Victorian Emergency Departments Research Articles

The Utilisation of Computed Tomography Pulmonary Angiography in a Regional Victorian Emergency Department.

Pulmonary embolism (PE) is a critical condition with various recognized risk factors. This study investigates these factors in a regional Australian population. The primary aim is to examine the significance of traditional risk factors in the clinical decision to request a computed tomography pulmonary angiography (CTPA) scan for suspected PE within this population and assess the association between the timing of CTPA requests (office vs. after-hours) and PE occurrence. In this single-center retrospective study, we analyzed data from 434 patients undergoing CTPA at Goulburn Valley Health's (GVH) emergency department (ED) between January and August 2022. Covariates included age, clinical indications, and medical background. Statistical tests were appliedwith a p-value <0.05 indicating significance. Pulmonary embolism was diagnosed in 39 (20.9%) males and 17 (6.9%) females, with a mean age of 65.04 years (SD: 16.11). Univariate regression indicated a positive association between age and PE. Multivariate analysis showed a significant positive associationfor unilateral lower limb (LL) swelling/deep vein thrombosis (DVT) (OR: 5.474, p=0.003) and a significant negative association for being female (OR: 0.308, p<0.001). Variables such as shortness of breath, tachycardia, syncope, and chest pain were not significantly associated with PE. No association was found between CTPA request time and PE (χ²=0.9535, df=1, p=0.3288). Increasing age and unilateral LL swelling/DVT are significantly associated with PE. Some signs and symptoms showed negative or positive odds but were not statistically significant. The timing of CTPA requests did not correlate with PE incidence.

The incidence of acute lower limb thrombosis, in symptomatic patients detected with ultrasound, with consideration of recent COVID‐19 vaccination or infection

AbstractIntroductionAfter the COVID‐19 vaccination roll out began in March 2021 patients began presenting to a Victorian Emergency Department with lower limb pain following their vaccination. As a result, radiology requests for ultrasound examinations, to exclude post vaccination deep vein thrombosis (DVT) began appearing.MethodA retrospective search of lower limb venous ultrasound examinations was undertaken for a 1‐year period from March 2021 to February 2022. Patients were included in the study if they had a clinical indication of having been referred following COVID‐19 vaccination. Bivariate analysis was conducted, using logistic regression, to determine the strength of association between independent variables (i.e., age, gender, vaccination status, and COVID‐19 diagnosis) and dependent variables (i.e., a diagnosis of DVT and superficial vein thrombosis [SVT]).ResultsThe study found 1627 examinations had a lower limb venous ultrasound examination over the study period. Ultrasound was positive for acute DVT in 218/1627 examinations (13.4%). 104/1627 (6.4%) presented for ultrasound following COVID‐19 vaccination. Six of these were found to have acute lower limb DVT detected. The association between post vaccination and DVT was an odds ratio (OR) of 0.379 (95% CI 0.164–0.874, p = .023). All examinations that were diagnosed with acute thrombus had recently received AstraZeneca (AZ) (Vaxzevria, ChAdOx1‐S/nCoV‐19) vaccine. Four examinations were diagnosed with superficial vein thrombosis (SVT) post recent COVID‐19 vaccination. One patient was diagnosed with Vaccine Induced Thrombosis with Thrombocytopenia after their first dose of AZ.ConclusionThis study found 6/1627 (0.37%) lower limb venous ultrasound examinations, over a 1‐year period, were positive for acute DVT after COVID‐19 vaccination. The results showed post vaccination examinations were less likely to be diagnosed with a DVT than the population referred who had not had recent vaccination.

Dermatological presentations to a regional Victorian hospital emergency department: A 1-year audit.

