Articles: emergency-department.
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Emerg Med Australas · Feb 2025
Observational StudyAmbulance offload performance, patient characteristics and disposition for patients offloaded to different areas of the emergency department.
Ambulance transfer of care (TOC) is a key performance indicator for New South Wales EDs, with 90% of ambulances to be offloaded within 30 min of arrival. Nepean Hospital ED has a number of strategies to improve TOC, including ambulatory areas where patients can be offloaded immediately. Offload data are supplied by ambulance and there is no study into its accuracy. The aim is to audit the accuracy of ambulance data of TOC compared to times recorded in the Nepean ED information system, and to examine TOC and patient demographics for different offload destinations. ⋯ Patients arriving by ambulance requiring an acute care bed were likely to be elderly and frail, and suffered substantial ambulance offload delays. Delays to ambulance offload for these patients is likely driven by acute care bed availability and access block.
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In patients with a high clinical probability of pulmonary embolism (PE), the high prevalence can lower the D-dimer negative predictive value and increase the risk of diagnostic failure. It is therefore recommended that these high-risk patients should undergo chest imaging without D-dimer testing although no evidence supports this recommendation. ⋯ In this study, ruling out PE in high-risk patients based on D-dimer below the age-adjusted threshold was safe, with no missed PE. However, the large CI of the primary endpoint precludes a definitive conclusion.
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Emerg Med Australas · Feb 2025
Experience, knowledge, practices and attitudes of emergency department medical staff regarding teledermatology.
The present study aimed to assess self-reported experience, knowledge, practices and attitudes of ED medical staff regarding teledermatology. ⋯ Skin photography image quality, knowledge and adherence to medicolegal policy were poor among ED medical staff. Education could reduce risk and improve outcomes.
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Observational Study
Factors associated with hospital revisitation within 7 days among patients discharged at triage: a case-control study.
Existing data are limited for determining the medical conditions best suited for an emergency department (ED) redirection strategy in a heterogeneous, nonurgent patient population. ⋯ Higher age and abdominal pain were associated with hospital revisitation and hospitalization within 7 days among patients directly discharged or redirected by the triage team. Regardless of the triage system in use, there might be patient groups that should be evaluated more cautiously if a triage-based discharge or redirection strategy is to be considered.
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Emerg Med Australas · Feb 2025
Prisoners in the emergency department: Lessons from a recent inquest.
The recent coronial finding in Victoria into the death of Joshua (Josh) Kerr highlights some of the challenges of treating patients who are in custody and under the supervision of custodial staff (prison officers or police) in the ED. Issues include ED clinicians' duty of care, roles and responsibilities of ED staff and custodial staff and the need for processes that facilitate collaboration and communication between ED clinicians and custodial staff.