Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2019
ReviewReview article: A primer for clinical researchers in the emergency department: Part 6. Measuring what matters: Core outcome sets in emergency medicine research.
In this series we address important topics for clinicians who participate in research as part of their work in the ED. The overarching goal of clinical research is to improve care and determine which treatment is best. Yet, defining and measuring outcomes - what is 'best' - can be one of the most difficult steps in the design of a study, in particular when answers to research questions cannot be captured in simple binary results. This article addresses how to choose outcome measures and highlights the increasingly important concept of core outcome sets.
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Emerg Med Australas · Feb 2019
Should freestanding emergency departments be considered in Australia?
The concept of freestanding EDs is a popular operational model of emergency care in the USA. This model has been described as an emergency physician-created innovative solution in resolving ongoing overcrowding issues in EDs. A decentralised community-based emergency care model may be a solution to meet the increasing demand for emergency and unscheduled acute care in Australia. ⋯ The aim of freestanding EDs should be to manage and discharge a cohort of patients, mainly in Australasian Triage Scale 3 and 4 categories, currently seen in hospital-based EDs. This article briefly examines the potential merits and issues if this concept is considered in Australia. It also provides an early proposed model for such EDs.
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Emerg Med Australas · Feb 2019
ReviewReview article: Managing medical emergencies in rural Australia: A systematic review of the training needs.
The aim of the study was to determine the training needs of doctors managing emergencies in rural and remote Australia. A systematic review of Australian articles was performed using MEDLINE (OVID) and INFORMIT online databases from 1990 to 2016. The search terms included 'Rural Health', 'Emergency Medicine', 'Emergency Medical Services', 'Education, Medical, Continuing' and 'Family Practice'. ⋯ However, many of the studies were performed by training providers that may benefit from deficient results. Given that the data was over 10 years old and that advances have been made in knowledge, training opportunities and technology, the implications for current training needs of rural doctors in Australia could not be accurately assessed. Thus there is a need for further research to identify current training needs.
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Emerg Med Australas · Feb 2019
Impact of the four-hour National Emergency Access Target on 30 day mortality, access block and chronic emergency department overcrowding in Australian emergency departments.
Previous research reported strong associations between ED overcrowding and mortality. We assessed the effect of the Four-Hour Rule (4HR) intervention (Western Australia (WA) 2009), then nationally rolled out as the National Emergency Access Target (Australia 2012) policy on mortality and patient flow. ⋯ The 4HR was introduced as a means of driving hospital performance by applying a time target. Patient flow improved, but the evidence for mortality benefit is controversial with improvement only in WA. Further research with more representative data from a larger number of hospitals over a longer time across Australia is needed to increase statistical power to detect long-term effects of the policy.