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This scoping review describes the current state of research about two‐wheeled delivery riders who have been injured while performing commercial food delivery. The key areas of interest are the patterns of injury, associated risk factors and current gaps in knowledge. Five databases were searched to identify key papers that describe injuries to two‐wheeled food delivery riders. Papers were assessed for quality and eligibility and key information was extracted relating to patterns of injury and risk factors. From an initial 264 records from PubMed, Embase, CINAHL, Scopus and SafetyLit, studies were screened by title, abstract and full text to yield 12 key papers for analysis. No papers reporting on Australian data were identified. Men comprise over 85% of workers in the food delivery industry. The average age of injured riders varies by country, but is commonly under 30 years old. Most injuries are lower limb musculoskeletal injuries, although there are no consistent data about frequency, severity or cost to the healthcare system. Twenty‐three key risk factors were categorised according to rider characteristics, working conditions and environmental factors. The most common risk factors were younger age, lack of driving experience, time‐pressured work and inadequate protective gear. There are very few publications describing food delivery rider injuries and risk factors. This is an emerging industry in which the worker population may be younger and more vulnerable. Given the different legal and cultural contexts across different countries, Australian‐specific research is needed. [ABSTRACT FROM AUTHOR]

The number of people presenting to EDs with mental health problems is increasing. To enhance and promote the delivery of safe and efficient healthcare to this group, there is a need to identify evidence‐based, best‐practice models of care. This scoping review aims to identify and evaluate current research on interventions commenced or delivered in the ED for people presenting with a mental health problem. A systematic search of eight databases using search terms including emergency department, mental health, psyc* and interventions, with additional reference chaining, was undertaken. For included studies, level of evidence was assessed using the NHMRC research guidelines and existing knowledge was synthesised to map key concepts and identify current research gaps. A total of 277 papers met the inclusion criteria. These were grouped thematically into seven domains based on primary intervention type: pharmacological (n = 43), psychological/behavioural (n = 25), triage/assessment/screening (n = 28), educational/informational (n = 12), case management (n = 28), referral/follow up (n = 36) and mixed interventions (n = 105). There was large heterogeneity observed as to the level of evidence within each intervention group. The interventions varied widely from pharmacological to behavioural. Interventions were focused on either staff, patient or institutional process domains. Few interventions focused on multiple domains (n = 64) and/or included the patient's family (n = 1). The effectiveness of interventions varied. There is considerable, yet disconnected, evidence around ED interventions to support people with mental health problems. A lack of integrated, multifaceted, person‐centred interventions is an important barrier to providing effective care for this vulnerable population who present to the ED. [ABSTRACT FROM AUTHOR]

Abstract: Musculoskeletal injuries are a common presentation to the ED, with significant costs involved in the management of these injuries, variances in care within the ED and associated morbidity. A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED. This paper presents the methodology used across the rapid reviews. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015. The search was repeated consistently for each topic area (injuries of the foot and ankle, knee, hand and wrist, elbow, shoulder, lumbar spine and cervical spine). English‐language primary studies, systematic reviews and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion. Data extraction of each included article was conducted, followed by a quality appraisal. The extracted data from each article was synthesised to group similar evidence together. For each rapid review, the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED, such as the assessment, diagnostic tests, management and follow‐up considerations from ED. The series of rapid reviews are designed to foster evidence‐based practice within the ED, targeting the injuries most commonly presenting. The reviews provide clinicians in EDs with rapid access to the best current evidence, which has been synthesised and organised to assist decision‐making. [ABSTRACT FROM AUTHOR]

People brought in by police (BIBP) to the ED are a potentially vulnerable group. This narrative scoping review aimed to identify, evaluate and summarise current literature regarding the frequency of presentation, demographic and clinical profile of patients (including reason for presentation), care delivery, and outcomes for people BIBP to the ED, and identify current gaps in knowledge. The review involved searching EMBASE, CINAHL and PubMed using a combination of terms: emergency/ED coupled with police custody/watch house or police presentation, for papers published in English language from January 2006 to November 2017. A total of 20 studies met the inclusion criteria. These included 17 observational (non‐randomised controlled trials) quantitative studies and three descriptive case reports. The proportion of presentations to ED that were BIBP varied depending on the study design and sampling frame. People BIBP often presented with mental health problems, substance use problems, aggressive behaviour and injury caused by self or others. Of studies focused specifically on patients arriving to the ED in mental health crisis (i.e. suicidal ideation or self‐harm), 18–27% were BIBP. ED presentations BIBP were mostly male and typically younger than people arriving by other means. The nature of care provided in the ED and outcomes of the acute episode of care were typically not well described. Limited research regarding people BIBP to the ED limits the ability to comprehensively understand their demographic and clinical profile and outcomes of emergency care. Further research is required to inform if and where in the patient's journey further improvements may be targeted. [ABSTRACT FROM AUTHOR]

