Queensland Emergency Department Research Articles

A Queensland research support network in emergency healthcare.

The purpose of this paper is to describe the structure and impact of a Queensland Research Support Network (RSN) in emergency medicine (EM). This paper presents a descriptive summary of EM networks, network evaluations and the structure and development of the Emergency Medicine Foundation's (EMF) RSN in Queensland, including an observational pre- and post-study of research metrics. In two years, the RSN supported 33 Queensland emergency departments (EDs), of which 14 developed research strategies. There was an increase in research active clinicians, from 23 in 2015 to 181 in 2017. Collaborator engagement increased from 9 in 2015 to 276 in 2017 as did the number of research presentations, from 6 in 2015 to 61 in 2017. EMF experienced a growth in new researchers, with new investigators submitting approximately 60 per cent of grant applications in 2016 and 2017. EMF also received new applications from a further three HHS (taking EMF-funded research activity from 8 to 11 HHS). This paper describes changes in KPIs and research metrics, which the authors attribute to the establishment of the RSN. However, it is possible that attribution bias plays a role in the KPI improvements. This network has actively boosted and expanded EM research capacity and capability in Queensland. It provides services, in the form of on-the-ground managers, to develop novice clinician-researchers, new projects and engage entire EDs. This model may be replicated nationwide but requires funding commitment. The RSN improves front-line clinician research capacity and capability and increases research activity and collaborations with clear community outcomes. Collaborations were extended to community, primary health networks, non-government organisations, national and international researchers and academic institutions. Evaluating and measuring a network's benefits are difficult, but it is likely that evaluations will help networks obtain funding.

Incidence of emergency department presentations for traumatic brain injury in Indigenous and non-Indigenous residents aged 15\u201364 over the 9-year period 2007\u20132015 in North Queensland, Australia

BackgroundTraumatic brain injury (TBI) is a leading cause of disability worldwide. Previous studies have shown that males have a higher incidence than females, and Indigenous populations have a higher rate than non-Indigenous. To date, no study has compared the incidence rate of TBI between Indigenous and non-Indigenous Australians for any cause. Here we add to this rather sparse literature.MethodsRetrospective analysis of data from North Queensland Emergency Departments between 2007 and 2015 using Australian Bureau of Statistics population estimates for North Queensland residents aged 15–64 years as denominator data. Outcome measures include incidence rate ratios (IRR) for TBI presentations by Indigenous status, age, sex, year of presentation, remoteness, and socio-economic indicator.ResultsOverall incidence of TBI presentations per 100,000 population was 97.8. Indigenous people had an incidence of 166.4 compared to an incidence in the non-Indigenous population of 86.3, providing an IRR of 1.93 (95% CI 1.77–2.10; p < 0.001). Males were 2.29 (95% CI 2.12–2.48; p < 0.001) times more likely to present than females. Incidence increased with year of presentation only in the Indigenous male population.ConclusionsThe greater burden of ED presentations for TBI in the Indigenous compared with the non-Indigenous population is of concern. Importantly, the need to provide quality services and support to people living with TBI in remote and very remote areas, and the major role of the new National Disability Insurance Scheme is discussed.

Characteristics of accidental injuries from power tools treated at two emergency departments in Queensland.

Injuries are a major burden on the Australian healthcare system. Power tool usage is a common cause of accidental injury. A better understanding of the trends of power tool injuries will inform prevention strategies and potentially mitigate costs. The ED databases from two level 1 hospitals were reviewed for presentations between 2005 and 2015 resulting from accidental injury with power tools. A subgroup of patients presenting to one hospital between 2016 and 2017 were interviewed about the activities and circumstances that led to their injuries, and followed up 3 months later to assess outcomes. A total of 4057 cases of accidental injury from power tool use were identified. Power saws and grinders contributed to 54% of injuries. Most injuries were located on an upper limb (48%) or the head and neck (30%). Over half (54%) of all head injuries were associated with metal and wood fragments to the eye from grinders, drills and saws. Hospital admission rates were highest for patients aged >60 years. Injuries to females were <5% of all presentations, but 40% of those caused by lawnmowers. Among the 200 patients interviewed, lapses in concentration during use, and modification and inappropriate use of a power tool were the main contributors to injury. Recovery periods >3 months were common. Accidental injuries from power tool use have a considerable impact on ED resources and can affect the long-term quality of life of those injured. Effective education about safe usage and protection may prevent many injuries.

