Topics
Emergency medicine
The Hospital Skills Program: a professional development program for non-specialist doctors in New South Wales
To the Editor: We refer to the article by Leslie and colleagues1 and seek to clarify some comments regarding emergency medicine in New South Wales. The Australasian College for Emergency Medicine (ACEM) unreservedly supports the spread of specialist emergency medical services across all hospitals and does not limit vocational trainee numbers. In 2011, 286 Fellows of the ACEM and 191 advanced trainees were working across at least 472 ...
Alana M Killen · Sally M McCarthy · Anthony P Joseph · Andrew D Gosbell
The Hospital Skills Program: a professional development program for non-specialist doctors in New South Wales
In reply: The Hospital Skills Program (HSP) is a lifelong self-directed education process, across three levels of expertise. It aims to support the individual learning needs of all non-specialist doctors, wherever and however they practise. This includes facilitating access to quality local, college and university programs when relevant to need. The HSP thus applauds and is appreciative of all Australasian learned colleges in the provision of ...
Simon D Leslie · Mary Webber · Michael Boyd
The comparability of emergency department waiting time performance data
To the Editor: In their recent article on emergency department (ED) waiting time performance data, Greene and Hall1 proposed that “assigning patients to a less urgent triage category than is appropriate” is a possible explanation for observed variations in waiting time performance. In Australia, triage decisions are made on the basis of clinical urgency. The Australasian Triage Scale is underpinned by a robust body of research ...
Julie Considine · Ramon Z Shaban · Marie F Gerdtz · Dianne Crellin
The comparability of emergency department waiting time performance data
In reply: We thank Considine and colleagues for their interest in our recent article. Our research documented a relationship between the reported urgency mix of patients in emergency departments and waiting time performance, and we discussed possible explanations for the relationship, including “undertriaging”.1 We were explicit that the study did not provide evidence of undertriaging, but argued that it was a possibility worthy of consideration, ...
Jessica Greene · Jane Hall
General practice patients form an insignificant part of the emergency department workload
To the Editor: The recent Australian Institute of Health and Welfare (AIHW) statistics on emergency department (ED) care show that 38% of attendances from 1 July 2011 to 30 June 2012 were potential general practice presentations.1 This indicator is reported under the National Healthcare Agreement. Both the AIHW and Council of Australian Governments acknowledge that this method is flawed and have agreed to review this indicator.2 To date, this ...
Yusuf Nagree · Andrew D Gosbell · Daniel M Fatovich · Peter A Cameron · Sally M McCarthy · David Mountain
Emergency department presentations during the State of Origin rugby league series: a retrospective statewide analysis
An analysis of emergency department databases in Australia’s victorious rugby league football state reveals a dip in presentations of State of Origin game days. Do the findings have broader implications for workforce planning, and could a spate of losses have spurned different results?
Jeremy S Furyk MB BS, MPHTM, MSc(CT) · Jenine M Lawlor BPsych, MPsych · Richard Franklin BSc, MSocSci, PhD · Carl J O’Kane BSc(Med), MB BS, MClinEd · David A Kault BSc, MB BS, PhD · Colin J Banks MB BS, FACEM · Peter J Aitken MB BS, EMDM, MClinEd
Exploring the economics of helicopter rescue in Australia
Helicopter emergency medical services (HEMS) have a considerable history in Australia, with operations in Sydney dating back to 1973. HEMS have evolved from their original use in water-based search and rescue to become an established mode of medical transport in the local health system, helping to alleviate the “tyranny of distance” that restricts equitable access to health ...
Colman B Taylor BPhEd, MND · Stephen Jan BEc, MEc, PhD · John A Myburgh PhD, FCICM, FAICD
Appropriateness of healthdirect referrals to the emergency department compared with self-referrals and GP referrals
GP referrals had the highest level of appropriateness, and healthdirect- and self-referrals had similar levels of appropriateness. More than half the healthdirect-referred patients attended the ED despite a contrary recommendation, probably due to difficulty accessing after-hours health services.