Residents from residential aged care services (RACS) (i.e. nursing homes) many of whom are frail or disabled, are frequently transferred to ED for treatment of acute episodes of illness or injury. This review scoped the research related to the ways in which frailty or activities of daily living (ADL) measures are used for clinical purposes, either prior to the transfer of patients to ED or in ED themselves. A search for original studies up to June 2021 that included participants aged 65 years or over was conducted across four databases. Abstracts were first reviewed, leading to full text screening and article selection. Thirty‐four studies were included in the scoping review. Most of the ADL and frailty assessments were conducted in residential aged care settings. In seven studies, ADL or frailty assessments in the aged care setting contributed to reduced transfer rates to ED. No results were found that associated the assessment of ADL or frailty with decisions related to treatment in the ED. A single ED study involved specialist emergency nursing in an ED as an intervention which included frailty assessment and led to decreased hospitalisation. This scoping review confirms an opportunity for further research into the ways frailty and ADL assessments are used for decision making in relation to the transfer of frail older people to ED, including how these assessments influence their treatment. [ABSTRACT FROM AUTHOR]

Pandemics can cause much distress to communities and present a major burden to the resources and functioning of hospitals. This scoping review aimed to identify, evaluate and summarise current literature regarding how pandemics impact rural EDs in terms of staff wellbeing, structure, function and resources. A systematic search of six databases using search terms including pandemic, ED and rural and remote was undertaken. Articles were included if they were peer‐reviewed, written in English, original research, published between January 2010 and October 2021 and discussed the impact of pandemics on rural EDs. Articles were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Three articles, one from Canada and two from the United States, met the inclusion criteria. The articles included were quantitative in design and fulfilled most of the MMAT critical analysis criteria. Pandemics reported on included H1N1 and COVID‐19. These pandemics impacted rural EDs in terms of functioning and resourcing; no description of staff wellbeing or structure was identified. Rural ED functioning was affected in terms of input; with an increase in patient presentations and time to physician assessment during H1N1, but a decrease in patient presentations and transfers during COVID‐19. Rural ED resources were impacted in regard to staffing, difficulty in obtaining stocks of personal protective equipment and medication, and community response. Further research to understand and address the short‐ and long‐term impacts pandemics may have on rural EDs is required. [ABSTRACT FROM AUTHOR]

E‐learning (EL) has been developing as a medical education resource since the arrival of the internet. The COVID‐19 pandemic has minimised clinical exposure for medical trainees and forced educators to use EL to replace traditional learning (TL) resources. The aim of this review was to determine the impact of EL versus TL on emergency medicine (EM) learning outcomes of medical trainees. A systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta‐analysis statement using articles sourced from CINAHL, Embase, OVID Medline and PubMed. Articles were independently reviewed by two reviewers following strict inclusion and exclusion criteria. Bias was assessed using the Cochrane Risk of Bias tool. The search yielded a total of 1586 non‐duplicate studies. A total of 19 studies were included for data extraction. Fifteen of the included studies assessed knowledge gain of participants using multiple‐choice questions as an outcome measure. Eleven of the 15 demonstrated no statistically significant difference while two studies favoured EL with statistical significance and two favoured TL with statistical significance. Six of the included studies assessed practical skill gain of participants. Five of the six demonstrated no statistical significance while one study favoured EL with statistical significance. This systematic review suggests that EL may be comparable to TL for the teaching of EM. The authors encourage the integration of EL as an adjunct to face‐to‐face teaching where possible in EM curricula; however, the overall low quality of evidence precludes definitive conclusions from being drawn. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander peoples continue to suffer adverse experiences in healthcare, with inequitable care prevalent in emergency settings. Individual, institutional and systemic factors play a significant part in these persisting healthcare disparities, with biases remaining entrenched in healthcare institutions. This includes implicit racial bias which can result in stereotyping of racial minorities and premature diagnostic closure. Furthermore, it may contribute to distrust of medical professionals resulting in higher rates of leave events and hinder racial minorities from seeking care or following treatment recommendations. The aim of this review is to analyse the effect of implicit bias on patient outcomes in the ED in international literature and explore how these studies correlate to an Australian context. [ABSTRACT FROM AUTHOR]

Emergency medicine (EM) is a discipline with complex leadership demands. However, studies of EM physician leadership and ED leadership are in their infancy. As such, there is a lack of clarity about the forms, antecedents, enablers, barriers and consequences of EM physician leadership. A systematic review of the scientific literature was conducted to reveal the different conceptualisations of EM physician leadership, the activities involved in the practice of leadership, and the knowledge and skills of effective ED leaders. Seven databases were systematically searched for peer‐reviewed empirical studies on the topic of EM physicians carrying out a manager or leadership role in an ED setting. Finally, 26 articles were included, and their findings were synthesised and analysed narratively. Two conceptualisations of EM physician leadership were found, reflecting clinical leadership and medical leadership, respectively. Clinical leadership is performed by all EM physicians, often informally, within their daily clinical practice, whereas medical leadership is performed by EM physicians who work at the management level within a hospital, in addition to or instead of their clinical practice. The focus of EM physician leadership and ED leadership research is team leadership, with much less attention given to wider organisation leadership. Consistent with the focus on team leadership, clinical knowledge and skill in orchestrating teams, especially trauma and resuscitation teams, emerged as the most important factors underpinning leadership effectiveness. Future research and training should make better use of existing leadership theory and research designs to illuminate the forms, dynamics, antecedents, moderators and consequences of EM physician leadership. [ABSTRACT FROM AUTHOR]

