ORCID Profile
0000-0001-9387-2489
Current Organisations
Max-Planck-Institut für Meteorologie
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Queensland University of Technology
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Publisher: Elsevier BV
Date: 02-2023
Publisher: Springer Science and Business Media LLC
Date: 30-11-2018
Publisher: Wiley
Date: 27-03-2017
DOI: 10.1111/JOCN.13760
Abstract: To describe the contextual, modal and psychological classification of medication errors in the emergency department to know the factors associated with the reported medication errors. The causes of medication errors are unique in every clinical setting hence, error minimisation strategies are not always effective. For this reason, it is fundamental to understand the causes specific to the emergency department so that targeted strategies can be implemented. Retrospective analysis of reported medication errors in the emergency department. All voluntarily staff-reported medication-related incidents from 2010-2015 from the hospital's electronic incident management system were retrieved for analysis. Contextual classification involved the time, place and the type of medications involved. Modal classification pertained to the stage and issue (e.g. wrong medication, wrong patient). Psychological classification categorised the errors in planning (knowledge-based and rule-based errors) and skill (slips and lapses). There were 405 errors reported. Most errors occurred in the acute care area, short-stay unit and resuscitation area, during the busiest shifts (0800-1559, 1600-2259). Half of the errors involved high-alert medications. Many of the errors occurred during administration (62·7%), prescribing (28·6%) and commonly during both stages (18·5%). Wrong dose, wrong medication and omission were the issues that dominated. Knowledge-based errors characterised the errors that occurred in prescribing and administration. The highest proportion of slips (79·5%) and lapses (76·1%) occurred during medication administration. It is likely that some of the errors occurred due to the lack of adherence to safety protocols. Technology such as computerised prescribing, barcode medication administration and reminder systems could potentially decrease the medication errors in the emergency department. There was a possibility that some of the errors could be prevented if safety protocols were adhered to, which highlights the need to also address clinicians' attitudes towards safety. Technology can be implemented to help minimise errors in the ED, but this must be coupled with efforts to enhance the culture of safety.
Publisher: Elsevier BV
Date: 05-2022
Publisher: Wiley
Date: 09-08-2021
DOI: 10.1111/JOCN.15983
Abstract: This study aims to examine the association between person, environment, health and illness factors, pain care and the patient experience in the emergency department, guided by symptom management theory. Current outcome measures of pain care in the emergency department focus on process measures such as the time taken to deliver analgesic medication. Patient‐reported outcomes of pain care are rare in emergency department literature and predominantly focus on patient satisfaction. Measuring overall patient experience is common, with extensive surveys undertaken in the United Kingdom, United States of America and Australia however, these are not used as an outcome of pain care. Prospective cohort study. One hundred and ninety patients arriving at a large, inner‐city adults‐only emergency department in moderate to severe pain were recruited to answer a modified version of the emergency department patient experience of care survey. Fifteen factors were identified as influencing the patient experience of care when presenting in pain. These influences of patient experience included the emergency department environment, time to first analgesic medication and the provision of analgesic medication. In addition to pain care factors, there is a significant association between the emergency department environment—especially workload, throughput and patient placement—and the experience of patients who present in pain to the emergency department. This study demonstrated an association between time to first analgesic medication and the patient experience of care. Providing timely care, including pain care, in emergency departments is difficult, but necessary to improve the patient experience of care.
Publisher: American Geophysical Union (AGU)
Date: 19-11-2019
DOI: 10.1029/2019AV000105
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.AUEC.2019.09.003
Abstract: Patients with cognitive impairment are at risk of substantial delays to analgesic medication when presenting to the emergency department in pain. To identify if patients from residential aged care facilities with cognitive impairment experience the same delays to analgesic medication are reported in the general emergency department population. This study is a retrospective case-control review of patients presenting to one emergency department with pain as a presenting complaint from residential aged care, with and without cognitive impairment. Patients without cognitive impairment experience delays in time to first analgesic medication (175min vs 98min, p=0.006) compared to cognitively impaired patients from residential aged care facilities. Both cohorts of patients waited more than three times the national benchmark for analgesic medication and 66% of all patients in this study did not have pain assessment completed. Patients presenting from residential caged care facilities in this study without cogitative impairment wait longer for analgesia then patients who present with cogitative impairment, contrary to previously described relationships. Pain assessment and treatment are open to cogitative bias, and in the absence of pain assessment cogitative bias may prevail leading to poor pain care and discrepancies between patients with and without cogitative impairment.
