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Self-care strategies are important to maintain psychological wellbeing. The aim of this study was to explore how self-care changed during the first COVID-19 lockdown in winter 2020 and identify targets for interventions.This was a cross-sectional study. Participants attending a COVID-19 testing clinic completed the Mindful Self-Care Scale (MSCS) and Hospital Anxiety and Depression Scale (HADS).A total of 332 participants completed questionnaires (mean age 38 years, 55% female). Self-care strategies used less frequently during lockdown when compared with pre-lockdown were in MSCS domains of Physical Care (P 0.001), Supportive Relationships (P 0.001), Supportive Structures (P 0.001) and Mindful Awareness (P 0.001). Mean anxiety and depression scores were 5.97 (standard deviation [SD] = 4.36) and 4.12 (SD = 3.594).Several pre-pandemic strategies were used less frequently, including individual activities not restricted during lockdown ('listening'; 'using images' to relax). This study provides insight into activities that are practised and reduced during a lockdown, which can guide wellbeing interventions to assist people in isolation.

OBJECTIVE Did not wait (DNW) is a frequently cited ED key performance indicator. We conducted a network-based observational study of consecutive DNW presentations. METHODS Prospective cohort study of Western Sydney Local Health District with a primary outcome measure of reported 30-day all-cause mortality and secondary outcomes of demographic characteristics and representation risk. For re-presenting patients who were subsequently admitted, a manual review of electronic records and incident report systems based on a priori plan assessed each case for the length of stay and adverse outcomes. RESULTS During the study window, there were 1114 DNW presentations with 172 (15.4%) re-presentation within 72 h. The analysis of re-presented patients did not reveal adverse outcomes or prolonged length of stay. A review of available outcomes data revealed one DNW patient died within 30 days but had a previous palliative plan for terminal illness. CONCLUSION While a proportion of DNW patients re-presented within 72 h, an excess prevalence of poor outcomes were not observed.

Objective To determine the prevalence of fundus pathology in metropolitan Australian EDs utilising a non-mydriatic fundus photography screening programme. Secondary objectives include diagnostic accuracy among emergency physicians compared to telehealth ophthalmologist review. Methods Prospective cross-sectional study investigating non-mydriatic fundus photography as a new diagnostic test in two tertiary Australian EDs. Consecutive adult patients were enrolled if they presented with headache, focal neurological deficit, visual disturbance or diastolic BP >120 mmHg. Diagnostic agreement was determined using kappa statistics and sensitivity and specificity using a reference standard consensus ophthalmology review. Results A total of 345 consecutive patients were enrolled among whom 56 (16%, 95% confidence interval [CI] 13-21) had urgent fundus pathology. Agreement between emergency physician and ophthalmic assessment of fundus photographs was 74% (kappa = 0.196, P = 0.001). Emergency physicians had 40% sensitivity (95% CI 27-54) and 82% specificity (95% CI 76-86) for detecting urgent pathology on photographs. Conclusions Fundus photography detects a clinically significant proportion of fundus pathology and urgent diagnoses. Telehealth specialist image review is important to detect some important, time-critical illnesses that can be missed in routine care. This offers an accurate alternative to direct ophthalmoscopy that warrants further research in Australian EDs.

Background: Rapid access clinics are an increasingly common model of care in tertiary hospitals. Early streaming of suitable patients to appropriate clinic services could reduce Emergency Department overcrowding. This study set out to investigate the current utilisation of rapid access clinic dispositions in a tertiary centre. The findings have led to useful mapping of local services and early nurse led identification of patients suitable for streaming to clinic locations. Methods: A cross-sectional observational study in a tertiary centre. Complete lists of consecutive discharged Emergency Department patients were generated by a trained data manger. Individual electronic medical records were reviewed for evidence of clinic disposition, patient demographics and compared with concurrent Emergency Department patients who were not referred. Results: 1367 patients included from 144 h of consecutive weekday presentations. Referral to clinic locations occurred in 179/1357 (13.2%) with rapid access clinics utilised in 129/179 (70.4%). No difference in median length of stay was observed for patients referred to clinics (3.9 h) versus patients not referred (3.8 h) (p = 0.29). Conclusion: In a tertiary Emergency Department setting, discharged patients were frequently referred to rapid access clinics. Early streaming to suitable outpatient locations may be an additional strategy to consider for mitigating Emergency Department overcrowding.