Joseph Y Ng MB BS, FANZCA · Daniel M Fatovich MB BS, FACEM, PhD · Valendar F Turner MB BS, FRACS, FACEM · Jennifer A Wurmel RN · Sally A Skevington BWS(Hons) · Michael R Phillips BSc(Hons), MMedSci
Take a deep breath . . . and talk
Eighty fewer deaths were recorded in the year following the adoption of the 4-hour rule by the emergency departments (EDs) of three tertiary hospitals in Western Australia1 — equivalent to almost half the state road toll. This remarkable result is regarded by some as preliminary. But if it stands the test of time, it will be testament to what is achievable with good up-front resourcing from a health department, plus improved communication — in this case, between the ED and the wards ...
Rachel E Nowak BSc, MA, PhD
The definite health risks from cutting power outweigh possible bushfire prevention benefits
On 2 January 2012, during a period of extremely hot weather, a South Australian electricity distributor deliberately cut power to several thousand homes because it was concerned that its electricity assets might cause a bushfire. Its action raises an important question: when does the risk of electricity assets causing a bushfire outweigh the benefits of having a power supply? ...
Richard A Broome MA, MB BS, MSc · Wayne T Smith MPH, FAFPHM, PhD
Severe burns from alkali drain cleaner
To the Editor: Alkali drain cleaner has previously been reported to cause oral, oesophageal and cutaneous burns.-4 The risk of these cleaners causing full thickness cutaneous burns in children needs to be emphasised. Two toddlers recently presented to our hospital with severe burns after exposure to alkali drain cleaning products. An 18-month-old boy opened the box and bit open the silver foil packet of a foaming ...
Rachel A D’Cruz · Erik R La Hei · Andrew J A Holland
Carbon monoxide-induced death and toxicity from charcoal briquettes
This case highlights the problem of burning charcoal briquettes in a poorly ventilated space, which can generate toxic carbon monoxide (CO) concentrations.1 CO is a colourless, odourless and non-irritating gas with no warning properties. Sources of CO are related to incomplete combustion of carbon-containing materials under conditions of restricted oxygen supply, and include faulty furnaces, unflued heaters, compressors, wood-burning stoves, vehicle exhaust, welders, other petrol- or ...
Chris Winder BA(Hons), MSc, PhD
Sleep tight
DISTURBANCES OF SLEEP and daytime function are important diagnostic symptoms. Although most of us are well versed in the features and important impacts of sleep apnoea, a search for insomnia should be an indispensable part of most history-taking.Almost a third of our symptomatic patients present with symptoms of stress or mood disorder, where investigations of physical symptoms such as fatigue, dizziness, daily headache, chest pain ...
John M Worthington
Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia
CorrectionIncorrect reference: In “Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia” in the 6 August 2012 issue of the Journal (Med J Aust 2012; 197: 148), the following statement was incorrectly attributed: “The authors stated that there were an estimated ‘120 deaths per annum associated with overcrowding in metropolitan Perth hospitals’, but that ‘[their] study did not examine the mechanisms by ...
Shyan L Goh
Measuring performance and outcomes of acute coronary syndromes management in Australia
A national registry for acute coronary syndromes will improve patient care and clinical resultsAcute coronary syndromes (ACS) represent a substantial burden of morbidity and mortality within Australia.1 Modern treatment of these syndromes requires efficient risk stratification, timely angiography and revascularisation, and use of proven secondary prevention therapies.2-4 With a robust evidence base, it is a reasonable societal expectation that care be applied as completely as ...
Derek Chew MB BS, MPH, FRACP · David Brieger MB BS, PhD, FRACP · Carolyn M Astley RN, BN(Hons) · Andrew Georgiou PhD, FACHI, FCHSM
Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia
To the Editor: I refer to Geelhoed and de Klerk’s article1 and related correspondence.2,3 While concerned with the rise in the overall rate of emergency department (ED) presentations, I am alarmed by the disproportionate increase in the ED admission rate (24% increase, from 3960 admissions per 10 000 ED presentations in July 2007 to June 2008, to 4910 admissions per 10 000 ED presentations in July 2010 to June 2011) since the introduction of ...
