Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2024
Experiences of Australian emergency doctors and nurses using advance care directives in the provision of care at the end of life.
An advance care directive is a legal document outlining the wishes made by a person about treatment options. However, there is increasing evidence that an advance care directive that has previously been documented may not always benefit the current prognosis of the patient. Therefore, the aim of the present study was to explore the experiences of Australian emergency doctors and nurses concerning the use of previously documented advance care directives at the point of care for patients and their families. ⋯ From the findings, advance care directives were believed to be beneficial in decision making when patients, families, and ED staff agreed with the decisions made. Advance care directives were often made a long time ago but were useful to start conversations around goals of care and end-of-life care relevant to the patient's current situation. Findings in the present study further reinforced that an advance care directive was beneficial when used alongside goals of care at the point of care in EDs.
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Emerg Med Australas · Apr 2024
Image quality and technical limitations in emergency department cardiac point-of-care ultrasound: A retrospective cohort study.
To assess the image quality and common technical limitations seen on cardiac point-of-care ultrasound (POCUS) performed and archived in a single New Zealand ED. ⋯ In the present study of clinically indicated cardiac POCUS, low image quality was common but the impact of image quality on diagnostic interpretation was very rarely documented in the medical record. Local quality assurance and training should be directed at credentialed and uncredentialed clinicians including strategies to improve off-axis imaging and managing artefacts where possible. Standardised documentation of image quality that may impact diagnostic accuracy should be encouraged.
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Emerg Med Australas · Apr 2024
Nine recommendations for the emergency department for patients presenting with low back pain based on management and post-discharge outcomes in an Australian, tertiary emergency department.
To ascertain and develop recommendations for analgesic management, discharge planning and further healthcare utilisation of adults presenting to an Australian tertiary ED with radicular or low back pain (LBP). ⋯ ED presentations for LBP were more often treated pharmacologically than non-pharmacologically, with opioids commonly prescribed and NSAIDs potentially under-utilised. Post-discharge, additional investigations/referrals, discharge analgesia reductions and maintenance of non-pharmacological management were common. Opioid initiation as a result of LBP presentations, signifies a potential 'gateway' towards unintentional long-term use. Key study findings form our nine recommendations to inform ED LBP pain management.
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Emerg Med Australas · Apr 2024
Clinical and longitudinal patterns of frequent presenters to emergency departments: A multi-centre data linkage analysis.
To describe clinical characteristics and longitudinal patterns of representation in a cohort of patients who frequently present to EDs for care. ⋯ Representations associated with MHDAS have a different trajectory of representation episodes compared to non-MHDAS group. Escalating number of presentations and clustering are important predictors of future representation numbers. Those 'did not waits' who appear to be representing would be the highest risk of ongoing and persistent representations in the future and should be the target of early interventions to ensure they are accessing appropriate care before this happens.
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Emerg Med Australas · Apr 2024
Casemix and performance of Australian emergency departments: A comparison of major city, regional and remote locations.
EDs are an essential service, and higher rates of presentations per population are seen in regional and remote areas compared to major cities. Australia-wide differences in utilisation and performance remain largely unknown. ⋯ Our study highlights ED utilisation, casemix and performance by location. The differences observed, especially areas of inequity and need for interventions, reiterate that imperative regional and remote EDs are appropriately resourced to support the communities they serve.