Emergency medicine Australasia : EMA
-
Emerg Med Australas · Dec 2019
COACHRED: A protocol for the safe and timely incorporation of focused echocardiography into the rhythm check during cardiopulmonary resuscitation.
Focused echocardiography may be a useful tool in cardiopulmonary resuscitation for prognostication, to identify certain reversible causes of cardiac arrest, and to guide further management and procedures. Nonetheless, many clinicians have reservations regarding its widespread adoption due to evidence that it leads to prolonged interruption of cardiac compressions. ⋯ This approach incorporates the best strategies identified to date that minimise interruptions to chest compressions. We demonstrate that, in a simulation environment, it is achievable to incorporate focused echocardiography into the rhythm check while keeping the interruption to chest compressions within the timeframe prescribed by international guidelines.
-
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.
-
Emerg Med Australas · Dec 2019
The Pacific Emergency Medicine Mentoring Program: A model for medical mentoring in the Pacific region.
To describe the development and implementation of a Pacific medical mentoring programme and to evaluate the programme after the first year. ⋯ The present study suggests a new model of Pacific mentoring that recognises the centrality of the mentoring relationship, and allows for flexible communication, shared responsibility of mentors and mentees as co-drivers and a broad understanding of goals and timelines. Future programmes should incorporate funding for in-person meetings and educational opportunities to enhance contextual and cultural understanding. These lessons can inform future medical mentorship programmes across the Pacific.
-
Emerg Med Australas · Dec 2019
Characteristics of short-term re-presentations to a regional emergency department.
The present study aims to describe the characteristics of early ED re-presentations in a regional hospital in New South Wales, Australia. ⋯ Re-presentations were common, but did not lead to increased admissions. The regional hospital in the present study had a higher 72 h ED re-presentation rate than the comparative major city hospital. In particular, paediatric and psychiatric re-presentations were a greater burden to the regional ED. This may be secondary to a lack of alternative services, particularly for these patient groups. Improving these outpatient services may help to reduce the burden of 72 h ED re-presentations.
-
Emerg Med Australas · Dec 2019
Picking the low-hanging fruit: Why not choose oral antibiotics for skin and soft-tissue infections in the emergency department.
Skin and soft-tissue infections are a common presentation to EDs in Australasia. In the absence of sepsis or decreased oral absorption, substantial supportive data exists that shows oral antibiotics are non-inferior to intravenous antibiotics for uncomplicated skin and soft-tissue infections. ⋯ This perspective reviews the relevant literature, discusses barriers to the implementation of this more parsimonious approach and also proposes several potential solutions. It is important that ED clinicians are encouraged to use oral antibiotics for uncomplicated infections, as this would lead to similar clinical outcomes but with fewer resources for staff and patient, as well as increased patient satisfaction.