke Berecki-Gisolf, Paul Sanfilippo, Dan I. Lubman, and Suzanne Nielsen. "Comparing rates and characteristics of emergency department presentations related to pharmaceutical opioid poisoning in Australia: a study protocol for a retrospective observational study." BMJ Open 10, no. 9 (September 2020): e038979. http://dx.doi.org/10.1136/bmjopen-2020-038979.
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Introduction and aimsPharmaceutical opioids are an important contributor to the global ‘opioid crisis’, and are implicated in 70% of Australia’s opioid-related mortality. However, there have been few studies which consider the relative contribution of different pharmaceutical opioids to harm.We aim to compare commonly used pharmaceutical opioids in terms of (1) rates of harm, and (2) demographic and clinical characteristics associated with that harm.Method and analysisObservational study of emergency department presentations for non-fatal poisoning related to pharmaceutical opioid use. Data from 2009 to 2019 will be extracted from the Victorian Emergency Minimum Dataset which contains data from public hospitals with dedicated emergency departments in Victoria, Australia’s second most populous state. A combination of free-text and International Classification of Diseases 10th Revision codes will be used to identify relevant cases, with manual screening of each case to confirm relevance. We will calculate supply-adjusted rates of presentations using Poisson regression for all pharmaceutical opioid cases identified, separately for nine commonly prescribed pharmaceutical opioids (buprenorphine, codeine, fentanyl, methadone, morphine, oxycodone, oxycodone-naloxone, tapentadol, tramadol), and for a multiple opioid category. We will use multinomial logistic regression to compare demographic and clinical characteristics, such as triage category, across opioid types.Ethics and disseminationThis work is conducted under approval 21427 from the Monash University Human Research Ethics Committee for ongoing injury surveillance. As per conditions of approval, cells of <5 will not be reported, though zeroes will be preserved. We will present project findings in a peer-reviewed journal article as well as at relevant scientific conferences.
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Bond, Katherine A., Ben Smith, Emma Gardiner, KC Liew, Eloise Williams, Nicola Walsham, Mark Putland, and Deborah A. Williamson. "Utility of SARS-CoV-2 rapid antigen testing for patient triage in the emergency department: A clinical implementation study in Melbourne, Australia." Lancet Regional Health - Western Pacific 25 (August 2022): 100486. http://dx.doi.org/10.1016/j.lanwpc.2022.100486.
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Gilholm, Patricia, Kristen Gibbons, Paula Lister, Amanda Harley, Adam Irwin, Sainath Raman, Michael Rice, and Luregn J. Schlapbach. "Validation of a paediatric sepsis screening tool to identify children with sepsis in the emergency department: a statewide prospective cohort study in Queensland, Australia." BMJ Open 13, no. 1 (January 2023): e061431. http://dx.doi.org/10.1136/bmjopen-2022-061431.
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ObjectiveThe Surviving Sepsis Campaign guidelines recommend the implementation of systematic screening for sepsis. We aimed to validate a paediatric sepsis screening tool and derive a simplified screening tool.DesignProspective multicentre study conducted between August 2018 and December 2019. We assessed the performance of the paediatric sepsis screening tool using stepwise multiple logistic regression analyses with 10-fold cross-validation and evaluated the final model at defined risk thresholds.SettingTwelve emergency departments (EDs) in Queensland, Australia.Participants3473 children screened for sepsis, of which 523 (15.1%) were diagnosed with sepsis.InterventionsA 32-item paediatric sepsis screening tool including rapidly available information from triage, risk factors and targeted physical examination.Primary outcome measureSenior medical officer-diagnosed sepsis combined with the administration of intravenous antibiotics in the ED.ResultsThe 32-item paediatric sepsis screening tool had good predictive performance (area under the receiver operating characteristic curve (AUC) 0.80, 95% CI 0.78 to 0.82). A simplified tool containing 16 of 32 criteria had comparable performance and retained an AUC of 0.80 (95% CI 0.78 to 0.82). To reach a sensitivity of 90% (95% CI 87% to 92%), the final model achieved a specificity of 51% (95% CI 49% to 53%). Sensitivity analyses using the outcomes of sepsis-associated organ dysfunction (AUC 0.84, 95% CI 0.81 to 0.87) and septic shock (AUC 0.84, 95% CI 0.81 to 0.88) confirmed the main results.ConclusionsA simplified paediatric sepsis screening tool performed well to identify children with sepsis in the ED. Implementation of sepsis screening tools may improve the timely recognition and treatment of sepsis.