The objective of this study is to describe the epidemiological features of each presentation with a primary dermatological diagnosis to a regional emergency department (ED). 1-year retrospective audit. Regional Victorian hospital emergency department. Any presentation to this regional emergency department with a dermatological condition from 1 January 2020 to 31 December 2020. Dermatology presentations to the ED in 2020 and the prevalence of the associated primary diagnosis. In total, 4.7% (n=1873) of ED presentations had a primary dermatological diagnosis. Of these, 1484 were ≥18 years of age and 389 were ≤17 years of age. Cellulitis (26.1%, n=388) was the most common primary diagnosis among presentations ≥18 years. Non-specific rash was the most common diagnosis (23.6%, n=92) in presentations ≤17 years. Indigenous Australians ≥18 years were more likely to be in a younger age group (p < 0.01), and dermatitis/eczema presentations ≥18 years (n=10) were the largest diagnostic group referred to a dermatologist. A total of 134 (7.1%) patients ≥18 years travelled more than 50 km to the ED. There were no dermatological emergencies identified. A high proportion of presentations to this regional ED with a dermatological diagnosis could be well managed by a dermatologist or general practitioner (GP) as an outpatient. The findings of this study inform the need for future rural public dermatology services. Options include teledermatology, or a public weekly or fortnightly rapid review dermatology clinic with a visiting dermatologist, in the absence of a dermatologist onsite.

Do young people with neurological conditions in residential aged care use hospitals differently than those in the community? Evidence from Victorian hospital data, 2014-2017.

This study describes the duration and reasons for hospitalisation for three cohorts of younger adults with neurological conditions who either used residential aged care (RAC) or lived in the community. Hospitalisations as a clinical event indicate conditions for which younger people in RAC may need support as they move into community-based housing. Data describing 3 years of hospitalisations in Victorian public hospitals and emergency departments were used. The neurological conditions occurring among the three cohorts include (1) Cerebral Vascular Accident (CVA), (2) Traumatic Brain Injury (TBI) and (3) Multiple Sclerosis (MS). Frequency of hospitalisation, length of stay and leading causes of potentially preventable hospitalisations were examined. Two hundred and fifty-two (2.7%) of 9333 patients hospitalised for these neurological conditions subsequently used RAC. Hospitalisations were more frequent for those using RAC compared to those living in the community for cohorts with CVA and TBI (6.26 vs. 2.65 events per person-year for CVA and 4.34 vs. 1.88 for TBI) while hospitalisations were more frequent among those in the community compared to those using RAC for the cohort living with MS (3.62 vs. 5.35 per person-year). However, for all the cohorts, the average length of acute hospital stays was longer among RAC users than among those in the community (19.6 vs. 6.2 days for CVA, 15.5 vs. 4.5 for TBI and 12.2 vs. 7.0 for MS). Leading causes for hospitalisation were complex comorbidities and changes in health status (such as seizures, ulcers, dehydration and cellulitis). Efforts should be made to design supports and proactively manage health needs leading to these hospitalisations.

Comparison of Stimulant-Related Presentations to Victorian Emergency Departments Pre-pandemic and During the COVID-19 Pandemic.

IntroductionVictoria, Australia, holds the unenviable record for the longest number of lockdown days in the world (262 days) and some of the most rigid restrictions. The purpose of this study was to determine whether changes in harmful drug use occurred during the pandemic by comparing stimulant-related presentations to Victorian emergency departments before and during the COVID-19 pandemic.MethodsA retrospective analysis of data from the Victorian Injury Surveillance Unit was undertaken for two time periods, March 2019 to September 2019 and March 2020 to September 2020.ResultsThe proportion of people presenting to an ED who used methylamphetamine/methamphetamine/amphetamine significantly increased from 2019 to 2020. Conversely, there was a significant reduction in ED presentations among people who used 3,4-methylenedioxy​methamphetamine (MDMA) and ecstasy during the study period.ConclusionsCOVID-19-related restrictions can affect mental health due to depression, or anxiety, particularly if people also experience loss of employment and income. In addition, mental health issues may affect substance use, including increased frequency of use and dose. This has implications for policy and planning during a pandemic and may be overlooked as the focus is on planning and resources for patients with COVID-19.

The influence of ambulance offload time on 30-day risks of death and re-presentation for patients with chest pain.