Publisher: American Geophysical Union (AGU)
Date: 03-2021
DOI: 10.1029/2021AV000426
Abstract: The editors thank the 2020 peer reviewers
Publisher: Cold Spring Harbor Laboratory
Date: 27-07-2023
DOI: 10.1101/2023.07.26.23293230
Abstract: Blood culture contamination is a significant problem in acute care settings. Contamination of a blood s le with pathogens not present in the patient’s blood leads to increases in length of stay, overuse of antimicrobials, and increases in healthcare cost. Several interventions have been reported in different settings within the literature to decrease the contamination. However, their overall effectiveness is currently unknown. This systematic review aimed to identify interventions to reduce contamination from peripherally collected blood cultures and to evaluate the effectiveness of these interventions. Systematic review and meta-analysis In March 2019 we performed a systematic search of English language literature from academic databases, registers of clinical trials and grey literature for interventions aimed at reducing blood culture contamination in adult acute care settings. Studies meeting inclusion criteria were reviewed and data were extracted by two independent reviewers. A total of 6,302 articles were retrieved from searches. After removal of duplicates and screening against inclusion criteria 57 studies were included. The majority of the 57 studies had a medium to high risk of bias. These studies identified eight specific interventions (collection packs, dedicated collection teams, education, staff feedback, intervention bundle, sterile procedure, Initial Specimen Diversion Devices, or change of asepsis solution) used in acute care. Thirty-four studies were included in the meta-analysis. There was a wide variation in the definition of contamination which precluded many studies from being included in the meta-analysis. Dedicated collection teams (RR 0.40, 95%CI 0.21 – 0.76, I 2 87%, p .001) and initial specimen ersion devices (RR 0.43, 95%CI0.31 – 0.58, I 2 84%, p .001) were the most successful at reducing blood culture contamination. Heterogeneity was high across all studies and interventions. The use of dedicated collection teams or initial specimen ersion devices showed the most significant reduction in blood culture contamination however, other interventions such as intervention bundles, education or feedback, may have benefits in terms of ease of implementation, and have still been shown to lower blood culture contamination.
Publisher: Wiley
Date: 29-03-2020
DOI: 10.1111/JAN.14350
Abstract: To determine the effectiveness of therapeutic activity kits on health service use and treatment delivered in the emergency department (ED) in patients with pre‐morbid dementia. Pragmatic randomized control trial with equal parallel groups. Participants with dementia will be randomly assigned to the control group ( N = 56) or the intervention group ( N = 56). The intervention group will be given access to a therapeutic activity kit containing several different activities and sensory stimuli to engage the person with dementia during their ED stay in addition to usual care, and the control group will be given usual care only. A research nurse will observe participants at 30–60‐min intervals throughout their ED stay for responsive behaviours, one‐on‐one nursing, and the use of chemical and physical restraint. This study has received Research Ethics Committee approval from the institutional review board and funding from the Rosemary Bryant Foundation (May 2019). Emergency departments are busy and noisy environments and can be intimidating and disorientating for patients with dementia, which can result in responsive behaviours. Responsive behaviours are often managed with restrictive interventions, such as chemical or physical restraint, or with constant bedside nursing (one‐on‐one nursing) to ensure patient safety. Alternatively, non‐restrictive and non‐pharmacological interventions that ert or occupy the attention of patients such as those contained in the therapeutic activity kit can be considered as a more person‐centred strategy. Therapeutic activity kits have been reported as feasible for the use in ED however, there is limited quality evidence at present to support the implementation of such interventions in the ED. If this study is successful, it will demonstrate that a therapeutic activity kit containing activities (puzzles, colouring, music, and tactile activities) is inexpensive, easily implemented intervention that can prevent this patient group from demonstrating unsafe behaviours and requiring one‐on‐one nursing and restraints.
Publisher: Cold Spring Harbor Laboratory
Date: 19-10-2022
DOI: 10.1101/2022.10.17.22280670
Abstract: Pain is the most common symptom experienced when presenting to the emergency department (ED). Estimates indicate over half of all patients will present in pain. EDs typically focus on care process measures, such as time to first analgesic medication. Process-based metrics remove the patient from their own experience. Unfortunately, when patient-reported measures of pain care are used in the ED for quality improvement or research, they vary widely and often lack validation. Previous work has demonstrated that a modified version of the American Pain Society – Patient Outcome Questionnaire – Revised Edition (APS-POQ-R) may provide an ideal patient-reported outcome measure for the adult ED population. However, previous work has left validation incomplete. In this multi-site, multistage research, we demonstrate the construct, convergent and ergent validity and the internal consistency of a modified version of the APS-POQ-R in adult patients presenting to two large, inner-city EDs with moderate to severe acute pain. After three stages of psychometric testing in 646 patients, we present a nine-question, three construct patient-reported outcome measure for moderate to severe pain in the adult emergency department, now known as the American Pain Society – Patient Outcome Questionnaire – Revised for the ED (APS-POQ-RED). This article presents the psychometric properties of a revised version of the APS-POQ-R for use in the adult ED. This shortened, ED-specific patient-reported outcome measure (APS-POQ-RED) seeks to provide a standardised, validated measure of patient-reported outcomes of acute pain care in the ED for quality and research purposes.