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Perry, Jeffrey J., Reena Goindi, Jamie Brehaut, Monica Taljaard, Sandra Schneider, and Ian G. Stiell. "Emergency physicians’ management of transient ischemic attack and desired sensitivity of a clinical decision rule for stroke in three countries." CJEM 13, no. 01 (January 2011): 19–27. http://dx.doi.org/10.2310/8000.2011.100269.
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ABSTRACTObjective:Four to 10% of patients with transient ischemic attack (TIA) suffer a stroke or die within 7 days. Our objectives were to determine (1) current practice for investigating and treating emergency department (ED) patients with TIA, (2) willingness to use a clinical decision rule to identify patients at high risk of impending stroke or death, and (3) the required sensitivity of this rule.Methods:We administered a mail survey to a random sample of members of three national emergency physician associations in Australia, Canada, and the United States using a modified Dillman technique. A prenotification letter and up to three surveys were sent.Results:A total of 801 responses (53.7%) from 1,493 surveys were received; 53.6% (95% CI 47.5–59.7) of emergency physicians reported routinely admitting TIA patients, ranging from 6.6% in Canada to 56.7% in the United States, and 9.9% of emergency physicians have a stroke prevention clinic, with 4.7% estimating that patients are seen within 7 days. A sensitive clinical decision rule for TIA patients would be used by 96.3% (95% CI 93.9–98.7) of emergency physicians. The median required sensitivity of this rule for stroke or death within 7 days was 97%.Conclusions:Almost half of all TIA patients are managed as outpatients,which is neither expedited nor in a dedicated stroke clinic. Emergency physicians indicate a willingness to use a highly sensitive clinical decision rule to triage TIA patients.
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Macgregor, Aisha, Alasdair Rutherford, Brendan McCormack, Jo Hockley, Margaret Ogden, Irene Soulsby, Maisie McKenzie, Karen Spilsbury, Barbara Hanratty, and Liz Forbat. "Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK." BMJ Open 11, no. 2 (February 2021): e049486. http://dx.doi.org/10.1136/bmjopen-2021-049486.
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IntroductionPalliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called ‘Palliative Care Needs Rounds’ (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life.Methods and analysisThis implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4–6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents’ quality of death and care home staff capability of adopting a palliative approach.Ethics and disseminationFrenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds.Registration detailsRegistration details: ISRCTN15863801.
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Ahn, Euijoon, Jinman Kim, Khairunnessa Rahman, Tanya Baldacchino, and Christine Baird. "Development of a risk predictive scoring system to identify patients at risk of representation to emergency department: a retrospective population-based analysis in Australia." BMJ Open 8, no. 9 (September 2018): e021323. http://dx.doi.org/10.1136/bmjopen-2017-021323.
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ObjectiveTo examine the characteristics of frequent visitors (FVs) to emergency departments (EDs) and develop a predictive model to identify those with high risk of a future representations to ED among younger and general population (aged ≤70 years).Design and settingA retrospective analysis of ED data targeting younger and general patients (aged ≤70 years) were collected between 1 January 2009 and 30 June 2016 from a public hospital in Australia.ParticipantsA total of 343 014 ED presentations were identified from 170 134 individual patients.Main outcome measuresProportion of FVs (those attending four or more times annually), demographic characteristics (age, sex, indigenous and marital status), mode of separation (eg, admitted to ward), triage categories, time of arrival to ED, referral on departure and clinical conditions. Statistical estimates using a mixed-effects model to develop a risk predictive scoring system.ResultsThe FVs were characterised by young adulthood (32.53%) to late-middle (26.07%) aged patients with a higher proportion of indigenous (5.7%) and mental health-related presentations (10.92%). They were also more likely to arrive by ambulance (36.95%) and leave at own risk without completing their treatments (9.8%). They were also highly associated with socially disadvantage groups such as people who have been divorced, widowed or separated (12.81%). These findings were then used for the development of a predictive model to identify potential FVs. The performance of our derived risk predictive model was favourable with an area under the receiver operating characteristic (ie, C-statistic) of 65.7%.ConclusionThe development of a demographic and clinical profile of FVs coupled with the use of predictive model can highlight the gaps in interventions and identify new opportunities for better health outcome and planning.
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Owens, Allison, Brian R. Holroyd, and Patrick McLane. "Patient race, ethnicity, and care in the emergency department: A scoping review." CJEM 22, no. 2 (February 17, 2020): 245–53. http://dx.doi.org/10.1017/cem.2019.458.
