Australasian Emergency Departments Research Articles

Vital signs monitoring in Australasian emergency departments: Development of a consensus statement from ACEM and CENA

BackgroundEmergency Department (ED) care is provided for a diverse range of patients, clinical acuity and conditions. This diversity often calls for different vital signs monitoring requirements. Requirements often change depending on the circumstances that patients experience during episodes of ED care. AimTo describe expert consensus on vital signs monitoring during ED care in the Australasian setting to inform the content of a joint Australasian College for Emergency Medicine (ACEM) and College of Emergency Nursing Australasia (CENA) position statement on vital signs monitoring in the ED. MethodA 4-hour online nominal group technique workshop with follow up surveys. ResultsTwelve expert ED nurses and doctors from adult, paediatric and mixed metropolitan and regional ED and research facilities spanning four Australian states participated in the workshop and follow up surveys. Consensus building generated 14 statements about vital signs monitoring in ED. Good consensus was reached on whether vital signs should be assessed for 15 of 19 circumstances that patients may experience. ConclusionThis study informed the creation of a joint position statement on vital signs monitoring in the Australasian ED setting, endorsed by CENA and ACEM. Empirical evidence is needed for optimal, safe and achievable policy on this fundamental practice.

What is the prevalence of orthostatic hypotension in an Australasian emergency department population?

Orthostatic hypotension (OH) is associated with increased morbidity and there is limited research on the prevalence in the Australian ED population. The aim was to determine the prevalence of OH in an Australian ED population. Secondary outcomes included any associations of OH with symptoms, presenting complaints, patient demographics, or hospital admission, and the timing of OH findings. Patients presenting to a regional Australasian ED underwent orthostatic measurements at 1, 3 and 5 min of standing following 5 min of supine bed rest. OH was defined as a drop in systolic and/or diastolic blood pressure by ≥20 and ≥10 mmHg, respectively. Of the 312 patients who were enrolled in the study, 69 (22.1%, 95% confidence interval 17.7-27.2%) had OH and 76.8% of cases were detected after 3 min of standing. There was evidence of difference in the prevalence of OH with age (P < 0.001). Similarly, there was evidence of a difference in supine systolic and diastolic blood pressure measurements (P = 0.012 and P < 0.001, respectively) between orthostatic and normotensive subjects. No association was found with OH and hospital admission, presenting complaints or comorbid medical illnesses. In this single Australian ED population, there was a high prevalence of OH (22.1%) with most cases detected within 3 min of standing. A higher-powered study across multiple sites would better substantiate these findings.

What factors help and hinder efforts to address incivility in Australasian emergency departments? A modified Delphi study of FACEM perspectives.

Workplace incivility is a global challenge for healthcare and a major leadership challenge facing emergency physicians. However, little is known about emergency physicians' understanding of the factors that help and hinder attempts to address incivility, or what emergency physicians believe are the priority factors to address. The present study makes a novel contribution to research in this area by examining the perceived enablers of, and barriers to, efforts to address incivility in Australian and Aotearoa New Zealand EDs. An online modified Delphi study was conducted with 22 FACEMs. To structure the process, participants were sorted into four panels. Using a three-phase Delphi process, participants were guided through the process of brainstorming, narrowing down and ranking the factors that help and hinder attempts to address incivility in EDs. There was general agreement that FACEMs' cross-department relationships and networks were key helping factors, and that poor workplace culture and time pressure were major hindering factors. However, despite agreement about these three factors, a wide range of intrapersonal, interpersonal, intergroup, and organisational factors were identified as pertinent to attempts to address incivility in EDs. The causes of incivility in Australian and Aotearoa New Zealand EDs are complex and highlight incivility in EDs as a key adaptive leadership challenge of emergency physicians. Fundamentally, the results underscore the need to foster a workplace culture of respect, inclusion and civility in Australasian hospitals.

Preparedness of Australasian emergency departments for point-of-care ultrasound in the COVID-19 pandemic.

