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Objective: This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods: This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results: There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58–0.59) and between the AIHW definition and review by EPS of 0.58 (0.57–0.58). Conclusions: The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs. What is known about this topic? It is unknown whether the Australian Institute of Health and Welfare (AIHW) definition of an emergency department (ED) mental health presentation definition accurately reflects ED mental health workload. What does this paper add? The AIHW definition appears to underestimate the clinical workload related to ED mental health presentations. There is moderate agreement between the AIHW definition and mental health presentations classified according to complaint recorded at triage, or whether the patient is reviewed by psychiatry services. What are the implications for practitioners? Accurate measurement of emergency psychiatry workload should not rely on the AIHW definition alone. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to describe the patterns in emergency department (ED) presentations and hospital admissions in children with Ambulatory Care Sensitive Conditions (ACSCs) before and during the coronavirus disease 2019 (COVID-19) pandemic restrictions in Victoria, Australia, to assess if changes in out-of-hospital care resulted in an increase in delayed/severe presentations. Methods: This study involved secondary analysis of Victorian Emergency Minimum Dataset and Victorian Admitted Episode Dataset data. Patients (<18 years) attending EDs with a diagnosis of an ACSC were included. We compared the number and severity of ASCS presentations pre-COVID-19 (1January 2018–27 March 2020) and during COVID-19 (28 March–31 October 2020). A linear regression prediction model was built to compare the observed versus predicted presentation number in the 2020 period. Results: In total, there were 108 104 paediatric ACSC ED presentations in Victoria during the study period. Females accounted for 51 462/108 104 (47.6%) of all presentations, with a median age of 3 years. A significant decrease in ED presentations was seen in 2020 (41 319 in 2018; 44 978 in 2019; and 21 807 until October 2020), predominantly due to reductions in conditions that are typically mediated by viruses in childhood (i.e. asthma, convulsions/epilepsy and ear, nose and throat conditions). The proportion of high-urgency presentations and those requiring admission was stable in 2020. Conclusions: An overall reduction in the number of ED presentations and admissions with paediatric ACSCs was seen in Victoria in 2020, indicating that rates of delayed or more severe presentations did not occur as a result of changes in out-of-hospital care. What is known about the topic? Ambulatory Care Sensitive Conditions (ACSCs) relate to conditions or diagnoses that in the paediatric context are frequently mediated by common viral illness. What does this paper add? A reduction in the numbers of presentations and admissions with paediatric ACSCs was seen during the public health measures implemented to reduce the transmission of COVID-19 in Victoria, Australia. What are the implications for practitioners? These data can assist development of healthcare policy to allow healthcare resources to be prioritised for patients in whom viral transmission is not relevant. [ABSTRACT FROM AUTHOR]

Objectives: Emergency intubation in children is an infrequent procedure both in the pre‐hospital and hospital setting. The anatomical, physiological and situational challenges together with limited clinician exposure can make this a difficult procedure with high risk of adverse events. The aim of this collaborative study between a state‐wide ambulance service and a tertiary children's hospital was to describe the characteristics of pre‐hospital paediatric intubations by Intensive Care Paramedics. Methods: We conducted a retrospective review of state‐wide ambulance service electronic patient care records (ePCRs) in Victoria, Australia, population: 6.5 million. Children aged 0–18 years who were attended by paramedics over a 12‐month period that required advanced airway management were analysed for demographics and first‐pass success rate. Results: Paramedics attended 2674 cases aged 0–18 years over the 12‐month study period who received basic or advanced airway management. A total of 78 cases required advanced airway management. The median age of patients was 12 years (interquartile range 3–16) and most were male (60.2%). Sixty‐eight patients (87.5%) were intubated successfully on the first attempt, first‐pass success was lowest in children <1 year of age. The most common indications for pre‐hospital intubation were closed head injury and cardiac arrest. It was not possible to report complication rates because of incomplete documentation. Conclusion: Pre‐hospital intubation in children is performed infrequently in an extremely unwell patient group. Continued high‐level paramedic training is required to prevent adverse events and ensure patient safety. [ABSTRACT FROM AUTHOR]

