ORCID Profile
0000-0002-4536-1358
Current Organisations
Canberra Hospital
,
Australian National University
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Publisher: Cold Spring Harbor Laboratory
Date: 31-03-2019
DOI: 10.1101/594457
Abstract: Adult lung function is highly heritable and 279 genetic loci were recently reported as associated with spirometry-based measures of lung function. Though lung development and function differ between males and females throughout life, there has been no genome-wide study to identify genetic variants with differential effects on lung function in males and females. Here, we present the first genome-wide genotype-by-sex interaction study on four lung function traits in 303,612 participants from the UK Biobank. We detected five SNPs showing genome-wide significant (P × 10 −8 ) interactions with sex on lung function, as well as 21 suggestively significant interactions (P × 10 −6 ). The strongest sex interaction signal came from rs7697189 at 4:145436894 on forced expiratory volume in 1 second (FEV 1 ) (P = 3.15 × 10 −15 ), and was replicated (P = 0.016) in 75,696 in iduals in the SpiroMeta consortium. Sex-stratified analyses demonstrated that the minor (C) allele of rs7697189 increased lung function to a greater extent in males than females (untransformed FEV 1 β = 0.028 [SE 0.0022] litres in males vs β = 0.009 [SE 0.0014] litres in females), and this effect was not accounted for by differential effects on height, smoking or age at puberty. This SNP resides upstream of the gene encoding hedgehog-interacting protein ( HHIP ) and has previously been reported for association with lung function and HHIP expression in lung tissue. In our analyses, while HHIP expression in lung tissue was significantly different between the sexes with females having higher expression (most significant probeset P=6.90 × 10 −6 ) after adjusting for age and smoking, rs7697189 did not demonstrate sex differential effects on expression. Establishing the mechanism by which HHIP SNPs have different effects on lung function in males and females will be important for our understanding of lung health and diseases, such as chronic obstructive pulmonary disease (COPD), in both sexes.
Publisher: AMPCo
Date: 03-2006
DOI: 10.5694/J.1326-5377.2006.TB00204.X
Abstract: To quantify any relationship between emergency department (ED) overcrowding and 10-day patient mortality. Retrospective stratified cohort analysis of three 48-week periods in a tertiary mixed ED in 2002-2004. Mean "occupancy" (a measure of overcrowding based on number of patients receiving treatment) was calculated for 8-hour shifts and for 12-week periods. The shifts of each type in the highest quartile of occupancy were classified as overcrowded. All presentations of patients (except those arriving by interstate ambulance) during "overcrowded" (OC) shifts and during an equivalent number of "not overcrowded" (NOC) shifts (same shift, weekday and period). In-hospital death of a patient recorded within 10 days of the most recent ED presentation. There were 34 377 OC and 32 231 NOC presentations (736 shifts each) the presenting patients were well matched for age and sex. Mean occupancy was 21.6 on OC shifts and 16.4 on NOC shifts. There were 144 deaths in the OC cohort and 101 in the NOC cohort (0.42% and 0.31%, respectively P=0.025). The relative risk of death at 10 days was 1.34 (95% CI, 1.04-1.72). Subgroup analysis showed that, in the OC cohort, there were more presentations in more urgent triage categories, decreased treatment performance by standard measures, and a higher mortality rate by triage category. In this hospital, presentation during high ED occupancy was associated with increased in-hospital mortality at 10 days, after controlling for seasonal, shift, and day of the week effects. The magnitude of the effect is about 13 deaths per year. Further studies are warranted.