ObjectiveTo assess whether ambulance offload time influences the risks of death or ambulance re‐attendance within 30 days of initial emergency department (ED) presentations by adults with non‐traumatic chest pain.Design, settingPopulation‐based observational cohort study of consecutive presentations by adults with non‐traumatic chest pain transported by ambulance to Victorian EDs, 1 January 2015 – 30 June 2019.ParticipantsAdults (18 years or older) with non‐traumatic chest pain, excluding patients with ST elevation myocardial infarction (pre‐hospital electrocardiography) and those who were transferred between hospitals or not transported to hospital (eg, cardiac arrest or death prior to transport).Main outcome measuresPrimary outcome: 30‐day all‐cause mortality (Victorian Death Index data). Secondary outcome: Transport by ambulance with chest pain to ED within 30 days of initial ED presentation.ResultsWe included 213 544 people with chest pain transported by ambulance to EDs (mean age, 62 [SD, 18] years; 109 027 women [51%]). The median offload time increased from 21 (IQR, 15–30) minutes in 2015 to 24 (IQR, 17–37) minutes during the first half of 2019. Three offload time tertiles were defined to include approximately equal patient numbers: tertile 1 (0–17 minutes), tertile 2 (18–28 minutes), and tertile 3 (more than 28 minutes). In multivariable models, 30‐day risk of death was greater for patients in tertile 3 than those in tertile 1 (adjusted rates, 1.57% v 1.29%; adjusted risk difference, 0.28 [95% CI, 0.16–0.42] percentage points), as was that of a second ambulance attendance with chest pain (adjusted rates, 9.03% v 8.15%; adjusted risk difference, 0.87 [95% CI, 0.57–1.18] percentage points).ConclusionsLonger ambulance offload times are associated with greater 30‐day risks of death and ambulance re‐attendance for people presenting to EDs with chest pain. Improving the speed of ambulance‐to‐ED transfers is urgently required.

Trends in calls to a state poisons centre and presentation to emergency departments for intentional antidepressant overdose in Victoria, Australia.

To describe the rates and trends of emergency department presentations and calls to a state poisons centre for antidepressant overdose. A retrospective cohort study utilising the Victorian Emergency Minimum Dataset and Victorian Poisons Information Centre call registry between January 2009 and December 2018 was conducted. This captured all presentations to Victorian emergency departments and calls to the Victorian Poisons Information Centre. Any intentional overdose involving an antidepressant was included. Annual rates of emergency department presentations and calls per 100,000 persons and 100,000 prescriptions for antidepressants overall and individual antidepressant classes, in addition to age-group-specific rates, were reported. A total of 3650 presentations to emergency department and 7096 calls to the poisons centre were included. No changes were seen in overall emergency department presentation rates when controlled for population or prescription numbers, but large and significant increases were seen for younger age groups. The 10-14- and 15-19-year age groups had average annual increases of 13.1% (95% CI = [6.5%, 19.7%], p < 0.001) and 7.2% (95% CI = [2.8%, 11.5%], p < 0.001) per 100,000 persons, respectively. Increases were seen in overall annual call rates of 6.7% (95% CI = [5.2%, 8.1%], p < 0.001) per 100,000 persons and 7.5% (95% CI = [4.9%, 10.1%], p < 0.001) per 100,000 prescriptions. Overall, emergency department presentation rates remained stable during the study period. Overall poisons centre call rates increased moderately. However, when examining younger persons, large increases were seen in both emergency department presentations and poison centre call rates. These findings highlight the need for future interventions to mitigate against intentional overdose in younger populations.

Association between COVID-19 restrictions and emergency department presentations for paediatric mental health in Victoria, Australia.

Objective To determine the association between coronavirus disease 2019 (COVID-19) restrictions and paediatric mental health emergency department presentations. Methods Secondary analysis of Victorian Emergency Minimum Dataset data from 38 Victorian public hospital emergency departments. Paediatric patients (birth to <18 years) attending emergency departments with an International Classification of Disease-Australian Modification (ICD-10-AM) diagnosis of a mental health problem between 1 January 2018 and 31 October 2020 were included. We compared pre-COVID-19 (1 January 2018-27 March 2020) to the COVID-19 period (28 March-26 October 2020) to examine the number of mental health presentations by patient age, socioeconomic status, location, and emergency department triage category. A Poisson regression prediction model was built for each diagnosis group to predict the presentation number in the COVID-19 period, assuming the pandemic and associated restrictions had not happened. Results There were 15 898 presentations (589 presentations/month on average) in the pre-COVID-19 period and 4747 presentations (678 presentations/month on average) in the COVID-19 period. Compared with predicted presentations, there was an increase in observed presentations for eating disorders throughout lockdown (on average, an increase of 36 presentations/month) and for anxiety (11/month) and self-harm (18/month). There were no meaningful changes for mood disorders or developmental and behavioural problems, and presentations for substance abuse mostly fell. Conclusions Pandemic restrictions were associated with increased emergency department presentations for eating disorders and, to a lesser extent, anxiety and self-harm. Given the ongoing pandemic, clinicians and policy makers must work together to find timely, accessible solutions to better manage these conditions.

