Emergency medicine Australasia : EMA
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Emerg Med Australas · Feb 2011
ReviewA systematic review: The role and impact of the physician assistant in the emergency department.
This systematic review describes the role and impact of physician assistants (PAs) in the ED. It includes reports of surveys, retrospective and prospective studies as well as guidelines and reviews. Seven hundred and twelve studies were identified of which only 66 were included, and many of these studies were limited by methodological quality. ⋯ The evidence indicates that PAs are reliable in assessing certain medical complaints and performing procedures, and are well accepted by ED staff and patients alike. There is limited evidence as to whether PAs improve ED flow or are cost-effective. Future studies on work processes, cost-effectiveness, unfamiliar patients' willingness to be treated by non-physician providers, and ED physicians' acceptability of PAs are needed to inform and guide the integration of PAs into EDs.
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Emerg Med Australas · Feb 2011
ReviewEmergency Department Workforce Models: What the literature can tell us.
The present study looks at what the literature can tell us about examples of innovative ED staffing. Numerous medical databases, journals specific to emergency care, and key government agency sites were searched to obtain Australian and relevant international literature between 1995 and the present. Studies which discussed appropriate staffing arrangements in the EDs were assessed with preference given to those which gathered evidence about the staff mix. ⋯ The few papers that do exist conclude that senior staffing, matching peak staffing levels with peak patient demand, having appropriately skilled staff mixes and designing the staff profile based upon individual hospital needs produces the most effective outcomes. Although there are some lessons to be learnt from the success of the staffing of various teams, and the introduction of new roles in the EDs, there are still significant gaps within the literature. There is a need for assessment of the effectiveness of various ED-wide staffing profiles (rather than just individual teams within an ED).
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Emerg Med Australas · Feb 2011
Variation in the management of hypothetical cases of acute agitation in Australasian emergency departments.
To describe the prescribing practice of emergency medicine clinicians in the management of highly agitated patients and to identify perceived barriers to management and the gaps in training. ⋯ There is considerable variation in the management of hypothetical cases of acute agitation in Australasian EDs. Benzodiazepines and antipsychotics, either alone or in combination, are commonly used. An ACEM-endorsed, Australasian CPG was perceived as useful.
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Emerg Med Australas · Dec 2010
Ultrasound guidance for central venous catheter placement in Australasian emergency departments: potential barriers to more widespread use.
To survey Fellows of the Australasian College for Emergency Medicine (FACEMs) in order to describe current ultrasound (US) usage during central venous catheter (CVC) placement and to compare practice and opinions between FACEMs routinely using US and those not. ⋯ We found that only 37% of FACEM respondents routinely used US to guide placement of CVCs and a number of barriers to more frequent use are identified. Practices and opinions regarding US use differed significantly between routine and non-routine users.