Publisher: Wiley
Date: 03-2016
DOI: 10.5694/MJA15.00858
Abstract: To survey emergency department (ED) clinical staff about their perceptions of alcohol-related presentations. A mixed methods online survey of ED clinicians in Australia and New Zealand, conducted from 30 May to 7 July 2014. The frequency of aggression from alcohol-affected patients or their carers experienced by ED staff the perceived impact of alcohol-related presentations on ED function, waiting times, other patients and staff. In total, 2002 ED clinical staff completed the survey, including 904 ED nurses (45.2%) and 1016 ED doctors (50.7%). Alcohol-related verbal aggression from patients had been experienced in the past 12 months by 97.9% of respondents, and physical aggression by 92.2%. ED nurses were the group most likely to have felt unsafe because of the behaviour of these patients (92% reported such feelings). Alcohol-related presentations were perceived to negatively or very negatively affect waiting times (noted by 85.5% of respondents), other patients in the waiting room (94.4%), and the care of other patients (88.3%). Alcohol-affected patients were perceived to have a negative or very negative impact on staff workload (94.2%), wellbeing (74.1%) and job satisfaction (80.9%). Verbal and physical aggression by alcohol-affected patients is commonly experienced by ED clinical staff. This has a negative impact on the care of other patients, as well as on staff wellbeing. Managers of health services must ensure a safe environment for staff and patients. More importantly, a comprehensive public health approach to changing the prevailing culture that tolerates alcohol-induced unacceptable behaviour is required.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.INJURY.2011.10.025
Abstract: Little is known about the contribution of protective clothing worn in motorcycle crashes to subsequent health-related outcomes, impairment and quality of life. A prospective cohort of 212 adult motorcyclists were recruited following presentations to hospitals or crash repair services in a defined geographic area in Australia between June 2008 and July 2009. Data was obtained from participant interviews and medical records at baseline, then by mailed survey two and six months post-crash (n=146, 69%). The exposure factor was usage of protective clothing classified as full protection (motorcycle jacket and pants), partial protection (motorcycle jacket) and unprotected (neither). Outcomes of interest included general health status (Short Form SF-36), disability (Health Assessment Questionnaire) treatment and recovery progress, quality of life and return to work in the six months post-crash. Odds ratios (OR) were estimated for categorical outcomes using multiple logistic regression to assess differences in outcomes associated with levels of protection adjusted for potential confounders including age, sex, occupation, speed and type of impact. Non-parametric procedures were used for data that was not normally distributed. Compared to unprotected riders, both fully and partially protected riders had fewer days in hospital and reported less pain immediately post-crash at two months both protection groups were less likely to have disabilities or reductions in physical function. By six months there were no significant differences in disability or physical function between groups, but both protection groups were more likely to be fully recovered and returned to pre-crash work than unprotected riders. Fully protected riders achieved better outcomes than either partially or unprotected riders on most measures. There were few significant differences between the full and partial protection groups although the latter showed greater impairment in physical health two months post-crash. We found strong associations between use of protective clothing and mitigation of the consequences of injury in terms of post-crash health and well-being. Given this evidence it seems likely that the use of protective clothing will confer significant benefits to riders in the event of a crash.
Publisher: Wiley
Date: 02-1998
DOI: 10.1111/J.1553-2712.1998.TB02599.X
Abstract: To examine the consistency of Australasian National Triage Scale (NTS) categorization in a large hospital ED, especially in relation to daily activity. This was a prospective, observational study of the relationship between NTS category, presenting features, and disposition in a large Australian adult ED. The "admission rate" was defined as the percentage of presentations whose dispositions were recorded as admitted to hospital, transferred to another hospital for admission, or died in the ED. A "busy" weekday was defined as one during which > 140 presentations were recorded in the 24 hours from midnight. For a "busy" weekend day, a figure of 100 presentations in 24 hours was used. "Nonbusy" days were defined as those during which presentation numbers were less than or equal to these thresholds. Data describing triage and disposition were available for 94,681 presentations in the 2-year period, representing 100% of ED presentations. "Busy" weekday admission rates in the 5 triage categories were 93.2%, 67.6%, 43.6%, 15.4%, and 1.6%, respectively. "Nonbusy" weekday admission rates were 91.4%, 68.3%, 43.7%, 15.6%, and 2.0%. Weekend days had a higher admission rate in NTS category 4 and 5 patients, but none of the differences between "busy" and "nonbusy" days reached statistical significance at the 0.05 level. Admission rates varied according to the time of day of presentation and increased with age, but did not change significantly over the 2 years of the study. In this ED, triage categorization according to the Australasian NTS does not vary with daily activity and has been consistent over time. Further study in other settings is required, particularly to identify variation dependent on the presenting population.
Publisher: Wiley
Date: 03-0088
Publisher: AMPCo
Date: 11-2006
DOI: 10.5694/J.1326-5377.2006.TB00668.X
Abstract: Existing trauma registries in Australia and New Zealand play an important role in monitoring the management of injured patients. Over the past decade, such monitoring has been translated into changes in clinical processes and practices. Monitoring and changes have been ad hoc, as there are currently no Australasian benchmarks for "optimal" injury management. A binational trauma registry is urgently needed to benchmark injury management to improve outcomes for injured patients.
