Emergency medicine Australasia : EMA
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Emerg Med Australas · Aug 2021
Planning for the Next Pandemic: Reflections on the Early Phase of the Australian COVID-19 Public Health Response from the Emergency Department.
EDs play a crucial role as frontline health services throughout public health emergencies, including pandemics. The strength of the Australian public health response to coronavirus disease 2019 (COVID-19) has mitigated the impact of the pandemic on clinical services, but there has still been a substantial impact on EDs and the health system. ⋯ Notwithstanding, the remarkable efforts of healthcare workers across the health system, COVID-19 has uncovered structural and planning challenges and highlighted weaknesses and strengths of the Australian federation. In anticipating future pandemics and other public health threats, particularly in the face of climate change, hard-won lessons from the COVID-19 response should be incorporated in future planning, policies, practice and advocacy.
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Emerg Med Australas · Aug 2021
Is a nudge all we need to promote deliberate clinical inertia and thoughtful clinical decision making?
Deliberate clinical inertia is the art of doing nothing as a positive response. Individual clinicians can promote deliberate clinical inertia through teaching, re-framing the act of 'doing nothing' as 'doing something' and engaging in shared decision making. Behaviour change on a larger scale requires a systematic approach. ⋯ A nudge unit could be used to design environments to prompt clinicians to re-think before ordering unnecessary tests or treatments. Nudge units could improve knowledge translation, support continuous quality improvement and help build a learning health system. They could also boost collaboration and empower staff to evaluate their workplace decision-making frameworks.
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Emerg Med Australas · Aug 2021
Unintended consequences: The impact of airway management modifications introduced in response to COVID-19 on intubations in a tertiary centre emergency department.
In response to COVID-19, we introduced and examined the effect of a raft of modifications to standard practice on adverse events and first-attempt success (FAS) associated with ED intubation. ⋯ This raft of modifications to ED intubation was associated with significant increase in hypoxia despite a very high FAS rate and more senior first laryngoscopist.
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Emergency medicine researchers face the challenge of prioritising patients' immediate interests and maintaining hospital flow while attempting to collect clinical data. Even in low-risk scenarios, excessive consent processes can make it difficult to recruit patients while observing guidelines on efficient triage. ⋯ We then argue that there need be no conflict between the imperatives of patient wellbeing and clinical research. Apparent conflicts between treatment and research could be reduced through creative recruitment techniques: the adoption of an 'opt-out' approach; securing the budget for a dedicated research assistant; early consultation with the institution's human research ethics committee; and the use of a short, simple participant information and consent form with a QR code linking to a more detailed outline of the study.
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Emerg Med Australas · Aug 2021
Emergency department crowding and mortality for patients presenting to emergency departments in New Zealand.
The association between ED crowding and mortality has been established internationally, but not in New Zealand. The aim was to determine which measures of crowding were associated with mortality for new patients presenting to New Zealand EDs. The primary outcome was mortality for patients within 7 days of arrival in the ED. ⋯ Access block had the strongest association with 7-day mortality. That ED occupancy and the number of arrivals were not associated with increased mortality suggests that system issues related to long ED stays may be most important in the link between ED crowding and mortality.