Background: Tonsillectomy, with or without adenoidectomy, is the leading reason for paediatric unplanned hospital readmission, some of which are potentially avoidable. Reducing unplanned hospital revisits would improve patient safety and decrease use of healthcare resources. This study aimed to describe the incidence, timing and risk factors for any surgery-related hospital revisits (both emergency presentation and readmission) following paediatric tonsillectomy and adenotonsillectomy in a large state-wide cohort. Methods: We conducted a population-based cohort study using linked administrative datasets capturing all paediatric tonsillectomy and adenotonsillectomy surgeries performed between 2010 and 2015 in the state of Victoria, Australia. The primary outcome was presentation to the emergency department or hospital readmission within 30-day post-surgery. Results: Between 2010 and 2015, 46,583 patients underwent 47,054 surgeries. There was a total of 4758 emergency department presentations (10.11% total surgeries) and 2750 readmissions (5.84% total surgeries). Haemorrhage was the most common reason for both revisit types, associated with 33.02% of ED presentations (3.34% total surgeries) and 67.93% of readmissions (3.97% total surgeries). Day 5 post-surgery was the median revisit time for both ED presentations (IQR 3–7) and readmission (IQR 3–8). Predictors of revisit included older age, public and metropolitan hospitals and peri-operative complications during surgery. Conclusions: Haemorrhage was the most common reason for both emergency department presentation and hospital readmission. The higher risk of revisits associated with older children, surgeries performed in public and metropolitan hospitals, and in patients experiencing peri-operative complications, suggest the need for improved education of postoperative care for caregivers, and avoidance of inappropriate early discharge. [ABSTRACT FROM AUTHOR]

Objective. The COVID-19 pandemic in Australia coincided with an early trend of reduced visits to the emergency department (ED), but to determine which patients presented less requires closer evaluation. Identifying which patient groups are presenting less frequently will provide a better understanding of health care utilisation behaviours during a pandemic and inform healthcare providers of the potential challenges in managing these groups. Methods. This single-centre retrospective study examined trends in presentations in 2020 to a private, mixed paediatric and adult ED in an inner city suburb within the state of Victoria that treats both COVID-19 and non-COVID-19 patients. The 2019 dataset was used as a reference baseline for comparison. All analyses were performed using baseline characteristics and triage data. Results. The total number of visits to the ED dropped from 24 775 in 2019 to 22 754 in 2020, representing an overall reduction of 8%. Significant reductions in daily presentations and admissions from the ED were observed in the months immediately following the peak of the two COVID-19 waves in the state of Victoria. Visits by those in the 0- to 17-year age group, triage categories 4 and 5 and musculoskeletal presentations were also reduced for most of 2020. Gastrointestinal/abdominal and urological/renal presentations were reduced immediately after the first COVID-19 wave, whereas infectious diseases visits were reduced during and after the second COVID-19 wave. Conclusions. These findings add to the growing body of evidence regarding emergency care underutilisation during the COVID-19 pandemic. Reduced private ED presentations were observed overall and in paediatric patients, lower acuity triage categories, musculoskeletal, abdominal/gastrointestinal and urological/renal presentations during the first wave, whereas infectious disease cases were reduced during the second wave. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to use epidemiological data to determine the incidence of soccer‐related head injuries in children aged 5–14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia. Methods: ED presentation and hospital admission de‐identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer‐related head injury data to determine the incidence of this injury among these children. Results: The incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011–2012 to 2015–2016). The 10–14‐years age group presented with more head injuries than the 5–9‐years age group. For the admissions data, soccer had a significantly lower (P = 0.0379) incidence of head injury when compared with 'sport as a whole'. Conclusions: The low incidence of soccer‐related head injuries presenting to an ED or admission to hospital is consistent with international findings. [ABSTRACT FROM AUTHOR]

