Emergency medicine Australasia : EMA
-
Emerg Med Australas · Apr 2019
Review Case ReportsReview article: Isolated proximal tibiofibular joint dislocation.
Proximal tibiofibular joint (PTFJ) dislocations are relatively rare injuries and this paper provides an up-to-date review and practical management approach for the assessment and management of these cases. Isolated PTFJ dislocations are a rare injury, accounting for less than 1% of all knee injuries. ⋯ This paper provides a review of the literature, anatomical analysis of the PTFJ in the dislocated state, and a technique for reduction. In the majority of cases, PTFJ dislocations are an injury that can be identified with simple imaging modalities and treated in the ED with manipulation under procedural sedation.
-
Emerg Med Australas · Apr 2019
ReviewReview article: Common emergency department presenting complaints of prisoners: A systematic review.
Prisoners are a particularly vulnerable minority group whose healthcare needs and management differ substantially from the general population. The overall burden of disease of prisoners is well documented; however, little is known regarding the aetiology and frequency of prisoners' acute medical complaints requiring an ED visit. Objectives of the review were to identify, review and appraise existing literature regarding prisoners' presentations to EDs. ⋯ Apart from two European studies in the past 5 years, there is a scarcity of literature primarily addressing the common presenting complaints to EDs by prisoners. Existing studies demonstrated that prisoners have a disproportionately high burden of traumatic, infectious and psychiatric disease requiring emergency treatment. With the increasing number of emergency presentations made by prisoners each year, it is vital that further research is undertaken to identify trends of these acute medical complaints in order to ensure optimal therapeutic outcomes for prisoners.
-
Emerg Med Australas · Apr 2019
Multicenter StudyLonger time to transfer from the emergency department after bed request is associated with worse outcomes.
To determine the relationships between: (i) total ED length of stay (EDLOS) and in-hospital mortality, ward clinical deterioration; and (ii) between time of bed request, ward transfer and in-hospital mortality, with a particular focus on patients transferred just prior to a 4 h EDLOS. ⋯ Both shorter time in ED and shorter time between bed request and ward transfer were independently associated with improved outcomes. Whole of hospital measures to reduce length of stay in the ED should focus on shorter ward transfer times after bed request.
-
Emerg Med Australas · Apr 2019
Why do paramedics choose to bring patients to a private emergency department?
While prior experience, favourable location and anticipation of high quality care are known to influence patient choice to attend a private ED, it is likely that decision-making is also influenced by other persons. In particular, patients arriving by ambulance are under the care of paramedics, whose values towards healthcare and rationale for choosing one ED over another have not been studied. This study aimed to describe reasons why paramedics choose to bring patients to a private ED. ⋯ Paramedics take into consideration when possible patient's wishes and are more likely to bring a patient to a private ED if they have specific direction from the patient or the patient's family or GP. The likelihood of presenting to a private ED is increased if the patient has an allegiance with the facility and the paramedics perceive favourably the hospital logistics and systems as well as service ethos.
-
Emerg Med Australas · Apr 2019
Impact of an emergency department-run clinical decision unit on access block, ambulance ramping and National Emergency Access Target.
ED access block is an ongoing significant problem and has been associated with excess mortality. Multiple models of care have been studied in an effort to improve access block and other key performance indicators (KPIs) of ED. ⋯ In summary, this ED led, consultant run CDU model of care resulted in significantly improved performance on a range of KPIs, including improvement in access block and NEAT figures. The substantial improvements in ambulance ramping and escalations also indicated that the department was able to cope better with periods of high activity.