Hospital-treated Australian Football injury in women and girls, Victoria, 2010/11-2019/20

Introduction: Rates of participation for women and girls playing Australian Football at the school, club and professional level in recent years has increased significantly, from 95,000 participants nationally in 2011 to 586,422 in 2019. In 2010, there were 58 female club teams in Victoria, increasing almost 20-fold to 1092 teams in 2019. The dramatic increase in participation has also seen a sharp rise in serious injuries such as concussion, ruptured ACLs and fractured wrists. The study aims to describe the incidence of hospital-treated Australian Football injuries among women and girls aged 5 years and above in Victoria, Australia. Methods: Routinely collected Victorian emergency department and hospital admissions data from 2010/11 to 2019/20 will be extracted and analysed. Trends over a ten-year period will be examined, while in-depth analysis will focus on the three most recent years of available data. Records will be restricted to females aged 5 plus years with an ICD-10-AM external cause activity code indicating Australian Football (admissions data), while narrative texts and Australian Football sports code will be used for selection of ED presentation data. Results: Outcome measures include frequencies and rates per 100,000 participants for hospital-treated Australian Football injury. Preliminary results: 2509 hospitalisations for women and girls injured while playing Australian Football from 2010/11 to 2019/20; hospitalisations were 94 in 2010/11, increased to 584 in 2018/19 and dropped to 311 in 2019/20 (reflecting limited activity during COVID-19 lockdown). Thirty-four percent (n=859) recorded for females aged 15 to 19 years, followed by 10 to 14 year olds (19%, n=473). Most injuries were to the head (29%, n=727), wrist/hand (24%, n=610) and knee/lower leg (21%, n=521). Discussion: It’s anticipated that both the frequency and participation-adjusted rate of hospital-treated female Australian Football injury will have increased over the past 10 years, with the highest increases occurring in more recent years of data. This research pushes the boundaries through the capture of state-wide population-based hospital treated injury cases. The inclusion of descriptive text regarding the circumstances of injury events in the VEMD is a unique feature that can provide valuable information not adequately described by standard health coding systems. The demographic profile and injury description might also provide a basis for injury prevention to curb the injury trend. Conflict of interest statement: I acknowledge that I have no conflict of interest of relevance to the submission of this abstract.

Smoke-related health impacts of an unprecedented 2019/2020 forest fire season in Victoria, Australia

Background Victoria is a state in south-eastern Australia with a population of 6.6 million people. The 21st of November 2019 was the start of an unprecedented forest fire season during which 1.5 million hectares were burnt in Victoria. The fires were preceded by record fire danger weather in Australia and smoke affected large populations for a longer duration and with higher concentrations than previous fire seasons. As this was a recent event, detailed analysis of the wide-ranging health impacts are ongoing. Methods EPA Victoria commenced monitoring fine particles on 25th November 2019. A total of 32 air monitors measuring PM2.5 were deployed across the state. Preliminary data on emergency department presentations from the Victorian Emergency Minimum Dataset were provided by the Victorian Department of Health and Human Services. Results Air pollution from the forest fires was worst in the eastern half of the State. The 24-hour air quality standard for PM2.5 (25 µg/m3) was exceeded for 50 days in the East Gippsland region. The maximum 24 hour average PM2.5 was 3,253 µg/m3 and was recorded in the town of Bright in the north east. The 1hr peak at Bright was 6,956 µg/m3. Initial descriptive analyses of Victorian emergency department data clearly demonstrate an increase in respiratory-related emergency department presentations during this period. For example, in January 2020 Victorian emergency departments reported over 1,500 additional respiratory-related presentations compared to the same period the previous year. More detailed analyses investigating the association between forest fire smoke exposure and health effects using hospital admissions, Ambulance Victoria call-outs and calls to Nurse-on-Call are in progress. Conclusions Preliminary analyses have revealed major increases in respiratory-related emergency department presentations during an unprecedented 2019/2020 forest fire season in Victoria, Australia. Results of further analysis will be presented at the conference.

Impact of COVID-19 State of Emergency restrictions on presentations to two Victorian emergency departments.