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ABSTRACTObjectivesHealth disparities between racial and ethnic groups have been documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there are no comprehensive literature reviews in this area. The objective of this review is to provide an overview of the literature on the impact of patient ethnicity and race on the processes of ED care.MethodsA scoping review was conducted to capture the broad nature of the literature. A database search was conducted in MEDLINE/PubMed, EMBASE, CINAHL Plus, Social Sciences Citation Index, SCOPUS, and JSTOR. Five journals and reference lists of included articles were hand searched. Inclusion and exclusion criteria were defined iteratively to ensure literature captured was relevant to our research question. Data were extracted using predetermined variables, and additional extraction variables were added as familiarity with the literature developed.ResultsSearching yielded 1,157 citations, reduced to 153 following removal of duplicates, and title and abstract screening. After full-text screening, 83 articles were included. Included articles report that, in EDs, patient race and ethnicity impact analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient subjective experiences. Authors of included studies propose a variety of possible causes for these disparities.ConclusionsFurther research on the existence of disparities in care within EDs is warranted to explore the causes behind observed disparities for particular health conditions and population groups in specific contexts.
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Zhang, Anthony L., Shefton J. Parker, De Villiers Smit, David McD Taylor, and Charlie C. L. Xue. "Acupuncture and Standard Emergency Department Care for Pain And/Or Nausea and Its Impact on Emergency Care Delivery: A Feasibility Study." Acupuncture in Medicine 32, no. 3 (June 2014): 250–56. http://dx.doi.org/10.1136/acupmed-2013-010501.
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Objective To evaluate the feasibility of delivering acupuncture in an emergency department (ED) to patients presenting with pain and/or nausea. Methods A feasibility study (with historical controls) undertaken at the Northern Hospital ED in Melbourne, Australia, involving people presenting to ED triage with pain (VAS 0–10) and/or nausea (Morrow Index 1–6) between January and August 2010 (n=400). The acupuncture group comprised 200 patients who received usual medical care and acupuncture; the usual care group comprised 200 patients with retrospective data closely matched from ED electronic health records. Results Refusal rate was 31%, with ‘symptoms under control owing to medical treatment before acupuncture’ the most prevalent reason for refusal (n=36); 52.5% of participants responded ‘definitely yes’ for their willingness to repeat acupuncture, and a further 31.8% responded ‘probably yes’. Over half (57%) reported a satisfaction score of 10 for acupuncture treatment. Musculoskeletal conditions were the most common conditions treated n=117 (58.5%), followed by abdominal or flank pain n=49 (24.5%). Adverse events were rare (2%) and mild. Pain and nausea scores reduced from a mean±SD of 7.01±2.02 before acupuncture to 4.72±2.62 after acupuncture and from 2.6±2.19 to 1.42±1.86, respectively. Conclusions Acupuncture in the ED appears safe and acceptable for patients with pain and/or nausea. Results suggest combined care may provide effective pain and nausea relief in ED patients. Further high-quality, sufficiently powered randomised studies evaluating the cost-effectiveness and efficacy of the add-on effect of acupuncture are recommended.
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Barnes, Cara, Daniel M. Fatovich, Stephen P. J. Macdonald, Richard F. Alcock, Jon R. Spiro, Tom G. Briffa, Carl J. Schultz, and Graham S. Hillis. "Single high-sensitivity troponin levels to assess patients with potential acute coronary syndromes." Heart 107, no. 9 (January 12, 2021): 721–27. http://dx.doi.org/10.1136/heartjnl-2020-317997.
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ObjectiveWe tested the hypothesis that patients with a potential acute coronary syndrome (ACS) and very low levels of high-sensitivity cardiac troponin I can be efficiently and safely discharged from the emergency department after a single troponin measurement.MethodsThis prospective cohort study recruited 2255 consecutive patients aged ≥18 years presenting to the Emergency Department, Royal Perth Hospital, Western Australia, with chest pain without high-risk features but requiring the exclusion of ACS. Patients were managed using a guideline-recommended pathway or our novel Single Troponin Accelerated Triage (STAT) pathway. The primary outcome was the percentage of patients discharged in <3 hours. Secondary outcomes included the duration of observation and death or acute myocardial infarction in the next 30 days.ResultsThe study enrolled 1131 patients to the standard cohort and 1124 to the STAT cohort. Thirty-eight per cent of the standard cohort were discharged directly from emergency department compared with 63% of the STAT cohort (p<0.001). The median duration of observation was 4.3 (IQR 3.3–7.1) hours in the standard cohort and 3.6 (2.6–5.4) hours in the STAT cohort (p<0.001), with 21% and 38% discharged in <3 hours, respectively (p<0.001). No patients discharged directly from the emergency department died or suffered an acute myocardial infarction within 30 days in either cohort.ConclusionsAmong low-risk patients with a potential ACS, a pathway which incorporates early discharge based on a single very low level of high-sensitivity cardiac troponin increases the proportion of patients discharged directly from the emergency department, reduces length of stay and is safe.Trial registration numberACTRN12618000797279.