IntroductionOut-of-hospital cardiac arrest (OHCA) is associated with poor survival outcomes, but prompt bystander action can more than double survival rates. Being trained, confident and willing-to-perform cardiopulmonary resuscitation (CPR) are known predictors of bystander action. This study aims to assess the effectiveness of a community organisation targeted multicomponent education and training initiative on being willing to respond to OHCAs. The study employs a novel approach to reaching community members via social and cultural groups, and the intervention aims to address commonly cited barriers to training including lack of availability, time and costs.Methods and analysisFirstCPR is a cluster randomised trial that will be conducted across 200 community groups in urban and regional Australia. It will target community groups where CPR training is not usual. Community groups (clusters) will be stratified by region, size and organisation type, and then randomly assigned to either immediately receive the intervention programme, comprising digital and in-person education and training opportunities about CPR and OHCA over 12 months, or a delayed programme implementation. The primary outcome is self-reported ‘training and willingness-to-perform CPR’ at 12 months. It will be assessed through surveys of group members that consent in intervention versus control groups and administered prior to control groups receiving the intervention. The primary analysis will follow intention-to-treat principles, use log binomial regression accounting for baseline covariates and be conducted at the individual level, while accounting for clustering within communities. Focus groups and interviews will be conducted to examine barriers and enablers to implementation and costs will also be examined.Ethics and disseminationEthical approval was obtained from The University of Sydney. Findings from this study will be disseminated via presentations at scientific conferences, publications in peer-reviewed journals, scientific and lay reports.Trial registration numberACTRN12621000367842.

Andrew W Kam,1– 3 Nathan Gunasekaran,1 Sarah G Chaudhry,1 Matthew Vukasovic,4 Andrew JR White,1,3,5 Adrian T Fung1,3,5,6 1Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia; 2Executive Unit, Westmead Hospital, Westmead, New South Wales, Australia; 3Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; 4Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia; 5The Westmead Institute for Medical Research, Westmead Hospital, Westmead, New South Wales, Australia; 6Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, AustraliaCorrespondence: Adrian T FungDepartment of Ophthalmology, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, AustraliaTel +1 612 9845 6668‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬Email adrian.fung@sydney.edu.auPurpose: To examine changing patterns of ophthalmic presentations to emergency departments (EDs) during the lockdowns associated with the first wave of the COVID-19 pandemic in Australia and the two months immediately following lockdown relaxation.Patients and Methods: This was a retrospective audit of triage coding and ICD-10-AM coding for all patient presentations to four Australian EDs from March 29 to May 31 in 2019 and 2020 (the COVID-19 lockdown period and the corresponding period in 2019), and from June 1 to July 31 in 2019 and 2020 (the post-lockdown period and the corresponding period in 2019). Number of ophthalmic presentations triaged per day and number of seven common and/or time-sensitive, vision threatening ophthalmic diagnoses were examined. Differences in mean daily presentation numbers were assessed with non-paired Student’s t-test with Bonferroni correction.Results: Total ophthalmic presentations per day during COVID-19 lockdowns fell by 16% compared to the corresponding period in 2019 (13.0 ± 4.0 in 2019 vs 10.8 ± 3.3 in 2020, mean ± standard deviation; p=0.01). There was also a significant decrease in presentations of atraumatic retinal detachment, conjunctivitis, and eye pain. In the two months following easing of lockdown restrictions, total ophthalmic presentations per day returned to the same level as that of the corresponding period in 2019 (12.2 ± 4.3 in 2019 vs 12.3 ± 4.1 in 2020, p=0.97).Conclusion: Total ophthalmic presentations and presentations of atraumatic retinal detachment, conjunctivitis and, eye pain to EDs fell during the lockdowns associated with the first wave of COVID-19 in Australia. These may represent delays in patients seeking appropriate medical attention and may have implications on patient morbidity long after the COVID-19 pandemic.Keywords: COVID-19, emergency medicine, ophthalmic epidemiology, retinal detachment, public health