Objective: Audit and research projects in the ED are important to improve patient care but can be time and resource consuming. We identified and prioritised audit and research topics among multidisciplinary ED staff to fill perceived knowledge gaps, encourage engagement, reduce duplication and facilitate translation of evidence into clinical practice. Methods: A two‐stage electronic Delphi survey process was undertaken by senior medical, nursing, education and social work staff at the Royal Children's Hospital, Victoria. Survey 1 collected demographic data and audit and research ideas following a series of open‐ended questions. Priority themes were defined as those that had more than four responses. Survey 2 used a 7‐point Likert ranking of these themes to generate a departmental audit and research prioritisation list. Results: 72/89 (82%) available senior staff responded to survey 1 and 63/83 (76%) responded to survey 2. Survey 1 yielded 208 audit and 130 research topics. Survey 2 established a prioritised list of 17 audit and 14 research topics. Top audit themes were mental healthcare, patient flow, management of sepsis and delays in ED specialist referrals. Top research priorities were the management of sepsis, mental healthcare, management of patients with autism and the management of severe asthma. Conclusions: This Delphi study has provided departmental audit and research priorities that are perceived to be of importance across the multidisciplinary ED team. This methodology allows strategic allocation of limited resources and may increase staff engagement. [ABSTRACT FROM AUTHOR]

Objectives: To examine trends in ED presentations with a mental health diagnosis (MHdx) in Australia by jurisdiction and by sex, between 2004–05 and 2016–17. Methods: Data were captured in the National Non‐Admitted Patient Emergency Department Care Database. Outcomes were the proportion of ED presentations with a principal diagnosis of ICD‐10‐AM F00‐F99 (MHdx), and the rate of all ED and MHdx presentations per 10 000 population. Results: Between 2004–05 and 2016–17, MHdx presentations experienced compounding annual growth of 5.9% nationally, and increased from 3.3% to 3.7% of all ED presentations with a diagnosis. Most growth occurred between 2010–11 and 2015–16. Northern Territory (NT) had the highest level of MHdx presentations per 10 000 population, more than double the Australian average. The proportion of MHdx presentations was highest in South Australia (SA) in most years, and the average annual proportion of MHdx presentations was statistically significantly higher than the national average in SA, Queensland (QLD) and Western Australia (WA). The proportion of MHdx presentations increased in each jurisdiction, with significant increases for Victoria, QLD, WA, Australian Capital Territory and NT. Males experienced greater numbers and rates of all ED and MHdx presentations, while the proportion of MHdx presentations was 8% higher for females. Conclusions: The proportion of ED presentations for MH conditions, narrowly defined, has increased in all Australian jurisdictions between 2004–05 and 2016–17, but particularly since 2010–11. Differences between jurisdictions indicate jurisdictional specific issues. However, significant or upward trend of MHdx presentations across all jurisdictions indicates generic issues necessitating concern and policy development at a national level. [ABSTRACT FROM AUTHOR]

Introduction: 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).Methods: 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.Results: 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.Conclusion: 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. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Background Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department; however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. Design A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. Methods The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. Results A 96% response rate was achieved ( n = 47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15- or 30-minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Conclusion Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data into vital sign decision-making. Relevance to clinical practice Accurate assessment and interpretation of vital sign data is fundamental to patient safety. Emergency nurses are responsible for the initial and ongoing assessment of undiagnosed or undifferentiated patients. Prior to medical assessment, emergency nurses are solely responsible for patient assessment, escalation of care and implementation of interventions within nursing scope of practice. [ABSTRACT FROM AUTHOR]

Aim: To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define 'primary care suitable' presentations to the ED.Methods: A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED. Surveys were distributed to the treating ED clinician, the child's parent/guardian, and the referring GP. Results between the three groups were analysed and compared.Results: There were a total of 1069 presentations during the study period. Six hundred (58.4%, 95% CI 55.3-61.4%) presentations were judged as 'ED appropriate' by the treating ED clinician. When compared with methods used to retrospectively judge whether ED patients are considered 'primary care suitable', ED clinicians disagree between 22.4 and 38.8% of the time. For patients who presented directly to ED, 85.6% did so for a medical reason, whilst 32.1% did so for a GP access reason. Being referred by a GP improved the ED clinicians' opinion of the appropriateness of the presentation (49.2 vs. 73.9%, P < 0.05).Conclusions: We caution that many strategies attempting to 'solve' the issue of increasing ED attendances by paediatric patients have been driven by opinion, and a better understanding of the motivators that drive this behaviour is needed. We believe the solution to increasing utilisation of EDs by children must be a balanced approach that addresses community expectations and appropriately resources EDs. [ABSTRACT FROM AUTHOR]