Abstract: Acute hand and wrist injuries are a common presentation to the ED and are associated with large individual and societal costs. Appropriate management of these injuries in the ED is crucial given that optimal hand function is essential for daily activities and quality of life. This rapid review investigated best practice for the assessment and management of common closed hand and wrist injuries in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines published in English language in the past 12 years that addressed the acute assessment, management, follow‐up plan or prognosis were considered for inclusion. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence. The search revealed 2454 articles, of which 55 were included in the review (n = 23 primary articles, n = 26 systematic reviews and n = 6 guidelines). This rapid review provides clinicians who manage common closed fractures and soft tissue injuries of the hand and wrist in the ED, a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is evidence to support taking a thorough history and physical examination with consideration of occupational and functional factors, restoring alignment and immobilising when necessary and referring onwards. Key points regarding the diagnosis and management of these injuries are provided. [ABSTRACT FROM AUTHOR]

Shoulder injuries are a commonly presenting complaint to the ED. In the absence of an obvious deformity, they can be difficult to assess and definitively diagnose because of the multiple structures that cause shoulder pain, the acuity and severity of pain and the lack of range of motion in the ED setting. The quality of ED care provided to patients with musculoskeletal shoulder pain is crucial to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common shoulder injuries and conditions in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines published in English-language in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were considered for inclusion. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence. The search revealed 1902 articles, of which 73 were included in the review (n = 12 primary articles, n = 49 systematic reviews and n = 12 guidelines). This rapid review provides clinicians who manage shoulder dislocations, fractures and soft tissue injuries in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is strong evidence to support taking a thorough history and physical examination, with cautious use of special tests because of their poor diagnostic accuracy. Key points regarding the diagnosis and management of these injuries are provided. [ABSTRACT FROM AUTHOR]

Abstract: Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English language articles published in the last 12 years that addressed the acute assessment, management or prognosis in the ED were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1242 articles, of which 71 were included in the review (n = 22 primary articles, n = 35 systematic reviews and n = 14 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the ankle and foot in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. Following a thorough history and physical examination, including the application of the Ottawa ankle rules, ED clinicians should not only provide a diagnosis, but rate the severity of soft tissue injuries, or stability of fractures and dislocations, which are the pivotal decision points in guiding ED treatment, specialist referral and the follow‐up plan. [ABSTRACT FROM AUTHOR]

Abstract: Low back pain (LBP) is a common presentation to the ED, and a frequent cause of disability globally. The ED management is often associated with high rates of imaging, misuse and overuse of pharmacology and subsequent financial implications. Given this, improved quality of care for patients with LBP in ED is essential. This rapid review investigated best practice for the assessment and management of LBP in the ED. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015. Primary studies, systematic reviews and guidelines were considered for inclusion. English‐language articles published in the past 10 years that addressed acute LBP assessment, management or prognosis in the ED or acute setting were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1538 articles, of which 38 were included in the review (n = 8 primary articles, n = 13 systematic reviews and n = 17 guidelines). This rapid review provides clinicians managing LBP in the ED a summary of the best available evidence to risk stratify and enhance the quality of care, optimising patient outcomes. Consistent evidence was found to support the use of ‘red flags’ to screen for serious pathologies, diagnostic tests being reserved for use only in the presence of red flags, the judicious prescribing of opioids, identification of psychosocial risk factors as predictors of poorer outcome and promotion of early return to work and function. [ABSTRACT FROM AUTHOR]

To explore the literature regarding three key strategies designed to promote patient throughput in the ED. CINAHL, Medline, PubMed, Scopus and Australian Government databases were searched for articles published between 1980 and 2014 using the key search terms ED flow/throughput, ED congestion, crowding, overcrowding, models of care, physician-assisted triage, medical assessment units, nurse practitioner, did not wait ( DNW) and ED length of stay ( LOS). Abstracts and articles not published in English and articles published before 1980 were excluded from the review. Quantitative and qualitative studies were considered for inclusion. The National Health Medical Research Council ( NHMRC ) Level of Evidence Hierarchy (2009) was applied to included studies. Twenty-one articles met criteria for review. The level of evidence assessed using the NHMRC guidelines of studies ranged from I to IV, with the majority falling into the Level II-2 ( n = 6) and III-3 ( n = 9) range. ED LOS was the outcome most often reported. Study quality was limited with few studies adjusting for confounding factors. Only one level I systematic review was included in this review. Advanced practice nursing roles, physician-assisted triage and medical assessment units are models of care that can positively impact ED throughput. They have been shown to decrease ED LOS and DNW rates. Confounding factors, such as site specific staffing requirements, patient acuity and rest-of-hospital processes, can also impact on patient throughput through the ED. [ABSTRACT FROM AUTHOR]