Publisher: Cold Spring Harbor Laboratory
Date: 30-05-2022
DOI: 10.1101/2022.05.29.22275652
Abstract: Accurate, reliable and efficient measures of pain-related presentations are essential to evaluate and improve pain care in the ED. Estimates of pain prevalence on arrival to the emergency department (ED) vary depending on the methods used. Artificial intelligence (AI) approaches are likely to be the future for identifying patients in pain from electronic health records (EHR). However, we need a robust method to identify these patients before this can occur. This study aims to identify patients presenting in pain to the ED using binary classification and to describe the population, treatment and outcomes. This study employs a cross-sectional design using retrospective data routinely collected in the EHR at a single ED. A random s le of 10 000 patients was selected for inclusion over three years. Triage nursing assessment underwent binary classification by three expert clinicians. The prevalence of pain on arrival is the primary outcome. Patients with pain were compared to those without pain on arrival regarding demographics, treatment and outcomes. The prevalence of pain on arrival was 55.2% (95%CI 54.2% - 56.2%). Patients who presented in pain differed from those without pain in terms of age, country of birth, socioeconomic status, mode of arrival, urgency and discharge destination. The median time to first analgesic medication was 65min (IQR 38 – 114 min), and 45.6% (95% CI 44.3% - 46.9%) of patients arriving in pain received analgesic medication. The prevalence of pain on arrival compares well with previously reported figures using similar methods. Differences in the cohort presenting in pain compared to the population may represent differences in the prevalence or be an extension of previous bias seen in the documentation of pain. This work has set a rigorous methodology for identifying patients presenting with pain from the EHR. It will form the basis for future applications of AI to identify patients presenting in pain to the ED.
Publisher: Wiley
Date: 16-05-2018
DOI: 10.1111/INM.12340
Abstract: Alcohol and other drug (AOD) use is common in our society. The use of these substances flow throughout all areas of healthcare, and is especially prevalent in patients presenting to the emergency department with signs of mental illness. At the extreme end of these presentations patients present involuntarily with either police or ambulance officers. The aim of this study was to identify and describe the population presenting to the ED involuntarily with and without substance misuse as a precipitating factor. Quantitative descriptive analysis was used to describe this population between April and June 2015. In patients presenting to one large inner city emergency department involuntarily, 30% had alcohol or other drug misuse as a precipitating factor. Patients who involuntarily presented with alcohol and other misuse stay longer in the emergency department then others that do not have alcohol or other drug misuse. These patients represent frequently, with over 50% representing at 90 days however this was not associated with alcohol or other drug misuse. Almost all patients who present involuntarily are discharged home post review by a mental health team. Significant improvements in care can be made in this population if the opportunistic treatment of both mental illness and AOD misuse is completed in the emergency department.
Publisher: Wiley
Date: 24-11-2015
Abstract: We aimed to provide 'adequate analgesia' (which decreases the pain score by ≥2 and to <4 [0-10 scale]) and determine the effect on patient satisfaction. We undertook a multicentre, cluster-randomised, controlled, intervention trial in nine EDs. Patients with moderate pain (pain score of ≥4) were eligible for inclusion. The intervention was a range of educational activities to encourage staff to provide 'adequate analgesia'. It was introduced into five early intervention EDs between the 0 and 6 months time points and at four late intervention EDs between 3 and 6 months. At 0, 3 and 6 months, data were collected on demographics, pain scores, analgesia provided and pain management satisfaction 48 h post-discharge (6 point scale). Overall, 1317 patients were enrolled. Logistic regression (controlling for site and other confounders) indicated that, between 0 and 3 months, satisfaction increased significantly at the early intervention EDs (OR 2.2, 95% CI 1.5 to 3.4 [P < 0.01]) but was stable at the control EDs (OR 0.8, 95% CI 0.5 to 1.3 [P = 0.35]). Pooling of data from all sites indicated that the proportion of patients very satisfied with their pain management increased from 42.9% immediately pre-intervention to 53.9% after 3 months of intervention (difference in proportions 11.0%, 95% CI 4.2 to 17.8 [P = 0.001]). Logistic regression of all data indicated that 'adequate analgesia' was significantly associated with patient satisfaction (OR 1.4, 95% CI 1.1 to 1.8 [P < 0.01]). The 'adequate analgesia' intervention significantly improved patient satisfaction. It provides a simple and efficient target in the pursuit of best-practice ED pain management.