Emergency department models of care in Queensland: a multisite cross-sectional study.

Objective The acuity and number of presentations being made to emergency departments (EDs) is increasing. In an effort to safely and efficiently manage this increase and optimise patient outcomes, innovative models of care (MOC) have been implemented. What is not clear is how these MOC reflect the needs of patients or relate to each other or to ED performance. The aim of this study was to describe ED MOC in Queensland, Australia. Methods Situated within a larger mixed-methods study, the present study was a cross-sectional study. In early 2015, leaders (medical directors and nurse managers) from public hospital EDs in Queensland were invited to complete a survey detailing ED activity, staffing profiles, treatment space, MOC and National Emergency Access Target (NEAT) performance. Routinely collected ED information system data was also used. Results Twenty of the 27 EDs invited participated in the study (response rate 74%). An extensive array of MOC were identified that were categorised into those that facilitate input, throughput and output from the ED. There was no consistent evidence as to the relative effectiveness of these MOC in achieving ED performance benchmarks, such as NEAT performance. Conclusion There is considerable variability in the MOC used throughout EDs in Queensland. A more complete analysis of the relative effectiveness of different MOC either in isolation or as part of a comprehensive approach would help inform more consistent MOC in Queensland EDs. What is known about the topic? MOC in any given ED are implemented in response to factors such as the geographical location of the hospital, hospital-specific characteristics and service profile, staffing profile and patient demographic profile. In the era of time-based targets, they may also serve to address a particular aspect of flow in the face of rising ED demand. Although many of the MOC attempt to deal with flow in a linear fashion, target specific phases of the ED journey or address particular patient cohorts, what is clear is that not all EDs are shaped and formed the same. What does this paper add? The study provides a comprehensive description of the varied models of care operating within Queensland public hospital EDs and how they relate to ED performance. A basic taxonomy of contemporary ED MOC is necessary to allow comparison between departments and inform decisions regarding safety, efficiency and cost-effectiveness. What are the implications to practitioners? A contemporary understanding of the presence and profile of ED MOC that currently exist within a network of hospitals and health services is important for managers, clinicians and patients to inform decision-making regarding the safety, clinical effectiveness and cost-effectiveness of these models. This understanding can also inform where and how further improvements in care delivery can progress.

Applying the Ottawa subarachnoid haemorrhage rule on a cohort of emergency department patients with headache.

The Ottawa subarachnoid haemorrhage (SAH) rule suggests that alert patients older than 15 years with a severe nontraumatic headache reaching maximum intensity within 1 h and absence of high-risk variables effectively have a SAH ruled out. We aimed to determine the proportion of emergency department (ED) patients with any headache fulfilling the entry criteria for the Ottawa SAH rule. The Ottawa SAH rule was applied retrospectively in a substudy of a prospective snapshot of 34 EDs in Queensland, Australia, carried out over 4 weeks in September 2014. Patient aged 18 years and older with a nontraumatic headache of any potential cause were included. Clinical data and results of investigations were collected. Data were available for 644 (76%) patients. A total of 149 (23.1%, 95% confidence interval: 20.0-26.5%) fulfilled and 495 (76.9%, 95% confidence interval: 73.5-80.0%) did not fulfil the entry criteria. In patients who fulfilled the entry criteria, 30 (<5% overall) did not have any high-risk variables for SAH. In patients who fulfilled the entry criteria and had at least 1 high-risk feature, almost half (46%) received a computed tomographic brain. No SAH were missed. In this descriptive observational study, the majority of ED patients presenting with a headache did not fulfil the entry criteria for the Ottawa SAH rule. Less than 5% of the patients in this cohort could have SAH excluded on the basis of the rule. More definitive studies are needed to determine an accepted benchmark for the proportion of patients receiving further work-up (computed tomographic brain) after fulfilling the entry criteria for the Ottawa SAH rule.

Understanding ED performance after the implementation of activity-based funding.

