Добірка наукової літератури з теми "Royal Adelaide Hospital; adult burn service"

Anecdotal evidence from specialist burn clinicians suggested patient numbers and workloads increased during lockdown periods. This study aimed to describe the impact of the early COVID-19-related public health control measures (i.e., lockdowns) on burn injuries, hospital admissions, and care in a statewide burn service. We examined admissions data from The Victorian Adult Burns Service (located at the Alfred Hospital) and the Royal Children’s Hospital Burns Service—both of which contribute to the Burns Registry of Australia and New Zealand—during lockdown periods between March and October 2020, compared to the same periods in previous years. There were 714 patients admitted during the control period and 186 during the COVID-19 period. Burns sustained during COVID-19 lockdowns were larger in size. During COVID-19 lockdowns a greater proportion of patients were admitted to intensive care. Although the number of burn-related admissions did not increase during lockdowns, burn injuries that did occur were more severe (i.e., affected a greater percentage of body surface area). These more severe injuries placed an additional and significant burden on an already strained healthcare system. Future public health messaging should include prevention information to minimize the number of injuries occurring during lockdowns and other responses.

This study was performed to estimate the effect of the retrieval process on mortality for patients admitted to a mixed adult intensive care unit (ICU) compared with propensity-matched, non-retrieved controls. Patients retrieved to the Royal Adelaide Hospital (RAH) ICU between 2011 and 2015 were propensity-score matched for age, gender, Aboriginal and Torres Strait Islander status, Acute Physiology and Chronic Health Evaluation (APACHE) III score and diagnostic group with non-retrieved ICU patients to estimate the average treatment effect of retrieval on hospital mortality. Factors associated with mortality in those retrieved were assessed by multiple logistic regression. Retrieved patients comprised 1,597 (14%) of 11,641 index ICU admissions; this group were younger, mean (standard deviation) 53 (18.5) versus 59 (17.7) years, had higher APACHE III scores, 61 (30.3) versus 56 (27.5), were more likely to be Indigenous (5.1% versus 3.7%) and to have sustained trauma (34% versus 9%). The average treatment effect for retrieval on hospital mortality, risk difference (95% confidence interval), was −0.7% (-2.8% to 1.3%), P=0.50. Variables independently associated with hospital mortality in those retrieved included age, APACHE III score and diagnostic category. Time from retrieval team activation to arrival with the patient, rural location, radial distance from the RAH and population size at the retrieval location were not significantly associated with mortality. The hospital mortality for retrieved patients was not significantly different when compared with propensity-matched controls. Mortality in those retrieved was associated with increasing age, APACHE III score and diagnostic category; however, was independent of time from team activation to arrival with the patient.

ABSTRACT The COVID-19 pandemic has seen health systems adapt and change in response to local and international experiences. This paper describes the experiences and learnings by the Central Adelaide Local Health Network (CALHN) in managing a campaign style, novel public health disaster response. BACKGROUND Disaster preparedness has focussed on acute impact, mass casualty incidents. In early 2020 CALHNs largest hospital the Royal Adelaide Hospital (RAH) was appointed as the state primary COVID-19 adult receiving hospital. Between the period of 1st February 2020 when the first COVID-19 positive patient was admitted, through to 31st December 2020 the RAH had admitted 146 inpatients with COVID-19, 118 admitted to our hospital in the home service, 18 patients admitted to Intensive Care and four patients died whilst inpatients. During this time CALHN has sustained an active (physical and virtual) Network Incident Command Centre (NICC) supported by a Network Incident Management Team (NIMT). RESULTS This paper describes our key lessons learnt in relation to the management of a campaign style disaster response including the importance of disaster preparedness, fatigue management and communication. Also described were the challenges of operating in a command model and the role of exercising and education and an overview of our operating rhythm, how we built capability and lessons management. CONCLUSION Undertaking a longer duration disaster response, relating to the COVID-19 pandemic has shown that whilst traditional disaster principles still are important there are many nuances that need to be considered to retain a proportionate response. Our key lessons have revolved around the key tenants of disaster management, communication, capability, and governance.

Title page, table of contents and abstract only. The complete thesis in print form is available from the University of Adelaide Library.
The objective of this thesis is the collation, integration and revelation of just over a decade of work; supported by publication with media stories appended. At the beginning of this decade, at the end of 2001, I immigrated to Australia to take on the Directorship of the Adult Burns Service based at the Royal Adelaide Hospital. At the time, the Service lacked medical leadership and direction; it's standard of care being maintained only by excellent nursing and nurse leadership. This did not protect it from investigation by the State Government and the revelation that the Service lacked several key criteria to continue calling itself a tertiary service. At the end of the 'decade', in 2012, the Service is widely regarded as one of the best in the world, with enviable outcomes, excellent research and education programmes, a prolific publication output, a national burns charity and a highly disciplined, professional and experienced multidisciplinary team approach to burn care. ln December 2012 following successful re-verification with the American Burn Association and the American College of Surgeons, the Service has been completely transformed from the inauspicious position it occupied when I assumed control. The journey has been planned from the outset, and those plans executed fastidiously, with every opportunity for service development and betterment grasped. This work honours all those who have taken part and helped in the creation of something very special.
Thesis (M.D.)-- University of Adelaide, School of Medicine, 2013