Search

Objective: Identify the incidence of intracranial haemorrhage in people from residential aged care facilities following falls who had a CT head performed. The secondary objectives were to identify predictor variables for intracranial haemorrhage to inform person‐centred shared decision making. Methods: Retrospective chart review of aged care residents who presented to ED with a triage of fall. Documented evidence of vomiting, headache, external signs of head injury, deviation from baseline neurology and the presence of anticoagulation or antiplatelet agents was reviewed. The rates of CT head, intracranial haemorrhage, emergent interventions, disposition and mortality were assessed. Results: Of the 2546 presentations, 1732 (68.0%) had a CT head and intracranial haemorrhage was found in 76 (4.4%) patients. External signs of head injury and deviation from neurological baseline have a strong association with intracranial haemorrhage in 26 (22.2%) patients, only 4 (0.61%) patients with intracranial haemorrhage had neither. There was a strong association between these clinical features and identification of intracranial haemorrhage on CT head. Anticoagulation and antiplatelet use had no association with intracranial haemorrhage. A 30‐day mortality was increased in patients with deviation from neurological baseline. No neurosurgical intervention was performed, and there was inconsistent advice regarding anticoagulation or antiplatelet agents. Conclusions: Deviation from neurological baseline or external signs of head injury may be predictors of intracranial haemorrhage. Vomiting, headache, anticoagulation or antiplatelets were not associated with intracranial haemorrhage. A person‐centred decision‐making approach, that is informed by treatment options could better guide clinicians on when to order a CT head after a fall. [ABSTRACT FROM AUTHOR]

Objective: Many factors influence patient flow through an ED, including streaming, treatment spaces and staff resources. This pilot study explored and compared real time patient flow using a single‐stream system versus varying configurations of possible two‐stream systems using computer simulation. Methods: Simulation modelling was used to assess the delay in treatment of a rapid‐antigen‐tested‐based, two‐stream model for patient flow through ED during the peak phase of the COVID pandemic. Results: Modelling two‐stream configuration for all patients (minimum time to be seen for both COVID‐positive and COVID‐negative patients) showed that in the case study ED, a two‐stream system and linked changes in bed configuration for managing the risks of infection can impact delays in treatment. Conclusions: Data‐driven modelling within specific clinical settings can inform the (in)efficiency of patient flow processes and help clinicians and managers make evidence‐based decisions about patient transition through EDs. This can assist with reconfiguration of ED patient streaming particularly during periods of unique need, such as the recent COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Context: Asthma affects over 15% of Australian Aboriginal people. Compliance in asthma management is poor. Interventions that will increase compliance are required. Purpose: The purpose of the study was to determine whether Aboriginal children, adolescents and adults would engage in music lessons to increase their knowledge of asthma and support management of their asthma. Methods: Participants were recruited from schools and through the local Aboriginal Medical Service. All participants identified as Aborigines and were diagnosed as being asthmatic. The intervention was a 6-month program of once weekly music lessons using a culturally significant wind instrument, the didgeridoo, for males and singing lessons for females. Findings: High school students enthusiastically engaged and had excellent retention in what they considered to be a most enjoyable program. Respiratory function improved significantly in both junior and senior boys who also reported a noticeable improvement in their health. Similar but less significant improvement was seen in the high school girls, although like the boys, they too perceived an improvement in their asthma. Conclusions: The project demonstrated that music has great potential for engaging and thus supporting asthma. Furthermore, cultural awareness was increased by those playing the didgeridoo and social skills were noticeably improved in the girls. Similar culturally appropriate activities have applications far beyond Aboriginal communities in Australia.

Objectives: To compare time metrics associated with a temporary disruption to ED computed tomography (CT) scanner location from adjacent to the ED with direct access from resuscitation rooms, to a location remote to the ED. Methods: A retrospective before and after study was conducted in a public metropolitan ED with over 66 000 presentations annually. Time‐to‐CT metrics, operational time metrics and ED length of stay were extracted and analysed from presentations between October 2020 and January 2021. Results: There were 3031 CT scans during the study period. Overall, the disruption was associated with a significant 27–36 min delay (P < 0.01) in time‐to‐CT start; these delays were also observed in a subset of trauma patients. In a subset of presumed stroke patients, time‐to‐brain perfusion was significantly delayed by up to 10 min (P < 0.01). There was a 14% (P < 0.01) greater demand for operational services and a time imposition of up to 8 min (P < 0.01) to transport patients to or from CT scanning when the CT scanner was located away from the ED. ED length of stay was consistent at all time points. Conclusion: Although rapid, proximate access to CT scanning is often considered desirable in terms of the management of trauma and other time‐critical emergencies, the wider time and resource implications demonstrated in this study suggest a potential broader benefit to co‐located CT scanning in ED. Our experience could be considered in future re‐design of EDs. [ABSTRACT FROM AUTHOR]

Objective: High‐occupational stress among ED staff has a detrimental impact on both staff wellness and patient care. The objective of the study is to determine whether 4 weeks of smartphone app‐guided mindfulness practice reduces stress levels of ED staff. Methods: This two‐arm randomised controlled trial was conducted in two Australian EDs in 2019–2020. Eligible participants were randomly assigned (1:1) to either an App group or a Wait to Treat group to practice daily 10 min app‐guided mindfulness for 4 weeks. Online surveys were collected for both groups at three time periods: before (T1), immediately after (T2) and 3 months after cessation (T3). Then the Wait to Treat group received the same intervention, followed by surveys immediately after the intervention (T4) and 3 months later (T5). Primary outcome was measured using the Perceived Stress Scale. Secondary outcomes were measured using the Maslach Burnout Inventory (three subscales: emotional exhaustion, depersonalisation and personal accomplishment), Mindfulness Attention Awareness Scale and Warwick‐Edinburgh Mental Well‐being Scale. Both intention‐to‐treat and per‐protocol analysis were performed. Repeated measurement data were analysed by the linear mixed model. Results: Of 148 enrolled participants 98 completed all the surveys, but only half (48%) reported continuous use of the app. Based on the results of the intention‐to‐treat analysis, there was a statistically significant improvement of perceived stress levels (F = 15.70, P < 0.001), all three components of burnout (emotional exhaustion [F = 14.22, P < 0.001], depersonalisation [F = 3.62, P = 0.030], personal accomplishment [F = 7.51, P < 0.001]), mindfulness (F = 8.83, P < 0.001) and wellbeing levels (F = 10.71, P < 0.001) from pre‐intervention to 3 months later with small effect sizes. Conclusion: Results of the present study demonstrate that brief mindfulness training via innovative digital technology had a small positive effect in improving emergency staff stress, burnout, mindfulness and wellbeing. [ABSTRACT FROM AUTHOR]