To determine if COVID-19 State of Emergency (SOE) restrictions were associated with a reduction in presentations to two urban EDs in Melbourne, Victoria. This retrospective observational study included adult patients presenting to The Alfred and Sandringham Hospital EDs during the first month of stage 2 and 3 SOE restrictions (26 March-25 April 2020). Patients transferred from other hospitals or diagnosed with COVID-19 were excluded. The primary outcome was the average number of presentations per day. Secondary outcomes included the average daily number of presentations for pre-specified subgroups defined by triage category and diagnosis. The independent impact of SOE restrictions, adjusted for underlying trends in attendance, was determined using negative binomial regression and reported as an incident rate ratio (IRR) with a 95% confidence interval (CI). Average daily attendance during the exposure period was 174.7. In the absence of SOE restrictions, 278.8 presentations per day were predicted, a reduction of 37.3% (IRR 0.63, 95% CI 0.59-0.67). Attendance was lower than anticipated for all triage categories (especially category 5 [IRR 0.51, 95% CI 0.44-0.59]) and diagnostic groups (including circulatory problems [IRR 0.62, 95% CI 0.50-0.76] and injury [IRR 0.58, 95% CI 0.53-0.63]). There were fewer than predicted presentations for several sentinel diagnoses, including gastroenteritis (IRR 0.27, 95% CI 0.17-0.42) and renal colic (IRR 0.55, 95% CI 0.33-0.92). SOE restrictions were associated with a significant reduction in ED presentations across a range of triage categories and diagnoses. Public health messaging should emphasise the importance of timely ED attendance for acute illness and injury.

Investigating emergency nurses’ beliefs and experiences with patient handling in the emergency department

BackgroundPatient handling policy intends to decrease the risk of musculoskeletal injury for nurses. Many factors influence nurses’ adherence to patient handling policy, including the context in which the activities take place. The aim of this study was to investigate emergency nurses’ beliefs and experiences with patient handling in the emergency department. MethodsA phenomenological approach was used to explore the participants’ experience of patient handling in the ED. Focus group interviews were held in a Victorian emergency department. The interviews were audio-recorded, transcribed, and the data were analysed using thematic analysis. ResultsFive interviews were held with 40 nurse participants. Four themes were identified that described participants beliefs and experiences of patient handling: ‘Putting the patient first’ describes participants prioritisation of patient safety over their own; ‘Patient -related challenges’ describes the patient factors (e.g. language, mobility, size) that make patient handling more difficult; ‘Staff knowledge’ of policy and procedure; and ‘Inadequate resources’ which describes the physical and human resource limitations that made patient handling more difficult. ConclusionsIssues with equipment, education and patient handling culture are widespread, and this study reaffirms the importance of considering context in developing interventions to improve practice. Introduction of a Safe Patient Handling Program in the ED, that addresses multiple barriers simultaneously, may improve adherence to policy, and reduce the risk of musculoskeletal injury in emergency nurses.

106 Responding to the First Fall to Prevent the Second: Successful RCT in Reducing Falls using a Person Centred Approach for Older Fallers Presenting to Emergency Departments

Abstract Background The majority of older people who fall and present to Emergency Departments (EDs) are reported not to receive guideline level care to reduce future risk of falls. The aim of this randomized controlled trial was to evaluate whether RESPOND, a 6-month telephone-based patient-centred program had an effect on falls and fall injuries in older people presenting to ED after a fall. Methods 541 older fallers who presented to a WA or Victorian ED were recruited (inclusion criteria: discharged home &amp;lt;72 hours, could walk without hands-on assistance, use a telephone, and no cognitive impairment (MMSE&amp;gt;23). Intervention participants (n=263, mean age=73) received the RESPOND intervention, comprising (1) home-based risk assessment; (2) six months telephone-based education, coaching, goal setting and support for evidence-based risk factor management; and (3) linkages to existing services; while controls (n=260, mean age=73) received usual care. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy and quality of life. Results Falls rate was significantly lower in the RESPOND group (incidence rate ratio 0.65 [95%CI 0.43-0.99]; p=0.042). Although there was no significant difference in fall injuries (p=0.374), the rate of fractures was significantly lower in the RESPOND group (p=0.03). There were no significant group differences in other secondary outcomes. Conclusion The RESPOND falls prevention program reduced falls and fractures, in older people presenting to the ED with a fall. Key learnings for translation include: potential scalability and sustainability of a patient-centred and predominantly telephone-based program.

