Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2014
Observational StudyChallenges in arranging interhospital transfer from a non-tertiary hospital emergency department in the Perth metropolitan area.
To describe the organisational demands on staff when arranging interhospital transfers (IHTs) from an ED. ⋯ While most IHTs are straightforward, critically ill transfers require considerable time, effort and teamwork to arrange.
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Emerg Med Australas · Dec 2014
Clearing emergency departments and clogging wards: National Emergency Access Target and the law of unintended consequences.
To assess ED length of stay (EDLOS), access block, inpatient length of stay (IPLOS) and waiting times before and after the implementation of the National Emergency Access Target (NEAT). ⋯ At the current institution NEAT success has been guarded, likely secondary to availability of inpatient beds. The implementation of NEAT appears to have reduced emergency waiting times. These early results suggest concurrent a detrimental effect on IPLOS; however, some of this effect may be a result of a large increase in short stay admissions.
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Emerg Med Australas · Dec 2014
Clinical decision rule to prevent unnecessary chest X-ray in patients with blunt multiple traumas.
Since the diagnostic yield of chest X-ray (CXR) is not high enough, when it is ordered for all the multiple trauma patients, this study was aimed to evaluate the relationship between clinical and CXR findings in order to formulate a clinical decision rule to prevent unnecessary CXR in these patients. ⋯ Based on TIRC, it seems that CXR in stable multiple blunt trauma patients who are conscious and under 60 and have no decrease in pulmonary sounds, no dyspnea, no thoracic skin abrasion, and no crepitation can be ignored.
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Emerg Med Australas · Dec 2014
Current and future directions in clinical fatigue management: An update for emergency medicine practitioners.
Physicians worldwide are working round the clock to meet the demands of healthcare systems, especially in acute medical settings such as EDs. Demanding shift work schedules cause fatigue and thus deterioration in mood and motor performance. This article explores the effects of sleep deprivation, focusing on cognition, executive decision-making and the implications for clinical care. ⋯ Fatigue management training shows promise in enhancing safety in aviation and might have a role in medical shift work. Strategic napping improves performance during night shift in the ED, but does not fully negate fatigue. Drugs offer limited benefit for performance under sleep-deprived conditions, and whenever possible, sleep and/or strategic napping takes precedence.
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Emerg Med Australas · Dec 2014
Resource implications of a national health target: The New Zealand experience of a Shorter Stays in Emergency Departments target.
The Shorter Stays in Emergency Departments health target was introduced in New Zealand in 2009. District Health Boards (DHBs) are expected to meet the target with no additional funding or incentives. The costs of implementing such targets have not previously been studied. ⋯ The fact that estimated expenditure on the target was over $50 million without additional funding suggests that DHBs were able to make savings through improved efficiencies and/or that funds were reallocated from other services. The majority of expenditure occurred in the ED. Most of the funds were spent on staff, and this was associated with improved target performance.