IntroductionPoint‐of‐care ultrasound (POCUS) has been brought to the limelight again, with a surge in lung ultrasound in suspected COVID‐19 patients. This is due to POCUS superiority over chest X‐ray, equivalent efficacy to computerised tomography chest for COVID‐19 diagnosis and potential minimisation of cross‐infection. However, inadequate disinfection practices could make ultrasound machines a vector for disease transmission. This study, conducted during the early phase of the COVID‐19 pandemic, surveyed the preparedness of Australasian Clinicians for responsible POCUS practice within the Emergency Department (ED).MethodsAn anonymous online survey conducted from 20th April to 3rd June 2020 among emergency clinicians providing POCUS within Australasian EDs investigated preparedness to provide effective POCUS while minimising cross‐infection.ResultsThe survey received 171 responses and 116 being eligible for analysis. Most respondents (n = 96, 98%) had a separate ‘hot zone’ with a dedicated US device (n = 75, 77%), but lacked COVID‐19‐specific standard‐operating procedures (n = 51, 52%) or a designated safety and compliance officer (n = 36, 37%). Most clinicians (n = 86, 88%) were willing to perform ultrasound in highly infectious patients, despite poor formal training (n = 66, 67%) or COVID‐19‐specific lung protocols (n = 59, 60%). Most (n = 92, 93%) had access to appropriate low‐level disinfectant wipes but varied significantly in disinfection practice due to a lack of timely, formal or unified guidelines.ConclusionAustralasian EDs significantly lacked investment in education, training and protocols to conduct safe POCUS in the COVID‐19 pandemic. A framework with evidence‐based, logistically feasible protocols supporting safe emergency POCUS is required to deal with similar future infectious outbreaks.

Screening major trauma patients for prevalence of illicit drugs.

Australasian emergency departments (ED) routinely test patient alcohol levels following major trauma, but assessment for illicit drugs is uncommon. A prospective cross-sectional study of major motor-vehicle-related trauma patients attending both adult major trauma centres in Victoria, Australia. All eligible patients had point-of-care saliva testing to determine the prevalence of common illicit drugs. Over 12 months, 1411 patients were screened, 36 refused (2.6%) and 63 were excluded. Of the final 1312 cases included, 173 (13.2%; 95% confidence interval 11.5, 15.1) tested positive to at least one illicit substance, with 133 (76.9%; 69.7, 82.8) positive for meth/amphetamines. One in five had more than one illicit substance detected. Patients testing positive were most frequently in motor vehicles (91.9% vs. 85.6%) and least frequently cyclists (2.3% vs. 4.2%) or pedestrians (5.2% vs. 10.3%), compared to those testing negative. They were younger (mean age 35.4 vs. 43.1 years), more likely to arrive overnight (27.2% vs. 12.1%) or after single vehicle crashes (54.3% vs. 42.3%). Although the initial disposition from ED did not differ, those testing positive were more likely to re-present within 28 days (13.9% vs. 5.4%). A high prevalence of potentially illicit substances among patients presenting with suspected major trauma supports the need for urgent preventive strategies. The low rate of patient refusal and large numbers screened by ED staff suggests that point-of care testing for illicit substances in major trauma is acceptable and feasible. This study and ongoing surveillance may be used to inform driver education strategies.

Paediatric intubation in Australasian emergency departments: A report from the ANZEDAR.

To describe the epidemiology, clinical practice and outcomes of paediatric ED intubation in Australia and New Zealand. Prospectively collected airway management audit data from 43 EDs in Australia and New Zealand that was submitted to the Australia and New Zealand Emergency Department Airway Registry between 2010 and 2015. Paediatric cases accounted for 4.94% (270/5463) of cases (median age = 3, interquartile range [IQR] = 2-9). A median of 5 (IQR = 2-9) intubations were reported per department per year. Most intubations were performed for medical indications (72.2%), including seizure (25.2%) and respiratory failure (15.2%). Patients were physiologically compromised prior to intubation with 69.5% comatose, 50.9% outside of the normal age-adjusted range for respiratory rate, 15.9% hypoxic and 12.6% hypotensive. Complication rate was 33.3% and desaturation was the most common (18.5%). The ED mortality rate was 3.8%. First pass success (FPS) was 80% (95% CI 75.2-84.8). Infants less than 1 year of age had lower FPS, higher rates of difficult laryngoscopy and higher rates of desaturation than other age groups. Paediatric intubation in Australasian EDs is rare from a departmental and individual provider viewpoint. Success rates are similar to contemporary international registries. Complications are common and ongoing collaborative multicentre audit with resultant quality improvement is desirable to facilitate improved success and reduced complications.

