Emergency medicine Australasia : EMA
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Emerg Med Australas · Jun 2017
Establishing a dedicated toxicology unit reduces length of stay of poisoned patients and saves hospital bed days.
This study evaluates the effect on the average length of stay (LOS), relative stay index (RSI), bed days and costs saved following the establishment of a dedicated clinical toxicology unit in an Australian tertiary referral hospital. ⋯ The reduction in average LOS is similar to results previously published by two Australian toxicology units over 15 years ago. Despite changes in healthcare delivery since this time, these results continue to support the efficiency and associated cost saving of a dedicated toxicology unit in managing poisoned patients.
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Emerg Med Australas · Jun 2017
Critical thinking, curiosity and parsimony in (emergency) medicine: 'Doing nothing' as a quality measure?
Current medical decision-making is influenced by many factors, such as competing interests, distractions, as well as fear of missing an important diagnosis. This can result in ordering tests or providing treatments that can be harmful. Unnecessary tests are more likely to lead to false positive diagnosis or incidental findings that are of uncertain clinical relevance. ⋯ The 'Choosing Wisely' campaign has identified many of these wasteful tests and treatments. This perspective proposes some suggestions to focus on our critical thinking, embrace shared decision-making and stay curious about the patient we are treating. Most importantly, 'doing nothing' could be a quality indicator for EDs, and ACEM supported audits and research to develop benchmarks for certain tests and procedures in the ED are important to achieve a cultural change.
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Emerg Med Australas · Jun 2017
Observational StudyTwo Hour Evaluation and Referral Model for Shorter Turnaround Times in the emergency department.
The objective of this study was to assess the implementation of a novel ED model of care, which combines clinical streaming, team-based assessment and early senior consultation to reduce length of stay. ⋯ A facilitated team leader role for senior doctors can help to reduce length of stay by via early disposition, without significant risks to the patient.
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Emerg Med Australas · Jun 2017
Improving emergency department medical clinical handover: Barriers at the bedside.
The present paper describes our experience of developing and piloting a best practice model of medical clinical handover. Secondary aims were to improve reliability of communication, identify negative effects on patient care and assess staff adherence and acceptance of the process. ⋯ Bedside handover using ISBAR resulted in improved patient involvement, communication and a non-significant trend to improved patient safety. Despite a majority of doctors acknowledging these findings, preference remained for a centralised handover using ISBAR. Gaining staff acceptance of a process change is essential to its success. A barrier to acceptance could be that staff are time-poor. We suggest handover processes can be strengthened by adequate staffing and small, incremental improvements to existing models combined with auditing of outcomes.
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Emerg Med Australas · Jun 2017
Observational StudyKetamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study.
The aim of this study was to review mental health patients transported by a dedicated statewide critical care retrieval team before and after the implementation of a ketamine sedation guideline. ⋯ The implementation of a ketamine clinical practice guideline for agitated mental health patients was associated with an increase in the number of patients receiving ketamine as part of their sedation regime and a reduction in the number of patients requiring intubation for transport. Appropriately trained critical care retrieval teams should consider ketamine as part of the sedation regime for agitated mental health patients.