Restrictive interventions in Victorian emergency departments: A study of current clinical practice.

To determine current clinical practices for managing behavioural emergencies within Victorian public hospital EDs. A multi-centre retrospective study involving all patients who attended ED in 2016 at the Alfred, Ballarat, Dandenong, Geelong and Royal Melbourne Hospitals. The primary outcome was the rate of patient presentations with at least one restrictive intervention. Secondary outcomes included the rate of security calls for unarmed threats (Code Grey), legal status under the Mental Health Act at both the time of ED arrival and the restrictive intervention, and intervention details. For each site, data on 100 patients who had a restrictive intervention were randomly extracted for indication and methods of restraint. In 2016, 327 454 patients presented to the five EDs; the Code Grey rate was 1.49% (95% CI 1.45-1.54). Within the Code Grey population, 942 had at least one restrictive intervention (24.3%, 95% CI 23.0-25.7). Details were extracted on 494 patients. The majority (62.8%, 95% CI 58.4-67.1) were restrained under a Duty of Care. Physical restraint was used for 165 (33.4%, 95% CI 29.3-37.8) patients, 296 were mechanically restrained (59.9%, 95% CI 55.4-64.3), median mechanical restraint time 180 min (IQR 75-360), and 388 chemically restrained (78.5%, 95% CI 74.6-82.0). Restrictive interventions in the ED largely occurred under a Duty of Care. Care of patients managed under legislation that covers assessment and treatment of mental illness has a strong clinical governance framework and focus on minimising restrictive interventions. However, this is not applied to the majority of patients who experience restraint in Victorian EDs.

Appropriateness of adult plain abdominal radiograph requesting in a regional Emergency Department.

Although commonly ordered, abdominal x-rays are thought to be overused and unhelpful in many emergency department patients. Our objectives were to evaluate the appropriateness of plain abdominal X-ray (AXR) requests in adult patients presenting to a Victorian regional emergency department (ED). A retrospective chart review was performed of all adult patients with a plain AXR requested by ED medical staff members in a regional healthcare centre in Victoria, Australia in 2016. Patient demographics, ED disposition and any further imaging results were extracted from the medical record. Indications for X-ray and clinician seniority were determined from the radiology request slips signed by the treating emergency doctor. Appropriateness of imaging was determined by comparing the indication for abdominal radiograph to local evidence-based guidelines. One hundred and nine episodes of plain AXR requests met the inclusion criteria. Of these, 40 were considered inappropriate according to clinical guidelines. Overall, 36% (39/109) had normal or non-specific findings and 42% (46/109) demonstrated faecal loading, while 22% (24/109) identified pathology. Thirty-three patients had further imaging, mostly with computed tomography (CT). Junior staff members were responsible for most of the AXR requests. In our regional hospital ED, over one third of AXRs requested for adult patients were inappropriate according to clinical guidelines. AXRs have a low diagnostic yield and frequently do not reduce the need for further imaging. The use of a clinical practice guideline and education of junior medical staff may increase the appropriate use of plain AXRs in the regional ED setting.

A Retrospective Study Investigating: Factors associated with mode of arrival and emergency department management for patients with acute stroke

BackgroundPresentation by ambulance to the emergency department is critical for stroke patients to receive time dependent treatments. However, little is known of the factors that influence presentation by ambulance. MethodsRetrospective analysis of all patients with an emergency department medical diagnosis of stroke who presented to one of three Victorian emergency departments over a three-year period (2011–2013). A multivariable model was used to investigate demographic characteristics (including triage assessment category, triage identified as stroke, time to CT, and time to diagnosis within the emergency department) as predictors of arrival by ambulance. Results3548 stroke patients were identified; mean age was 70 years, 53% were males, and 92% had an ischemic stroke. Arrival by ambulance occurred in 71% (n=2509) with arrival by private transport accounting for 29% (n=1039) of patients. Factors significantly associated with arrival by ambulance were older age (p=<0.001), being born in Australia (p=<0.001), and speaking English in the home (p=0.003). Arrival by ambulance was independently associated with rapid stroke care in the emergency department, arrival within 2h from symptom onset, attending an advanced stroke service (access to thrombolysis), triaged for stroke, medical assessment within 25min and referral for CT within 45min. ConclusionIn this Australian multicenter study, it was identified that patients who arrived by ambulance received faster acute stroke care within the emergency department. Public health education which targets patients who are younger and from a non-English speaking background is needed as these demographics were not associated with timely arrival by ambulance to the emergency department.