Objectives Primary: to determine incidence of 30 day major adverse cardiac events (MACE) in patients discharged from the ED following assessment using an accelerated diagnostic pathway (ADP). Secondary: to determine incidence of 30 day MACE for all ADP patients. Methods Monash Health ED patients thought at low risk for acute myocardial infarction (AMI) or hospital admission are assessed using an ADP, based on arrival and 90 min point-of-care (POC) cardiac troponin I and myoglobin concentration. Other patients are assessed using a traditional pathway of arrival and 6 h central lab cardiac troponin I. Choice of pathway is based on the clinical judgement of the attending ED doctor. To investigate the safety of the ADP component, an observational study of all ADP patients presenting from 6 June 2013 to 30 September 2013 was conducted. After 30 days, occurrence of MACE was determined by examination of hospital records or telephone contact with patients who had not returned. Results Of 1547 eligible patients, 1384 (89.5%) were followed up. Of the 1143 discharged patients with follow-up information, 30 day MACE occurred in one (0.09%, 95% CI 0.002-0.5). Of all 1547 patients, 60 patients had a MACE detected: 56 AMI during the initial attendance, four AMI post-discharge (one from ED, three after hospital admission). In total, of the 1328 patients who did not have AMI during the target admission and were followed up, 30 day post-discharge MACE occurred in four patients (0.3%, 95% CI 0.08-0.8). Conclusion The ADP supports safe, early discharge of low-risk chest pain patients from the ED. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore emergency nurses perceptions of the use of manual restraint. Background Manual restraint of patients has historically been an accepted practice, though little is known about the use of manual restraint in general hospitals. Design A qualitative, descriptive, exploratory, study was undertaken. Method Fifteen semi-structured interviews with emergency nurses were completed. Data were analysed using qualitative thematic analysis procedures. Results The following themes were identified: 'part of the job', 'reasons for manual restraint', 'restraint techniques', 'consequences' and 'lack of documentation'. Manual restraint occurred frequently each shift and most were not documented. This may be due to nurse's perceptions that manually restraining a patient did not comprise formal restraint and was the only option. Nurses used manual restraint to manage patients who were violent and aggressive or to perform procedures. However, they reported a lack of education and training in manual restraint. Nurses identified several consequences for the patient, staff and the organisation as a result of these events including psychological and physical injuries. Conclusions Empirical research of prevalence and issues surrounding manual restraint events is required to inform health care organisations and government to develop, implement and evaluate appropriate policies and strategies to ensure safety of patients and staff. The employment of peer support workers and professionals with expertise in mental health and dementia may aid in the reduction of manual restraint events and improve care of all patients within the Emergency Department. Research on manual restraint in health settings is also needed. Relevance to clinical practice Nurses need to be aware that manual restraint is not just an accepted part of their work, but is a strategy of last resort that should be documented. Organisations must implement standardised educational programmes for nurses together with policies and processes to monitor and evaluate manual restraint events. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study was to investigate the experiences of relatives who had a family member in an aged care facility subsequently transferred to an emergency department. Background. The provision of timely and relevant patient information is vital for assessment and management of older patients presenting to the emergency department from aged care facilities. Older people are commonly accompanied by relatives who are an important resource for emergency department staff, providing medical information and assisting with treatment decisions. Investigating the experiences of relatives may provide key information to enable improvements in the delivery of emergency department care. Design. This study used a descriptive qualitative design. Methods. Semi-structured interviews were undertaken with 24 relatives of residents who were transferred from an aged care facility to an emergency department in Victoria, Australia in the previous three years. Inductive content analysis was used to analyse the transcripts. Results. Relatives reflected on four main themes following their emergency department visit: The need for clear communication; The role of relatives in emergency department care; How older people are perceived in the health care system and an Ability to provide specialised care. Conclusions. Many people link their emergency department experience to the quality of communication with emergency department staff, and participants in this study felt satisfied with their visit when they were included in discussions about treatment, and their role was recognised by staff members. In contrast, participants were dissatisfied with the care provided to their family member when staff members failed to communicate with them, or recognise their role in the care of the family member. Relevance to clinical practice. The findings of this study emphasise the importance of effective communication between emergency department staff and family members, in relation to treatment and end-of-life care. [ABSTRACT FROM AUTHOR]