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Fortune, Sarah, Sarah Hetrick, Vartika Sharma, Gabrielle McDonald, Kate M. Scott, Roger T. Mulder, and Linda Hobbs. "Multisite sentinel surveillance of self-harm in New Zealand: protocol for an observational study." BMJ Open 12, no. 5 (May 2022): e054604. http://dx.doi.org/10.1136/bmjopen-2021-054604.
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IntroductionNew Zealand (NZ) has a persistently high rate of suicide, particularly among young people. Hospital presentation for self-harm (SH) is one of the strongest predictors of death by suicide. Improving the monitoring of SH and suicide is a key recommendation for suicide prevention by WHO. This study will establish the first ever sentinel surveillance for SH at several large hospitals and a monthly survey of all practicing paediatricians in NZ. The study will provide robust information about the epidemiology of SH, factors associated with SH and the types of interventions required for those presenting to hospital with SH.Method and analysisThis observational study will establish SH surveillance in the emergency departments of three public hospitals for the first time in NZ, where study population will include individuals of all ages who present with SH or suicidal ideation. The study methodology is in line with the WHO Best Practice guidelines and international collaborators in Australia and Europe. Electronic triage records will be reviewed manually by the research team to identify potential cases that meet inclusion criteria. For all eligible cases, variables of interest will be extracted from routine clinical records by the research team and recorded on a secure web-based survey application. Additionally, SH surveillance data for the national paediatric population (<15 years) will be obtained via the New Zealand Paediatric Surveillance Unit (NZPSU); paediatricians will report on included cases using the same variables using a secure survey application. A deidentified dataset will be produced for aggregated statistical analysis.Ethics and disseminationThe University of Otago Health Ethics Committee granted ethical approval for this study in addition to local ethics approval at participating hospital sites. The study findings will be disseminated to relevant stakeholders in NZ, in addition to international audiences through publications in peer-reviewed scientific journals and conference presentations.
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James, David V. "Court Diversion in Perspective." Australian & New Zealand Journal of Psychiatry 40, no. 6-7 (June 2006): 529–38. http://dx.doi.org/10.1080/j.1440-1614.2006.01835.x.
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Court diversion schemes have been running for a decade in New Zealand and are increasing in number in Australia. This paper aims to give an international and historical context to these developments, by reference to psychiatric initiatives at courts in the US and in England and Wales. From a review of the specialist literature, an account is given of three forms of psychiatric intervention in courts over the last 90 years: court psychiatric clinics and mental health courts in the US, and court diversion schemes in England and Wales. High levels of psychiatric morbidity among prisoners, coupled with a continuing increase in prisoner numbers, demonstrate the need for systems for dealing with mentally ill people who come before the courts. Court diversion in England and Wales developed as part of a system where the mentally ill who are found guilty are sent to hospital in lieu of any other sentence. Its focus is on a form of psychiatric triage, and its ethos is the health of the patient. Court psychiatric clinics in the US grew up as an alternative to assessment in prison. Their focus has been on full psychiatric evaluation in an insanity and incompetence jurisdiction. The ethos has been that of serving the court. Mental health courts are heavily influenced by ideas of therapeutic jurisprudence, and their emphasis has been on a judge holding minor offenders in community care through the threat of judicial sanction. Experience in England and Wales has shown that court diversion can be a powerful and effective intervention. In order for it to function properly, those running court schemes need direct admission rights to psychiatric beds, both open and locked. Court diversion schemes are best as part of a spectrum of services to police stations, courts and prisons, which involved both general and forensic psychiatrists.
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Flynn, Julie, Frank Archer, and Amee Morgans. "Sensitivity and Specificity of the Medical Priority Dispatch System in Detecting Cardiac Arrest Emergency Calls in Melbourne." Prehospital and Disaster Medicine 21, no. 2 (April 2006): 72–76. http://dx.doi.org/10.1017/s1049023x00003381.