Publisher: AMPCo
Date: 04-2010
Publisher: Wiley
Date: 28-11-2018
Abstract: To assess utility and accuracy of general observation modified early warning score charts and compare sensitivity and specificity of single- and multiple-parameter-based trigger scores on patient outcomes in the ED. Retrospective cohort clinical audit of all adult Modified Early Warning Score charts in the ED of a mixed tertiary hospital over 4 weeks. Data extracted included recorded parameters required to calculate Modified Early Warning Score and evidence of response. Of 5901 ED presentations, medical records system identified 2482 Modified Early Warning Score 347 were missing or blank. Of 2135 Modified Early Warning Score charts, 19.5% contained a calculation error, 51.9% had one or more missing parameters and 36.6% did not have usual/target systolic blood pressure recorded with 25.1% (95% confidence interval [CI] 23.3-27.0) charts correctly completed. Four hundred and forty-three had a single-abnormal parameter of which chart review showed 96.6% (94.5-97.3) were identified as abnormal by nurses with 25.7% (21.9-30.0) only 5.6% (3.9-8.2) had evidence of recognition by medical staff. Modified Early Warning Score sensitivity and specificity for ward admission was 14.7% and 96.1%, respectively. Modelling using the dataset of a single-abnormal parameter suggested sensitivity and specificity of 31.6% and 85.8%, respectively. This study highlights serious deficiencies in documentation of abnormal parameters and emergency response. It has also shown poor accuracy of both single- and multiple-parameter-based trigger scores in predicting patient outcomes within the ED. However, single-parameter-based trigger scores are twice as sensitive as total Modified Early Warning Score for admission and reduces documentation error by 23%.
Publisher: Wiley
Date: 12-06-2019
Abstract: To quantify the direct cost of alcohol-related presentations to Royal Perth Hospital ED, as part of the binational Alcohol Harm in Emergency Departments study. Secondary analysis of a prospective observational study of all ED presentations over a 168-h period in December 2014. Direct costs for health service usage were based on activity-based costing methodologies from the Royal Perth Hospital Business Intelligence Unit. Patients were classified as either alcohol positive or alcohol negative (using predetermined criteria) to determine the direct cost of these presentations. Of the 213 alcohol-positive presentations in the original study, 206 had costing data available. Direct cost of care in the ED for alcohol-positive patients was $121 619 across all age groups during the study week (annual estimate $6.3 million). This cost was largely driven by injuries. On average, the direct cost of care in the ED was $590 per alcohol-positive and $575 per alcohol-negative patient. Costs of care provided in the ED were largely attributable to ED (72%) and radiology (17%) services. Extrapolation using mean costs for the patients without costing data, the study week cost was $144 629, with the annual estimate $7.5 million. Alcohol-related presentations to the ED are a significant public health burden. If the study week is representative, the annual cost is substantial. Although the direct mean cost of presentations to the ED is similar between alcohol-positive and alcohol-negative patients, these presentations would not have occurred without the influence of alcohol.
Publisher: Wiley
Date: 08-2011
Publisher: Wiley
Date: 24-07-2019
Abstract: To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi-level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short-stay admission (≤24 h), >24 h admissions, unplanned ED re-attendances within 7 days and 'left at own risk' (including 'did not wait for assessment'). Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24 P < 0.001) and access block decreased (OR = 0.41 and 0.22 P 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short-stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re-attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time-based measures. Significant increases in short-stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re-attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.
Publisher: Wiley
Date: 12-2011
DOI: 10.1111/J.1553-2712.2011.01235.X
Abstract: The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States through health policy interventions and hospital operational changes.
Publisher: AMPCo
Date: 02-2012
DOI: 10.5694/MJA12.10003
Publisher: Wiley
Date: 04-2010
DOI: 10.1111/J.1742-6723.2010.01270.X
Abstract: Prospective and retrospective access block hospital intervention studies from 1998 to 2008 were reviewed to assess the evidence for interventions around access block and ED overcrowding, including over 220 documents reported in Medline and data extracted from The State of our Public Hospitals Reports. There is an estimated 20-30% increased mortality rate due to access block and ED overcrowding. The main causes are major increases in hospital admissions and ED presentations, with almost no increase in the capacity of hospitals to meet this demand. The rate of available beds in Australia reduced from 2.6 beds per 1000 (1998-1999) to 2.4 beds per 1000 (2002-2007) in 2002, and has remained steady at between 2.5-2.6 beds per 1000. In the same period, the number of ED visits increased over 77% from 3.8 million to 6.74 million. Similarly, the number of public hospital admissions increased at an average rate of 3.4% per year from 3.7 to 4.7 million. Compared with 1998-1999 rates, the number of available beds in 2006-2007 is thus similar (2.65 vs 2.6 beds per 1000), but the number of ED presentations has almost doubled. All patient groups are affected by access block. Access block interventions may temporarily reduce some of the symptoms of access block, but many measures are not sustainable. The root cause of the problem will remain unless hospital capacity is addressed in an integrated approach at both national and state levels.
Publisher: AMPCo
Date: 03-2011
Publisher: Wiley
Date: 13-11-2014
DOI: 10.5694/MJA14.00344
Abstract: To determine the proportion of alcohol-related presentations to emergency departments (EDs) in Australia and New Zealand, at a single time point on a weekend night shift. A point prevalence survey of ED patients either waiting to be seen or currently being seen conducted at 02:00 local time on 14 December 2013 in 106 EDs in Australia and New Zealand. The number of ED presentations that were alcohol-related, defined using World Health Organization ICD-10 codes. At the 106 hospitals (92 Australia, 14 New Zealand) that provided data, 395 (14.3% 95% CI, 13.0%-15.6%) of 2766 patients in EDs at the study time were presenting for alcohol-related reasons 13.8% (95% CI, 12.5%-15.2%) in Australia and 17.9% (95% CI, 13.9%-22.8%) in New Zealand. The distribution was skewed left, with proportions ranging from 0 to 50% and a median of 12.5%. Nine Australian hospitals and one New Zealand hospital reported that more than a third of their ED patients had alcohol-related presentations the Northern Territory (38.1%) and Western Australia (21.1%) reported the highest proportions of alcohol-related presentations. One in seven ED presentations in Australian and New Zealand at this 02:00 snapshot were alcohol-related, with some EDs seeing more than one in three alcohol-related presentations. This confirms that alcohol-related presentations to EDs are currently underreported and makes a strong case for public health initiatives.
Publisher: Informa UK Limited
Date: 26-11-2013
DOI: 10.1080/15389588.2013.781591
Abstract: Cyclists are increasingly overrepresented in traffic crash casualties in Australia. There is evidence that better cycling infrastructure increases participation, but whether it reduces the numbers of injured cyclists is less clear. This study examined injury outcomes of crashes in different cycling environments. Adult cyclists injured on- and off-road were recruited from emergency departments from November 2009 to May 2010 in the Australian Capital Territory. Eligible participants (n = 313/372, 84.1%) were interviewed and their injury self-reports were corroborated with medical records where available. Participants who had crashed in transport-related areas (n = 202, 64.5%) are the focus of this article. Participants had crashed in traffic (39.1%), in cycle lanes (7.9%), on shared paths (36.1%), and on footpaths (16.8%). Based on average weekly traffic counts, the crash involvement rate per 1000 cyclists was 11.8 on shared paths compared to 5.8 on cycle lanes. Over half of the participants (52.0%) were injured in single-vehicle bicycle crashes. The remainder involved other road users, including motor vehicles (20.8%), other bicycles (18.8%), pedestrians (6.4%), and animals (2.0%). Pedestrians were involved in 16.4 percent of crashes on shared paths. Minor injuries (Abbreviated Injury Scale [AIS] 1) were sustained by 58.4 percent of cyclists, moderately severe injuries (AIS 2) were sustained by 36.1 percent of cyclists, and 5.4 percent of cyclists were seriously injured (AIS 3+). The average treatment required was 1.8 days with 7.5 days off work and cost to the cyclist of $869 excluding medical treatment. Cyclists who crashed on shared paths or in traffic had higher injury severity scores (ISS 4.4, 4.0) compared to those in cycle lanes or on footpaths (3.3, 3.4) and required more treatment days (2.8, 1.7 versus 0.0, 0.2). Fewer cyclists were injured in on-road cycle lanes than in other cycling environments, and a high proportion of injuries were incurred on shared paths. This study highlights an urgent need to determine appropriate criteria and management strategies for paths classified as suitable for shared or segregated usage. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental files.
Publisher: Wiley
Date: 05-04-2017
Abstract: The objective of this study was to determine the impact of a management-supported, multimodal, hospital-wide intervention on ED crowding and quality measures. This is a prospective descriptive study of the first 20 weeks of the intervention, with 3 years of historical controls. The study was conducted in a 600 bed adult aediatric tertiary hospital with 80 000 ED presentations annually. ED information system data were collected on all presentations in matched 20 week periods. Multiple interventions included ED Navigator role, ED Medical Staff teaming, corporate focus with key performance indicators and dashboards, appointment of a Director of Operations, Long Length of Stay Committee and reorganisation of the flow (bed management) unit. Process outcomes were 4 h performance as a proportion of all patients and mean daily length of crowding with more than 10 inpatients awaiting beds expressed as a time. Quality outcomes were proportions of patients who did not wait and who re-presented within 72 h. There was a 9.1% increase in presentations and a 22.6% decrease in mean ED occupancy over the previous year. The 4 h performance improved from 56.1% (95% confidence interval [CI] 55.5-56.7) to 68.8% (95% CI 68.3-69.3) and daily crowding with more than 10 inpatients improved from 6:34 (95% CI 5:32-7:37) to 0:29 (95% CI 0:15-0:42). Did not wait improved significantly from 5.1 to 3.0% and rate of representation did not change. This prospective study shows significant improvement in ED flow without compromise in quality measures from a hospital-wide intervention requiring minimal additional resources. Further research is required on sustainability and patient outcomes beyond the ED.
Publisher: AMPCo
Date: 02-2003
Publisher: Wiley
Date: 06-01-2018
DOI: 10.1111/ADD.14109
Abstract: Emergency department (ED) alcohol-related presentation data are not routinely collected in Australia and New Zealand. It is likely that previous research has underestimated the numbers of patients presenting with alcohol-related conditions. This study aimed to quantify the level of alcohol harm presenting to EDs in Australia and New Zealand [Correction added on 23 Jan 2018, after first online publication: The 'aims' section was missing and is updated in this version]. Multi-centre, prospective study. Patients were screened prospectively for alcohol-related presentations during a 7-day period in December 2014. Part 1 involved screening to determine alcohol-positive ED presentations and data collection of patient demographic and clinical information. Part 2 involved a consent-based survey conducted with patients aged ≥ 14 years to perform Alcohol Use Disorders Identification Test (AUDIT) scores. Eight EDs in Australia and New Zealand, representing differing hospital role delineations. A total of 8652 patients aged ≥ 14 years attended and 8435 (97.5%) were screened. The main outcome measure was the proportion of patients who had an alcohol-related presentation termed 'alcohol-positive', using pre-defined criteria. It included injuries, intoxication, medical conditions and injuries caused by an alcohol-affected third party. Secondary outcomes included demographic and clinical information, the type of alcohol-related presentations and AUDIT scores. A total of 801 [9.5% 95% confidence interval (CI) = 8.9-10.1%] presentations were identified as alcohol-positive, ranging between 4.9 and 15.2% throughout sites. Compared with alcohol-negative patients, alcohol-positive patients were more likely to be male [odds ratio (OR) = 1.90, 95% CI = 1.63-2.21], younger (median age 37 versus 46 years, P < 0.0001), arrive by ambulance (OR = 1.94, 95% CI = 1.68-2.25) or police/correctional vehicle (OR = 4.56, 95% CI = 3.05-6.81) and require immediate treatment (OR = 3.20, 95% CI = 2.03-05.06). The median AUDIT score was 16 (interquartile range = 10-24). Almost one in 10 presentations to emergency departments in Australia and New Zealand are alcohol related.
Publisher: Oxford University Press (OUP)
Date: 22-07-2005
DOI: 10.1093/QJMED/HCI102
Abstract: Activated charcoal (AC) is commonly used for the routine management of oral drug overdose. To determine whether the routine use of activated charcoal has an effect on patient outcomes. Randomized controlled unblinded trial. We recruited all adult patients presenting with an oral overdose at The Canberra Hospital, excluding only transfers, late presenters, those who had ingested drugs not adsorbed by activated charcoal or where administration was contraindicated, and very serious ingestions (at the discretion of the admitting physician). Patients were randomized to either activated charcoal or no decontamination. The trial recruited 327 patients over 16 months. Of 411 presentations, four refused consent, 27 were protocol violations and 53 were excluded from the trial. Only seven were excluded due to the severity of their ingestion. The most common substances ingested were benzodiazepines, paracetamol and selective serotonin reuptake inhibitor antidepressants. More than 80% of patients presented within 4 h following ingestion. There were no differences between AC and no decontamination in terms of length of stay (AC 6.75 h, IQR 4-14 vs. controls 5.5 h, IQR 3-12 p=0.11) or secondary outcomes including vomiting, mortality and intensive care admission. Routine administration of charcoal following oral overdose did not significantly influence length of stay or other patient outcomes following oral drug overdose. There were few adverse events. This does not exclude a role in patients who present shortly after ingestion of highly lethal drugs.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.AAP.2011.04.027
Abstract: Apart from helmets, little is known about the effectiveness of motorcycle protective clothing in reducing injuries in crashes. The study aimed to quantify the association between usage of motorcycle clothing and injury in crashes. Cross-sectional analytic study. Crashed motorcyclists (n=212, 71% of identified eligible cases) were recruited through hospitals and motorcycle repair services. Data was obtained through structured face-to-face interviews. The main outcome was hospitalization and motorcycle crash-related injury. Poisson regression was used to estimate relative risk (RR) and 95% confidence intervals for injury adjusting for potential confounders. Motorcyclists were significantly less likely to be admitted to hospital if they crashed wearing motorcycle jackets (RR=0.79, 95% CI: 0.69-0.91), pants (RR=0.49, 95% CI: 0.25-0.94), or gloves (RR=0.41, 95% CI: 0.26-0.66). When garments included fitted body armour there was a significantly reduced risk of injury to the upper body (RR=0.77, 95% CI: 0.66-0.89), hands and wrists (RR=0.55, 95% CI: 0.38-0.81), legs (RR=0.60, 95% CI: 0.40-0.90), feet and ankles (RR=0.54, 95% CI: 0.35-0.83). Non-motorcycle boots were also associated with a reduced risk of injury compared to shoes or joggers (RR=0.46, 95% CI: 0.28-0.75). No association between use of body armour and risk of fracture injuries was detected. A substantial proportion of motorcycle designed gloves (25.7%), jackets (29.7%) and pants (28.1%) were assessed to have failed due to material damage in the crash. Motorcycle protective clothing is associated with reduced risk and severity of crash related injury and hospitalization, particularly when fitted with body armour. The proportion of clothing items that failed under crash conditions indicates a need for improved quality control. While mandating usage of protective clothing is not recommended, consideration could be given to providing incentives for usage of protective clothing, such as tax exemptions for safety gear, health insurance premium reductions and rebates.
Publisher: Wiley
Date: 24-11-2009
DOI: 10.1111/J.1742-6723.2009.01241.X
Abstract: Access block is the inability of ED patients requiring admission to access appropriate inpatient beds in a timely fashion, defined in Australasia as more than 8 h in the ED. The present study describes changes in prevalence of access block in Australia over a 4 year period. Email, telephone and fax survey of ED on six Mondays at 10.00 hours (31 May, 30 August 2004, 18 June, 3 September 2007, 2 June, 2 September 2008). Data collected included point data on the status of patients in the ED at the index time and of recent ED attendance numbers. Results were collated and analysed by state and hospital role delineation. Forty-eight (60%) of 80 eligible ED answered all six surveys. Presentations to the ED the day before rose 15% (P < 0.0001, paired t-test) in 4 years, and nationally access block patients in the ED rose an average of 27%, and patients waiting to be seen by a doctor 31%. There were differences between states, with hospitals in New South Wales reporting a significant reduction in access block patients (-51%, P= 0.0002), but all other states a significant increase (+45%, P= 0.001). There were differences by role delineation, with non-paediatric major referral hospitals experiencing the greatest access block, but smaller hospitals experiencing the greatest increase in patients waiting. Around one-third of all patients receiving care in these ED surveys were experiencing access block. There is evidence that flow through New South Wales ED has improved. The data suggest that most hospitals have passed the point of efficiency.
Publisher: Elsevier BV
Date: 04-2018
Publisher: Wiley
Date: 08-2009
DOI: 10.1111/J.1742-6723.2009.01201.X
Abstract: The present study aimed to identify any relationship between existing access block occupancy (ABO) at the time of patient presentation and delay to definitive procedure. Retrospective descriptive cohort study of all patients aged over 50 years with an ED diagnosis of fractured neck of femur admitted through a tertiary ED over 2 years. The independent variable was the ABO at the start of the hour in which the patient presented, derived from existing ED records, and expressed as the quartile for that hour of the day. The dependent variable was start of surgery more than 24 h after arrival without a documented reason for delay. The data abstractor was blinded to the ABO. All 442 diagnoses of fractured neck of femur recorded in the ED were reviewed, 73 were excluded (16 age, 5 misdiagnosis, 31 no surgery, 21 documented medical reasons for delay). There was a significant relationship between ABO quartile and the rate of delay to surgery ranging from 54% (95% CI 43-63%) for those presenting in the lowest ABO quartile to 77% (68-85%) in the highest (P= 0.006, chi(2)). Subgroup analysis showed that arrival ABO predicted patient access block, and that patient access block was associated with delay to surgery and longer postoperative length of stay (geometric mean 12.9 vs 9.9 days, P < 0.01, t-test). The number of access block patients at the time of arrival directly predicts delay to operation in this setting. This suggests that access block occupancy is a marker of hospital dysfunction.
Publisher: AMPCo
Date: 04-2009
DOI: 10.5694/J.1326-5377.2009.TB02451.X
Abstract: Overcrowding occurs when emergency department (ED) function is impeded, primarily by overwhelming of ED staff resources and physical capacity by excessive numbers of patients needing or receiving care. Access block occurs when there is excessive delay in access to appropriate inpatient beds (> 8 hours total time in the ED). Access block for admitted patients is the principal cause of overcrowding, and is mainly the result of a systemic lack of capacity throughout health systems, and not of inappropriate presentations by patients who should have attended a general practitioner. Overcrowding is most strongly associated with excessive numbers of admitted patients being kept in the ED. Excessive numbers of admitted patients in the ED are associated with diminished quality of care and poor patient outcomes. These include (but are not limited to) adverse events, errors, delayed time-critical care, increased morbidity and excess deaths (estimated as at least 1500 per annum in Australia). There is no evidence that telephone advice lines or collocated after-hours GP services assist in reducing ED workloads. Changes to ED structure and function do not address the underlying causes or major adverse effects of overcrowding. They are also rapidly overwhelmed by increasing access block. The causes of overcrowding, and hence the solutions, lie outside the ED. Solutions will mainly be found in managing hospital bedstock and systemic capacity (including the use of step-down and community resources) so that appropriate inpatient beds remain available for acutely sick patients.
Publisher: Wiley
Date: 08-1992
DOI: 10.5694/J.1326-5377.1992.TB137125.X
Abstract: To describe the characteristics of elderly patients presenting to an emergency department and the outcome for these patients at 90 days. Prospective, descriptive study of all patients over 75 years of age presenting in a four week period. Follow-up data were obtained from the case notes, the Registry of Deaths, the Geriatric Assessment Team and, where necessary, contact with the family doctor. The Department of Emergency Medicine at the Royal Hobart Hospital, Tasmania, in late 1989. Death or increased dependence as defined by permanent institutionalisation, moving in with family, or more than 90 days inpatient care. There were 210 presentations by 191 different patients 116 were admitted to our hospital (55.2%), and three (1.4%) to other hospitals. Follow-up data were obtained for all but five patients. At 90 days from first presentation 23 had died (12.4%) and in a further 19 (10.2%) their dependence had increased. Risk factors for death were fractured neck of femur or cardiac failure. Risk factors for either death or increased dependence were referral by someone outside the immediate family, neurological disease, cardiac failure, an apparent social lacement problem, and being assessed as needing admission. The strongest predictor was a social problem. Age was not a risk factor. A predictive formula for poor outcome in this group can be derived. However, outcome may not be altered by admission, or intervention. In the elderly, it is quality rather than duration of life which should be paramount in considering the benefits of therapy.
Publisher: Wiley
Date: 04-02-2021
Publisher: Elsevier BV
Date: 10-2018
Publisher: Wiley
Date: 30-07-2019
Abstract: Previous research reported strong associations between ED overcrowding and mortality. We assessed the effect of the Four-Hour Rule (4HR) intervention (Western Australia (WA) 2009), then nationally rolled out as the National Emergency Access Target (Australia 2012) policy on mortality and patient flow. A longitudinal cohort study of a population-wide 4HR, for 16 hospitals across WA, New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD). Mortality trends were analysed for 2-4 years before and after 4HR using interrupted time series technique. Main outcomes included the effect of 4HR on patient flow markers admitted 30 day mortality trends and patient flow marker performance during the study period. There were 40 281 deaths from 952 726 emergency admissions. All jurisdictions, except ACT, had improved flow and access block after 4HR. Age-standardised mortality was decreasing before the intervention. Post-intervention, WA had a significant reduction in mortality rate of -0.28 per 1000 patients per quarter (P = 0.040) while QLD had mixed results and NSW/ACT trends did not change significantly. Meta-regression of aggregated data for hospitals grouped on flow performances did not show significant mortality changes associated with the policy. The 4HR was introduced as a means of driving hospital performance by applying a time target. Patient flow improved, but the evidence for mortality benefit is controversial with improvement only in WA. Further research with more representative data from a larger number of hospitals over a longer time across Australia is needed to increase statistical power to detect long-term effects of the policy.
Publisher: AMPCo
Date: 07-2004
DOI: 10.5694/J.1326-5377.2004.TB06159.X
Abstract: On 18 January 2003, Canberra experienced major bushfires. Over 6 hours, The Canberra Hospital Emergency Department treated 139 patients, 105 with fire-related problems (mostly ophthalmological and respiratory), representing an additional workload of one patient every 4 minutes above average. Only 15% required hospital admission. We believe this is the largest single emergency department response to a disaster since Cyclone Tracy devastated Darwin in 1974, although the total severity of injury was relatively low. Major issues were communication difficulties and transport, with most patients (including the two most critically ill) arriving by private vehicle. Overall, medical outcomes were excellent, and the hospital system coped well.
Publisher: AMPCo
Date: 03-2010
Publisher: Wiley
Date: 06-2001
DOI: 10.1046/J.1442-2026.2001.00216.X
Abstract: To characterize the prerequisite experience and training undertaken by nurses for the role of triage in emergency departments in Australasia. Postal survey of charge nurses/unit nurse managers of all Australasian emergency departments accredited for specialist emergency physician training by the Australasian College for Emergency Medicine. The response rate was 89%. The most common duration of prerequisite experience was 12-18 months. Most programmes use a combination of educational activities, with self-directed learning packages, lectures and mentored experience being the most common. Three hospitals reported no preparation for triage. In Australasia, there is wide variability in required training and experience before triage duties are performed. Strategies to set suggested minimum standards in these areas and to make training activities more accessible are recommended.
Publisher: AMPCo
Date: 11-2002
DOI: 10.5694/J.1326-5377.2002.TB04917.X
Abstract: To investigate the relationship between access block in the emergency department (ED) (defined as total time from arrival to transfer from the ED over eight hours) and inpatient length of stay (LOS). Retrospective cohort study of all admissions through the ED to a tertiary hospital in Canberra, Australian Capital Territory, during 1999. Total time in the ED and LOS, calculated in days from ED departure to hospital discharge (non-overnight admissions were assigned LOS of one day, and all LOS were truncated at 10 days). 11 906 admissions were included, and 919 experienced access block (7.7%). Mean LOS was 4.9 days in those who experienced access block (95% CI, 4.7-5.1), compared with 4.1 days in the no-block group (95% CI, 4.0-4.2 P < 0.0001). Subgroup analysis showed that this "access block effect" occurred across different severities of illness and diagnoses. A strong relationship was found between longer LOS and arrival of access-block patients on the inpatient ward outside office hours (0800-1600 weekdays). This is the first study to show an association between access block and a measure of outcome outside the ED. If the effect of access block on LOS is reproduced in other settings, there are major implications for hospital management.
Publisher: AMPCo
Date: 11-2003
No related grants have been discovered for Drew Richardson.