Objective To determine the accuracy and reliability of triage of children in public hospital EDs using the Australasian Triage Scale ( ATS). This is the first study to examine these issues in paediatric triage following the 2007 development of the Emergency Triage Education Kit ( ETEK) to foster accurate and consistent application of the ATS. Methods A convenience sample of 167 triage nurses working at three general hospitals and one speciality paediatric hospital in greater metropolitan Melbourne assigned triage ratings for nine paediatric clinical scenarios using the ATS. Scenarios were derived from the ETEK or from other published sources. Kappa was used to assess interrater reliability within and between hospitals. Results Triage nurses correctly assigned triage scores to an average of 5.3 of nine paediatric clinical scenarios. Accuracy in specific hospitals ranged from a low of 15% on one scenario, to 100% accuracy on a different scenario at a different hospital. Interrater reliability within and across the EDs studied was found to be kappa = 0.27. Both accuracy and interrater reliability were marginally higher at the speciality paediatric hospital. Conclusions Our findings demonstrate inconsistencies in the accuracy and reliability in which sick children presenting to EDs receive triage scores both within and across hospitals. These results suggest the need for improvements either in current triage nurse training or training resources. Use of the ETEK alone has not resulted in high levels of paediatric triage accuracy or reliability. [ABSTRACT FROM AUTHOR]

Objective Residents from aged care facilities make up a considerable proportion of ED presentations. There is evidence that many residents transferred from aged care facilities to EDs could be managed by primary care services. The present study aimed to describe the characteristics of residents transferred from residential aged care facilities to EDs, and to evaluate the appropriateness and cost of these presentations. Methods A retrospective review of ED records was undertaken for residents transferred from residential aged care facilities to two EDs in Melbourne, Victoria, in 2012. Data examined included residents' mode and time of arrival to ED, presenting complaint, triage category, procedures within ED, diagnosis, length of stay, and disposition. Data were examined against a previously established tool to identify resident transfers that might be 'potentially avoidable'. Results There were 2880 resident transfers included in the sample, of which 408 transfers were randomly selected for scrutiny of documentation. Seventy-one residents (17.4%) were identified as being potentially avoidable transfers. Conclusion Many resident transfers might have been avoided with better primary care services in place. Future strategies to improve resident care might include aged care staff skill mix and the availability of outreach or primary care services. [ABSTRACT FROM AUTHOR]

Background: The Alfred Emergency Short Stay Unit initiated a chest pain protocol for patients presenting with chest pain to risk stratify for acute coronary syndrome (ACS). A 30-day follow-up of patients discharged with low-or-intermediate risk of ACS demonstrated no deaths or ACS. Aims: The purpose of this study was to evaluate the long-term safety of the chest pain protocol, a one year follow-up was undertaken. Methods: A questionnaire was designed for the one-year follow-up and it was administered via a telephone interview by emergency nurses to document adverse cardiac events and health care utilisation. Results: From 297 patients, 224 (75%) were contacted 12 months following discharge. There was one death from stroke (0.4%; 95% confidence interval (CI): 0.01–2.5%) and another from an unknown cause. Five patients had been diagnosed with atrial fibrillation (2.2%; 95% CI: 0.7–5.1%), two patients had an acute myocardial infarction (0.9%; 95% CI: 0.03–2.1%) and four were diagnosed with angina (1.8%; 95% CI: 0.9–3.2%). Nearly half (n=103, 46%; 95% CI: 39.5–52.5%) had returned to the emergency department (ED) for various conditions including 42 patients with further chest pain. Ninety-six patients (43%; 95% CI: 39.3–52.7%) had specialist referrals and 124 investigations were performed. Thirty-four patients had cardiology referrals (15%; 95% CI: 10.7–20.5%) and 25 patients had gastroenterology referrals (11%; 95% CI: 7.3–16.0%). Diagnostic cardiac tests were performed on 38 patients: coronary angiography (n=10), 24-hour Holter monitoring (n=17), 24-hour blood pressure (BP) monitoring (n=4), thallium scans (n=5), exercise stress test (n=1) and CT scan (n=1). Conclusion: Patients had a low risk of adverse events 12 months after discharge but substantial continuing health care utilization was observed. Complete assessment by health care professionals prior to discharge may help mitigate representations. [ABSTRACT FROM AUTHOR]

