Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2018
CommentChoosing public or private emergency departments in Australia.
Emergency medicine was once exclusively provided in public hospitals in Australia, but now over half a million consultations per annum are in private (7% total emergency consultations). Private EDs have excess capacity and are staffed by senior doctors (majority FACEM) with open access to investigations and broad specialist inpatient services. Public EDs struggle with rising attendances and overcapacity. ⋯ Stakeholder relationships should be strengthened. Research and education about decision-making in the choice between public and private ED attendance should be encouraged, particularly regarding paramedic advice to patients. Finally, patients who have purchased private insurance should be able to utilise it during evaluation of an acute illness.
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Emerg Med Australas · Feb 2018
Do instability markers predict satisfactory reduction and requirement for later surgery in emergency department patients with wrist fracture?
Research suggests that the presence of instability markers in patients with displaced distal radial fractures is associated with poorer outcome. Our aims were to determine whether the presence of previously defined instability markers could predict the likelihood of successful ED reduction and requirement for a secondary procedure after ED reduction. ⋯ Instability risk factors are common in patients with wrist fractures requiring reduction in ED. The number of instability factors is not a strong predictor of the performance of secondary procedures.
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Emerg Med Australas · Feb 2018
Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre-based, high fidelity scenarios.
To measure scenario participant and faculty self-reported realism, engagement and learning for the low fidelity, in situ simulations and compare this to high fidelity, centre-based simulations. ⋯ Some aspects of in situ simulations may be less 'real' than centre-based simulations, but there was no significant difference in self-reported engagement or learning by scenario participants. Low fidelity, in situ simulation provides adequate realism for engagement and learning.
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Emerg Med Australas · Feb 2018
Lessons learnt from incidents involving the airway and breathing reported from Australasian emergency departments.
To review incident reports relating to problems encountered during the ED management of patients with 'airway or breathing' problems, with the aim of finding and highlighting common themes within these rare events, and making recommendations to further improve patient safety in the areas in which deficiencies have been identified. ⋯ Recommendations for improving preparedness of ED staff and facilities have been made for each of the problem areas identified with respect to clinical practice, equipment, communication and clinical process. Analysis of incidents from the Australasian Emergency Medicine Events Register allows clusters of like-events to be identified and characterised, providing the possibility of getting a better idea of how problems present and progress, with some information about contributing factors, characteristics and context. This will pave the way for earlier and better detection of life-threatening problems and the development and reinforcement of preventive and corrective strategies.
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Emerg Med Australas · Feb 2018
Medical scribes have no impact on the patient experience of an emergency department.
We aimed to evaluate patient perceptions of medical scribes in the ED and to test for scribe impacts on ED Net Promoter Scores, Press Ganey Surveys and other patient-centred topics. ⋯ We found no evidence that scribes reduce patient satisfaction during emergency consultations, nor prompt discomfort that might cause a patient to withhold information.