Publisher: Cold Spring Harbor Laboratory
Date: 25-09-2023
Publisher: Queensland University of Technology
Date: 2018
Publisher: Wiley
Date: 05-2020
Publisher: Australian Nursing and Midwifery Federation
Date: 28-02-2022
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16263
Abstract: Objectives The aim of this study was to assess the relationship between compliance with time-based Emergency Department (ED) targets (known as NEAT) and the time taken to collect an electrocardiogram (TTE) in patients presenting with chest pain. Methods This was a pilot descriptive retrospective cohort study completed in a large inner city tertiary ED. Patients who presented with active or recent chest pain between July 2014 and June 2015 were eligible for inclusion. Pregnant patients, inter-hospital transfers, and traumatic chest pain were excluded. A random selection of 300 patients from the eligible cohort comprised the final s le. The differences of TTE between categories of NEAT compliance were compared using Kruskal-Wallis test. Also, the factors affecting with the acquisition of ECG within ten minutes of arrival were explored using proportional hazards regression. Results There was a significant inverse association between the percentage of admitted patients leaving the ED within four hours (admitted NEAT) and TTE. As admitted NEAT compliance increased TTE decreased (p = 0.004). A number of variables including triage score, arrival time, total NEAT, first location, doctor wait time, and cardiac diagnosis were all significant predictors of TTE. After adjusting for other variables Admitted NEAT remained as an independent predictor of TTE. Conclusion There is likely to be a relationship between NEAT and TTE that is reflective of overall hospital and not just ED functioning however the exact relationship remains uncertain. Further study in a multisite study is warranted to further explore the relationship between NEAT, TTE and other important clinical metrics of ED performance. What is known about the topic? The 4-h time target or National Emergency Access Target (NEAT) is implemented in Australia to ease crowding and access block. However, little is known of its effect on important clinical endpoints, particularly ‘time-to-ECG’ (TTE). What does this paper add? This paper demonstrates a complex relationship between measures of time-based targets, such as time to ECG. It is likely that increasing compliance with admitted NEAT shortens TTE, demonstrating the effect of hospital functioning on the ability to deliver quality care in the emergency department. What are the implications for practitioners? Emergency department flow has an effect on the ability of the department to deliver key assessment. There is a relationship between NEAT compliance and TTE, but the exact relationship requires further exploration in larger multicentre studies.
Publisher: American Geophysical Union (AGU)
Date: 04-2022
DOI: 10.1029/2022AV000716
Abstract: The editorial board of AGU Advances thanks the in iduals who reviewed for the journal in 2021.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.AENJ.2016.05.003
Abstract: The aim of this study was to determine the role that heated, humidified high-flow nasal oxygen (HHHFNO) plays in the adult ED with particular focus on the indications and outcomes of use. An explorative study was undertaken using retrospective chart review to identify characteristics of adult patients who received HHHFNO in a tertiary adult ED between January and December 2014. Thirty-nine patients were identified as having received HHHFNO during the study period with a range of indications for this use. No clear guidelines existed for initiation of this use. Two patients failed on HHHFNO therapy, requiring increased respiratory support twenty-seven patients were admitted to hospital with HHHFNO still being delivered and seven patients were successfully treated with HHHFNO in the ED. The use of HHHFNO was associated with a 4.91bpm (95% CI 2.23-7.59 P=0.001) decrease in mean RR and an 11.26bpm (95% CI 4.62-17.90 P=0.002) decrease in mean HR from baseline at 120min of use. Hypercapnic patients showed a significant decrease in mean PaCO HHHFNO is currently being used as a device for supplemental oxygen delivery within the adult Emergency Department however, further research is needed in this area to quantify its use in many of the indications seen.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-08-2019
Publisher: Cold Spring Harbor Laboratory
Date: 18-09-2020
DOI: 10.1101/2020.09.15.20194738
Abstract: 3. Pain is a common presenting complaint to the emergency department (ED), yet is often undertreated. When assessing the outcomes of pain care in the ED, process measures are commonly reported. Attempts to measure patient-reported outcomes existing in current ED literature. However, they are frequently unvalidated and lack standardization. The American Pain Societies – Patient Outcome Questionnaire-Revised edition (APS-POQ-R) has been identified as the most likely, pre-existing tool to be useful in the acute pain in the ED. However, this requires feasibility and construct validation before use. To assess the feasibility and construct validity of the APS-POQ-R in patients presenting to the adult emergency department with acute pain. This study is an initial psychometric evaluation of the constructs contained within the APS-POQ-R in adult patients presenting with moderate to severe acute pain to a large urban ED. The study is guided by the methods described in the initial development of the instrument. Two hundred adult patients were recruited and completed the APS-POQ-R. The APS-POQ-R demonstrated content validity in patients presenting with acute pain. Exploratory factor analysis demonstrated five subgroups. The tool demonstrated discriminatory ability based on patient urgency, and subscale measurement was associated with patient satisfaction with care. The APS-POQ-R has demonstrable construct validity in adult patients presenting with acute pain to the ED. Further psychometric analysis across multiple EDs is required before the APS-POQ-R can be recommended as a validated PROM for ED patients in pain.