Objective The present study summarises the methodology and findings of a pilot project designed to measure the sources and locations of alcohol-related harm by implementing anonymised 'last drinks' questions in the ED of a rural community. Methods 'Last drinks' questions were added to computerised triage systems at South West Healthcare ED in rural Warrnambool, Victoria, from 1 November 2013 to 3 July 2014. For all injury presentations aged 15 years or older, attendees were asked whether alcohol was consumed in the 12 h prior to injury, how many standard drinks were consumed, where they purchased most of the alcohol and where they consumed the last alcoholic drink. Results From 3692 injury attendances, 10.8% ( n = 399) reported consuming alcohol in the 12 h prior to injury. 'Last drinks' data collection was 100% complete for participants who reported alcohol use prior to injury. Approximately two-thirds (60.2%) of all alcohol-related presentations had purchased their alcohol at packaged liquor outlets. During high-alcohol hours, alcohol-related injuries accounted for 36.1% ( n = 101) of all ED injury presentations, and in total 41.7% of alcohol-related attendances during these hours reported consuming last drinks at identifiable hotels, bars, nightclubs or restaurants, or identifiable public areas/events. Conclusions This pilot demonstrates the feasibility and reliability of implementing sustainable 'last drinks' data collection methods in the ED, and the ability to effectively map the source of alcohol-related ED attendances in a rural community. [ABSTRACT FROM AUTHOR]

Aim and objectives To explore healthcare experiences of Australian women living with intimate partner violence ( IPV) and consider how these influence their understanding of IPV and sense of self. Background Despite international campaigns condemning violence against women, IPV remains a worldwide problem and recent Australian community attitudes demonstrate ongoing beliefs condemning women in abusive relationships. Women experiencing IPV are over-represented in healthcare-seeking populations; however, they are rarely identified as experiencing abuse and are often not provided care directed towards achieving ongoing safety. While women seek empathetic healthcare, disclosure of abuse often results in being judged negatively or blamed. Design A grounded theory study drawing on Clarke's (Sage Publications, London, 2005) analytic approach of situational analysis. Methods Semi-structured interviews conducted with seven women. Data was analysed using nvivo 8 software within a Situational Analysis framework. Results Four major categories were identified: Accessing healthcare: challenges and barriers; Care women need vs. care women receive; Discourses of IPV and constructions of self; and Acknowledging IPV: moving on and re-constructing self. Women faced significant challenges in accessing emergency healthcare and healthcare then often lacked empathy. Women created an understanding of self from a world dominated by an abusive partner and needed assistance re-labelling their experiences as IPV. Healthcare professionals who provided empathetic care were instrumental in assisting this process, enhancing women's abilities to explore options for limiting abuse and assisting them to enhance their self-efficacy and reconstruct a positive sense of self. Conclusions Healthcare is one of the few avenues women living with IPV have to receive emotional and physical support. Healthcare that ignores psychosocial issues further damages women's sense of self. Relevance to clinical practice Women require timely information and empathetic support from healthcare professionals to assist them in understanding and labelling their experiences as IPV. This enhances women's ability to feel deserving of, and ideally achieve, a life without violence. [ABSTRACT FROM AUTHOR]

Purpose Alcohol consumption is higher in regional and rural areas compared to metropolitan locations, but it is unclear which areas suffer different levels of harm. The current study investigated the rates of alcohol-related injury presentations at emergency departments (EDs) in Victoria, Australia, across metropolitan, regional, rural, and remote areas, and within coastal locations. Methods Using ED injury presentations data for Victorian hospitals from June 1999 to June 2011, the trends in alcohol-related injury rates over time were investigated. Findings Compared to metropolitan locations, alcohol-related injuries were higher in larger regional and rural areas and similar in small rural towns. The rates of alcohol-related injuries are also significantly increasing over time for regional and rural locations. Lastly, for males, rates of alcohol-related injuries increased in coastal areas during November to February compared to the remaining months. Conclusions Regional and coastal areas experience increased alcohol-related injury rates. The causes of this have yet to be investigated and future research is required to determine why and what interventions may be most effective at reducing these harms. [ABSTRACT FROM AUTHOR]