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AbstractIntroduction:In Australia, cardiac arrest kills 142 out of every 100,000 people each year; with only 3–4% of out-of-hospital patients with cardiac arrest in Melbourne surviving to hospital discharge. Prompt initiation of cardiopulmonary resuscitation (CPR), defibrillation, and advanced cardiac care greatly improves the chances of survival from cardiac arrest. A critical step in survival is identifying by the emergency ambulance dispatcher potential of the probability that the person is in cardiac arrest. The Melbourne Metropolitan Ambulance Service (MAS) uses the computerized call-taking system, Medical Priority Dispatch System (MPDS), to triage incoming, emergency, requests for ambulance responses. The MPDS is used in many emergency medical systems around the world, however, there is little published evidence of the system's efficacy.Objective:This study attempts to undertake a sensitivity/specificity analysis to determine the ability of MPDS to detect cardiac arrest.Methods:Emergency ambulance dispatch records of all cases identified as suspected cardiac arrest by MPDS were matched with ambulance, patient-care records and records from the Victorian Ambulance Cardiac Arrest Registry to determine the number of correctly identified cardiac arrests. Additionally, cases that had cardiac arrests, but were not identified correctly at the point of call-taking, were examined. All data were collected retrospectively for a three-month period (01 January through 31 March 2003).Results:The sensitivity of MPDS in detecting cardiac arrest was 76.7% (95% confidence interval (CI): 73.6%–79.8%) and specificity was 99.2% (95% CI: 99.1–99.3%). These results indicate that cardiac arrests are correctly identified in 76.7% of cases.Conclusion:Although the system correctly identified 76.7% of cardiac arrest cases, the number of false negatives suggests that there is room for improvement in recognition by MPDS to maximize chances for survival in out-of-hospital cardiac arrest. This study provides an objective and comprehensive measurement of the accuracy of MPDS cardiac-arrest detection in Melbourne, as well as providing a baseline for comparison with subsequent changes to the MPDS.
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Gerdtz, Marie Frances, Marnie Collins, Matthew Chu, Audas Grant, Robin Tchernomoroff, Cecily Pollard, Judy Harris, and Jeff Wassertheil. "Optimizing triage consistency in Australian emergency departments: The Emergency Triage Education Kit." Emergency Medicine Australasia 20, no. 3 (June 2008): 250–59. http://dx.doi.org/10.1111/j.1742-6723.2008.01089.x.
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Cooper, M. G., A. C. Gebels, R. J. Bailey, and D. K. M. Whish. "Unusual Partnerships: The Corfe–McMurdie Anaesthetic Inhaler of 1918 and the 2nd Australian Casualty Clearing Station." Anaesthesia and Intensive Care 46, no. 1_suppl (July 2018): 29–34. http://dx.doi.org/10.1177/0310057x180460s105.
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This World War 1 ether/chloroform vaporiser-inhaler was designed by and made for Captain Anstruther John Corfe by Private Eric Aspinall McMurdie, both of the 2nd Australian Casualty Clearing Station (ACCS), Australian Army Medical Corps (AAMC). It has a plaque attached labelled 25 May 1918. It is a perfect example of the ingenuity forced by the realities of war, and is one of the unique pieces in the Harry Daly Museum at the Australian Society of Anaesthetists (ASA) headquarters in Sydney, Australia. While serving in Blendecques, France, Private McMurdie ingeniously fashioned this vaporiser from discarded items he found on the battlefield. These included Horlick's Malted Milk bottles, on which he etched measurements for ether and chloroform, and a spent brass artillery shell, which made the heating component of the inhaler. The 2nd ACCS triaged and operated on thousands of troops, and this inhaler is a reflection of the skills and innovative expertise of the staff of the 2nd ACCS which included X-rays to localise foreign bodies, and locally made splints and apparatus to treat trench foot.
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Meadmore, Katie, Kathryn Fackrell, Alejandra Recio-Saucedo, Abby Bull, Simon D. S. Fraser, and Amanda Blatch-Jones. "Decision-making approaches used by UK and international health funding organisations for allocating research funds: A survey of current practice." PLOS ONE 15, no. 11 (November 5, 2020): e0239757. http://dx.doi.org/10.1371/journal.pone.0239757.
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Innovations in decision-making practice for allocation of funds in health research are emerging; however, it is not clear to what extent these are used. This study aims to better understand current decision-making practices for the allocation of research funding from the perspective of UK and international health funders. An online survey (active March-April 2019) was distributed by email to UK and international health and health-related funding organisations (e.g., biomedical and social), and was publicised on social media. The survey collected information about decision-making approaches for research funding allocation, and covered assessment criteria, current and past practices, and considerations for improvements or future practice. A mixed methods analysis provided descriptive statistics (frequencies and percentages of responses) and an inductive thematic framework of key experiences. Thirty-one responses were analysed, representing government-funded organisations and charities in the health sector from the UK, Europe and Australia. Four themes were extracted and provided a narrative framework. 1. The most reported decision-making approaches were external peer review, triage, and face-to-face committee meetings; 2. Key values underpinned decision-making processes. These included transparency and gaining perspectives from reviewers with different expertise (e.g., scientific, patient and public); 3. Cross-cutting challenges of the decision-making processes faced by funders included bias, burden and external limitations; 4. Evidence of variations and innovations from the most reported decision-making approaches, including proportionate peer review, number of decision-points, virtual committee meetings and sandpits (interactive workshop). Broadly similar decision-making processes were used by all funders in this survey. Findings indicated a preference for funders to adapt current decision-making processes rather than using more innovative approaches: however, there is a need for more flexibility in decision-making and support to applicants. Funders indicated the need for information and empirical evidence on innovations which would help to inform decision-making in research fund allocation.
