Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2020
ReviewReview article: Prevalence of burnout in paramedics: A systematic review of prevalence studies.
Paramedic wellness is an increasing priority within the profession. Burnout has been described as having areas of 'emotional exhaustion, depersonalisation and reduced personal accomplishment'. Prevalence of burnout is unclear, hampering evaluation of protective initiatives. ⋯ Included studies were of low to moderate quality. The prevalence of burnout in paramedics varies from 16% to 56%. Existing evidence describing burnout in paramedics is weak; research of good methodological rigour is needed to quantify prevalence of burnout, providing a reliable baseline against which protective interventions could be measured.
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Emerg Med Australas · Apr 2020
When a health policy cuts both ways: Impact of the National Emergency Access Target policy on staff and emergency department performance.
To explore the impact of the Four-Hour Rule/National Emergency Access Target (4HR/NEAT) on staff and ED performance. ⋯ There was strong evidence of an association between high stress and low morale and the implementation of the 4HR/NEAT across all levels of performance. These adverse consequences of the 4HR/NEAT implementation indicate that a more nuanced approach to efficiency improvements is required. This would balance processes measured by 4HR/NEAT against a range of other clinical and organisational performance measures.
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Emerg Med Australas · Apr 2020
Observational StudyPatients with life-limiting illness presenting to the emergency department.
To examine characteristics, outcomes and flow for patients over the age of 45 years with a life-limiting illness (LLI) presenting to a regional ED. ⋯ A significant proportion of patients 45 years or older had an LLI which had implications for their length of ED stay and discharge destination.
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Emerg Med Australas · Apr 2020
Viscoelastic haemostatic assays and fibrinogen in paediatric acute traumatic coagulopathy: A comprehensive review.
Haemorrhage in paediatric trauma remains a significant cause of morbidity and mortality. Over recent years there has been increasing attention to the role of fibrinogen in traumatic haemorrhage and the association of low fibrinogen levels with poor patient outcomes. In addition, there has been a move towards using viscoelastic haemostatic assays (VHAs) to rapidly assess coagulation status and guide clinicians in the replacement of coagulation factors, including fibrinogen. In the paediatric population, there has been limited uptake of these principles and a paucity of data to support a change in practice. This paper summarises the available evidence in the published literature through a systematic review, presented in narrative format. ⋯ The early identification of hypo-fibrinogenemia and acute traumatic coagulopathy in paediatric trauma using VHA testing and subsequent early fibrinogen replacement with a concentrated off the shelf product is an attractive treatment option. However, there is currently insufficient high-level evidence to support the use of fibrinogen concentrate over cryoprecipitate in the paediatric trauma population. Pilot studies currently under way will go some way to addressing this important knowledge gap, and facilitate the design of larger definitive multi-centre randomised trials.
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Emerg Med Australas · Apr 2020
Leadership challenges of directors of emergency medicine: An Australasian Delphi study.
Emergency medicine (EM) is an emerging profession with complex clinical and leadership demands. However, studies of leadership in EM are in their infancy. The present study makes a novel contribution to empirical research in this area by examining the leadership challenges faced by Australasian directors of emergency medicine (DEMs). ⋯ The recommendation for DEMs is that they need to engage in programmes which will support the development of the leadership and non-clinical skills required to enable them to cope with responsibilities of hybrid role of physician-leader. The development and delivery of specialised leadership programmes attuned to the hybridity of the director role and the complexity of hospitals is vital for ensuring high-quality patient care and successful running of EDs.