Procedural sedation in a tertiary referral trauma centre: A retrospective audit

Procedural sedation complications are common in Australasian Emergency Departments (EDs). This study aimed to compare procedural sedation complications between The Canberra Hospital ED (TCH ED) and the available Australasian literature and to determine if sedation associated complications were amenable to simple intervention. All procedural sedations performed over two and half years in TCH ED were retrospectively reviewed. Complications were defined as per the previous comparable Australasian study, as those events requiring an intervention. 1793 sedations were reviewed: 1125 (63%) for orthopaedic procedures, other 276 (a collection of painful procedures), 208 suturing and 169 direct current cardioversions. The median age was 29 years with 538 (30%) children under the age of 16 years. The complication rate in the initial six-months was 4.0% dropping to 1.3% after multiple education sessions before rebounding to 3.1% in the last six-months. The overall complication rate was 3.1% (95% CI 2.3-4.0) which is significantly lower (P&lt;0.0001) than the comparable previous major Australian study (7.2%, 95% CI 6.2-8.2). There was significantly less use of Midazolam (10.3% vs 23.8% P&lt;0.00001) and Morphine (1.5% vs 7.9% P&lt;0.00001). There was one case of laryngospasm requiring intubation but subsequently discharged at baseline, otherwise no recorded major adverse events. Therefore procedural sedation at TCH ED has a complication rate less than that previously reported and this may be due to evolution of the agents used. The complications seem to be readily amenable to education around prevention, but the benefit of these education sessions appears to decay over time.

Australasian bronchiolitis guideline.

Bronchiolitis is the most common lower respiratory tract disorder in infants aged less than 12 months, and research has demonstrated that there is substantial variation in practice patterns despite treatment being well defined. In order to align and improve the consistency of the management of bronchiolitis, an evidence-based guideline was developed for the Australasian population. The guideline development committee included representation from emergency and paediatric specialty medical and nursing personnel in addition to geographical representation across Australia and New Zealand - rural, remote and metropolitan. Formulation of the guideline included identification of population, intervention, comparator, outcomes and time questions and was associated with an extensive literature search from 2000 to 2015. Evidence was summarised and graded using the National Health and Medical Research Council and Grading of Recommendations Assessment, Development and Evaluation methodology, and consensus within the guideline group was sought using nominal group technique principles to formulate the clinical practice recommendations. The guideline was reviewed and endorsed by key paediatric health bodies. The guideline consists of a usable clinical interface for bedside functionality supported by evidence summary and tables. The Grading of Recommendations Assessment, Development and Evaluation and National Health and Medical Research Council processes provided a systematic and transparent process to review and assess the literature, resulting in a guideline that is relevant to the management of bronchiolitis in the Australasian setting. This is the first robust Australasian acute paediatric guideline and provides clear guidance for the management of the vast majority of patients seen in Australasian emergency departments and general paediatric wards with bronchiolitis.

A point‐prevalence survey of alcohol‐related presentations to Australasian emergency departments

We report the results from our second point‐prevalence survey of alcohol harm in Australasian emergency departments (EDs). This was conducted as part of the Australasian College for Emergency Medicine (ACEM) Alcohol Harm in EDs Project.1 The project's aim was to quantify the amount of alcohol harm presenting to Australasian EDs and to raise awareness of the scale of this public health issue. Previous research attempting to quantify alcohol harm in EDs has been largely retrospective, coding‐based or single‐site, and has estimated total ED alcohol‐related attendances in the range of 0.5 to nine per cent.

Lessons learnt from incidents involving the airway and breathing reported from Australasian emergency departments.

To review incident reports relating to problems encountered during the ED management of patients with 'airway or breathing' problems, with the aim of finding and highlighting common themes within these rare events, and making recommendations to further improve patient safety in the areas in which deficiencies have been identified. Thematic analysis of 36 incidents reported from Australasian EDs, which were related to problems with airway and breathing. In all, 51 problems were identified among the 36 incidents related to airway and/or breathing. Fourteen involved clinical decision-making, 11 equipment, nine communication, seven intubation, five surgical access and five pneumothorax. Eight incidents involved children and there were nine deaths within hours or days. Recommendations for improving preparedness of ED staff and facilities have been made for each of the problem areas identified with respect to clinical practice, equipment, communication and clinical process. Analysis of incidents from the Australasian Emergency Medicine Events Register allows clusters of like-events to be identified and characterised, providing the possibility of getting a better idea of how problems present and progress, with some information about contributing factors, characteristics and context. This will pave the way for earlier and better detection of life-threatening problems and the development and reinforcement of preventive and corrective strategies.