The aim of this study was to describe emergency department (ED) activities and staffing after the introduction of activity-based funding (ABF) to highlight the challenges of new funding arrangements and their implementation. A retrospective study of public hospital EDs in Queensland, Australia, was undertaken for 2013-2014. The ED and hospital characteristics are described to evaluate the alignment between activity and resourcing levels and their impact on performance. Twenty EDs participated (74% response rate). Weighted activity units (WAUs) and nursing staff varied based on hospital type and size. Larger hospital EDs had on average 9076 WAUs and 13 full time equivalent (FTE) nursing staff per 1000 WAUs; smaller EDs had on average 4587 WAUs and 10.3 FTE nursing staff per 1000 WAUs. Medical staff was relatively consistent (8.1-8.7 FTE per 1000 WAUs). The proportion of patients admitted, discharged, or transferred within 4hours ranged from 73% to 79%. The ED medical and nursing staffing numbers did not correlate with the 4-hour performance. Substantial variation exists across Queensland EDs when resourcing service delivery in an activity-based funding environment. Historical inequity persists in the staffing profiles for regional and outer metropolitan departments. The lack of association between resourcing and performance metrics provides opportunity for further investigation of efficient models of care.

HIV- PEP (Post Exposure Prophylaxis) Access Project

Post-Exposure Prophylaxis (PEP) is a preventive strategy that aims to avert the transmission of HIV to an exposed individual following occupational and non-occupational exposure, e.g. sexual contact, injecting drug use (IDU), needle stick injuries. Timely access to PEP (Within 72 hours) is an integral component to treatment as prevention alongside early treatment to achieve a significant reduction in a new transmission of HIV. In Queensland, it is estimated that around 5000 people live with HIV. The year 2014 saw an increase of 35% newly diagnosed cases of HIV as compared to the year 2013, thus the need to impede the spread of this pandemic is crucial. This project aims to improve the out of hour access to PEP in Queensland through Emergency Departments(ED). A mapping activity of access to PEP across Queensland was carried out by the project team through: • Consultation with the Queensland Department of Health, Communicable Diseases Branch (CDB) • A Community Survey to scope the experiences of people accessing PEP. • Consultation with Community organisations, Public/Private hospitals, HIV Public Health Team, Sexual Health Clinics to scope issues received regarding access to PEP. • Enquiry to all HHS Emergency Departments, Directors of Emergency Medicine and Nurse Unit Managers prescribing PEP to obtain local PEP protocol implementation. A PEP working group was formed that comprised of state-wide representatives from HIVFQ, sexual health clinics, hospital emergency dept., community groups and the Communicable Disease Branch of Queensland Department of Health. Some of the key points identified by the working group were: • Demand for PEP is steadily increasing each year. • People have positive experiences accessing PEP at sexual health clinics, however, some negative experiences were reported by those accessing PEP out of hours at Hospital Emergency Departments (EDs). • Some hospital EDs were less knowledgeable about PEP and were unable to locate the clinical guidelines in a timely manner. • Wait times in EDs averaged 4 hours, which was an added stressor for people waiting for PEP. • Some people experienced stigma, discrimination and judgements when trying to access PEP at EDs. The working group met to review the current PEP landscape and developed the following interventions to improve access to PEP: • Development of a user-friendly PEP Folder for Emergency and Pharmacy Departments including algorithms and flowcharts. This will be rolled out with nursing and pharmacy champions around Queensland, who are best placed to raise awareness of PEP (and PrEP3). • Coordination of resources available to the community including updating the clinic search tool on the ENDHIV website and PEP Emergency Card. • Production of PEP education/training videos for hospital staff to be incorporated into all Queensland hospital pre-vocational trainings and other clinical inductions • Endorsement of the resources from the Queensland Emergency Department State Advisory Panel. We hope these interventions will not only help reduce new transmission of HIV, but also educate clinicians and community on testing, treatment and stigma associated with HIV, thus working towards an HIV-free generation

The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: a multisite prospective longitudinal nested cohort study

BackgroundHealth reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities.MethodsThis study used a prospective, longitudinal nested cohort study of rural emergency departments in Queensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November 2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or confirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and diagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included service indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction with care, quality-of-life, and functional status. Data were examined and compared for differences for participants managed by emergency nurse practitioners and those managed in the standard model of care.ResultsThe median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were 2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority of participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day follow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were comparable with previous studies. No differences were demonstrated between service models.ConclusionsThere was a high level of adherence to clinical guidelines for the emergency nurse practitioner service model and a concomitant high level of diagnostic accuracy. Nurse practitioner service demonstrated comparable effectiveness to that of the standard care model in the evaluation of the service indicators and patient reported outcomes. These findings provide a foundation for the beginning evaluation of rural emergency nurse practitioner service in the delivery of safe and effective beyond the setting of minor injury and illness presentations.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12616000823471 (Retrospectively registered).

