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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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
Effect of tourniquet time on whole blood point-of-care lactate concentration: A healthy human volunteer study.
Lactate is frequently utilised in clinical practice. Some have concerns that tourniquet application for venous blood collection may falsely elevate venous lactate. The objective of the present study was to determine the effect of tourniquet time on varying venous lactate concentrations. ⋯ In the present study tourniquet application for blood collection did not significantly increase lactate concentration. Hence, clinically a raised venous lactate concentration should not be attributed to prolonged tourniquet application.
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Emerg Med Australas · Aug 2021
Characteristics of Aboriginal and Torres Strait Islander peoples attending Australian emergency departments.
Aboriginal and Torres Strait Islander patients are overrepresented in Australian EDs. The present study aimed to assess their characteristics in utilising ED services at a national level. ⋯ This is the first national study looking at the characteristics of and reasons for presenting to Australian EDs for Indigenous and non-Indigenous patients. Our findings provide important insight into the potential factors affecting Indigenous patient care, and an impetus for ongoing research and advocacy work to improve the quality of emergency care provided to Indigenous Australians.