Bell's palsy in children: Current treatment patterns in Australia and New Zealand. A PREDICT study.

The aetiology and clinical course of Bell's palsy may be different in paediatric and adult patients. There is no randomised placebo controlled trial (RCT) to show effectiveness of prednisolone for Bell's palsy in children. The aim of the study was to assess current practice in paediatric Bell's palsy in Australia and New Zealand Emergency Departments (ED) and determine the feasibility of conducting a multicentre RCT within the Paediatric Research in Emergency Departments International Collaborative (PREDICT). A retrospective analysis of ED medical records of children less than 18 years diagnosed with Bell's palsy between 1 January, 2012 and 31 December, 2013 was performed. Potential participants were identified from ED information systems using Bell's palsy related search terms. Repeat presentations during the same illness were excluded but relapses were not. Data on presentation, diagnosis and management were entered into an online data base (REDCap). Three hundred and twenty-three presentations were included from 14 PREDICT sites. Mean age at presentation was 9.0 (SD 5.0) years with 184 (57.0%) females. Most (238, 73.7%) presented to ED within 72 h of symptoms, 168 (52.0%) had seen a doctor prior. In ED, 218 (67.5%) were treated with steroids. Prednisolone was usually prescribed for 9 days at around 1 mg/kg/day, with tapering in 35.7%. Treatment of Bell's palsy in children presenting to Australasian EDs is varied. Prednisolone is commonly used in Australasian EDs, despite lack of high-level paediatric evidence. The study findings confirm the feasibility of an RCT of prednisolone for Bell's palsy in children.

RESPECT-ED: Rates of Pulmonary Emboli (PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Rates.

IntroductionOveruse of CT Pulmonary Angiograms (CTPA) for diagnosing pulmonary embolism (PE), particularly in Emergency Departments (ED), is considered problematic. Marked variations in positive CTPA rates are reported, with American 4–10% yields driving most concerns. Higher resolution CTPA may increase sub-segmental PE (SSPE) diagnoses, which may be up to 40% false positive. Excessive use and false positives could increase harm vs. benefit. These issues have not been systematically examined outside America.AimsTo describe current yield variation and CTPA utilisation in Australasian ED, exploring potential factors correlated with variation.MethodsA retrospective multi-centre review of consecutive ED-ordered CTPA using standard radiology reports. ED CTPA report data were inputted onto preformatted data-sheets. The primary outcome was site level yield, analysed both intra-site and against a nominated 15.3% yield. Factors potentially associated with yield were assessed for correlation.ResultsFourteen radiology departments (15 ED) provided 7077 CTPA data (94% ≥64-slice CT); PE were reported in 1028 (yield 14.6% (95%CI 13.8–15.4%; range 9.3–25.3%; site variation p <0.0001) with four sites significantly below and one above the 15.3% target. Admissions, CTPA usage, PE diagnosis rates and size of PE were uncorrelated with yield. Large PE (≥lobar) were 55% (CI: 52.1–58.2%) and SSPE 8.8% (CI: 7.1–10.5%) of positive scans. CTPA usage (0.2–1.5% adult attendances) was correlated (p<0.006) with PE diagnosis but not SSPE: large PE proportions.Discussion/ ConclusionsWe found significant intra-site CTPA yield variation within Australasia. Yield was not clearly correlated with CTPA usage or increased small PE rates. Both SSPE and large PE rates were similar to higher yield historical cohorts. CTPA use was considerably below USA 2.5–3% rates. Higher CTPA utilisation was positively correlated with PE diagnoses, but without evidence of increased proportions of small PE. This suggests that increased diagnoses seem to be of clinically relevant sized PE.

Physician assistants in Australasian emergency departments.

A physician assistant (PA) is a university qualified health professional who's primary role is to provide medical care under the direction and supervision of medical staff. This is a new profession in Australasia. The PA is well suited to working in both rural, regional and urban settings that deliver emergency medical care. A perspective is presented on their role and scope of practice within the Australasian emergency care system supported by some early findings from their use in a tertiary ED.