The impact of an Emergency Department ambulance offload nurse role: A retrospective comparative study

ObjectiveThis study aimed to evaluate the impact of an Emergency Department Ambulance Offload Nurse (EDAOLN) role on patient and health services outcomes in one Queensland Emergency Department (ED). MethodsA retrospective study of all ED presentations (n=21,454) made to a tertiary hospital ED in Queensland, Australia, during July 9, 2012 – November 2, 2012; 39days before (T1), during (T2) and after (T3) the introduction of the trial of an EDAOLN role. The primary outcome of interest was time to be seen by a clinician. ResultsDemographic and clinical profiles of ED presentations made during each of the time periods were relatively similar. Time to be seen improved marginally during the trial period of the EDAOLN (T1: 34min vs. T2: 31min, p=0.002). The proportion of hospital admissions and those who did not wait differed between T1 and T2 (lower during T2 vs. T3). Most outcomes were not sustained when the role was removed (i.e. T2 vs. T3), and most returned close to baseline (i.e. T1 vs. T3). ConclusionsAs part of a health services framework designed to improve timely access to emergency care, an EDAOLN may be one of several options to consider.

Older persons who re-present to the Emergency Department: An observational study

BackgroundModels of emergent care evolve in response to an ageing population. The Medical Assessment Unit (MAU) receives patients from the Emergency Department (ED) for up to 48h to facilitate assessment, care and treatment before discharge home or to another inpatient unit. AimTo describe the clinical and social characteristics of older people who had a stay in the MAU and then re-present to the ED within 28days of discharge from hospital. MethodsA retrospective observational study design was used. Data were extracted from electronic medical records of older people who re-presented to two public teaching hospital EDs in Queensland, Australia, over a two-week period in 2014. FindingsThere were 78 older people who made 84 re-presentations. The average age was 79 years; average number of co-morbidities was seven (range 1–18); almost one-quarter (23%) lived alone; more (63%) were female; half (58%) were married; and one-fifth (20%) had some form of cognitive impairment. Of those who re-presented with the same diagnosis, 46% had cardio-respiratory conditions. One-quarter (28%) of the re-presenters had a discharge summary from the last admission. DiscussionMost of the re-presenters in this study had cardio-respiratory conditions. While a discharge summary was available, it was not consistently completed, raising the importance of discharge summaries as part of continuity across services for older people. ConclusionHow the ED, MAU and primary health services are coordinated bears further investigation. Research into the value of coordination roles, such as nurse navigators, for older people re-presenting to ED is recommended.

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Agreement between triage category and patient's perception of priority in emergency departments.

BackgroundPatients attending hospital emergency departments (ED) commonly cite the urgency and severity of their condition as the main reason for choosing the ED. However, the patients’ perception of urgency and severity may be different to the nurses’ perception of their urgency and severity, which is underpinned by their professional experience, knowledge, training and skills. This discordance may be a cause of patient dissatisfaction. The purpose of this study is to understand the extent of agreement/disagreement between the patient’s perceived priority and actual triage category and associated factors.MethodsA cross-sectional survey of 417 patients attending eight public hospital EDs in Queensland, Australia between March and May 2011 was conducted. The survey included patient’s perceived priority and other health-related, socio-demographic and perceptual factors. Patients’ triage category data were retrieved from their ED records and linked back to their survey data. Descriptive and multinomial logistic regression analyses were used.ResultsOver 48 % of the respondents expected to be given higher priority than the actual triage category they were assigned; 31 % had their perceived priority matched with the triage category; and 20 % of the respondents expected a lower priority than the triage category they received (Kappa 0.07, p < 0.01). Patients who expected a higher priority tended to be more frequent users (≥3 times in the past six months), and to score higher on perceived seriousness, perceived urgency, and pain score compared to the patients whose perceived priority matched the triage category or anticipated a lower priority. In the multivariate analysis, only perceived urgency remained significantly associated with expected higher priority (OR = 1.27, 95 % CI: 1.14–1.43).DiscussionOur findings clearly confirmed the discrepancy between patient perception of urgency and staff assessment of urgency. This can have important implications particularly for the patients who underrate the urgency of their condition. Improved and open communication and the incorporation of the ‘patient voice’ into the triage process require understanding the patient’s perspectives and their involvement in the decision making process.ConclusionsNoted differences between patient and practitioner perception of clinical urgency were identifed in this study.