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Van Gerven, R., H. Delooz, and W. Sermeus. "Systematic triage in the emergency department using the Australian National Triage Scale: a pilot project." European Journal of Emergency Medicine 8, no. 1 (March 2001): 3–7. http://dx.doi.org/10.1097/00063110-200103000-00002.
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Broadbent, Marc, Lorna Moxham, and Trudy Dwyer. "Implications of the emergency department triage environment on triage practice for clients with a mental illness at triage in an Australian context." Australasian Emergency Nursing Journal 17, no. 1 (February 2014): 23–29. http://dx.doi.org/10.1016/j.aenj.2013.11.002.
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Beuran, M. "TRAUMA CARE: HIGHLY DEMANDING, TREMENDOUS BENEFITS." Journal of Surgical Sciences 2, no. 3 (July 1, 2015): 111–14. http://dx.doi.org/10.33695/jss.v2i3.117.
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From its beginning, mankind suffered injuries through falling, fire, drowning and human aggression [1]. Although the frequency and the kinetics modifiy over millennia, trauma continues to represent an important cause of morbidity and mortality even in the modern society [1]. Significant progresses in the trauma surgery were due to military conflicts, which next to social sufferance came with important steps in injuries’ management, further applied in civilian hospitals. The foundation of modern trauma systems was started by Dominique Jean Larrey (1766-1842) during the Napoleonic Rin military campaign from 1792. The wounded who remained on the battlefield till the end of the battle to receive medical care, usually more than 24 hours, from that moment were transported during the conflict with flying ambulances to mobile hospitals. Starting with the First World War, through the usage of antiseptics, blood transfusions, and fracture management, the mortality decreased from 39% in the Crimean War (1853–1856) to 10%. One of the most preeminent figures of the Second World War was Michael DeBakey, who created the Mobile Army Surgical Hospitals (MASH), concept very similar to the Larrey’s unit. In 1941, in England, Birmingham Accident Hospital was opened, specially designed for injured people, this being the first trauma center worldwide. During the Golf War (1990–1991) the MASH were used for the last time, being replaced by Forward Surgical Teams, very mobile units satisfying the necessities of the nowadays infantry [1].
Nowadays, trauma meets the pandemic criteria, everyday 16,000 people worldwide are dying, injuries representing one of the first five causes of mortality for all the age groups below 60 [2]. A recent 12-month analysis of trauma pattern in the Emergency Hospital of Bucharest revealed 141 patients, 72.3% males, with a mean age of 43.52 ± 19 years, and a mean New Injury Severity Score (NISS) of 27.58 ± 11.32 [3]. The etiology was traffic related in 101 (71.6%), falls in 28 (19.9%) and crushing in 7 (5%) cases. The overall mortality was as high as 30%, for patients with a mean NISS of 37.63 [3].
At the scene, early recognition of severe injuries and a high index of suspicion according to trauma kinetics may allow a correct triage of patients [4]. A functional trauma system should continuously evaluate the rate of over- and under-triage [5]. The over-triage represents the transfer to a very severe patient to a center without necessary resources, while under-triage means a low injured patient referred to a highly specialized center. If under-triage generates preventable deaths, the over-triage comes with a high financial and personal burden for the already overloaded tertiary centers [5]. To maximize the chance for survival, the major trauma patients should be transported as rapid as possible to a trauma center [6]. The initial resuscitation of trauma patients was divided into two time intervals: ten platinum minutes and golden hour [6]. During the ten platinum minutes the airways should be managed, the exsanguinating bleeding should be stopped, and the critical patients should be transported from the scene. During the golden hour all the life-threatening lesions should be addressed, but unfortunately many patients spend this time in the prehospital setting [6]. These time intervals came from Trunkey’s concept of trimodal distribution of mortality secondary to trauma, proposed in 1983 [7]. This trimodal distribution of mortality remains a milestone in the trauma education and research, and is still actual for development but inconsistent for efficient trauma systems [8].
