Emergency medicine

Restrictions should be accompanied by advice about appropriate locations for seeking medical care, by condition severity and type

Amy L Sweeny · Gerben Keijzers · Andrea Marshall · Emma J Hall · Jamie Ranse · Ping Zhang · Gary Grant · Ya‐Ling Huang · Dinesh Palipana · Yang D Teng · Benjamin Gerhardy · Jaimi H Greenslade · Philip Jones · Julia L Crilly

After adjusting for age and other factors, survival outcomes are poorer for Indigenous than non-Indigenous people admitted to ICUs

Paul J Secombe · Alex Brown · Michael J Bailey · Sue Huckson · Shaila Chavan · Edward Litton · David Pilcher

To the Editor: We read with interest the article by Drewett and colleagues,1 on anaphylaxis presentations to emergency departments in Victoria, and the linked editorial by Lucas and Vale,2 which proposes a comprehensive adverse drug reaction registry to improve patient safety and care. Re‐exposure of a patient to a medicine to which they have had a previously documented allergy or adverse drug reaction (ADR) is a preventable clinical incident. The Australian sentinel events list includes “medication error resulting in serious harm or death” to ensure public accountability and transparency and drive national improvements in patient safety.3 The availability of accurate and up to date allergy/ADR information for prescribers is vital to support the decision on appropriate treatment and to prescribe a medicine. It is also critical that health professionals who administer medicines and pharmacists who dispense medicines have access to accurate allergy/ADR information, as they provide redundancy within the medication management system to prevent unintentional re‐exposure. We recently undertook an audit to assess the accuracy of medication history documentation performed by pharmacists. Our methodology has been published elsewhere.4 As part of this work, we assessed the quality of pharmacist‐documented allergy/ADR information. Allergy/ADR documentation best practice suggests documentation of the medication name, reaction details and reaction date.5 New findings from our audit identified a total of 108 allergies/ADRs across 99 patients. Of the 52 patients with a previous history of allergy/ADR, only 31% (n = 16) had complete and correct allergy/ADR information documented. These results highlight that the current systems do not adequately support clinicians to provide safe and high quality care. Moreover, these systems risk patient harm through inadvertent re‐exposure to a medicine where there is a previously documented allergy/ADR, given that, at the point of prescribing, administration or dispensing, data are not available, disparate, incorrect or incomplete. We believe the national allergy/ADR registry proposed by Lucas and Vale2 should go one step further, and legislation should mandate interoperability between all electronic prescribing, administration and dispensing systems in Australia. A further challenge will be populating accurate historical allergy/ADR information into the registry. It would require high quality documentation to assist informed clinical decision making. An additional challenge is the complex, hybrid paper and electronic prescribing and documentation systems used across health care settings. Even though these may be challenges to overcome, there are potential opportunities through patient engagement, incentive schemes and machine learning. There needs to be a national consumer‐focused education campaign so the public can be active participants in their own care to support optimal medicine choice based on their allergy/ADR history. We believe a national allergy/ADR registry is of key importance to further enhance patient safety and will be a true system change to overcome the barriers we face in day‐to‐day clinical practice.

Martin L Canning · Andrew Munns · Bonnie Tai

Our efforts to prepare and respond to the challenges posed by climate change must focus on community support and recovery, providing sustainable financial security and social connectedness

George Braitberg

Seafarers’ access to health care is limited, pre-employment screening is variable, and delayed presentations to Australian facilities are common in this vulnerable patient group

John J Bockxmeer · Nilukshi Ranwala

Given the unique geographic, socio-economic and health care system considerations, Australasian-specific research evaluating trauma care verification is essential

for the Trauma Care Verification and Quality Improvement Writing Group †

Despite being the largest cause of death and disability after physical trauma, national data are not currently available for Australia

Gerard M O'Reilly · Kate Curtis · Yesul Kim · Biswadev Mitra · Kate Hunter · Courtney Ryder · Delia V Hendrie · Nick Rushworth · Afsana Afroz · Shane D'Angelo · Jin Tee · Mark C Fitzgerald

Evidence-based guideline recommendations are not always followed in the ED

Kevin Chu · Anne‐Maree Kelly · Frances Kinnear · Gerben Keijzers · Sinan Kamona

Despite its potential value, a number of questions require answers before its role in clinical practice becomes clear

Mark Little

Refining the assessment of symptoms in women in pre-hospital emergency services care could improve patient outcomes

Xia Wang · Cheryl Carcel · Benjumin Hsu · Sultana Shajahan · Matthew Miller · Sanne Peters · Deborah A Randall · Alys Havard · Julie Redfern · Craig S Anderson · Louisa Jorm · Mark Woodward

Longer ambulance offload times are associated with greater 30-day risks of death and ambulance re-attendance

Luke P Dawson · Emily Andrew · Michael Stephenson · Ziad Nehme · Jason Bloom · Shelley Cox · David Anderson · Jeffrey Lefkovits · Andrew J Taylor · David Kaye · Karen Smith · Dion Stub

Emergency department presentations are opportunities to discuss cardiovascular risk factors while the patient’s awareness of their importance is heightened

Christopher Zeitz · Angus Baumann

Aboriginal and Torres Strait Islander people may benefit from culturally appropriate cardiac risk factor management