Publisher: Informa UK Limited
Date: 07-2020
DOI: 10.2147/JMDH.S255785
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.AENJ.2016.11.001
Abstract: Falls are a significant source of healthcare related morbidity and mortality of patients in hospitals and residential healthcare settings. Commonly falls are thought of as an affliction of the elderly and the frail. The emergency department (ED) is a unique healthcare setting that sees patients in the acute and hyper acute stages of physical and mental illness and intoxication. Falls occur in this setting, however there is little knowledge about the factors that influence falls in the emergency department. This study was conducted in a large inner city, tertiary ED. Data was collected from the electronic incident management system for the period of time 2011-2015 and additional information was extracted from the patient's medical record. During the study period a total of 190 fall incidents at a fall rate of 0.63 falls per 1000 presentations. 95.7% of these falls resulted in no or minimal harm to the patient. Patients who fell in the emergency department were younger them previously identified in other settings. The use of high-risk medications, recreational substances and alcohol was prevalent throughout the ED falls population. The most likely time for a patient to fall was during mobilisation, especially to the bathroom. Falls occur in all healthcare settings, which include the ED. The cohort that falls in the ED is younger then in other settings and is more likely to have ingested recreational substances such as alcohol. A rethinking of falls risk specific to the emergency department needs to occur, along with further research into ED related falls.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Wiley
Date: 09-10-2020
DOI: 10.1111/JAN.14216
Abstract: To determine the association between time to first analgesic medication and emergency department length of stay (ED LOS). Retrospective cohort study. We conducted this study in a large, inner-city emergency department and included adult patients who presented with pain as a symptom and received analgesic medication(s). Study participants were identified from a random selection of 2,000 adult patients who presented between August-October 2018. The relationship between ED LOS and time to first analgesic medication was described using bivariate and multivariate linear regression. Of the 2,000 randomly selected patients presenting between August and October 2018, 727 (36.35%) had pain as a symptom on arrival, 423 (21.15%) had analgesic medication administered. The median time to first analgesic medication was in 62 (interquartile range: 36-105) minutes and median ED LOS was 218 (interquartile range: 160-317.5) minutes. After adjusting for the effects of sex, urgency of the presentation, emergency department location first seen by clinician, departure destination and workload metrics (average daily time to be seen and daily access block). Time to first analgesic medication was independently associated with ED LOS, contributing to 6.96% of the variance in the multivariate model. Providing analgesic medication faster to patients presenting in pain, in addition to previously demonstrated positive patient outcomes, may decrease their ED LOS. Reducing ED LOS through faster pain care, benefits the patient through faster pain relief and can benefit the department by reducing the total amount of care delivered in the emergency department. Reducing total care delivery frees up resources to improve the care to all emergency department patients.
Publisher: SAGE Publications
Date: 08-11-2021
DOI: 10.1177/17449871211013073
Abstract: Missed nursing care is a complex healthcare problem. Extant literature in this area identifies several interventions that can be used in acute hospital settings to minimise the impact of missed nursing care. However, controversy still exists as to the effectiveness of these interventions on reducing the occurrence of missed nursing care. This theoretical paper aimed to provide a conceptual understanding of missed nursing care using complexity theory. The method utilised for this paper is based on a literature review on missed care and complexity theory in healthcare. We found that the key virtues of complexity theory relevant to the missed nursing care phenomenon were adaptation and self-organisation, non-linear interactions and history. It is suggested that the complex adaptive systems approach may be more useful for nurse managers to inform and prepare nurses to meet uncertain encounters in their everyday clinical practice and therefore reduce instances of missed care. This paper envisions that it is time that methods used to explore missed care changed. Strategies proposed in this paper may have an important impact on the ability of nursing staff to provide quality and innovative healthcare in the modern healthcare system.
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJOPEN-2022-067022
Abstract: Poor patient assessment results in undetected clinical deterioration. Yet, there is no standardised assessment framework for 000 Australian emergency nurses. To reduce clinical variation and increase safety and quality of initial emergency nursing care, the evidence-based emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) was developed and piloted. This paper presents the rationale and protocol for a multicentre clinical trial of HIRAID. Using an effectiveness-implementation hybrid design, the study incorporates a stepped-wedge cluster randomised controlled trial of HIRAID at 31 emergency departments (EDs) in New South Wales, Victoria and Queensland. The primary outcomes are incidence of inpatient deterioration related to ED care, time to analgesia, patient satisfaction and medical satisfaction with nursing clinical handover (effectiveness). Strategies that optimise HIRAID uptake (implementation) and implementation fidelity will be determined to assess if HIRAID was implemented as intended at all sites. Ethics has been approved for NSW sites through Greater Western Human Research Ethics Committee (2020/ETH02164), and for Victoria and Queensland sites through Royal Brisbane & Woman’s Hospital Human Research Ethics Committee (2021/QRBW/80026). The final phase of the study will integrate the findings in a toolkit for national rollout. A dissemination, communications (variety of platforms) and upscaling strategy will be designed and actioned with the organisations that influence state and national level health policy and emergency nurse education, including the Australian Commission for Quality and Safety in Health Care. Scaling up of findings could be achieved by embedding HIRAID into national transition to nursing programmes, ‘business as usual’ ED training schedules and university curricula. ACTRN12621001456842.
Publisher: BMJ
Date: 14-03-2023
DOI: 10.1136/EMERMED-2021-211167
Abstract: Domestic violence (DV) is a major cause of morbidity worldwide. The ED is a location recommended for opportunistic screening. However, screening within EDs remains irregular. To examine intrinsic and extrinsic barriers to routine screening in Australian EDs, while describing actions taken after identification of DV. Emergency clinicians at nine public hospitals participated in an anonymous online survey. Factor analysis was performed to identify principal components around attitudes and beliefs towards screening. In total, 496 emergency clinicians participated. Universal screening was uncommon less than 2% of respondents reported screening all adults or all women. Although willing, nearly half (45%) reported not knowing how to screen. High patient load and no single rooms were ‘very or severely limiting’ for 88% of respondents, respectively, while 24/7 social work and interpreter services, and online/written DV protocols were top enablers. Factor analysis identified four distinct intrinsic belief components: (1) screening is not futile and could be done in ED, (2) screening will not cause harm, (3) there is a duty to screen and (4) I am willing to screen. This study describes a culture of Queensland ED clinicians that believe DV screening in ED is important and interventions are effective. Most ED clinicians are willing to screen. In this setting, availability of social work and interpreter services are important mitigating resources. Clinician education focusing on duty to screen, coupled with a built-in screening tool, and e-links to a local management protocol may improve the uptake of screening and subsequently increase detection.