The concept of patients’ management in the prehospital setting covered a continuous interval, with two extremities: stay and play/treat then transfer or scoop and run/ load and go. Stay and play, usually used in Europe, implies airways securing and endotracheal intubation, pleurostomy tube insertion, and intravenous lines with volemic replacement therapy. During scoop and run, used in the Unites States, the patient is immediately transported to a trauma center, addressing the immediate life-threating injuries during transportation.
In the emergency department of the corresponding trauma center, the resuscitation of the injured patients should be done by a trauma team, after an orchestrated protocol based on Advanced Trauma Life Support (ATLS). The modern trauma teams include five to ten specialists: general surgeons trained in trauma care, emergency medicine physicians, intensive care physicians, orthopedic surgeons, neurosurgeons, radiologists, interventional radiologists, and nurses. In the specially designed trauma centers, the leader of the trauma team should be the general surgeon, while in the lower level centers this role may be taken over by the emergency physicians.
The implementation of a trauma system is a very difficult task, and should be tailored to the needs of the local population. For example, in Europe the majority of injuries are by blunt trauma, while in the United States or South Africa they are secondary to penetrating injuries. In an effort to analyse at a national level the performance of trauma care, we have proposed a national registry of major trauma patients [9]. For this registry we have defined major trauma as a New Injury Severity Score higher than 15. The maintenance of such registry requires significant human and financial resources, while only a permanent audit may decrease the rate of preventable deaths in the Romanian trauma care (Figure 1) [10].
Figure 1 - The website of Romanian Major Trauma Registry (http://www.registrutraume.ro).
USA - In the United States of America there are 203 level I centers, 265 level II centers, 205 level III or II centers and only 32 level I or II pediatric centers, according to the 2014 report of National Trauma Databank [11]. USA were the first which recognized trauma as a public health problem, and proceeded to a national strategy for injury prevention, emergency medical care and trauma research. In 1966, the US National Academy of Sciences and the National Research Council noted that ‘’public apathy to the mounting toll from accidents must be transformed into an action program under strong leadership’’ [12]. Considerable national efforts were made in 1970s, when standards of trauma care were released and in 1990s when ‘’The model trauma care system plan’’[13] was generated. The American College of Surgeons introduced the concept of a national trauma registry in 1989. The National Trauma Databank became functional seven years later, in 2006 being registered over 1 million patients from 600 trauma centers [14].
Mortality from unintentional injury in the United States decreased from 55 to 37.7 per 100,000 population, in 1965 and 2004, respectively [15]. Due to this national efforts, 84.1% of all Americans have access within one hour from injury to a dedicated trauma care [16].
Canada - A survey from 2010 revealed that 32 trauma centers across Canada, 16 Level I and 16 Level II, provide definitive trauma care [18]. All these centers have provincial designation, and funding to serve as definitive or referral hospital. Only 18 (56%) centers were accredited by an external agency, such as the Trauma Association of Canada. The three busiest centers in Canada had between 798–1103 admissions with an Injury Severity Score over 12 in 2008 [18].
Australia - Australia is an island continent, the fifth largest country in the world, with over 23 million people distributed on this large area, a little less than the United States. With the majority of these citizens concentrated in large urban areas, access to the medical care for the minority of inhabitants distributed through the territory is quite difficult. The widespread citizens cannot be reached by helicopter, restricted to near-urban regions, but with the fixed wing aircraft of the Royal Flying Doctor Service, within two hours [13]. In urban centers, the trauma care is similar to the most developed countries, while for people sparse on large territories the trauma care is far from being managed in the ‘’golden hour’’, often extending to the ‘’Golden day’’ [19].
Germany - One of the most efficient European trauma system is in Germany. Created in 1975 on the basis of the Austrian trauma care, this system allowed an over 50% decreasing of mortality, despite the increased number of injuries. According to the 2014 annual report of the Trauma Register of German Trauma Society (DGU), there are 614 hospitals submitting data, with 34.878 patients registered in 2013 [20]. The total number of cases documented in the Trauma Register DGU is now 159.449, of which 93% were collected since 2002. In the 2014 report, from 26.444 patients with a mean age of 49.5% and a mean ISS of 16.9, the observed mortality was 10% [20].
The United Kingdom - In 1988, a report of the Royal College of Surgeons of England, analyzing major injuries concluded that one third of deaths were preventable [21]. In 2000, a joint report from the Royal College of Surgeons of England and of the British Orthopedic Association was very suggestive entitled "Better Care for the Severely Injured" [22]. Nowadays the Trauma Audit Research network (TARN) is an independent monitor of trauma care in England and Wales [23]. TARN collects data from hospitals for all major trauma patients, defined as those with a hospital stay longer than 72 hours, those who require intensive care, or in-hospital death. A recent analysis of TARN data, looking at the cost of major trauma patients revealed that the total cost of initial hospital inpatient care was £19.770 per patient, of which 62% was attributable to ventilation, intensive care and wards stays, 16% to surgery, and 12% to blood transfusions [24].
