Epworth Collection:http://hdl.handle.net/11434/2432024-03-28T14:12:44Z2024-03-28T14:12:44ZCharacteristics of Aboriginal and Torres Strait Islander peoples attending Australian emergency departments.Harrison, Glenhttp://hdl.handle.net/11434/19192021-01-12T04:24:02Z2020-12-01T00:00:00ZTitle: Characteristics of Aboriginal and Torres Strait Islander peoples attending Australian emergency departments.
Epworth Authors: Harrison, Glen
Abstract: Objective: Aboriginal and Torres Strait Islander patients are overrepresented in Australian EDs. The present study aimed to assess their characteristics in utilising ED services at a national level.
Methods: This exploratory, quantitative study used 2016-2017 de-identified data from the National Non-admitted Patient Emergency Department Care Database to assess the proportions (with 95% confidence interval) of Indigenous and non-Indigenous Australians across various aspects of ED presentations, including mode of arrival, triage scale, diagnosis information, episode end status and ED length of stay. Episode level ED data were compared by Indigenous status and geographical remoteness of EDs.
Results: Of 7.4 million presentations, 6.58% were Indigenous presentations, with over two-thirds occurring in regional and remote EDs. Indigenous patients were more likely than non-Indigenous patients to arrive to EDs by ambulance and police/correctional services vehicle across all remoteness areas. Additionally, they were more likely to present with respiratory system illness, illness of the skin/subcutaneous tissue/breast and mental/behavioural disorders. Indigenous Australians were more likely to leave EDs before being seen or care complete (odds ratio 1.73, 95% confidence interval 1.71-1.74), and this was observed for patients classified across all levels of triage scale.
Conclusions: This is the first national study looking at the characteristics of and reasons for presenting to Australian EDs for Indigenous and non-Indigenous patients. Our findings provide important insight into the potential factors affecting Indigenous patient care, and an impetus for ongoing research and advocacy work to improve the quality of emergency care provided to Indigenous Australians.
Keywords: Indigenous; case mix; emergency presentation; health service; remoteness.2020-12-01T00:00:00ZRisk of clinical deterioration and Medical Emergency Team activation in patients admitted to hospital via the Emergency Department compared to elective admission.Schepers, ClaireBotti, Marihttp://hdl.handle.net/11434/14582018-07-27T03:04:24Z2018-06-01T00:00:00ZTitle: Risk of clinical deterioration and Medical Emergency Team activation in patients admitted to hospital via the Emergency Department compared to elective admission.
Epworth Authors: Schepers, Claire; Botti, Mari
Abstract: Background
Medical Emergency Team (MET) and Clinical Review (CRC) criteria are abnormal vital signs indicative of clinical deterioration. CRC are used to trigger rapid review and, at Epworth, general hospital wards and the ED have slightly different trigger criteria. The aims of this study were to: (i) compare the prevalence and median time to MET activation within 24 hours of admission, between patients admitted electively and via the ED, and (ii) compare the prevalence of CRC antecedent to MET activation between the same cohorts.
Methods
Two-phase retrospective, descriptive study using electronic patient database of all patients admitted to Epworth Richmond in the 2016 calendar year (Phase 1) and medical record audit of 100 randomly selected patients (n=50 elective, n=50 ED) to evaluate prevalence of CRC antecedent to MET activation and the nature of MET criteria achieved (Phase 2).
Results
ED-admission patients were three times more likely to achieve MET activation (n=556/9,222,6.03%) than elective admissions (n=1,007/52,601,1.91%) during their admission overall. For MET activation within 24-hours of admission (n=560), time to MET activation was longer for ED (Med-14,Q1,Q3=8,19hrs) than elective (Med-9, Q1,Q3=1 6,16hrs) admissions (p<0.001). Hypotension was the most common MET activator (elective:39.9%;ED:27.8%). ‘Nurse worried’ (26%) and pain (22%) were next for the ED cohort compared to hypertension for elective admissions (18%). Phase 2: 72% (n=36) of elective and 74% (n=37) of ED-admissions experienced one or more CRC prior to MET activation. Hypotension (38%), nurse worried (19%), pain (16%) and hypertension (9%) were the most prevalent.
Summary
Patients admitted via ED are more likely to achieve MET activation during admission and experience later deterioration than elective admissions. Standardised CRC is recommended hospital-wide. Uncontrolled pain contributed significantly to MET activation in the ED cohort, suggesting inadequate analgesia at the ED-ward interface. Further research of the ‘nurse worried’ criterion is recommended.2018-06-01T00:00:00ZEffectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation.Wasiak, Jasonhttp://hdl.handle.net/11434/12942018-03-14T01:42:37Z2015-11-01T00:00:00ZTitle: Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation.
Epworth Authors: Wasiak, Jason
Abstract: BACKGROUND:
Rapid sequence induction (RSI) for endotracheal intubation is a technique widely used in anaesthesia, emergency and intensive care medicine to secure an airway in patients deemed at risk of pulmonary aspiration. Cricoid pressure is conceptually used to reduce the risk of aspiration by compressing the oesophagus.
OBJECTIVES:
To identify and evaluate all randomized controlled trials (RCTs) involving participants undergoing elective or emergency airway management via RSI and compare participants who have cricoid pressure administered with participants who do not have cricoid pressure administered.