Perceptions of Australasian emergency department staff of the impact of alcohol-related presentations.

To survey emergency department (ED) clinical staff about their perceptions of alcohol-related presentations. A mixed methods online survey of ED clinicians in Australia and New Zealand, conducted from 30 May to 7 July 2014. The frequency of aggression from alcohol-affected patients or their carers experienced by ED staff; the perceived impact of alcohol-related presentations on ED function, waiting times, other patients and staff. In total, 2002 ED clinical staff completed the survey, including 904 ED nurses (45.2%) and 1016 ED doctors (50.7%). Alcohol-related verbal aggression from patients had been experienced in the past 12 months by 97.9% of respondents, and physical aggression by 92.2%. ED nurses were the group most likely to have felt unsafe because of the behaviour of these patients (92% reported such feelings). Alcohol-related presentations were perceived to negatively or very negatively affect waiting times (noted by 85.5% of respondents), other patients in the waiting room (94.4%), and the care of other patients (88.3%). Alcohol-affected patients were perceived to have a negative or very negative impact on staff workload (94.2%), wellbeing (74.1%) and job satisfaction (80.9%). Verbal and physical aggression by alcohol-affected patients is commonly experienced by ED clinical staff. This has a negative impact on the care of other patients, as well as on staff wellbeing. Managers of health services must ensure a safe environment for staff and patients. More importantly, a comprehensive public health approach to changing the prevailing culture that tolerates alcohol-induced unacceptable behaviour is required.

Public health in Australasian emergency departments: Attitudes, barriers and current practices.

To understand the attitudes of consultant emergency medicine physicians and advanced trainees and the perceived barriers to public health interventions in Australasian EDs. This was a voluntary cross-sectional, mixed-methods online survey of consultant emergency physicians and advanced trainees of the ACEM, conducted between December 2011 and March 2012. Eight hundred and fifty-six ACEM members responded to the survey - a response rate of 33%. A similar number of consultants (70%) and trainees (75%) believed public health initiatives should be provided in the ED. Barriers identified by a similar majority of consultants and trainees to the implementation of public health interventions in EDs included dedicated time available for staff to be involved; available public health resources; available funding; clinical staff skills and expertise in public health; and the availability of staff training. Public health and health promotion are perceived by the majority of emergency medicine physicians as important in emergency medicine; however, substantial barriers exists to their implementation. Development of an evidence-based approach to public health interventions, which are effective and feasible in the ED environment, will facilitate a more comprehensive approach to public health initiatives in emergency medicine.

The Medical Boomerang: Will it come back?

ObjectivesTo explore the increasing numbers of emergency medicine (EM) registrars that obtained their primary medical degree from UK or Irish universities, who work in emergency departments (ED) throughout Australia and...

Survey of alcohol-related presentations to Australasian emergency departments.

To determine the proportion of alcohol-related presentations to emergency departments (EDs) in Australia and New Zealand, at a single time point on a weekend night shift. A point prevalence survey of ED patients either waiting to be seen or currently being seen conducted at 02:00 local time on 14 December 2013 in 106 EDs in Australia and New Zealand. The number of ED presentations that were alcohol-related, defined using World Health Organization ICD-10 codes. At the 106 hospitals (92 Australia, 14 New Zealand) that provided data, 395 (14.3%; 95% CI, 13.0%-15.6%) of 2766 patients in EDs at the study time were presenting for alcohol-related reasons; 13.8% (95% CI, 12.5%-15.2%) in Australia and 17.9% (95% CI, 13.9%-22.8%) in New Zealand. The distribution was skewed left, with proportions ranging from 0 to 50% and a median of 12.5%. Nine Australian hospitals and one New Zealand hospital reported that more than a third of their ED patients had alcohol-related presentations; the Northern Territory (38.1%) and Western Australia (21.1%) reported the highest proportions of alcohol-related presentations. One in seven ED presentations in Australian and New Zealand at this 02:00 snapshot were alcohol-related, with some EDs seeing more than one in three alcohol-related presentations. This confirms that alcohol-related presentations to EDs are currently underreported and makes a strong case for public health initiatives.

THE MEDICAL BOOMERANG—WILL IT COME BACK?

