Emergency medicine Australasia : EMA
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Emerg Med Australas · Apr 2023
Missed presentations, missed opportunities: A cross-sectional study of mental health presentation undercounting in the emergency department.
The burden of mental illness is increasing across developed countries. EDs are often used as access points by people experiencing mental health crises, with such rising demand in Australasia. Accurate data is critical to track and address this need, but research suggests that current data collection methods undercount mental health presentations to the EDs. The present study aimed to quantify and characterise ED mental health presentations that were not identified by usual clinical coding processes. ⋯ The present study demonstrates that ED mental health presentations may be underestimated by nearly 5%, revealing greater mental health demand than current figures suggest.
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EDs are highly demanding workplaces generating considerable potential for occupational stress experiences. Previous research has been limited by a focus on specific aspects of the working environment and studies focussing on a range of variables are needed. The aim of the present study was to describe the perceptions of occupational stress and coping strategies of ED nurses and doctors and the differences between these two groups. ⋯ The present study found organisational stressors adversely impact the well-being of ED nurses and doctors. Organisational-focused interventions including leadership development, strategic recruitment, adequate staffing and resources may mitigate occupational stress and complement individual coping strategies. Expanding this research to understand broader perspectives and especially the impact of COVID-19 upon ED workers is recommended.
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Emerg Med Australas · Apr 2023
Observational StudyRaising the D-dimer threshold for ruling out pulmonary embolism: A single-site, observational study with a historical comparison.
The objective of this study was to assess the impact of introduction of a new pulmonary embolism (PE) diagnostic guideline with a raised D-dimer threshold. ⋯ The introduction of the new guideline was associated with a reduction in overall imaging rates without evidence of missed PE. Further evaluation in other settings is recommended.
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Emerg Med Australas · Apr 2023
Multicenter StudyAssociation between timing and adequacy of antibiotics and adverse outcomes in patients with sepsis and septic shock: A multicentre retrospective cohort study.
To investigate the association between the timing and adequacy of antibiotics administered to patients presenting with culture-positive sepsis and septic shock to the ED and in-hospital mortality and/or intensive care unit (ICU) admission. ⋯ In a large multicentre sample of patients with culture-positive sepsis, inadequacy of antibiotics was associated with higher risk of in-hospital mortality or ICU admission.
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Emerg Med Australas · Apr 2023
Observational StudyOutcome of reduction of paediatric forearm fracture by emergency department clinicians.
Paediatric forearm fractures are common. Anecdotally, there is a trend towards ED reduction of selected fractures under procedural sedation. We aimed to determine the rate of subsequent operative intervention for fracture re-displacement. ⋯ Reduction of paediatric forearm fractures under procedural sedation by ED clinicians is increasingly common and results in a low rate of subsequent operative intervention.