Shyan L Goh
The effect of clinical history on accuracy of electrocardiograph interpretation among doctors working in emergency departments
Objective: To investigate whether bias in clinical history affects accuracy of electrocardiograph (ECG) interpretation among doctors working in emergency departments.Design and setting: Observational study conducted at four teaching hospitals in Sydney from May to September 2011.Participants: Emergency registrars and physicians (senior doctors), and interns, resident medical officers and senior resident medical officers (junior doctors).Intervention: Participants interpreted 30 ECGs ...
Monique F Cruz BSc(Med), MB BS · James Edwards MB BS, MMedEd, FACEM · Michael M Dinh MB BS, MPH, FACEM · Elizabeth H Barnes MStat
Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13)
Objectives: To describe the clinical syndrome associated with definite tiger snake (Notechis spp) envenoming and to examine the ability of tiger snake antivenom (TSAV) to bind free venom in vivo. Design, setting and participants: We conducted a prospective cohort study within the Australian Snakebite Project, reviewing all definite tiger snake envenoming cases between October 2004 and June 2011. Definite cases were identified by ...
Geoffrey K Isbister · Margaret A O’Leary · Matthew Elliott · Simon G A Brown
Understanding the mouth, nose and throat
PATIENTS COMMONLY have problems in the mouth, nose and throat. This new book by Geoffrey Quail, who is Clinical Associate Professor at the Department of Surgery, Monash University, Melbourne, and Director of the Dental and Maxillofacial Surgery Unit at Southern Health, Melbourne, provides clear and succinct information on the diagnosis of conditions affecting these areas. It will be helpful to anyone who needs an illustrated and ...
Michael Barakate
Weather to evacuate?
To the Editor: Woods and colleagues provide a timely and descriptive reminder of cyclone Yasi and the 2010–2011 summer.1 The evacuation of the hospitals on the Cairns foreshore, a decision made by the Queensland Premier, was the largest hospital evacuation in Australian history. The capability to successfully aeromedically transport 297 patients 1800 km, in a window of 22 hours, without loss of life or reported adverse clinical incident, was ...
Jeannette R Young · Mark S Elcock · Peter J Aitken
The Independent Hospital Pricing Authority and mental health services: it is not a case of “one size fits all”
Applying a generic form of activity-based funding to mental health risks perpetuating an inappropriate hospital-centric model of psychiatric care. The upcoming implementation of activity-based funding (ABF) should drive unprecedented levels of transparency and has the potential to deliver vital funding increases to mental health services. However, current plans to apply a generic form of ABF based on diagnosis-related groups (DRGs) to mental health risk a continuation ...
Alan Rosen FRANZCP, MRCPsych, DPM · Patrick D McGorry AO, MD, PhD, FRANZCP · Hamish R M Hill BA(Psych)Hons, GradDipCouns, AssocMAPS · Sebastian P Rosenberg BA, MPA
“Anywhere to palliative care” — a fast-track pathway from the emergency department to palliative care
Patients receiving end-of-life care often present to the emergency department (ED). Although such patients may be more appropriately cared for in a palliative care unit (PCU), the ED can represent a critical decision-making point where goals of care are agreed. We piloted a fast-track palliative care pathway in a Melbourne metropolitan health service ...
Sonia L Fullerton · David J Kenner · Maria T Tucker
Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia
To the Editor: We would like to congratulate Geelhoed and de Klerk1 for reporting the expected decreases in emergency department (ED) overcrowding following introduction of the 4-hour rule in Western Australia. Their study highlighted potential adverse effects and inflated demand across hospital systems — specifically, concerns regarding patient safety and junior medical staff training; significantly ...
Biswadev Mitra · Peter A Cameron
Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia
To the Editor: We read with interest the article by Geelhoed and de Klerk1 regarding the mortality benefits of a policy that ensures high numbers of patients are admitted to hospital within 4 hours of arrival at an emergency department (ED). The proof of improved performance following service intervention within a complex institution requires careful consideration. ...
Dylan J Toh · Campbell H Thompson · Josephine S Thomas · Jeffrey Faunt
Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia
In reply: We thank Mitra and Cameron, and Toh and colleagues for their remarks. Comments from some physicians that the 4-hour rule might increase mortality provided the initial stimulus for us to look at data related to its introduction in Western Australia. Given our results, their hypothesis seems unlikely to be true. Mitra and Cameron point ...
Gary C Geelhoed · Nicholas H de Klerk