Objective The ED discharge stream short stay units (EDSSUs) aim to facilitate patient flows through EDs. We investigate the relationship between EDSSU census and hospital bed occupancy rates (BORs) on National Emergency Access Target (NEAT) performance and did-not-wait (DNW) rates at a tertiary metropolitan adult ED in Sydney, Australia. Methods We collated data for all ED presentations between 1 January 2012 and 31 December 2014. Daily ED, EDSSU census and ED-accessible hospital BORs were tabulated with daily ED NEAT performance and DNW rates. Non-parametric regression analyses was conducted on cohorts of appropriate, inappropriate, successful and failed EDSSU admissions based on local admission policies and BOR for NEAT and DNW outcomes. Results Among all presentations (n = 192 506) during the study period, 43.8% of patients were admitted in hospital including 10.4% for EDSSU (n = 20 081). Analyses reveal modest positive correlation of EDSSU admissions with NEAT performance (τ = 0.35, P 100% (τ = 0.39 and τ = −0.36, P 100% were associated with reduced EDSSU admits, NEAT performance and increased DNW rates (P

Objective Discharge-stream emergency short-stay units (ESSU) improve ED and hospital efficiency. Age of patients and time of hospital presentations have been shown to correlate with increasing complexity of care. We aim to determine whether an age and time cut-off could be derived to subsequently improve short-stay unit success rates. Methods We conducted a retrospective audit on 6703 (5522 inclusions) patients admitted to our discharge-stream short-stay unit. Patients were classified as appropriate or inappropriate admissions, and deemed successful if discharged out of the unit within 24 h; and failures if they needed inpatient admission into the hospital. We calculated short-stay unit length of stay for patients in each of these groups. A 15% failure rate was deemed as acceptable key performance indicator (KPI) for our unit. Results There were 197 out of 4621 (4.3%, 95% CI 3.7–4.9%) patients up to the age of 70 who failed admission to ESSU compared with 67 out of 901 (7.4%, 95% CI 5.9–9.3%, P 70 years of age have higher rates of failure after admission to discharge-stream ESSU. Although in appropriately selected discharge-stream patients, no age group or time-band of presentation was associated with increased failure rate beyond the stipulated KPI.

The ED discharge stream short stay units (EDSSUs) aim to facilitate patient flows through EDs. We investigate the relationship between EDSSU census and hospital bed occupancy rates (BORs) on National Emergency Access Target (NEAT) performance and did-not-wait (DNW) rates at a tertiary metropolitan adult ED in Sydney, Australia.We collated data for all ED presentations between 1 January 2012 and 31 December 2014. Daily ED, EDSSU census and ED-accessible hospital BORs were tabulated with daily ED NEAT performance and DNW rates. Non-parametric regression analyses was conducted on cohorts of appropriate, inappropriate, successful and failed EDSSU admissions based on local admission policies and BOR for NEAT and DNW outcomes.Among all presentations (n = 192 506) during the study period, 43.8% of patients were admitted in hospital including 10.4% for EDSSU (n = 20 081). Analyses reveal modest positive correlation of EDSSU admissions with NEAT performance (τ = 0.35, P 0.001) and weak negative correlation with DNW rates (τ = -0.29, P 0.001). These associations were more pronounced on days when BOR100% (τ = 0.39 and τ = -0.36, P 0.001). BOR of100% were associated with reduced EDSSU admits, NEAT performance and increased DNW rates (P 0.001). Appropriate EDSSU admissions had shorter EDSSU length of stay than inappropriate EDSSU admissions (350 vs 557 min, median difference -158 min, P 0.001).Appropriate use of EDSSU provides effective conduit for ongoing patients' management beyond mandated timelines. Health systems should focus on reducing hospital BORs to mitigate exclusive ED pressure to deliver NEAT performance targets.