Objective. To examine the clinical characteristics and financial charges associated with treating adult cancer patients receiving chemotherapy in outpatient clinics who presented to the emergency department (ED) with neutropenia. Design and Setting. A retrospective audit was conducted across two health services involving ED episodes and subsequent hospital admissions of patients who received chemotherapy through day oncology from January 1 to December 31, 2007 and presented to the ED with neutropenia. ED data were collected from the Victorian Emergency Minimum Dataset and charges were collected from Health Information Services. Descriptive and bivariate statistics were used to describe the patient and clinical characteristics and financial outcomes, and to explore associations between these factors. Results. In total, 200 neutropenic episodes in 159 outpatients were seen in the ED over the survey period. The mean patient age was 56.6 years (standard deviation, 13.2 years) and 47.2% were male. Overall, 70.0% of ED episodes were triaged as Australasian Triage Scale 2 (emergency). The median ED wait time was 10 minutes and the median ED length of stay was 6.8 hours. The median charge for each ED episode was $764.08 Australian dollars. The total combined ED and inpatient charge per episode was in the range of $144.27-$174,732.68, with a median charge of $5,640.87. Conclusions. This study provides important insights into the clinical and economic burden of neutropenia from both the ED and inpatient perspectives. Alternative treatment models, such as outpatient treatment, early discharge programs or prophylactic interventions to reduce the clinical and economic burden of neutropenia on our health system, must be explored. [ABSTRACT FROM AUTHOR]

Ambulance bypass occurs when the emergency department (ED) of a hospital becomes so busy that ambulances are requested to take their patients elsewhere, except in life-threatening cases. It is a major concern for hospitals in Victoria, Australia, and throughout most of the western world, not only from the point of view of patient safety but also financially-hospitals lose substantial performance bonuses if they go on ambulance bypass too often in a given period. We show that the main cause of ambulance bypass is the inability to move patients from the ED to a ward. In order to predict the onset of ambulance bypass, the ED is modelled as a queue for treatment followed by a queue for a ward bed. The queues are assumed to behave as inhomogeneous Poisson arrival processes. We calculate the probability of reaching some designated capacity C within time t, given the current time and number of patients waiting. [ABSTRACT FROM AUTHOR]

The Victorian Emergency Minimum Dataset (VEMD) records details of approximately 80% of Victoria's ED presentations. Its usefulness for quality assurance and research relies on the data being both complete and accurate. We aimed to determine the factors that impact adversely on the collection of high-quality VEMD data.The study was a voluntary, anonymous, cross-sectional survey of a range of ED staff (medical, nursing, clerical) who collect and enter data into the VEMD. Nine of the 28 hospitals that contribute to the VEMD were surveyed. The questionnaire was purpose-designed and self-administered.A total of 218 staff participated (response rate 95%). Six different software types were used, with 40% of respondents using the Pickware (MCAT) system. There was no consistency of ED personnel for the completion of specific data fields. One hundred and twenty-six (56%) respondents had heard of the VEMD, 67 (29%) had had its structure and purpose explained and 65 (30%) had been trained to enter data. Ninety-seven (45%) respondents knew what the VEMD data was used for, 38 (17%) knew they could request VEMD data for their own use and 17 (7.8%) had done so. Time constraints, software problems and lack of formal orientation and training in data entry were reported as the most important factors impacting adversely upon quality data entry.Staff knowledge of the VEMD system and its uses are poor. Numerous factors impact on the quality of data entered and interventions aimed at improving staff education, training and feedback and software are indicated. [ABSTRACT FROM AUTHOR]

