ORCID Profile
0000-0001-7349-1128
Current Organisations
Western Sydney Local Health District
,
Westmead Millennium Institute for Medical Research
,
University of Sydney
,
Macquarie University
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 04-04-2012
DOI: 10.1111/J.1742-6723.2012.01550.X
Abstract: 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% (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 <0.001). 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.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JEMERMED.2015.03.005
Abstract: The incidence of cervical spine injuries (CSI) in people over 65 years of age from low-energy mechanisms is far greater than in younger populations. Algorithms and decision rules exist for selection of trauma patients requiring cervical spine imaging. To determine the validity of the NEXUS criteria in the elderly population with low-mechanism injuries. We prospectively conducted computed tomography (CT) imaging in patients > 65 years of age presenting with fall from standing height or less to rule out predefined clinically significant CSI. Eligible patients were prospectively categorized into NEXUS positive or negative. There were 169 patients included in the final analyses. One hundred twenty (71%) patients in the cohort were classified as "NEXUS positive." Eleven patients (6.5% of the cohort) had CSI detected on CT imaging of the cervical spine. Nine patients had clinically significant CSI. The NEXUS decision instrument demonstrated 88.9% sensitivity (50.7-99.4%) and 98% negative predictive value (NPV) (87.8-99.9%) in detecting clinically significant CSI. The NEXUS decision instrument demonstrated 81.8% sensitivity (47.8-96.8%) and 95.9% NPV (84.9-99.3%) in detecting any CSI. In our study, the NEXUS decision instrument was not a valid tool to rule out imaging for patients > 65 years of age presenting after a fall from standing height or less. We advocate the liberal use of CT imaging of the cervical spine in this cohort of patients to rule out cervical spine injury.
Publisher: Wiley
Date: 16-04-2017
Abstract: 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 100% (τ = 0.39 and τ = -0.36, P 100% 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.
Publisher: Wiley
Date: 09-09-2013
Abstract: The study aims to determine the interpretation accuracy of computed tomography of the kidneys, ureters and bladder (CT-KUB) by emergency physicians (EPs) compared with the formal radiology report, as the reference standard, in patients with suspected acute urinary tract calculous disease. A s le of 20 consecutive CT-KUB scans for suspected acute calculous disease was compiled from the medical imaging department of an adult tertiary teaching hospital. Ten EPs with a minimum of 2 years' experience post-Fellowship interpreted each scan using a template form. The total s le of 200 reports by EPs was compared with the formal radiology report for agreement in detecting renal tract stones, signs of obstruction and other clinical findings. Interrater agreement and the kappa statistic were used for comparative data analysis. There was a high level of agreement (%, kappa value) between EPs and radiologists for the detection of large (≥5 mm) calculi (94.5%, κ 0.89), signs of obstruction (93%, κ 0.86) and clinically significant findings (90%, κ 0.78). The level of agreement was low for the detection of small (<5 mm) calculi (79%, κ 0.48) and clinically non-significant findings (67.5%, κ 0.33). EPs can accurately detect clinically significant acute calculous disease and signs of obstruction on CT-KUB, allowing for ongoing acute management and early disposition of the patient. However, their findings should be verified against the formal radiology report when available.
Publisher: Wiley
Date: 12-04-2016
Abstract: Systemic inflammatory response syndrome (SIRS)-based severe sepsis screening algorithms have been utilised in stratification and initiation of early broad spectrum antibiotics for patients presenting to EDs with suspected sepsis. We aimed to investigate the performance of some of these algorithms on a cohort of suspected sepsis patients. We conducted a retrospective analysis on an ED-based prospective sepsis registry at a tertiary Sydney hospital, Australia. Definitions for sepsis were based on the 2012 Surviving Sepsis C aign guidelines. Numerical values for SIRS criteria and ED investigation results were recorded at the trigger of sepsis pathway on the registry. Performance of specific SIRS-based screening algorithms at sites from USA, Canada, UK, Australia and Ireland health institutions were investigated. Severe sepsis screening algorithms' performance was measured on 747 patients presenting with suspected sepsis (401 with severe sepsis, prevalence 53.7%). Sensitivity and specificity of algorithms to flag severe sepsis ranged from 20.2% (95% CI 16.4-24.5%) to 82.3% (95% CI 78.2-85.9%) and 57.8% (95% CI 52.4-63.1%) to 94.8% (95% CI 91.9-96.9%), respectively. Variations in SIRS values between uncomplicated and severe sepsis cohorts were only minor, except a higher mean lactate (>1.6 mmol/L, P 2 mmol/L rather than >4 mmol/L performed better. ED sepsis registry-based characterisation of patients may help further refine sepsis definitions of the future.
Publisher: Annals of Laboratory Medicine
Date: 2014
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.CRAD.2016.02.008
Abstract: To assess trends in medical imaging requests before and after the 4-hour rule commenced and to assess the imaging time component of emergency department (ED) length of stay (LOS). Retrospective analysis of ED patients and imaging requests 1 year prior to and 3 years after implementation of the 4-hour rule (April to December for 2011-2014) was performed at a single adult tertiary referral Level 1 trauma hospital with Level 6 ED. Logistic regression was used to evaluate trends in the number of ED patient presentations, patient triage categories, and imaging requests for these patients. The imaging component of the total ED LOS was compared for patients who met the 4-hour target and patients who did not. Compared to 2011 (before the 4-hour rule), ED presentations increased 4.74% in 2012, 12.7% in 2013, 21.28% in 2014 (p<0.01). Total imaging requests increased 23.05% in 2012, 48.04% in 2013, 60.77% in 2014 (p<0.01). For patients breaching the 4-hour rule, the mean time before radiology request was 2.4-2.8 hours mean time from imaging request to completion was 1.2-1.3 hours mean time from imaging completion to discharge from ED was the longest component of ED LOS (4.9-5.9 hours). There has been a significant increase in imaging requests, with a trend towards more CT and less radiography requests. Imaging requests for patients who breached the 4-hour target were made on average 2.4-2.8 hours after triage and average time after imaging in itself, exceeded 4 hours. Imaging is not likely a causative factor for patients breaching the 4-hour target.
Publisher: Wiley
Date: 27-01-2023
Publisher: Annals of Laboratory Medicine
Date: 2013
Publisher: BMJ
Date: 2018
Publisher: Wiley
Date: 26-11-2017
Abstract: The Sepsis-3 task force recommends the use of the quick Sequential Organ Failure Assessment (qSOFA) score to identify risk for adverse outcomes in patients presenting with suspected infection. Lactate has been shown to predict adverse outcomes in patients with suspected infection. The aim of the study is to investigate the utility of a post hoc lactate threshold (≥2 mmol/L) added qSOFA score (LqSOFA Retrospective cohort study was conducted on a merged dataset of suspected or proven sepsis patients presenting to ED across multiple sites in Australia and The Netherlands. Patients are identified as candidates for quality improvement initiatives or research studies at respective sites based on local screening procedures. Data-sharing was performed across sites of demographics, qSOFA, SOFA, lactate thresholds and outcome data for included patients. LqSOFA In a merged dataset of 12 555 patients where a full qSOFA score and outcome data were available, LqSOFA The lactate ≥2 mmol/L threshold-based LqSOFA
Publisher: Wiley
Date: 12-2010
DOI: 10.1111/J.1742-6723.2010.01349.X
Abstract: To determine whether CO₂ GAP [(a-ET) PCO₂] value differs consistently in patients presenting with shortness of breath to the ED requiring ventilatory support. To determine a cut-off value of CO₂ GAP, which is consistently associated with measured outcome and to compare its performance against other derived variables. This prospective observational study was conducted in ED on a convenience s le of 412 from 759 patients who underwent concurrent arterial blood gas and ETCO₂ (end-tidal CO₂) measurement. They were randomized to test s le of 312 patients and validation set of 100 patients. The primary outcome of interest was the need for ventilatory support and secondary outcomes were admission to high dependency unit or death during stay in ED. The randomly selected training set was used to select cut-points for the possible predictors that is, CO₂ GAP, CO₂ gradient, physiologic dead space and A-a gradient. The sensitivity, specificity and predictive values of these predictors were validated in the test set of 100 patients. Analysis of the receiver operating characteristic curves revealed the CO₂ GAP performed significantly better than the arterial-alveolar gradient in patients requiring ventilator support (area under the curve 0.950 vs 0.726). A CO₂ GAP ≥10 was associated with assisted ventilation outcomes when applied to the validation test set (100% sensitivity 70% specificity). The CO₂ GAP [(a-ET) PCO₂] differs significantly in patients requiring assisted ventilation when presenting with shortness of breath to EDs and further research addressing the prognostic value of CO₂ GAP in this specific aspect is required.
Publisher: Wiley
Date: 20-05-2013
Abstract: Blood pressure (BP) cuffs are potential vectors for transmission of multi-resistant organisms (MROs). The present study aims to determine MRO colonisation rates in BP cuffs from areas of high patient flow as an assessment of the quality of disinfection and infection control practices. BP cuffs in the ED, high dependency unit (HDU) and operating theatres (OT) were prospectively examined after routine disinfection procedures. Swabs collected from the inner and outer surfaces of BP cuffs during inter-patient intervals were plated onto replicate organism detection and counting, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) chromogenic agar plates to detect rates of bacterial, MRSA and VRE colonisation, respectively. High bacterial colonisation rates were detected in BP cuffs from all three areas. BP cuffs from OT were significantly less colonised compared with cuffs from HDU and ED 76% versus 96% and 100% (P < 0.0001) for inner surfaces and 86% versus 98% and 100% (P < 0.0001) for outer surfaces, respectively. Equivalent or higher bacterial growth was observed on the inner surface compared with outer surface in 54%, 84% and 86% of BP cuffs from OT, HDU and ED, respectively. MRSA was detected in 3 of 150 (2%) swabs collected, but no VRE was detected. Although MRSA and VRE were infrequently isolated, current disinfection and infection control protocols need to be improved given the greater recovery of organisms from the inner compared with outer surfaces of BP cuffs.
Publisher: Wiley
Date: 20-08-2018
Abstract: To compare patient satisfaction levels, staff perspectives and the time required using Structured Interdisciplinary Bedside Rounds (SIBR Emory University, Atlanta, GA, USA) versus traditional medical ward rounds (TR) in the ED. We conducted an observational cross-sectional study. Ward rounds were categorised into a modified SIBR and TR at a tertiary ED in Australia according to predefined criteria. We compared the duration of ward rounds, invited patients and staff to complete anonymous questionnaires to compare patient satisfaction and staff perspectives. During the study period, SIBR group took significantly longer time than TR per patient (122 vs 88 s, P < 0.001). Patient questionnaires were completed for 320 encounters (101 SIBR, 219 TR). Patient satisfaction scores across all measured domains were significantly higher in SIBR than in the TR group. Patients often pointed out a lack of communication with medical staff during TR. Based on 131 completed staff questionnaires, nurses reported SIBR to be more useful than TR (nurses 78% vs doctors 44%, P = 0.001). The SIBR group had increased instances of staff introductions to patients (91% vs 66%, P < 0.001) and patients' involvement in discussion of management plans (98% vs 53%, P < 0.01). SIBR only weakly correlated with the overall positive experience in the ED (r = 0.19, P = 0.001). Organisational implementation issues raised through qualitative methods are reported in the paper. Our study highlights the benefits that could be gained through SIBR technique over the TR method. Better workforce and resource planning is needed to support the sustainable implementation of SIBR in ED.
Publisher: BMJ
Date: 16-05-2014
Publisher: Wiley
Date: 16-01-2018
Abstract: Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplicated infection (i.e. without organ dysfunction) and/ or risk stratification. Appropriate s le collection for microbiological testing remains key for subsequent confirmation of diagnosis and rationalisation of antimicrobials. Routine laboratory investigations such as creatinine, bilirubin, platelet count and lactate are now critical elements in the diagnosis of sepsis and septic shock. With no biomarker sufficiently validated to rule out bacterial infection in the ED, there remains substantial interest in biomarkers representing various pathogenic pathways. New technologies for screening multiple genes and proteins are identifying unique network 'signatures' of clinical interest. Other future directions include rapid detection of bacterial DNA in blood, genes for antibiotic resistance and EMR-based computational biomarkers that collate multiple information sources. Reliable, cost-effective tests, validated in the ED to promptly and accurately identify sepsis, and to guide initial antibiotic choices, are important goals of current research efforts.
Publisher: Wiley
Date: 23-03-2018
Abstract: Pain management and patient satisfaction are key markers for health systems performance. There is a lack of consensus on the role of analgesia, its adequacy, and its links to patient satisfaction in the ED. The present study aimed to assess the relationship between adequacy of analgesia and patient satisfaction in the ED setting. Consenting adult patients (n = 115) presenting to the ED with pain were enrolled, and their pain tracked throughout admission with 11 point numerical pain scores. Eleven point numerical scores were also utilised to measure satisfaction and compassion at the end of each ED stay. The primary outcome was patient satisfaction score ≥7. Of 115 enrolled patients, 94 (81.7%) were eligible for analysis. Median time to physician evaluation was 54.0 min (inter-quartile range [IQR] 35.0-98.0) and median ED length of stay was 205 min (IQR 129.0-280.0). Fifty-four patients (57.5%) received analgesia during their stay, of whom 36 (38.3%) had a significant response to analgesia (≥2 change in pain score). Median time to analgesia was 87.5 min (IQR 66.1-108.9). Patient satisfaction was inversely associated with male sex, and positively correlated (Spearman's rank correlation P < 0.05) with increasing age, significant change in pain score (±2) and compassion scores. In the present study of patients presenting to the ED with pain, oligoanalgesia remains a significant issue. Male sex was inversely associated with satisfaction, whereas compassion, and significant change in pain score were associated with improved patient satisfaction. Of the factors analysed, staff compassion demonstrated the strongest correlation with satisfaction.
Publisher: Wiley
Date: 19-11-2014
Abstract: 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 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.
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: Wiley
Date: 02-08-2017
Abstract: Age-related policies allow adolescents to access paediatric and adult EDs. Anecdotally, paediatric and adult EDs report challenges when caring for older and younger adolescents, respectively. Our aim was to describe the characteristics of an adolescent population attending an adult ED, co-located with a tertiary paediatric ED. The Westmead Hospital ED database was accessed for 14.5-17.9 years old presentations between January 2010 and December 2012. Patient diagnosis coding (SNOMED) was converted to ICD-10. De-identified data were transferred into Microsoft Excel with analysis performed using spss V22. There were 5718 presentations made to the Westmead Hospital, Sydney, Australia ED by 4450 patients, representing 3.3% (95% CI 3.2-3.4) of total visits from all patients 14.5 years and above. The mean age of the s le was 16.6 years (male 51.8%). Presentations triaged as level 4 or 5 represented 61.0% (95% CI 58.7-61.3) of visits. The proportion of patients who did not wait to receive care was 13.8% (95% CI 12.9-14.7), which was significantly higher than adult rates (P < 0.01). There were 279 unscheduled return visits (visits made <72 h of discharge) representing 4.9% (95% CI 4.4-5.8) of all presentations. Injury was the most common diagnosis (30.2%, 95% CI 28.8-31.6). Chronic physical illness and alcohol-related visits comprised 2.1% (95% CI 1.7-2.5) and 0.8% (95% CI 0.6-1.0) of adolescent presentations, respectively. Contrary to reported staff perceptions, adolescent chronic physical illness presentations were not a major burden. Alcohol was likely under-recorded as a contributing factor to presentations.
Publisher: Wiley
Date: 02-11-2017
Abstract: Sepsis has recently been redefined as acute organ dysfunction due to infection. The ED plays a critical role in identifying patients with sepsis. This is challenging due to the heterogeneity of the syndrome, and the lack of an objective standard diagnostic test. While overall mortality rates from sepsis appear to be falling, there is an increasing burden of morbidity among survivors. This largely reflects the growing proportion of older patients with comorbid illnesses among those treated for sepsis.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.AENJ.2014.07.003
Abstract: Emergency departments (ED) continue to evolve models of care and streaming as interventions to tackle the effects of access block and overcrowding. Tertiary ED may be able to design patient-flow based on predicted dispositions in the department. Segregating discharge-stream patients may help develop patient-flows within the department, which is less affected by availability of beds in a hospital. We aim to determine if triage nurses and ED doctors can predict disposition outcomes early in the patient journey and thus lead to successful streaming of patients in the ED. During this study, triage nurses and ED doctors anonymously predicted disposition outcomes for patients presenting to triage after their brief assessments. Patient disposition at the 24-h post ED presentation was considered as the actual outcome and compared against predicted outcomes. Triage nurses were able to predict actual discharges of 445 patients out of 490 patients with a positive predictive value (PPV) of 90.8% (95% CI 87.8-93.2%). ED registrars were able to predict actual discharges of 85 patients out of 93 patients with PPV of 91.4% (95% CI 83.3-95.9%). ED consultants were able to predict actual discharges of 111 patients out of 118 patients with PPV 94.1% (95% CI 87.7-97.4%). PPVs for admission among ED consultants, ED registrars and Triage nurses were 59.7%, 54.4% and 48.5% respectively. Triage nurses, ED consultants and ED registrars are able to predict a patient's discharge disposition at triage with high levels of confidence. Triage nurses, ED consultants, and ED registrars can predict patients who are likely to be admitted with equal ability. This data may be used to develop specific admission and discharge streams based on early decision-making in EDs by triage nurses, ED registrars or ED consultants.
Publisher: Wiley
Date: 26-12-2022
DOI: 10.5694/MJA2.51828
Publisher: Wiley
Date: 12-12-2023
Abstract: To investigate the association between the timing and adequacy of antibiotics administered to patients presenting with culture‐positive sepsis and septic shock to the ED and in‐hospital mortality and/or intensive care unit (ICU) admission. Multicentre retrospective cohort study of ED presentations at four metropolitan hospitals in Sydney, Australia between January 2017 and November 2019. Encounters for patients aged ≥16 years meeting specified criteria for sepsis or septic shock with antibiotic administration within the first 6 h of presentation were included. Of 7611 encounters included in the study, 2328 (31%) were culture positive, and 2228 (29%) met the criteria for septic shock. In culture‐positive sepsis encounters, partial or inadequate antibiotic coverage was associated with higher risk of death or ICU admission (adjusted odds ratio [AOR] 1.50, 95% confidence interval [CI] 1.04–2.06 and 1.95, 95% CI 1.28–2.99, respectively). This effect was not significant in septic shock encounters (AOR 1.10, 95% CI 0.64–1.88) with partial coverage and (AOR 1.63, 95% CI 0.81–3.3) inadequate coverage. Time to antibiotics was not significantly associated with the risk of mortality/ICU admission. This inference remained the same when analysis was restricted to cases with adequate antibiotic coverage. In a large multicentre s le of patients with culture‐positive sepsis, inadequacy of antibiotics was associated with higher risk of in‐hospital mortality or ICU admission.
Publisher: Wiley
Date: 16-03-2016
Abstract: Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations. We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were classified based on the aim of consultation and deemed as 'positive', 'neutral' or 'negative' based on the perceptions of the consulting doctor. Training levels, time bands and specialty data were collected for both consulting and consulted parties. Fifty-seven of 714 included consultations (7.98%, 95% CI 6.2-10.2%) were reported as negative by ED medical staff. Factors associated with significant incidence of negative grading of consultation involved requests for investigations (19.3% vs 5.3%, P 4 (9.1% vs 3.8%, P < 0.01) and those involving radiology specialty (18% vs 5.32%, P < 0.01). The risk was lower when the consulted professional was a specialist medical practitioner as compared to specialist trainee (4.1% vs 9.4%, P = 0.02). Multiple logistical modelling suggests that female (adjusted OR 2.4, 95% CI 1.1-5.2) medical staff are more likely to report perceived incivility during ED phone consultations. Perceived incivility occurs infrequently during ED phone consultations. ED female medical staff are at an increased risk of perceived incivility during phone consultations with non-ED medical professionals. Health organisations should actively pursue programmes to investigate the occurrence of incivility during healthcare consultations and implement programmes to mitigate the risk of developing a negative workplace culture.
Publisher: Wiley
Date: 13-05-2018
Abstract: The arterial to end-tidal carbon dioxide tension difference (CO Patients presenting to tertiary Australian ED with suspected sepsis (n = 215) underwent near-simultaneous end-tidal carbon dioxide and partial pressure of carbon dioxide measurements. We investigated the correlation of CO Among patients included in the analysis (n = 165), the CO In this pilot study of patients with suspected sepsis from non-respiratory causes, an increased CO
Location: Australia
No related grants have been discovered for Amith Shetty.