Jaimi H Greenslade · Sara Berndt · Laura Stephensen · Katrina Starmer · Greg Starmer · William Parsonage · Victor Lau · Tileah Drahm‐Butler · Tania Davis · Virginia Campbell · Richard Stone · Robert Bonnin · Sarah Ashover · Tanya Milburn · Elizabeth Mowatt · Karlie Proctor · Anthony Brazzale · Louise Ann Cullen

Telestroke is an example of technology facilitating the delivery of time-dependent therapies in regional Australia

Carlos Garcia‐Esperon · Christopher F Bladin · Timothy J Kleinig · Helen Brown · Jennifer J Majersik · Andrew Wesseldine · Kenneth Butcher

A 25-year-old woman presented via ambulance following a jellyfish sting

Anthony C Rengel · Sue Davel · Sarah O’Connor · Nicholas Medcraft

A 7-year-old girl presented to the emergency department with fever and right forearm redness

Yu‐Lin Tai · Chien‐Yu Lin

Adjusted 30-day and 12-month rates declined for patients who underwent surgery

Lara Harvey · Ian A Harris · Rebecca J Mitchell · Adrian Webster · Ian D Cameron · Louisa Jorm · Hannah Seymour · Pooria Sarrami · Jacqueline Close

An 85-year-old man with a history of type 2 diabetes, vascular disease and chronic kidney disease awoke with central sharp pleuritic pain radiating through to his back

Elliot T Bowden · Paul Smith · Karen M Dwyer

To the Editor: Recent media reports imply there is an increased pressure on Adelaide’s metropolitan emergency medical system which has resulted in additional ambulance ramping and consequent industrial action.1,2,3 We collected a novel dataset of emergency department (ED) capacity state observations at 30‐minute intervals from the public South Australia ED Dashboard4 to investigate the claims of increased pressure. The dashboard uses a traffic light system to indicate ED busyness. The 7‐day moving average of the daily percentage of EDs in “green” status (≤ 80% of capacity) oscillated around 25% between 3 October 2019 and 16 March 2020 and then steeply increased to 80%, coinciding with the first wave of coronavirus disease 2019 (COVID‐19) cases in South Australia, which drove a major reduction in ED presentations (Box).5 The graph then shows a slow return to a baseline fluctuation of around 25% until January 2021. Since then, the moving average of EDs in “green” has been lower than 25%, showing an overall trend of increasing pressure over the subsequent months. This pattern is mirrored in the daily percentage of “red” and “white” status (ED at ≥ 95% of capacity). The 7‐day moving average of the daily percentage of EDs in “red” and “white” status exceeded 75% for the first time in February 2021. Four new record highs have been recorded since 10 May 2021, with the highest daily percentage of “red” and “white” observations at 98% on 27 May 2021. The average daily proportion of “red” and “white” observations pre‐pandemic (from 4 October 2019 to 19 March 2020) was 55% and has since increased to 64% (from 5 December 2020 to 29 June 2021), indicating that EDs are currently under significantly more strain. These issues are not new; EDs are one component of a complex interdependent health care system. EDs operating for extended periods at or near capacity is often the most conspicuous symptom of a broader system under pressure. It is doubtful that a solution to this problem can be found within the ED. Long term ED congestion relief lies in redesigning multiple aspects of the health and social care systems, which should involve health care consumer groups. Suggestions include: i) reducing hospital access block, ii) increasing social and community care, iii) adequate hospital beds, iv) alternatives to traditional care such as urgent care facilities or virtual wards, and v) cohort‐specific interventions to reduce ED presentations (eg, rehabilitation centres for alcohol and substance misuse). Box – Seven‐day moving average of the daily proportions of observations of the six metropolitan public hospitals (excluding the Women’s and Children’s Hospital) classified as alert codes “green” (0–80% occupied capacity), “amber” (80–95% occupied capacity), “red” (95–125% occupied capacity), and “white” (> 125% occupied capacity) between 4 November 2019 and 19 June 2021* * Due to problems in the data collection system, the data for the period between 14 and 31 July 2020 are missing.

Laura M Boyle · Mark Mackay · Keith Stockman

Given the limitations of our resources, we need well planned processes for optimising health care should demand exceed capacity

Raymond Raper

Maximising the availability of trained staff and coordinated matching of ICU capacity with demand are urgently needed

Edward Litton · Sue Huckson · Shaila Chavan · Tamara Bucci · Anthony Holley · Evan Everest · Sean Kelly · Steven McGloughlin · Johnny Millar · Nhi Nguyen · Mark Nicholls · Paule Secombe · David Pilcher

A public health unit in Sydney was notified of two unrelated patients who presented on the previous day with methaemoglobinaemia

Caitlin O’Neill · Zeina Najjar · Andrew Ingleton · Alan Edwards · Andrew Dawson · Leena Gupta

A 31-year-old Caucasian woman presented to the emergency department with a 1-day history of vomiting and lethargy, but no other symptoms

Nardeen S Habashy · Hwang Tan · Emily J Hibbert

Patient survival is more likely when general practitioners and their staff are trained in resuscitation and equipped with defibrillators

Siobhán Masterson · Tomás Barry