To identify the nature, severity, impact, frequency and risk factors for patient perceived privacy infringements in the ED of St Vincent's Health Melbourne with 32 000 emergency attendances per annum.Patients 18 years and older attending emergency over a 2-week period were offered a nine-item questionnaire using a Likert scale. A privacy incident was defined as: (i) overhearing medical or personal information; (ii) being overheard; (iii) having private body parts exposed or (iv) seeing others’ body parts. Differences between demographic, emergency environment, length of stay and other factors suspected of affecting patient privacy were quantified.From 1169 emergency presentations, 235 patients returned questionnaires, with 105 of these (45%) reporting a total of 159 privacy incidents. Seventy-eight patients (33%, 95% CI 28–36%) reported a definite privacy incident and 81 (35%, 95% CI 29–37%) reported a probable privacy incident. Ninety-six patients (41%, 95% CI 35–47%) reported overhearing other patient's conversations with the staff whereas 36 (15%, 95% CI 11–21%) felt their conversations with staff were overheard by others. Twenty-seven patients (11%, 95% CI 6–14%) experienced or observed inappropriate exposure of private body parts. Ten patients (4%, 95% CI 2–7%) changed or withheld information from staff because they felt others may overhear it and two refused part of their physical examination because they felt they may be seen by inappropriate people. Twenty-four patients (10%, 95% CI 6–14%) did not have their expectations of privacy met. The longer a patient was in emergency the greater the number of privacy incidents they experienced (Spearman correlationP < 0.01). Patients in walled cubicles experienced fewer privacy incidents than those in curtained cubicles (P < 0.05).Patient privacy incidents occur frequently in an ED, risk factors being length of stay and absence of a walled cubicle. Patients who have their conversations overheard are more likely to withhold information from staff and less likely to have had their expectations of privacy met. [ABSTRACT FROM AUTHOR]

Objective: To describe the nature of psychiatry work within a general medical hospital and to compare and contrast the nature of that work between emergency department and inpatient settings. Method: The data from the Royal Melbourne Hospital (RMH) consultation-liaison service database relating to referral, patient demographics, psychiatric diagnosis service use, management and discharge arrangements was recorded for all referrals to the RMH C-L service in 1999. The inpatient and emergency department arms of the service were compared. Results: The referral rate for inpatients and the emergency department was 2.9% and 2.1% respectively. The reasons for referral and frequency of psychiatric diagnosis differed significantly between the two settings. Conclusions: The provision of C-L services to inpatients and the emergency department needs to be tailored to the different patient populations. [ABSTRACT FROM AUTHOR]

This descriptive study was designed to describe and compare the level of patient satisfaction and explore differences and relationships of demographic variables with patient satisfaction in two emergency department patient populations in Victoria, Australia. The sample consisted of 103 rural and urban emergency patients. Tests for differences demonstrated that urban patients were more satisfied with nurse teaching behaviours (P = 0.017), with female patients at the urban hospital more satisfied with nurse caring behaviours (P = 0.026). An item, ‘The nurse performed his/her duties with skill’ scored highest and had the lowest variability. Qualitative analysis of two open-ended questions regarding what respondents liked best about the experience and what could have made the experience better, produced four and six themes, respectively. Conclusions indicated the need for more research comparing rural and urban emergency patients and patients of different cultures. [ABSTRACT FROM AUTHOR]

Aim: To determine the accuracy of emergency department (ED) paediatric anaphylaxis diagnosis, and to identify factors associated with misdiagnosis.Methods: Retrospective chart review of children aged 0-18 years with allergic presentations to three Victorian EDs in 2014. Cases were included if an ED diagnosis of anaphylaxis was recorded, or the presentation met international consensus criteria for anaphylaxis.Results: Of the 60 143 paediatric ED presentations during the study period, 1551 allergy-related presentations were identified and reviewed. One hundred and eighty-seven met consensus criteria for anaphylaxis, and another 24 were diagnosed with anaphylaxis without meeting criteria. Of the 211 presentations, 105 cases were given an ED diagnosis of anaphylaxis and 106 cases were given an alternative diagnosis in ED. ED assessment had a sensitivity of 43.2% (95% confidence interval (CI) 36.1-50.7%) and specificity of 97.9% (95% CI 96.9-98.7%) for anaphylaxis. Multiple logistic regression demonstrated that an ED anaphylaxis diagnosis was associated with previous anaphylaxis (odds ratio (OR) 3.20; 95% CI 1.52-6.75), arrival by ambulance (OR 2.80; 95% CI 1.36-5.74), a high-acuity triage category (OR 4.51; 95% CI 2.20-9.25) and presentation to a tertiary hospital (OR 2.86; 95% CI 1.44-5.67). ED diagnosis of anaphylaxis was less likely in those with resolution of symptoms and signs in at least one organ system prior to arrival (OR 0.27; 95% CI 0.12-0.62).Conclusion: In children with allergic presentations, ED assessment has a low sensitivity but high specificity for anaphylaxis. Attention to resolved pre-hospital symptoms and awareness of diagnostic criteria are important considerations for accurate ED diagnosis of anaphylaxis. [ABSTRACT FROM AUTHOR]