Measuring the impact of the working environment on emergency department nurses: A cross-sectional pilot study

BackgroundThe emergency department (ED) is characterised by high workload and competing demands. This study describes ED nurses perceptions of their working environment with a sub group analysis for those who also worked at the local police watch house, where individuals are detained in custody. MethodsA cross-sectional pilot study was undertaken involving a survey of nurses working in one ED in Queensland, Australia. The Working Environment Score (WES-10) consists of four subscales: Self Realisation, Workload, Conflict, and Nervousness; and is used to measure stress and staff morale. This was administered at two time periods: T1: May 2013 and T2: July 2013; before and after 10 ED nurses worked in the watch house. ResultsQuestionnaires were returned by 34 nurses at T1 and 41 nurses at T2. The perception of working environment differed between T1 and T2 for nurse respondents who worked at the local police watch house but not for nurse respondents who did not work in the watch house. Of the four sub-scales, workload was the factor that impacted most on working environment in both groups and was notably higher for those who worked in the watch house and responded at T2. ConclusionsThis pilot study identified that for ED nurses’ satisfaction with their working environment was relatively high, although certain areas (e.g., nervousness) were better than others (e.g., workload). The perception of workload was higher for T2 staff offered the opportunity to use their ED skills in a different setting, however further work with a larger sample size is required.

A time series analysis of alcohol-related presentations to emergency departments in Queensland following the increase in alcopops tax

BackgroundRaising duty on alcohol across the board can reduce morbidity, mortality and other adverse consequences of alcohol use. However, effectiveness is less certain for measures that target specific types of...

The impact of a flow strategy for patients who presented to an Australian emergency department with a mental health illness

ObjectivesTo describe and compare characteristics, care delivered, and outcomes of patients who presented to an emergency department (ED) with a mental health illness before and after the implementation of a patient flow strategy. MethodsThis was a retrospective, descriptive study. Health care data of patients who presented to a public teaching hospital ED in Queensland, Australia diagnosed with a mental health illness before (5th September 2011–4th March 2012) and after (5th March 2012–4th September 2012) the implementation of a patient flow strategy were analysed. ResultsA total of 3037 (before: n = 1511; after: n = 1526) mental health presentations (4.5% of all ED presentations) were made to the ED. Following the implementation of a patient flow strategy, improvements in ED length of stay, tests performed and nursing observations were seen. These varied by mental health diagnosis. ConclusionOur results indicate that a targeted approach to improving service delivery for a specific cohort of ED patients can make a difference without additional staffing. Further focused refinement of the strategy (such as time waiting for treatment) may be required.

Effectiveness of an emergency nurse practitioner service for adults presenting to rural hospitals with chest pain: protocol for a multicentre, longitudinal nested cohort study

IntroductionChest pain is common in emergency department (ED) patients and represents a considerable burden for rural health services. Health services reforms to improve access to care need appropriately skilled and...

Retrospective observational study of patients who present to Australian rural emergency departments with undifferentiated chest pain.

To identify the demographic and clinical characteristics of patients who present to Australian rural emergency departments (EDs) with chest pain. Retrospective, observational study. Rural EDs in Queensland, Australia. Three hundred thirty-seven consecutive adult patients with undifferentiated chest pain who presented between 1 September 2013 and 30 November 2013. Service indicators, discharge diagnoses and disposition. Presentations for undifferentiated chest pain represented 3.5% of all patient presentations during the sampling period. The mean age of patients was 48 years and 54% were male. Overall, 92% of patients left the ED within the 4-hour NEAT target. The majority of presentations were related to cardiac concerns (39%), followed by non-cardiac chest pain (17%), musculoskeletal (15%) and respiratory (10%) conditions. More than half of these patients were discharged at the completion of the ED service (52.8%), 40.6% were admitted, 3.3% left at own risk, 2.4% did not wait and less than 1% of patients required transfer to another hospital directly from the ED. This study has provided information on the characteristics and processes of care for patients presenting to Australian rural EDs with undifferentiated chest pain that will inform service planning and further research to evaluate the effectiveness of care for these patients.

