Australasian Emergency Nursing Journal

Editorial Board

2010-05-01

CENA Membership Application Form

2010-05-01

Philippa Moore Publication Prize

2010-05-01

Ben Morley Scholarship

2010-05-01

Australasian Emergency Department of the Year

2010-05-01

Australasian Emergency Nurse of the Year

2010-05-01

International Academy of Nursing Editors

2010-05-01

Thanks to Reviewers Volume 12

2010-05-01

Incoming Executive Director's address

Dianne Crellin — 2010-05-01

It is with great pleasure that I provide this opening address as the new Executive Director for the College of Emergency Nursing Australia. I would like to begin by first and foremost acknowledge those who have come before me, in particular outgoing Executive Director Julie Finucane OAM RFD. Julie has been with CENA from its very beginning, when we formed as a national organisation in 2002. Julie has worked tirelessly on our behalf and with the help of the National Board and State Committees. She has been instrumental in making CENA the successful professional body that it is now. Julie highlighted some of the College's current activities and achievements in her last editorial and there are many more which are too numerous to list. CENA members should be proud of the progress made by the College in such a short time. I am sure that everyone will join me in thanking Julie for her extraordinary efforts to make many of these achievements possible.

Applying lessons learned to the Haiti Earthquake response

Paul Arbon — 2010-05-01

On the12th January at 4.53 p.m. (local time) the impoverished Caribbean nation of Haiti was struck by an earthquake measuring 7.0 on the Richter scale. This was the largest earthquake to hit the island nation in over 200 years and the initial impact and subsequent aftershocks caused extreme damage and affected a population of over 3 million. The epicentre was approximately 17km south-west of Haiti's capital, Port-au-Prince. The nearby population centres and areas to the west and south of the epicentre were most severely affected. At the time of writing the numbers killed and injured are unknown and the dead are thought to number in the tens of thousands. Many were buried in the rubble of collapsed buildings in this desperately poor nation in which infrastructure, rescue and health capability and capacity are exceptionally poor. Damage to buildings and essential services such as power and water supplies, hospitals and government services was extensive, in part because of poor building standards and already overstretched services. Following the disaster many of the essential services necessary to support an effective response were too badly damaged to be used. Shipping was unable to berth and the airport control tower was destroyed severely limiting access by air. Both the main sea port and the airport were, as a result, left with very limited capacity to receive essential supplies and rescue personnel from other nations. The road network was in ruins severely limiting the distribution of aid. The extent of the damage and the already poor condition of national infrastructure inevitably affected the speed and reach of the international humanitarian response.

Testing the safety of after-hours telephone triage: Patient simulations with validated scenarios

Michael Montalto, David R. Dunt, Susan E. Day, Margaret A. Kelaher — 2010-05-01

Summary: Background: The aim of this study is to estimate the appropriateness of recommended dispositions made in response to calls to after hours services offering telephone triage, usually involving nurses. The setting was five local trials sponsored by the Australian government aimed at addressing problems in after hours general practice service provision. All five trials offered telephone triage though the form of this varied considerably.Methods: The study was a prospective service audit. Simulated patient calls using validated patient care scenarios with different levels of clinical significance were developed by a consensus panel of experts. Sixty telephone calls were monitored by a member of the research team to assess whether provider responses were in conformity with recommended dispositions.Results: Services fell well short of a 100% appropriate response rate across all five trials. Services generally performed poorly for cases with high clinical implications such as presumed meningococcal meningitis and gastroenteritis with dehydration in a child. In general, problems of undertriage were more common than overtriage.Conclusions: The safety of dispositions of telephone triage services requires further study. Simulated patient calls may be more useful for quality improvement purposes than the usual method of random audit of audiotaped calls of real patients using service records.

The effects of ambulance ramping on Emergency Department length of stay and in-patient mortality

2010-05-01

Summary: Background: Ambulance ramping within the Emergency Department (ED) is a common problem both internationally and in Australia. Previous research has focused on various issues associated with ambulance ramping such as access block, ED overcrowding and ambulance bypass. However, limited research has been conducted on ambulance ramping and its effects on patient outcomes.Methods: A case-control design was used to describe, compare and predict patient outcomes of 619 ramped (cases) vs. 1238 non-ramped (control) patients arriving to one ED via ambulance from 1 June 2007 to 31 August 2007. Cases and controls were matched (on a 1:2 basis) on age, gender and presenting problem. Outcome measures included ED length of stay and in-hospital mortality.Results: The median ramp time for all 1857 patients was 11 (IQR 6–21)min. Compared to non-ramped patients, ramped patients had significantly longer wait time to be triaged (10min vs. 4min). Ramped patients also comprised significantly higher proportions of those access blocked (43% vs. 34%). No significant difference in the proportion of in-hospital deaths was identified (2% vs. 3%). Multivariate analysis revealed that the likelihood of having an ED length of stay greater than eight hours was 34% higher among patients who were ramped (OR 1.34, 95% CI 1.06–1.70, p=0.014). In relation to in-hospital mortality age was the only significant independent predictor of mortality (p<0.0001).Conclusion: Ambulance ramping is one factor that contributes to prolonged ED length of stay and adds additional strain on ED service provision. The potential for adverse patient outcomes that may occur as a result of ramping warrants close attention by health care service providers.