Objectives &amp; BackgroundTo explore the increasing numbers of Emergency Medicine registrars that obtained their primary medical degree from United Kingdom (UK) or Irish universities, who work in Emergency Departments (ED) throughout Australia and New Zealand.Table 1Trends in Australasian Emergency Medicine registrar numbers 2008–2013 (courtesy of ACEM Policy &amp; Research Department)YearTotal registrarsTotal IMGsUK/Ire IMGs% UK/Ire of total IMGs% UK/Ire of total registrars2008142078728536.220.12009165495832934.319.920101952113741336.321.220111973114443738.222.120122078118548140.623.120132258125256645.225.1MethodsThe VERS-2013 (Victoria Emergency Registrar Study) was published at the Australasian College for Emergency Medicine (ACEM) annual scientific meeting in Adelaide in November 2013.1As a follow on, ACEM provided the authors with data regarding country of primary degree for international medical graduates (IMG) working in Australasian EDs.ResultsUK and Irish Emergency Medicine registrars make up the largest proportion of IMGs in working in Australasian EDs. These figures have increased from 36.2% in 2008 to 45.2% in 2013 (table 1). In 2013 alone, the largest year-on-year increase occurred, of UK and Irish ED IMG registrars, migrating to work in Australia and New Zealand. Current data shows that over 25% of all ED registrars working in Australasian EDs, studied for their primary medical degree in a university either in Ireland or the UK (table 1).ConclusionMany IMGs (in particular from UK and Ireland) leave their country of origin to work overseas in Australia and New Zealand. Highly trained, skilled independent practitioners have, in the past, returned to the UK to work at consultant level. However, evidence from ACEM (table 1) and the VERS-20131 study show clearly that these doctors are now migrating to Australia for the long-term, leaving EDs the length and breath of the British Isles bereft of talented senior EM decision-making personnel. Meanwhile in Australia, continued IMG influx is at odds with a stated Health Workforce Australia taskforce aim to achieve self-sufficiency by 2025.2 The challenge is set for the College of Emergency Medicine, in conjunction with the UK and Irish governments, to enhance the attractiveness of Emergency Medicine as a credible and sustainable career option.

The utilization of poisons information resources in Australasia

PurposeTo identify poisons information resources most commonly utilized by Australasian Emergency Department staff, and examine attitudes regarding the benefits and user experience of the electronic products used. MethodsA survey tool was mailed to six Emergency Departments each in New Zealand and Australia to be answered by medical and nursing staff. ResultsEighty six (71.7%) responses were received from the 120 survey forms sent: 70 (81%) responders were medical staff, the remainder nursing. Electronic resources were the most accessed poisons information resource in New Zealand; Australians preferring discussion with a colleague; Poisons Information Centers were the least utilized resource in both countries. With regard to electronic resources, further differences were recognized between countries in: ease of access, ease of use, quality of information and quantity of information, with New Zealand better in all four themes. ConclusionsNew Zealand ED staff favored electronic poisons information resources while Australians preferred discussion with a colleague. That Poisons Information Centers were the least utilized resource was surprising.

A prospective comparative pilot study comparing the urine collection pad with clean catch urine technique in non-toilet-trained children

IntroductionThere are many different methods for collecting urine from paediatric patients in emergency departments. Therefore, the aims of the study were to:(i)Compare the contamination rate of urine collection pad samples (UCP) and clean catch urine (CCU).(ii)Compare the time taken for each urine collection technique.(iii)Undertake a comparative cost analysis of the two urine collection techniques.(iv)Survey parents/carers perceptions of the two urine collection techniques. MethodsThe three month study was a prospective non-randomised comparative paediatric pilot study. A purposeful sample of children, requiring a urine microscopy for clinical management, presenting to one district emergency department was enrolled in the study to compare two non-invasive techniques of urine collection. ResultsThirty-three patients were enrolled and satisfactory samples were obtained from 22 patients. The heavy (mixed growth) contamination rate in the UCP group (n=2; 9.1%) versus the CCU group (n=1; 4.5%) was not statistically significant (p=0.50 by Fisher’s exact test). The rate of agreement (n=20; 91%) in diagnosing or excluding urinary tract infection between the two groups was high. The median time to urine collection between the two groups (UCP method 30min; CCU 107.5min) was statistically significant (p<0.002, Mann–Whitney U test). ConclusionsThis study suggests that UCPs are practicable in Australasian Emergency Departments and may lead to faster diagnosis, disposition and reduced hospital stay.