Publisher: Australian College of Perioperative Nurses
Date: 16-03-2022
Publisher: Cold Spring Harbor Laboratory
Date: 25-09-2023
Publisher: SAGE Publications
Date: 16-02-2023
DOI: 10.1177/15271544231155845
Abstract: Missed nursing care is a multifaceted patient safety issue receiving increased attention among healthcare scholars worldwide. There is limited research on missed nursing care in the Jordanian healthcare context. The current study sought to examine the perceptions of Jordanian nurses toward the amount and types of missed nursing care in medical and surgical wards. We also examined the differences in missed care items between public, private, and university hospitals in Jordan. This was a cross-sectional study using the MISSCARE Survey tool. Data collection spanned 4 months between March and July 2021. The final study s le consisted of 672 registered nurses employed in five public, three private, and two university hospitals in Jordan. Data were analyzed using descriptive statistics, Analysis of variance, and Pearson correlation coefficent test. Of the 672 registered nurses who participated, the majority were females ( n = 421 62.6%). Most participants held a bachelor's degree in nursing ( n = 577 85.9%). The three most common missed nursing activities in the participating hospitals were: ambulation, oral care, and emotional support. Nurses working in public hospitals reported the highest missed nursing care. The age and number of patients under care significantly correlated with missed nursing care. The findings could help nursing managers develop plans to reduce missed nursing care in their healthcare institutions.
Publisher: American Geophysical Union (AGU)
Date: 06-2023
DOI: 10.1029/2023AV000974
Abstract: The editorial board of AGU Advances thanks the in iduals who reviewed for the journal in 2022.
Publisher: American Geophysical Union (AGU)
Date: 20-04-2020
DOI: 10.1029/2020AV000181
Publisher: Wiley
Date: 08-11-2018
Abstract: Injuries are a major burden on the Australian healthcare system. Power tool usage is a common cause of accidental injury. A better understanding of the trends of power tool injuries will inform prevention strategies and potentially mitigate costs. The ED databases from two level 1 hospitals were reviewed for presentations between 2005 and 2015 resulting from accidental injury with power tools. A subgroup of patients presenting to one hospital between 2016 and 2017 were interviewed about the activities and circumstances that led to their injuries, and followed up 3 months later to assess outcomes. A total of 4057 cases of accidental injury from power tool use were identified. Power saws and grinders contributed to 54% of injuries. Most injuries were located on an upper limb (48%) or the head and neck (30%). Over half (54%) of all head injuries were associated with metal and wood fragments to the eye from grinders, drills and saws. Hospital admission rates were highest for patients aged >60 years. Injuries to females were 3 months were common. Accidental injuries from power tool use have a considerable impact on ED resources and can affect the long-term quality of life of those injured. Effective education about safe usage and protection may prevent many injuries.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16025
Abstract: Objectives The aim of the present study was to assess the relationship between and the effect of the 4-h target or National Emergency Access Target (NEAT) on the time-to-analgesia (TTA), as well as the provision of analgesia in an adult emergency department (ED). Methods The present study was a pilot descriptive explorative retrospective cohort study conducted in a public metropolitan ED. Eligible presentations for analysis were adults presenting with a documented pain score of ≥4 out of 10 between 1 and 14 September 2014. Triage Category 1, pregnant, chest pain and major trauma cases were excluded from the study. As a result, data for 260 patients were analysed. Results Of 260 patients, 176 had analgesia with a median TTA of 49 min. Increased NEAT compliance did not significantly decrease TTA. However, when the factors that affected the provision of analgesia were analysed, an association was demonstrated between Admitted and Short Stay NEAT performance and the provision of analgesia. The likelihood of receiving analgesia at all increased as Admitted and Short Stay NEAT compliance improved. Conclusion NEAT is a significant health policy initiative with little clinical evidence supporting its implementation. However, as the Admitted NEAT compliance increases, the probability of receiving analgesia increases, demonstrating a possible link between hospital function and clinical care provision that needs to be explored further. What is known about the topic? The 4-h target or NEAT is a widely used initiative in EDs to allay crowding and access block. However, little is known of its impact on clinical endpoints, such as TTA. What does this paper add? TTA was not significantly reduced as NEAT compliance increased. However, when the focus was on the probability of receiving analgesia, the results demonstrated that an improvement in Admitted and Short Stay NEAT compliance was associated with an increase in the likelihood of patients receiving analgesia. What are the implications for practitioners? NEAT is a relatively recent initiative, hence evidence of its effect on clinically orientated outcomes is limited. Nevertheless, evidence of safety and effectiveness is emerging. The results of the present pilot study provide preliminary data on the timeliness of patient-centred care as demonstrated by TTA and administration of analgesia when required. Further, the results would seem to suggest that the provision of analgesia is affected by how timely patients are moved out of the ED to the in-patient setting. As for future investigations on TTA as a result of NEAT, a wider time period should be considered so that the accurate effect of compliance thresholds (e.g. ≥90%, 81–89%, ≤80%) of NEAT can be explored.
