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Goals-of-care discussions aim to establish patient values for shared medical decision-making. These discussions are relevant towards end-of-life as patients may receive non-beneficial treatments if they have never discussed preferences for care. End-of-life care is provided in Emergency Departments (EDs) but little is known regarding ED-led goals-of-care discussions. We aimed to explore practitioner perspectives on goals-of-care discussions for adult ED patients nearing end-of-life. We report the qualitative component of a mixed methods study regarding a 'Goals-of-Care' form in an Australian ED. Eighteen out of 34 doctors who completed the form were interviewed. We characterised ED-led goals-of-care consultations for the first time. Emergency doctors perceive goals-of-care discussions to be relevant to their practice and occurring frequently. They aim to ensure appropriate care is provided prior to review by the admitting team, focusing on limitations of treatment and clarity in the care process. ED doctors felt they could recognise end-of-life and that ED visits often prompt consideration of end-of-life care planning. They wanted long-term practitioners to initiate discussions prior to patient deterioration. There were numerous interpretations of palliative care concepts. Standardisation of language, education, collaboration and further research is required to ensure Emergency practitioners are equipped to facilitate these challenging conversations. [ABSTRACT FROM AUTHOR]

Objective: To compare publicly available information on aged care systems in 7 countries to determine the degree of transferability for research on aged care between these countries., Design: A cross-country comparative analysis., Setting: Aged care systems in 7 countries classified as liberal welfare states (Australia, Canada, Japan, New Zealand, Switzerland, United Kingdom, and United States)., Measures: This study involved the search and review of international data sets, government reports and national statistics, and relevant peer-reviewed literature. Information was extracted for 24 variables at the macro (societal), meso (organizational), and micro (individual) levels to enable a multilevel comparison of aged care systems in each country., Results: The structured search identified 63 relevant documents. All 7 countries included in the review were overall generally comparable across the 3 domains with some expected variations. Comparison of information was not possible for all variables owing to a paucity of publicly available information reported in a consistent manner. Using Australia as a reference point, Canada and New Zealand were the most comparable with Australia, followed by the United Kingdom, United States, and Switzerland. Japan was the least comparable country with Australia based on the variables considered., Conclusions and Implications: This is the most recent collation and detailed comparison of national-level information on aged care systems in countries classified as liberal welfare states. This information provides policy makers in these countries the data necessary to determine the degree contemporary research findings from another country are transferable to their local aged care system. Efforts to improve the health, well-being, and quality of care for older people continue to be hampered by the overall paucity of consistently reported standardized data to enable valid international comparisons. Optimal use of standardized data also requires developing explicit criteria to describe the key factors to be considered in determining transferability of an intervention from 1 country to another., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

We describe a novel ambulance diversion programme, piloted in Victoria. This article discusses creating increased emergency capacity during surge or disasters by utilising private EDs, tested during a recent thunderstorm asthma disaster and an influenza epidemic. Public hospitals and EDs often run at or over capacity during normal operations. This leaves limited ability to manage surges in demand, resulting in suboptimal outcomes for patients, public ED staff and ambulance services. It is feasible to create surge capacity in private EDs for public ambulance patients. Other states could consider this option to help manage health disasters., (© 2019 Australasian College for Emergency Medicine.)

Objective: There is limited literature to inform the content and format of Goals-of-Care forms, for use by doctors when they are undertaking these important conversations., Methods: This was a prospective, qualitative and quantitative study evaluating the utility of a new 'Goals-of-Care' form to doctors in a private, tertiary ED, used from December 2016 to February 2017 at Cabrini, Melbourne. A Goals-of-Care form was designed, incorporating medical aims of therapy and patient values and preferences. Doctors wishing to complete a Not-for-CPR form were also supplied with the trial Goals-of-Care form. Form use, content and patient progress were followed. Doctors completing a form were invited to interview., Results: Forms were used in 3% of attendances, 120 forms were taken for use and 108 were analysed. The median patient age was 91, 81% were Supportive and Palliative Care Indicators Tool (SPICT) positive and patients had a 48% 6-month mortality. A total of 34 doctors completed the forms, 16 were interviewed (two ED trainees, 11 senior ED doctors and three others). Theme saturation was only achieved for the senior doctors interviewed. Having a Goals-of-Care form was valued by 88% of doctors. The frequency of section use was: Aims-of-Care 91%; Quality-of-Life 75% (the term was polarising); Functional Impairments 35%; and Outcomes of Value 29%. Opinions regarding the ideal content and format varied. Some doctors liked free-text space and others tick-boxes. The median duration of the conversation and documentation was 10 min (interquartile range 6-20 min)., Conclusions: Having a Goals-of-Care form in emergency medicine is supported; the ideal contents of the form was not determined., (© 2018 Australasian College for Emergency Medicine.)