Implementation of a guideline to improve prescription of analgesia for adult trauma patients in an Emergency Department

Julie Gawthorne, Susan Welch, Fiona Robertson, Karon McDonell, Andrew Finckh — 2010-05-01

Summary: Objectives: To improve pain management of patients presenting to the emergency department with traumatic injuries through the development and implementation of a trauma pain guideline.Methods: A retrospective review of 100 Emergency Department trauma patients (50 intubated and 50 non-intubated) was conducted in June 2005. Pain management guidelines were developed by the multidisciplinary group and implemented through intensive staff education in December 2005 and again in February 2006. A second review was conducted in April–June 2006.Results: There was a significant increase in the number of intubated patients receiving analgesia in the post-implementation group, 32% (16/50) compared to 68% (34/50) (p=0.0002). Use of morphine and midazolam infusions, a specific recommendation of the guideline, increased from 16% (8/50) to 36% (18/50) (p=0.02), and the use of sedation (other than midazolam) together with analgesia increased from 16% (8/50) to 32% (18/50) (p=0.02).In the non-intubated group the use of analgesia increased from 86% (43/50) to 100% (50/50) (p=0.006). Median time to analgesia decreased from 38min to 14min and the use of multimodal analgesia increased from 30% (15/50) to 61% (30/50) (p=0.002).Conclusion: The implementation of trauma pain management guidelines and associated education has resulted in improved analgesic use in trauma patients in the emergency department.

Emergency management of dental trauma

Tony Skapetis, Kate Curtis — 2010-05-01

Summary: Dental first aid is both simple and inexpensive and can dramatically improve future dental outcomes; however, it is rarely appropriately provided. We provide a simple guide with instructions and images and links to further resources.

Transient loss of consciousness misdiagnosed as epileptic seizure: About one case

Lise Duggan — 2010-05-01

Abstract: Syncopal events resulting in a transient loss of consciousness (TLOC) are a common Emergency Department (ED) presentation. However, successful identification of syncopal events as the cause of a TLOC can be a diagnostic challenge. In this paper, the case of a 54-year-old man presenting to the ED with TLOC and seizure-like activity will be examined. In addition to the patient's presentation, management and disposition, the underlying pathophysiology of the patient's diagnosis is also reviewed. In this case, the patient's TLOC episodes were initially misdiagnosed as first presentation epileptic seizure. The patient, Mr A, may have gone on to undergo unnecessary testing and potentially dangerous pharmacotherapy. A key factor in this case was accurate initial and ongoing emergency nursing assessment that eventually highlighted the true cause of Mr A's TLOC. This case highlights the crucial role of emergency nurses and demonstrates that accurate nursing assessment can improve diagnostic accuracy and contribute towards positive patient outcomes.

Emergency nurses—Where will we be in 25 years?

Kate Curtis — 2010-05-01

The organisers and speakers at 7th International conference for Emergency Nursing held on the Gold Coast in October this year succeeded in demonstrating the emergency nurses are thoughtfully and successfully “balancing the art and science”. As the conference promotion stated “Emergency Nurses are busier than ever.” The push for evidence-based practice and quality and safety in health care means emergency nurses are doing more with less. These and other competing priorities are challenging the provision of emergency nursing care.

Calendar of Events

2010-05-01

Instructions for Authors

2010-05-01

Australasian Emergency Nursing Journal

Editorial Board

CENA Membership Application Form

Contents

Philippa Moore Publication Prize

Ben Morley Scholarship

Australasian Emergency Department of the Year

Australasian Emergency Nurse of the Year

International Academy of Nursing Editors

Thanks to Reviewers Volume 12

Incoming Executive Director's address

Applying lessons learned to the Haiti Earthquake response

Testing the safety of after-hours telephone triage: Patient simulations with validated scenarios

The effects of ambulance ramping on Emergency Department length of stay and in-patient mortality

Implementation of a guideline to improve prescription of analgesia for adult trauma patients in an Emergency Department

Emergency management of dental trauma

Transient loss of consciousness misdiagnosed as epileptic seizure: About one case

Emergency nurses—Where will we be in 25 years?

Calendar of Events

Instructions for Authors