Family presence during resuscitation (FPDR): A qualitative study of implementation experiences and opinions of emergency personnel

AimTo explore the experiences of nurses and doctors on the implementation of family presence during resuscitation (FPDR) in Victorian emergency departments. MethodsAn interpretative qualitative study design was utilized which incorporated the open ended responses on a state wide Victorian survey of emergency department nurses and doctors. A thematic analysis of the responses was conducted involving data reduction, identification of key words, phrases and themes. ResultsA total of 18 emergency departments consented to participate with a mean participant age of 41 years, made up of 91 (81) nurses and 21(19) doctors. The participants came from both metropolitan (64 (57), hospitals 300 – >500 beds) and regional (48 (43), hospitals <80 – 300 beds) health services. There were four emerging themes from the analysis; Depends on the day, impact family have on staff, organisational considerations and incorporating family centred care. ConclusionThere remain a number of variables which have been identified as continuing to create barriers to implementation of family presence during resuscitation that need to be investigated further in order to ensure emergency personnel have consistency of FPDR practice.

Paediatric mental and physical health presentations to emergency departments, Victoria, 2008-15.

To identify trends in presentations to Victorian emergency departments (EDs) by children and adolescents for mental and physical health problems; to determine patient characteristics associated with these presentations; to assess the relative clinical burdens of mental and physical health presentations. Secondary analysis of Victorian Emergency Minimum Dataset (VEMD) data. Participants, setting: Children and young people, 0-19 years, who presented to public EDs in Victoria, 2008-09 to 2014-15. Absolute numbers and proportions of mental and physical health presentations; types of mental health diagnoses; patient and clinical characteristics associated with mental and physical health presentations. Between 2008-09 and 2014-15, the number of mental health presentations increased by 6.5% per year, that of physical health presentations by 2.1% per year; the proportion of mental health presentations rose from 1.7% to 2.2%. Self-harm accounted for 22.5% of mental health presentations (11 770 presentations) and psychoactive substance use for 22.3% (11 694 presentations); stress-related, mood, and behavioural and emotional disorders together accounted for 40.3% (21 127 presentations). The rates of presentations for self-harm, stress-related, mood, and behavioural and emotional disorders each increased markedly over the study period. Patients presenting with mental health problems were more likely than those with physical health problems to be triaged as urgent (2014-15: 66% v 40%), present outside business hours (36% v 20%), stay longer in the ED (65% v 82% met the National Emergency Access Target), and be admitted to hospital (24% v 18%). The number of children who presented to Victorian public hospital EDs for mental health problems increased during 2008-2015, particularly for self-harm, depression, and behavioural disorders.

Systems for recognition and response to clinical deterioration in Victorian emergency departments

BackgroundThe study aim was to explore the systems for recognising and responding to clinical deterioration in adult and paediatric Victorian emergency department (ED) patients after their initial triage assessment. MethodsA survey of Victorian EDs was conducted. Senior ED nursing staff was asked about ED characteristics, vital sign documentation, systems for recognising and responding to deteriorating ED patients, quality assurance and governance of ED rapid response systems (RRSs). ResultsSixteen EDs participated (17 metropolitan and 13 regional or rural) giving a response rate of 53.3% (16/30). The organisational definition of a deteriorating patient applied to the ED at 50% of sites (n=8). Vital sign documentation was paper-based (43.6%), electronic (37.6%) or a combination (18.8%) of both. The majority of EDs (87.5%, n=14) had an ED RRS; 50% had one tier, single trigger RRS and 31.3% of EDs had a two tier, single trigger RRS. At 68.8% of sites the ED RRS activation criteria were the same as ward MET (medical emergency team) activation criteria. The most common method of escalation of care for deteriorating ED patients were face-to-face communication (87.5%) and overhead announcements within the ED (68.8%). The ED rapid response team (RRT) was composed of ED specific staff in 50.5% of sites, and staff external to the ED at 12.5% of sites. Two thirds of sites (68.7%) collected data about clinical deterioration in ED patients. ConclusionsMost EDs had an RRS but there was variability in activation criteria and members of the responding team both between EDs, and between ED and the ward RRSs.

Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study

ObjectiveTo investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage.DesignA pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within...