Detecting and diagnosing hotspots for the enhanced management of hospital emergency departments in Queensland, Australia

BackgroundPredictive tools are already being implemented to assist in Emergency Department bed management by forecasting the expected total volume of patients. Yet these tools are unable to detect and diagnose when estimates fall short. Early detection of hotspots, that is subpopulations of patients presenting in unusually high numbers, would help authorities to manage limited health resources and communicate effectively about emerging risks. We evaluate an anomaly detection tool that signals when, and in what way Emergency Departments in 18 hospitals across the state of Queensland, Australia, are significantly exceeding their forecasted patient volumes.MethodsThe tool in question is an adaptation of the Surveillance Tree methodology initially proposed in Sparks and Okugami (IntStatl 1:2–24, 2010). for the monitoring of vehicle crashes. The methodology was trained on presentations to 18 Emergency Departments across Queensland over the period 2006 to 2008. Artificial increases were added to simulated, in-control counts for these data to evaluate the tool’s sensitivity, timeliness and diagnostic capability. The results were compared with those from a univariate control chart. The tool was then applied to data from 2009, the year of the H1N1 (or ‘Swine Flu’) pandemic.ResultsThe Surveillance Tree method was found to be at least as effective as a univariate, exponentially weighted moving average (EWMA) control chart when increases occurred in a subgroup of the monitored population. The method has advantages over the univariate control chart in that it allows for the monitoring of multiple disease groups while still allowing control of the overall false alarm rate. It is also able to detect changes in the makeup of the Emergency Department presentations, even when the total count remains unchanged. Furthermore, the Surveillance Tree method provides diagnostic information useful for service improvements or disease management.ConclusionsMultivariate surveillance provides a useful tool in the management of hospital Emergency Departments by not only efficiently detecting unusually high numbers of presentations, but by providing information about which groups of patients are causing the increase.

Patient characteristics and institutional factors associated with those who “did not wait” at a South East Queensland Emergency Department

Patients who do not wait in Emergency Departments (ED) are a key concern for healthcare consumers, providers and policymakers. A six month descriptive retrospective cross-sectional designed study was undertaken at a public, metropolitan, adult tertiary referral ED in South East Queensland (SEQ). Using hospital administrative data, all patient presentations were examined over the timeframe with the aim of identifying and describing patient, institution and economic factors for individuals who attend the ED with the focus on patients who did not wait for medical treatment. A total of 1088 (4.2%) of 25,580 ED patient presentations did not wait (DNW). When compared to patients who waited those who DNW differed significantly regarding age (p<0.001), triage category (p<0.001), mode (p<0.001) and shift of arrival (p<0.001). Patients who DNW were younger, assigned less urgent triage categories and presented in higher proportions by private transport, during evenings and overnight. Some (n=550) were incorrectly coded as DNW when they actually waited, but left after treatment commenced. The crude cost of incorrectly coding these patients amounted to >$160,000. Understanding the characteristics of patients who DNW enables strategies to be considered and implemented to manage and mitigate both the potential clinical risk to patients and the financial implications for health care institutions.

Language affects length of stay in emergency departments in Queensland public hospitals.

A long length of stay (LOS) in the emergency department (ED) associated with overcrowding has been found to adversely affect the quality of ED care. The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home. A secondary data analysis of a Queensland state-wide hospital EDs dataset (Emergency Department Information System) was conducted for the period, 1 January 2008 to 31 December 2010. The interpreter requirement was the highest among Vietnamese speakers (23.1%) followed by Chinese (19.8%) and Arabic speakers (18.7%). There were significant differences in the distributions of the departure statuses among the language groups (Chi-squared=3236.88, P<0.001). Compared with English speakers, the Beta coefficient for the LOS in the EDs measured in minutes was among Vietnamese, 26.3 (95%CI: 22.1-30.5); Arabic, 10.3 (95%CI: 7.3-13.2); Spanish, 9.4 (95%CI: 7.1-11.7); Chinese, 8.6 (95%CI: 2.6-14.6); Hindi, 4.0 (95%CI: 2.2-5.7); Italian, 3.5 (95%CI: 1.6-5.4); and German, 2.7 (95%CI: 1.0-4.4). The final regression model explained 17% of the variability in LOS. There is a close relationship between the language spoken at home and the LOS at EDs, indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.