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Objectives: The COVID-19 Delta variant of concern continues to pose significant challenges to health systems globally, with increased transmissibility and different patient populations affected. In Sydney, a virtual model of care was implemented in response to the COVID-19 pandemic and Special Health Accommodation (SHA) was made available for community patients with COVID-19 who could not isolate at home or needed health support., Methods: This retrospective observational cohort study of all patients with COVID-19 Delta variant in SHA during the initial phases of the Delta variant outbreak in Sydney describes the demographic and clinical characteristics of patients with Delta variant COVID-19 and determines predictors of need for in-patient hospital admission., Results: Data from 794 patients were analysed. One hundred and fifty-seven patients (19.8%) were transferred to ED. Of those, 125 were admitted to an in-patient unit (admission rate from ED 79.6%), and of these 30 (24%) went to ICU and seven were intubated. Two patients died within the follow-up period. Age >40 years, obesity, and presence of fever (temperature >37.5°C), hypoxia (oxygen saturation <95%), tachycardia or gastrointestinal symptoms on initial assessment in SHA were independent predictors of in-patient admission with an AUROC of 0.78 (95% confidence interval 0.73, 0.82)., Conclusions: Initial symptoms and vital signs were just as predictive for short-term deterioration as age and pre-existing comorbidities and should be included in future risk prediction models for COVID-19. Based on this, we derive a proposed risk prediction score that incorporates these predictors with further validation required., (© 2022 Australasian College for Emergency Medicine.)

Objective: The present study describes patients with acute behavioural disturbance presenting to the ED, the impact they have on the department and any complications that occur., Methods: We performed a prospective observational study of adult patients (>17 years old) requiring parenteral sedation for acute behavioural disturbance over a 13 month period. Demographic data, mode of arrival, indication, drug type and dosing used for sedation were collected. Departmental data were recorded including the staff type and numbers involved and the condition of the department. The main outcomes were complications from sedative medication and injury sustained to patients or staff., Results: Over the study period 173 patients met inclusion criteria, the majority (n = 104, 60%) were men with a mean age of 38.5 years (standard deviation 14.4); 51% of patients had more than one indication for sedation (n = 89), the commonest being mental health related plus drug intoxication (n = 30, 33.7%). Intoxication was frequently from either alcohol (n = 62, 47%) or methamphetamine (n = 41, 31%). The median number of staff involved was 10 (interquartile range 8-12). Staff members received an injury in 12% (n = 20) of sedations, with only 1% (n = 2) of patients receiving any physical injury; 12% (n = 20) had a minor complication from the sedation medication. No patient had any major complication (apnoea, intubation, arrhythmias or cardiac arrest)., Conclusion: Patients with acute behavioural disturbance often have a history of mental illnesses and are commonly intoxicated. These patients have impacts on healthcare resources and pose risks to staff safety, but significant complications to patients do not occur frequently., (© 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objective: The objective of the present study is to demonstrate a novel method of mapping ED activity to analyse patterns presentations, occupancy and performance trends., Methods: This was a retrospective, descriptive analysis of de-identified and linked ED presentations across NSW, Australia, over five calendar years, 2010-2014. It was undertaken as part of the Demand for Emergency Services Trend in Years 2010-2014 (DESTINY) study. The DESTINY project analysed 10.8 million presentations during 2010-2014. Hourly Emergency Activity Tracking (HEAT) maps were generated to visually represent and analyse the number of emergency arrivals to ED occupancy and proportion of patients leaving the ED within 4 h per hour of day across consecutive months of the year., Results: HEAT maps provided a means of visually representing ED activity to demonstrate hour-to-hour trends in presentations, occupancy and performance between 2010 and 2014. This analysis has shown that the most marked increase in presentations per hour has occurred during the 10.00-14.00 hour period, associated with an improvement in ED performance during the same period., Conclusion: HEAT maps may be used to facilitate further analyses of ED demand, patterns of patient presentations and patient flow and future health system redesign., (© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objective: The objective of this study is to describe the trends and characteristics of short-term and frequent