Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2019
Driving change: A partnership study protocol using shared emergency department data to reduce alcohol-related harm.
Sharing anonymised ED data with community agencies to reduce alcohol-related injury and assaults has been found effective in the UK. This protocol document outlines the design of an Australian multi-site trial using shared, anonymised ED data to reduce alcohol-related harm. ⋯ Primary outcomes will be: (i) the number and proportion of ED attendances among patients reporting recent alcohol use; and (ii) the number and proportion of ED attendances during high-alcohol hours (Friday and Saturday nights, 20.00-06.00 hours) assigned an injury diagnosis. Process measures will assess logistical and feasibility concerns, and clinical impacts of implementing this systems-change model in an Australian context. An economic cost-benefit analysis will evaluate the economic impact, or return on investment.
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Emerg Med Australas · Dec 2019
Knowledge, attitude and practices of clinical quality and performance assessment among emergency medical services personnel in South Africa: A mixed methods study.
Deficits in healthcare quality are becoming an increasing concern globally. Within the low- to middle-income country (LMIC) setting insufficient quality has become a bigger barrier to reducing mortality than insufficient access, where 60% of deaths from conditions amenable to healthcare, are due to poor quality care. Measuring quality is key towards improving the effectiveness of healthcare in this setting. ⋯ Within EMS, quality systems are in their infancy. It could be argued that this is somewhat more pronounced in the LMICs, where knowledge of organisational quality systems was found to be poor. Despite this, there was a strong general understanding of the importance of quality systems, and the role they have to play in this setting.
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Emerg Med Australas · Dec 2019
Comparative StudyComparison of emergency physiotherapy practitioner prescribers versus existing emergency department prescribers for musculoskeletal injuries.
The scope of selected emergency physiotherapy practitioners (EPP) in this Australian non-tertiary ED has recently extended to include the prescription of a limited drug formulary, including paracetamol, some NSAIDs and opioids, an anti-emetic, a benzodiazepine and nitrous oxide. Although there are large-scale studies investigating prescription errors made by doctors, there is a lack of data on prescribing practices of physiotherapists in the ED setting. The aim of present study is to compare the prescribing practices of EPP to their medical and nursing colleagues within the setting of treating musculoskeletal injuries in the ED. ⋯ In the management of ED patients with musculoskeletal complaints, prescription-trained EPP appear to perform similarly if not better than their medical and nursing colleagues with regards to NIMC audit tool results.
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Emerg Med Australas · Dec 2019
Development and evaluation of a code frame to identify potential primary care presentations in the hospital emergency department.
A major challenge in evaluating the appropriateness of ED presentations is the lack of a universal and workable definition of patients who could have received primary care instead. Our objective was to develop a standardised code frame to identify potential primary care patients in the ED. ⋯ This standardised code frame enables accurate retrospective local and national data estimations. The code frame could be used prospectively to evaluate interventions such as diverting patients to primary care settings, and to identify populations for specifically targeted interventions. The conservative nature of the code frame ensures that only those that can safely receive care in a primary care setting are identified as potential primary care.
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Emerg Med Australas · Dec 2019
Gaming National Emergency Access Target performance using Emergency Treatment Performance definitions and emergency department short stay units.
To evaluate potential gaming of the 4 h ED length of stay metric known as the National Emergency Access Target (NEAT) in Australia and Emergency Treatment Performance (ETP) in New South Wales (NSW). ⋯ The opportunity of NEAT may be squandered unless gaming of the definitions and use of ED short stay beds is addressed. We argue that the longstanding issue of 'departure time' should be defined as 'physically leaving' the department, in accordance with the Australasian College for Emergency Medicine (ACEM) definition. Patient occupancy is a real measure of ED resource use and NSW and national recommendations should be adjusted. ACEM accreditation of EDs should include review of their application of NEAT definitions to ensure they truly reflect patient flow processes.