Publisher: Ochsner Journal
Date: 2018
DOI: 10.31486/TOJ.17.0112
Publisher: World Journal of Emergency Medicine
Date: 2017
Publisher: Wiley
Date: 15-08-2023
Abstract: To determine the independent predictors for clinician fatigue and decline in cognitive function following a shift in the ED during early stages of the COVID‐19 pandemic. This was a prospective, quasi‐experimental study conducted in a metropolitan adult tertiary‐referral hospital ED over 20 weeks in 2021. The participants were ED doctors and nurses working clinical shifts in an ED isolation area or high‐risk zone (HRZ) with stringent personal protective equipment (PPE). The participants' objective and subjective fatigue was measured by the Samn–Perelli fatigue score and a psychomotor vigilance ‘smart game’ score, respectively. Postural signs/symptoms and urine specific gravity (SG) were measured as markers of dehydration. Sixty‐three participants provided data for 263 shifts. Median (interquartile range) age was 33 (28–38) years, 73% were female. Worsening fatigue score was associated with working afternoon shifts (afternoon vs day, adjusted odds ratio [aOR] 5.16 [95% confidence interval (CI) 1.32–20.02]) and in non‐HRZ locations (HRZ vs non‐HRZ, aOR 0.23 [95% CI 0.06–0.87]). Worsening cognitive function (game score) was associated with new onset postural symptoms (new vs no symptoms, aOR 4.14 [95% CI 1.34–12.51]) and afternoon shifts (afternoon vs day, aOR 3.13 [95% CI 1.16–8.44]). Working in the HRZ was not associated with declining cognitive function. Thirty‐four (37%) of the 92 participants had an end of shift urine SG .030. Working afternoon shifts was associated with fatigue. There was no association between HRZ allocation and fatigue, but our study was limited by a low COVID workload and fluctuating PPE requirements in the non‐HRZs. Workplace interventions that target the prevention of fatigue in ED clinicians working afternoon shifts should be prioritised.
Publisher: Springer Science and Business Media LLC
Date: 20-06-2023
DOI: 10.1186/S43058-023-00452-0
Abstract: Emergency department (ED) overcrowding is a global problem and a threat to the quality and safety of emergency care. Providing timely and safe emergency care therein is challenging. To address this in New South Wales (NSW), Australia, the Emergency nurse Protocol Initiating Care—Sydney Triage to Admission Risk Tool (EPIC-START) was developed. EPIC-START is a model of care incorporating EPIC protocols, the START patient admission prediction tool, and a clinical deterioration tool to support ED flow, timely care, and patient safety. The aim of this study is to evaluate the impact of EPIC-START implementation across 30 EDs on patient, implementation, and health service outcomes. This study protocol adopts an effectiveness-implementation hybrid design (Med Care 50: 217-226, 2012) and uses a stepped–wedge cluster randomised control trial of EPIC-START, including uptake and sustainability, within 30 EDs across four NSW local health districts spanning rural, regional, and metropolitan settings. Each cluster will be randomised independently of the research team to 1 of 4 dates until all EDs have been exposed to the intervention. Quantitative and qualitative evaluations will be conducted on data from medical records and routinely collected data, and patient, nursing, and medical staff pre- and post-surveys. Ethical approval for the research was received from the Sydney Local Health District Research Ethics Committee (Reference Number 2022/ETH01940) on 14 December 2022. Australian and New Zealand Clinical trial, ACTRN12622001480774p. Registered on 27 October 2022.
