Emergency medicine Australasia : EMA
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Emerg Med Australas · Oct 2010
ReviewThe four hour target to reduce Emergency Department 'waiting time': a systematic review of clinical outcomes.
Governments in Australasia are introducing emergency department length of stay (EDLOS) time targets similar to the UK 'four hour rule'. There is debate about whether this rule had beneficial effects on health-care outcomes. We sought to determine what effects the four hour time target for EDLOS had on clinically relevant outcomes in the UK by conducting a systematic search for evidence. ⋯ One hospital demonstrated a small reduction in return rate. The impact of the introduction of an ED time target and the associated massive financial investment has not resulted in a consistent improvement in care with markedly varying effects being reported between hospitals. Countries seeking to emulate the UK experience should proceed with caution.
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Emerg Med Australas · Oct 2010
ReviewA primer for clinical researchers in the emergency department: Part II: research science and conduct.
Research is an important part of emergency medicine and provides the scientific underpinning for optimal patient care. Although increasing numbers of emergency physicians participate in research activities, formal research training is currently neither part of emergency physician training in Australia nor easily available for clinicians interested in clinical research. ⋯ Part I addressed ethical and regulatory aspects. In Part II, we describe important elements of research science, and practical elements of research conduct and administration, which form the basis for high-quality research.
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Emerg Med Australas · Oct 2010
Clinical TrialStress testing before discharge is not required for patients with low and intermediate risk of acute coronary syndrome after emergency department short stay assessment.
To investigate the usefulness of stress testing before discharge in patients assessed low to intermediate risk of acute coronary syndrome (ACS). ⋯ The present study showed that an ED short stay unit can effectively evaluate and manage patients with low and intermediate risk of ACS. The study suggests that patients with low and intermediate risk for ACS might safely be discharged after normal serial ECG and cardiac biomarkers, with a view to early outpatient stress testing. With strict adherence to admission criteria, there does not appear to be any benefit of stress testing before discharge.
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Emerg Med Australas · Oct 2010
Comparative StudyEmergency care workload units: a novel tool to compare emergency department activity.
Funding bodies have traditionally used attendance figures as a way of determining the allocation of funding for resources in the EDs. Using attendance figures only might not accurately reflect the funding and resources required. The need to create an easily implemented tool to compare workload and resources required was identified. Using the Australasian Triage Scale, a tool was developed to estimate staffing requirements and resource use within each ED. This, although currently not validated, provides a promising start in finding a way to accurately determine ED workload. ⋯ This tool provides a simple method to calculate equitable distribution of staffing and budget allocation based on workload across the different EDs within Australia.
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Emerg Med Australas · Oct 2010
A primer for clinical researchers in the emergency department: part I: ethical and regulatory background.
Research is an important part of emergency medicine and provides the scientific underpinning for optimal patient care. Although increasing numbers of emergency physicians participate in research activities, formal research training is currently neither part of emergency physician training in Australia nor easily available for clinicians interested in clinical research. ⋯ The ethics of research in children as a particularly vulnerable group will also be addressed. Part II will address important elements of research science and conduct.