Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2017
Impact of an education session on clinical handover between medical shifts in an emergency department: A pilot study.
To evaluate the impact of a medical education session on the implementation of a new change of shift medical clinical handover format in an urban hospital ED. ⋯ Time pressures need to be taken into consideration when introducing changes to current processes. Also, it is recommended that, in addition to ongoing education, senior clinicians are engaged during the planning and execution stages of changes to practice.
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Emerg Med Australas · Jun 2017
Learning on the fly: How rural junior doctors learn during consultations with retrieval physicians.
This study explores how rural junior doctors learn while consulting retrieval physicians about critically ill and injured patients, as well as the tensions characterising teaching and learning in this setting. ⋯ Support provided by retrievalists extends the abilities of the junior doctors and often results in learning. When junior doctors are extended too far, they become overwhelmed and learning ceases. Junior doctors would like the retrievalists to spend more time explaining their actions and providing feedback. Even when both retrievalists and junior doctors are interested in teaching, it may not occur due to misunderstandings and differences in status.
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Emerg Med Australas · Jun 2017
Establishing a dedicated toxicology unit reduces length of stay of poisoned patients and saves hospital bed days.
This study evaluates the effect on the average length of stay (LOS), relative stay index (RSI), bed days and costs saved following the establishment of a dedicated clinical toxicology unit in an Australian tertiary referral hospital. ⋯ The reduction in average LOS is similar to results previously published by two Australian toxicology units over 15 years ago. Despite changes in healthcare delivery since this time, these results continue to support the efficiency and associated cost saving of a dedicated toxicology unit in managing poisoned patients.
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Emerg Med Australas · Jun 2017
Critical thinking, curiosity and parsimony in (emergency) medicine: 'Doing nothing' as a quality measure?
Current medical decision-making is influenced by many factors, such as competing interests, distractions, as well as fear of missing an important diagnosis. This can result in ordering tests or providing treatments that can be harmful. Unnecessary tests are more likely to lead to false positive diagnosis or incidental findings that are of uncertain clinical relevance. ⋯ The 'Choosing Wisely' campaign has identified many of these wasteful tests and treatments. This perspective proposes some suggestions to focus on our critical thinking, embrace shared decision-making and stay curious about the patient we are treating. Most importantly, 'doing nothing' could be a quality indicator for EDs, and ACEM supported audits and research to develop benchmarks for certain tests and procedures in the ED are important to achieve a cultural change.
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Emerg Med Australas · Jun 2017
Observational StudyTwo Hour Evaluation and Referral Model for Shorter Turnaround Times in the emergency department.
The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. ⋯ A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient.