Emergency medicine Australasia : EMA
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Emerg Med Australas · Dec 2014
Current and future directions in clinical fatigue management: An update for emergency medicine practitioners.
Physicians worldwide are working round the clock to meet the demands of healthcare systems, especially in acute medical settings such as EDs. Demanding shift work schedules cause fatigue and thus deterioration in mood and motor performance. This article explores the effects of sleep deprivation, focusing on cognition, executive decision-making and the implications for clinical care. ⋯ Fatigue management training shows promise in enhancing safety in aviation and might have a role in medical shift work. Strategic napping improves performance during night shift in the ED, but does not fully negate fatigue. Drugs offer limited benefit for performance under sleep-deprived conditions, and whenever possible, sleep and/or strategic napping takes precedence.
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Emerg Med Australas · Dec 2014
Resource implications of a national health target: The New Zealand experience of a Shorter Stays in Emergency Departments target.
The Shorter Stays in Emergency Departments health target was introduced in New Zealand in 2009. District Health Boards (DHBs) are expected to meet the target with no additional funding or incentives. The costs of implementing such targets have not previously been studied. ⋯ The fact that estimated expenditure on the target was over $50 million without additional funding suggests that DHBs were able to make savings through improved efficiencies and/or that funds were reallocated from other services. The majority of expenditure occurred in the ED. Most of the funds were spent on staff, and this was associated with improved target performance.
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Emerg Med Australas · Dec 2014
Capacity building for emergency care: Training the first emergency specialists in Myanmar.
The Myanmar Ministry of Health has formed a partnership with Australasian professional colleges and international medical specialists to deliver a comprehensive programme for emergency care training and development. We describe this programme, emphasising the training of the first emergency specialists for Myanmar. ⋯ The first Myanmar postgraduate diploma in EM provides an example of collaborative and responsive clinical health capacity building in a context of very limited resources.
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Emerg Med Australas · Dec 2014
Management of retrieval service patients within a paediatric emergency department.
The Victorian Paediatric Emergency Transport Service (PETS) transports critically unwell children to tertiary paediatric hospitals. Children not directly admitted to ICU go to a tertiary ED. These patients might require prolonged and high-level care. In light of the National Emergency Access Target, we describe this cohort, clinical care needs and process measures. ⋯ Most patients retrieved to the ED ultimately go to a ward rather than ICU and most have an ED stay in excess of National Emergency Access Target. Several retrieval associated care issues, such as timely and appropriate ward disposition, can be addressed by administrative changes.
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This study aimed to investigate the benignancy of primary spontaneous pneumomediastinum (PSP), and to establish an appropriate management strategy. ⋯ Our management protocol (i.e. routine check of chest CT without any additional diagnostic tests, no special treatment, and early discharge with short-term follow up) may be safe and feasible for the treatment of PSP.