Publisher: Mark Allen Group
Date: 02-07-2023
Abstract: Falls are a key patient safety concern because of the associated physical injuries, emotional impact and financial burden on patients and the healthcare system. This study aimed to describe the characteristics of falls and assess the potential risk factors among hospitalised patients in a medium-sized acute care hospital in Queensland, Australia. This was a retrospective descriptive study using routinely collected information. The study was conducted in a medium-sized public hospital in Queensland, Australia. Characteristics of patients, their fall risk classification and circumstances of patient falls were extracted from the incident report provided by the hospital. Data were analysed using descriptive statistics. A total of 677 patient fall incidents were documented on the hospital's electronic incident system from 2015–17. The majority of falls (98%) occurred in inpatient units and caused no or minimal harm to patients. Older age groups (75–84 years and 85–94 years) made up the greatest proportion of patients who fell. Falls were largely related to toileting activities. The most common locations for inpatient falls were the bed, bedside trolley or treatment chair. Intervention studies are needed to develop and evaluate procedures to prevent falls, particularly for activities with a high risk of falls, such as toileting, and for older patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-01-2023
Publisher: Wiley
Date: 11-10-2023
DOI: 10.1111/JOCN.16520
Abstract: Patients presenting to the emergency departments in pain often experience co‐occurring symptoms. Anticipatory anxiety in the emergency department may be currently under‐recognised. Clinical tools to facilitate the assessment of co‐occurring symptoms aligns with providing more patient centred care and improved outcomes and experience. This integrative review aimed to identify and examine the psychometric properties of tools currently used for pain and anticipatory anxiety assessment in adult patients presenting to the emergency department. This study also aimed to identify the current clinical practice used to assess adult pain and anticipatory anxiety. Whittemore and Knafl's methodology guided the review process, and it is reported according to relevant items from PRISMA checklist. Studies were included if they focused on tools for pain or anxiety assessment of adults in emergency departments in English language publications since 2010. Quality of studies was evaluated using the Mixed Methods Appraisal Tool (MMAT). The results were summarised through narrative synthesis. A total of 15 studies were identified for narrative synthesis. Six tools for pain, and four tools for anticipative anxiety were found. All currently used clinical tools assess symptoms in isolation. There was limited discussion of the clinical context of identified tools within the included studies. Pain and anxiety assessment are currently performed in symptom isolation with a variety of tools with varying degrees of reliability. There exists a lack of clinical tools able to assess co‐occurring symptoms of pain and anticipatory anxiety in the clinical setting of the emergency department. No studies discussed clinical tool use in current practice. The reconstruction of available pain and anxiety assessment tools into one validated and holistic tool for assessment in the ED clinical setting, would provide a contextually appropriate guide to clinical assessment and treatment. Acknowledging and measuring these symptoms may facilitate future rigorous testing of experimental studies of novel methods to reduce pain and anxiety in the ED. Patient or public contribution does not apply to this Integrative Review. Not applicable.
Publisher: Wiley
Date: 07-04-2021
DOI: 10.1111/JOCN.15750
Abstract: To examine the factors associated with time to first analgesic medication in the emergency department. Pain is the most common symptom presenting to the emergency department, and the time taken to deliver analgesic medication is a common outcome measure. Factors associated with time to first analgesic medication are likely to be multifaceted, but currently poorly described. Retrospective cohort study. Cox proportional hazards regression modelling was undertaken to evaluate the associations between person, environment, health and illness variables within Symptom Management Theory and time to first analgesic medication in a s le of adult patients presenting with moderate‐to‐severe pain to an emergency department over twelve months. This study was completed in line with the STROBE statement. 383 patients were included in the study, 290 (75.92%) of these patients received an analgesic medication in a median time of 45 minutes (interquartile range, 70 minutes). A model containing nine explanatory variables associated with time to first analgesic medication was identified. These nine variables (employment status, discharge location, triage score, Charlson score, arrival pain score, socio‐economic status, first location, daily total treatment time and patient time to be seen) represent all of the domains of the Symptom Management Theory. Person, environment, health and illness factors are associated with the time taken to deliver analgesic medication to those in pain in the emergency department. This study demonstrates the complexity of factors associated with pain care and the applicability of Symptom Management Theory to pain care in the emergency department. Identifying a model of factors that are associated with the time in which the most common symptom presenting to the emergency department is treated allows for targeted interventions to groups likely to receive poor care and a framework for its evaluation.
Publisher: Wiley
Date: 05-03-2019
Abstract: To compare the documentation of security interventions in ED presentations between clinical notes and security records. Presentations (n = 680) were randomly selected from all ED presentations to a public tertiary referral hospital in Queensland, Australia between April 2016 and August 2017 that were perceived by the treating clinician as alcohol-related. Retrospective data, manually extracted from clinical notes and the security service database, were compared for the documentation of any security interventions. Security interventions were defined as observation without physical contact, verbal de-escalation or physical restraint by security officers. Forty-one presentations had security interventions documented in the security services database and, of those, 20 (48.8%) had documentation in the clinical notes. Patients who required security interventions were admitted to hospital in higher proportions compared with those who did not (73.2% vs 26.8%, respectively, P < 0.0001). The rate of documentation of security interventions in clinical notes was less than 50%. Documentation of critical information, including alerts and risks, in the clinical notes is an essential component of communication that the multi-disciplinary team use to ensure patient safety. Strategies aimed at improving the documentation of security interventions in clinical notes will help to optimise risk management and the safety of patients, staff and visitors along the continuum of care.
Publisher: American Geophysical Union (AGU)
Date: 03-2021
DOI: 10.1029/2020AV000296
Abstract: As in iduals serving on the AGU Advances editorial board, we condemn racism, affirm that Black Lives Matter, and recognize that inequality is built into the systems that have allowed us to prosper. We aim to persistently foster discussion about racism, inequity, and the need to make our community more erse and inclusive. This will help AGU Advances do a better job in publishing important science that inclusively reflects the ideas and contributions of all in our community.
No related grants have been discovered for James Hughes.