representations to EDs in New South Wales, Australia., Methods: This was a retrospective analysis of a linked population-based registry of ED representations in New South Wales, conducted as part of the Demand for Emergency Services in Years 2010-2014 project. Trend analysis of unplanned representations to ED within 3 days of discharge from ED, readmission to an in-patient unit within 30 days of index in-patient admission from ED and demographic data and trends for frequent and very frequent ED presenters is discussed., Results: A total of 10 798 797 ED presentations were identified from 4 188 283 individual patients. Within 1 year, 48.9% of ED presentations had a previous presentation, and 4.9% had represented within 3 days of a previous presentation. The readmission rate within 30 days was 2.8%, the proportion of frequent (representing 5212 [0.1%] individual patients) and very frequent representations (representing 1186 [0.03%] individual patients) were 1.7% and 1.0%, respectively. The overall rate of representations within 3 days has decreased from 5.1% in 2010 to 4.7% in 2014 (P < 0.001). The rate of readmissions within 30 days has increased from 2.4% in 2010 to 3.1% in 2014 (P < 0.001)., Conclusions: In this population-based study, short-term representations were highest in the infant patient population, in-patient readmission rates were highest in the elderly and very frequent representations to ED were characterised by middle-aged patients with mental health or drug and alcohol related presentations., (© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objectives: Our primary aim was to analyse the quality of letters from general practitioners (GPs) to the ED as defined by two checklists: the authors' own nine-item list and a template published in 2013 by the New South Wales Agency for Clinical Innovation. The secondary aim was to determine if referral quality was influenced by letter format (handwritten or computer-generated) or urgency of the patient's condition (defined by triage category)., Methods: The present study is a retrospective audit of records of patients presenting to Royal Prince Alfred Hospital ED from a GP during February and March 2014., Results: Out of 12 199 ED presentations, 575 (4.7%) were recommended by a GP and 414 (72.0%) had a letter. Greater than 60% completion was achieved in 80.9% of letters compared to our own checklist, and in 6.3% compared to the Agency for Clinical Innovation checklist. Computer-generated letters were more likely to be fully legible and include an accurate medical history and medication list. Handwritten letters were less frequent (11.9%) but of poorer quality and legibility. Overall, less than half of letters contained results, psychosocial history or vaccination history. Referrals for patients assigned an urgent triage category were more likely to contain examination findings, but there was otherwise no difference in quality., Conclusions: Referral quality was influenced by letter format but not by urgency of the patient's condition. Omission of information from referral letters potentially risks patient safety. Handwritten referrals should be abandoned. Comprehensive electronic letter templates and regular updating of medications, comorbidities and allergies are encouraged., (© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objective: This study aims to describe the general characteristics and data definitions used in a population-based data set of ED presentations in New South Wales (NSW), used to form the basis of future-trend analyses., Methods: Retrospective analysis of the Emergency Department Data Collection registry, which provided clinical and demographic information of ED presentations across all EDs in NSW between 2010 and 2014. Presenting problems and ED diagnoses were classified using broad clinical categories including injury/musculoskeletal, respiratory, cardiovascular, ear nose and throat, and mental health. Presentations were linked by patient to allow for analysis of representations, and population data were obtained from the Australian Bureau of Statistics., Results: There were 11.8 million presentations that were analysed from 150 EDs (80.6% of all EDs). The rate of ED presentations was highest in those aged 85 years and older and appears to increase across all age groups between 2010 and 2014. The most common ED diagnosis categories were injury/musculoskeletal (27.5%) followed by abdominal/gastrointestinal (12.3%), respiratory (9%) and cardiovascular (8%). Both the Systematised Nomenclature of Medicine Clinical Terms (66%) and the International Classification of Diseases (24%) were used to code ED diagnoses., Conclusions: The elderly population had the highest rate of ED attendances. The use of diverse diagnosis classifications and source information systems may present problems with further analysis. Patterns and characteristics of ED presentations in NSW were broadly consistent with those reported in other states in Australia., (© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)