Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2019
Impact of an emergency department-run clinical decision unit on access block, ambulance ramping and National Emergency Access Target.
ED access block is an ongoing significant problem and has been associated with excess mortality. Multiple models of care have been studied in an effort to improve access block and other key performance indicators (KPIs) of ED. ⋯ In summary, this ED led, consultant run CDU model of care resulted in significantly improved performance on a range of KPIs, including improvement in access block and NEAT figures. The substantial improvements in ambulance ramping and escalations also indicated that the department was able to cope better with periods of high activity.
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Emerg Med Australas · Apr 2019
Extracorporeal membrane oxygenation retrieval factors and survival to intensive care unit discharge.
Audit of extracorporeal membrane oxygenation (ECMO) retrieval service operating in Victoria, Australia, regarding retrieval factors and patient survival to intensive care unit (ICU) discharge. ⋯ Retrieval ECMO achieves similar survival outcomes to in-house ECMO. The demonstrated relationship of adverse events during retrieval phase to subsequent mortality in ICU highlights the need for optimised case management and retrieval processes.
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Emerg Med Australas · Apr 2019
Observational StudyOur observations with cold calling: Patient anger and undesirable experiences.
Little is known about the effects of the 'cold calling' technique (telephone contact without prior warning) for patient follow up in ED research. Recently, we undertook a prospective, observational pain management study. Patients were cold called 48 h post-discharge and surveyed regarding their pain management satisfaction. ⋯ Among these, we observed 12 cases of patient anger: mistaken identity, disbelief that the hospital was calling, frustration that test results and appointment times could not be provided, abuse about ED management and outpourings of sadness. We also observed eight cases of an undesirable experience for either the patient, their family or the caller: five patients had died (including one 'at her last moments'), precipitation of patient distress and uncomfortable situations for the caller. Given our experience, we believe that cold calling should be avoided, where possible, and other techniques (e.g. limited disclosure) considered as alternatives.