Emergency medicine Australasia : EMA
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Emerg Med Australas · Aug 2021
ReviewReview article: Emergency department crowding measures associations with quality of care: A systematic review.
ED crowding has been reported to reduce the quality of care. There are many proposed crowding metrics, but the metric most strongly associated with care quality remains unknown. The present study aims to determine the crowding metric with the strongest links with processes and outcomes of care linked to the Institute of Medicine quality domains. ⋯ ED length of stay, boarding time and total occupancy had the strongest association with safety and effectiveness of care. ED length of stay was also associated with equity. The certainty of evidence for associations between crowding measures varied across domains of quality, from very low to moderate certainty.
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Emerg Med Australas · Aug 2021
Prehospital Resuscitation Decision Making: A model of ambulance personnel experiences, preparation and support.
This paper presents the first Naturalistic Decision Making model of prehospital resuscitation decision-making, which has clear implications for education, practice and support. ⋯ This research project is the first to comprehensively explore and model ambulance personnel perspectives on decisions to start, continue or stop resuscitation. The decision-making process is complex and difficult to simply formularise. Education and supports must assist ambulance personnel in navigating this complexity. Where resuscitation is withheld or terminated, ambulance personnel need to feel confident that they can effectively provide after-death care.
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Ocular ultrasound (US) is not one of ACEMs 'big 5' in terms of US capability that is expected of a trainee or FACEM. Most texts have a small chapter dedicated to ocular US but it is usually at the back or a subsection of a chapter where it is rarely seen or appreciated. However, it is a straightforward scan to perform with many benefits which will be discussed in this article. ⋯ This has the added benefit of being able to share images with an ophthalmologist remotely, improving time to definitive treatment. It can also be used in patients who cannot cooperate with sitting at a slitlamp, for example moribund or trauma patients. The authors propose that ocular US teaching should be incorporated into the ACEM syllabus, being a vital adjunct to a comprehensive eye examination.