Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2017
Observational StudyAnalysing the emergency department patient journey: Discovery of bottlenecks to emergency department patient flow.
Despite significant workflow reform to comply with the federally mandated National Emergency Access Target (NEAT), Australian public hospitals continue to face significant barriers in achieving good ED patient flow. This study was undertaken to identify and analyse the impact of individual waypoints on an ED patient's journey and identify which waypoints act as bottlenecks to a hospital's 4 h ED disposition performance. ⋯ The results reinforces the need for a whole-of-hospital effort to address flow bottlenecks, and identify moving a patient from emergency to inpatient care as the critical bottleneck in ED system performance.
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Emerg Med Australas · Feb 2017
High-flow oxygen in patients undergoing procedural sedation in the emergency department: A retrospective chart review.
Hypoxia is a recognised complication of procedural sedation. This study sought to determine whether there was an association between the use of high-flow oxygen delivery by a non-rebreather (NRB) mask during ED procedural sedation and decreased rates of hypoxia when compared with alternative oxygenation methods. ⋯ This study demonstrates an association with a statistically significant reduction in hypoxia when high-flow oxygen via NRB mask is administered during emergency procedural sedation. This intervention is simple, safe and inexpensive, and we would advocate that it be evaluated further in prospective trials.
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Ramping is the practice of requiring paramedics to continue to care for patients rather than hand over clinical responsibility to the ED. It arose as an alternative to admitting patients to EDs that are deemed to be already operating at or beyond capacity. This paper analyses the ethics of ramping. ⋯ However, this perspective fails to adequately consider the implications, especially the opportunity cost of requiring paramedics to remain at the hospital rather than make themselves available for other patients. From this perspective, ramping negatively impacts the wider provision of emergency medical services, with potentially serious consequences for people's health. Advocates of ramping must consider people in the community who require a medical emergency response.
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Emerg Med Australas · Feb 2017
Comparison of methods used to quantify general practice-type patients in the emergency department: A tertiary paediatric perspective.
The aim of this study was to compare methods for quantifying general practice-type (GP-type) patients in a paediatric ED to determine the robustness of current identification methods. ⋯ We demonstrated that current models to quantify perceived GP-type presentations were inconsistent in paediatric patients. All methods flagged a high proportion of GP-type presentations, and although the reasons for these presentations are multifactorial and not easily explained by access to GP services alone, they do represent a significant workload in the paediatric ED.