SEARCH METHODS:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 4), MEDLINE via OvidSP (1946 to May 2015), EMBASE via OvidSP (1980 to May 2015), ISI Web of Science (from 1940 to May 2015) and CINAHL via EBSCOhost (1982 to May 2015).
SELECTION CRITERIA:
We included all RCTs comparing people undergoing RSI who have cricoid pressure applied, either intermittently or continuously, with people undergoing RSI who do not have cricoid pressure applied in the context of endotracheal intubation using a direct laryngoscopic technique. We included both elective and emergency cases. We included studies of blinded and unblinded participants. Participants (male or female) were involved in any type of procedure where general anaesthetic utilizing RSI or emergency airway management utilizing RSI and endotracheal intubation was undertaken. We expected the control arm to be the absence of cricoid pressure at any stage during RSI. The primary outcome of interest was the reported event rate or prevalence of aspiration determined by a) documented gastric aspiration determined by visual inspection of aspirated stomach contents on laryngoscopy; b) pepsin detection in tracheal aspirate using the Ufberg method; c) post-anaesthetic radiographic changes suggestive of aspiration pneumonitis or d) any combination of a to c. Secondary outcomes of interest included documented impaired visualization of the airway by a treating laryngoscopist, force applied during cricoid pressure, the direction of application of force of applied cricoid pressure, independent risk factors for aspiration and whether the person applying cricoid pressure had previously done so in an emergency airway context.
DATA COLLECTION AND ANALYSIS:
Two review authors independently screened the titles and abstracts of all the studies obtained from the search using recognition of words such as 'cricoid pressure', 'rapid sequence intubation', 'emergency airway management' and 'aspiration'. Two authors independently determined the study inclusion by using a study eligibility form that we developed for the purpose of this review. We also reported the decisions regarding inclusion and exclusion in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. We assumed that studies that did not describe the use of RSI in their title, abstract or methodology used an alternative method of anaesthetic induction or emergency airway management and thus we excluded them. Data extracted from included studies comprised study characteristics, participant demographics, intervention and comparison details plus outcome measures and results. We contacted primary authors of studies with missing or unreported but potentially relevant data to obtain missing data.
MAIN RESULTS:
Of 493 records that we identified from databases as a result of the search (excluding duplicates), we regarded 70 abstracts/titles as potentially relevant studies. Independent scrutiny of these 70 titles and abstracts identified 29 potentially relevant studies. Of the 29 potentially relevant studies, one study met the criteria for inclusion. This study was a RCT that compared participants undergoing RSI and endotracheal intubation in the context of elective surgery requiring a general anaesthetic. Forty participants were recruited, 20 of whom had cricoid pressure applied and 20 of whom had cricoid pressure simulated. The main outcomes reported were systolic arterial pressure and heart rate after laryngoscopy and tracheal intubation. We did not consider these outcomes relevant for the purposes of this systematic review. The search also identified one study that could potentially be included in an updated systematic review in the future, but was at the time of the search a proposal for a trial only and had no reported outcomes at this time.
AUTHORS' CONCLUSIONS:
There is currently no information available from published RCTs on clinically relevant outcome measures with respect to the application of cricoid pressure during RSI in the context of endotracheal intubation. On the basis of the findings of non-RCT literature, however, cricoid pressure may not be necessary to undertake RSI safely, and therefore well-designed and conducted RCTs should nonetheless be encouraged to properly assess the safety and effectiveness of cricoid pressure.2015-11-01T00:00:00ZInterprofessional communication supporting clinical handover in emergency departments: An observation study.Redley, BerniceBotti, MariWood, Beverleyhttp://hdl.handle.net/11434/12052017-08-09T02:28:20Z2017-08-01T00:00:00ZTitle: Interprofessional communication supporting clinical handover in emergency departments: An observation study.
Epworth Authors: Redley, Bernice; Botti, Mari; Wood, Beverley
Abstract: BACKGROUND: Poor interprofessional communication poses a risk to patient safety at change-of-shift in emergency departments (EDs). The purpose of this study was to identify and describe patterns and processes of interprofessional communication impacting quality of ED change-of-shift handovers. METHODS: Observation of 66 change-of-shift handovers at two acute hospital EDs in Victoria, Australia. Focus groups with 34 nurse participants complemented the observations. Qualitative data analysis involved content and thematic methods. RESULTS: Four structural components of ED handover processes emerged represented by (ABCD): (1) Antecedents; (2) Behaviours and interactions; (3) Content; and (4) Delegation of ongoing care. Infrequent and ad hoc interprofessional communication and discipline-specific handover content and processes emerged as specific risks to patient safety at change-of-shift handovers. Three themes related to risky and effective practices to support interprofessional communications across the four stages of ED handovers emerged: 1) standard processes and practices, 2) teamwork and interactions and 3) communication activities and practices. CONCLUSIONS: Unreliable interprofessional communication can impact the quality of change-of-shift handovers in EDs and poses risk to patient safety. Structured reflective analysis of existing practices can identify opportunities for standardisation, enhanced team practices and effective communication across four stages of the handover process to support clinicians to enhance local handover practices. Future research should test and refine models to support analysis of practice, and identify and test strategies to enhance ED interprofessional communication to support clinical handovers.2017-08-01T00:00:00Z