Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2016
ReviewReview article: The utility of flexion-extension radiography for the detection of ligamentous cervical spine injury and its current role in the clearance of the cervical spine.
Detecting the presence of injuries to the cervical spine is an important component of the initial assessment of patients sustaining blunt trauma. A small proportion of cervical spine injuries consists of ligamentous disruption. Accurate detection of ligamentous injury is essential as it may result in sequelae including radiculopathy, quadriplegia and death. ⋯ There are studies that call into question the diagnostic accuracy of FE, the high proportion of inadequate FE images due to muscle spasm and the adverse effects of prolonged cervical collar immobilisation while awaiting FE. Other literature indicates that FE provides no additional diagnostic information following a multi-detector helical computed tomography. This review evaluates the literature on the utility of FE for the detection of ligamentous injury and explores alternate strategies for clearing the cervical spine of ligamentous injury.
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Emerg Med Australas · Apr 2016
Observational StudyDischarge timeliness and its impact on hospital crowding and emergency department flow performance.
The objective of this research is to identify optimal inpatient discharge time targets to help hospitals reduce crowding, improve patient flow through the ED and balance staff workload. ⋯ Conventional discharge targets like '80% by 11 a.m.' and others that spread targets across the day to balance staff workload freed up the equivalent of nine available beds for incoming patient flow, significantly reducing time spent waiting for an inpatient bed, hospital LOS and occupancy, and delivering much needed improvements in NEAT performance. While different strategies and workload distributions may suit individual hospital services, the study makes a strong case for improving 'early in the day' discharge timeliness to deliver better ED flow.
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Emerg Med Australas · Apr 2016
Low-acuity presentations to regional emergency departments: What is the issue?
To explore GP-referrals and self-referrals to EDs and factors associated with patients seeking low-acuity care at ED. ⋯ Over 85% of patients who seek emergency care in this region self-refer, so understanding health-seeking behaviour is important. Most low-acuity patients are acutely injured or unwell, and the decision to go to ED is based on their perception of accessibility of expertise aligned with their need. The term 'GP-type' is misleading in this context and should not be used. Providing low-acuity care in parallel with providing a specialised emergency service meets the needs of the local community and is likely to be the lowest cost model in a regional and rural area. Funding models must reflect the actual cost of delivering this important service rather than presentation types.
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Emerg Med Australas · Apr 2016
Parent perspectives and reasons for lower urgency paediatric presentations to emergency departments.
The age band with, by far, the greatest number of ED presentations is children 0-4 years, with other paediatric age bands also among the highest. As the majority of these presentations are for lower urgency conditions, we sought to determine why parents seek ED care for their child for lower urgency conditions. ⋯ The current magnitude and the growth of lower urgency paediatric ED presentations is a strain on the health care system. Efforts to educate parents regarding the suitability and availability of GP appointments can be the cornerstone of an initial strategy to address this issue. However, efforts to address the high rates of GP referral to EDs for low urgency presentations will be more vexing to develop, yet no less important. They will require addressing fundamental issues in both current GP care for children and the training of GP registrars.