Global health care models
Countries where is applied
Functioning concept
Total healthcare costs from GDP
Bismarck model
Germany
Privatized insurance companies (approx. 180 nonprofit sickness funds). Half of the national trauma beds are publicly funded trauma centers; the remaining are non-profit and for-profit private centers.
11.1%
Beveridge model
United Kingdom
Insurance companies are non-existent. All hospitals are nationalized.
9.3%
National health insurance
Canada, Australia, Taiwan
Fusion of Bismarck and Beveridge models. Hospitals are privatized, but the insurance program is single and government-run.
11.2% for Canada
The out-of-pocket model
India, Pakistan, Cambodia
The poorest countries, with undeveloped health care payment systems. Patients are paying for more than 75% of medical costs.
3.9% for India
GDP – gross domestic product
Table 1 - Global health care models with major consequences on trauma care [17].
Traumas continue to be a major healthcare problem, and no less important than cancer and cardiovascular diseases, and access to dedicated and timely intervention maximizes the patients’ chance for survival and minimizes the long-term morbidities. We should remember that one size does not fit in all trauma care. The Romanian National Trauma Program should tailor its resources to the matched demands of the specific Romanian urban and rural areas.
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Grouse, A. I., R. O. Bishop, and A. M. Bannon. "The Manchester Triage System provides good reliability in an Australian emergency department." Emergency Medicine Journal 26, no. 7 (June 22, 2009): 484–86. http://dx.doi.org/10.1136/emj.2008.065508.
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Cameron, Mitchell. "Re: Evaluation of the trauma triage accuracy in a Level 1 Australian trauma centre." Emergency Medicine Australasia 31, no. 2 (December 10, 2018): 291–92. http://dx.doi.org/10.1111/1742-6723.13216.
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Broadbent, Marc, Anne Creaton, Lorna Moxham, and Trudy Dwyer. "Review of triage reform: the case for national consensus on a single triage scale for clients with a mental illness in Australian emergency departments." Journal of Clinical Nursing 19, no. 5-6 (March 2010): 712–15. http://dx.doi.org/10.1111/j.1365-2702.2009.02988.x.
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Mitchell, Simon, Michael Bennett, Phillip Bryson, Frank K. Butler, David J. Doolette, James R. Holm, Jacek Kot, and Pierre Lafère. "Consensus guideline: Pre-hospital management of decompression illness: expert review of key principles and controversies." Undersea and Hyperbaric Medicine 45, no. 3 (May 1, 2018): 273–86. http://dx.doi.org/10.22462/05.06.2018.3.
Full textAbstract:
Guidelines for the pre-hospital management of decompression illness (DCI) had not been formally revised since the 2004 Divers Alert Network/Undersea and Hyperbaric Medical Society workshop held in Sydney, entitled “Management of mild or marginal decompression illness in remote locations.” A contemporary review was initiated by the Divers Alert Network and undertaken by a multinational committee with members from Australasia, the USA and Europe. The process began with literature reviews by designated committee members on: the diagnosis of DCI; first aid strategies for DCI; remote triage of possible DCI victims by diving medicine experts; evacuation of DCI victims; effect of delay to recompression in DCI; pitfalls in management when DCI victims present at hospitals without diving medicine expertise and in-water recompression. This was followed by presentation of those reviews at a dedicated workshop at the 2017 UHMS Annual Scientific Meeting, discussion by registrants at that workshop and, finally, several committee meetings to formulate statements addressing points considered of prime importance to the management of DCI in the field. The committee placed particular emphasis on resolving controversies around the definition of “mild DCI” arising over 12 years of practical application of the 2004 workshop’s findings, and on the controversial issue of in-water recompression. The guideline statements are promulgated in this paper. The full workshop proceedings are in preparation for publication.
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Gerdtz, M. F., and M. Chu. "68: Achieving Consistency With Triage in Australian Emergency Departments: Implications for Training and Guideline Development." Annals of Emergency Medicine 51, no. 4 (April 2008): 491. http://dx.doi.org/10.1016/j.annemergmed.2008.01.035.
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Broadbent, Marc, Lorna Moxham, and Trudy Dwyer. "Issues associated with the triage of clients with a mental illness in Australian emergency departments." Australasian Emergency Nursing Journal 13, no. 4 (November 2010): 117–23. http://dx.doi.org/10.1016/j.aenj.2010.08.087.
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