Objective: Access block (AB) and hospital overcrowding adversely affect ED functionality. ED throughput measures have been described in the literature with positive impacts on key performance indicators (KPIs) – time to first seen, did-not-wait rates, off-stretcher times for ambulances and ED length of stay figures. In this study, we aimed to assess the impact of a new model of care, the Senior Streaming Assessment Further Evaluation after Triage (SAFE-T) zone concept on ED performance indicators and statistical outcomes. Methods: We implemented a model of care at our tertiary hospital ED amalgamating multiple ED throughput interventions. These interventions included dynamic transition waiting room concept, early senior ED physician assessment and decision-making, early streaming, acute-care bed quarantining and ED short stay and observation units. The principal intervention was the SAFE-T zone. End-point data were compared for similar periods (77 days) of 2010 and 2011 with and without the new model of care. Results: In total, 11 408 and 11 845 patients were included in the study periods pre- and post-intervention, respectively. Time to physician KPI improved from 72.5% to 84.1%. Did-not-wait rates dropped from 10.7% to 9.6% (P= 0.02) and off-stretcher times for ambulances KPI improved from 74.5% to 79.5% (P < 0.001). ED length of stay dropped most significantly for Australasian Triage Scale categories 3 and 4 (14.3% and 11.8%, P-values

Discharge-stream emergency short-stay units (ESSU) improve ED and hospital efficiency. Age of patients and time of hospital presentations have been shown to correlate with increasing complexity of care. We aim to determine whether an age and time cut-off could be derived to subsequently improve short-stay unit success rates.We conducted a retrospective audit on 6703 (5522 inclusions) patients admitted to our discharge-stream short-stay unit. Patients were classified as appropriate or inappropriate admissions, and deemed successful if discharged out of the unit within 24 h; and failures if they needed inpatient admission into the hospital. We calculated short-stay unit length of stay for patients in each of these groups. A 15% failure rate was deemed as acceptable key performance indicator (KPI) for our unit.There were 197 out of 4621 (4.3%, 95% CI 3.7-4.9%) patients up to the age of 70 who failed admission to ESSU compared with 67 out of 901 (7.4%, 95% CI 5.9-9.3%, P 0.01) of patients over the age of 70, reflecting an increased failure rate in geriatric population. When grouped according to times of admission to the ESSU (in-office 06.00-22.00 hours vs out-of-office 22.00-06.00 hours) no significant difference rates in discharge failure (4.7% vs 5.2%, P = 0.46) were noted.Patients70 years of age have higher rates of failure after admission to discharge-stream ESSU. Although in appropriately selected discharge-stream patients, no age group or time-band of presentation was associated with increased failure rate beyond the stipulated KPI.

Access block (AB) and hospital overcrowding adversely affect ED functionality. ED throughput measures have been described in the literature with positive impacts on key performance indicators (KPIs)--time to first seen, did-not-wait rates, off-stretcher times for ambulances and ED length of stay figures. In this study, we aimed to assess the impact of a new model of care, the Senior Streaming Assessment Further Evaluation after Triage (SAFE-T) zone concept on ED performance indicators and statistical outcomes.We implemented a model of care at our tertiary hospital ED amalgamating multiple ED throughput interventions. These interventions included dynamic transition waiting room concept, early senior ED physician assessment and decision-making, early streaming, acute-care bed quarantining and ED short stay and observation units. The principal intervention was the SAFE-T zone. End-point data were compared for similar periods (77 days) of 2010 and 2011 with and without the new model of care.In total, 11 408 and 11 845 patients were included in the study periods pre- and post-intervention, respectively. Time to physician KPI improved from 72.5% to 84.1%. Did-not-wait rates dropped from 10.7% to 9.6% (P= 0.02) and off-stretcher times for ambulances KPI improved from 74.5% to 79.5% (P0.001). ED length of stay dropped most significantly for Australasian Triage Scale categories 3 and 4 (14.3% and 11.8%, P-values0.001). These results were achieved despite worsened AB and hospital bed-occupancy rates during the intervention period (+3.9% and +6.7%).The SAFE-T zone model of care involving multiple ED throughput measures achieved improvements in ED performance despite AB and hospital overcrowding.