Emergency medicine Australasia: EMA

Publisher: Australasian College for Emergency Medicine; Australasian Society for Emergency Medicine, Wiley

Journal description

Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM) and aims to present papers and opinions on all aspects of emergency care in the prehospital and hospital environment. Authors are invited to submit any work that will contribute to the progress of emergency medicine within Australasia and worldwide. The Journal publishes original research articles, critical reviews, editorials, short reports, case reports, letters to the Editor and book and video reviews in the broad area of emergency medicine. Accepted papers become the copyright of the Journal. All original research articles, critical reviews and case reports are reviewed by at least two referees expert in the field of the submitted paper.

Current impact factor: 1.30

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 1.296
2013 Impact Factor 1.22
2012 Impact Factor 0.993
2011 Impact Factor 0.979
2010 Impact Factor 1.089
2009 Impact Factor 0.901

Impact factor over time

Impact factor
Year

Additional details

5-year impact 1.25
Cited half-life 4.80
Immediacy index 0.40
Eigenfactor 0.00
Article influence 0.36
Website Emergency Medicine Australasia (EMA) website
Other titles Emergency medicine Australasia (Online), EMA
ISSN 1742-6723
OCLC 54312513
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Wiley

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Some journals have separate policies, please check with each journal directly
    • On author's personal website, institutional repositories, arXiv, AgEcon, PhilPapers, PubMed Central, RePEc or Social Science Research Network
    • Author's pre-print may not be updated with Publisher's Version/PDF
    • Author's pre-print must acknowledge acceptance for publication
    • Non-Commercial
    • Publisher's version/PDF cannot be used
    • Publisher source must be acknowledged with citation
    • Must link to publisher version with set statement (see policy)
    • If OnlineOpen is available, BBSRC, EPSRC, MRC, NERC and STFC authors, may self-archive after 12 months
    • If OnlineOpen is available, AHRC and ESRC authors, may self-archive after 24 months
    • Publisher last contacted on 07/08/2014
    • This policy is an exception to the default policies of 'Wiley'
  • Classification
    yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The objective of this research is to identify optimal inpatient discharge time targets to help hospitals reduce crowding, improve patient flow through the ED and balance staff workload. Methods: Fifteen months of emergency and inpatient records from a large quaternary teaching hospital were used to reconstruct patient pathways from hospital presentation to discharge. Discrete event simulation was used to assess operationally realistic discharge scenarios on flow performance. Main output measures included National Emergency Access Target (NEAT) performance (an ED performance metric), time spent waiting for a bed, hospital length of stay (LOS) and occupancy. Results: Similar levels of improvement in NEAT performance (16%), and reductions in average bed occupancy (1.5%) and inpatient bed wait time (25%) were observed across the simulation that discharged 80% patients before 11 a.m. and one that spread the target between 10 a.m. and 2 p.m. Individual inpatient wards returned potential improvements in NEAT performance (median 10%, interquartile range (IQR) 7%), and reductions in hospital LOS (median 1%, IQR 1%) and average occupancy (median 1%, IQR 2%) across the discharge scenarios. Conclusions: Conventional discharge targets like '80% by 11 a.m.' and others that spread targets across the day to balance staff workload freed up the equivalent of nine available beds for incoming patient flow, significantly reducing time spent waiting for an inpatient bed, hospital LOS and occupancy, and delivering much needed improvements in NEAT performance. While different strategies and workload distributions may suit individual hospital services, the study makes a strong case for improving 'early in the day' discharge timeliness to deliver better ED flow.
    No preview · Article · Feb 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: This study aims to describe the general characteristics and data definitions used in a population-based data set of ED presentations in New South Wales (NSW), used to form the basis of future-trend analyses. Methods: Retrospective analysis of the Emergency Department Data Collection registry, which provided clinical and demographic information of ED presentations across all EDs in NSW between 2010 and 2014. Presenting problems and ED diagnoses were classified using broad clinical categories including injury/musculoskeletal, respiratory, cardiovascular, ear nose and throat, and mental health. Presentations were linked by patient to allow for analysis of representations, and population data were obtained from the Australian Bureau of Statistics. Results: There were 11.8 million presentations that were analysed from 150 EDs (80.6% of all EDs). The rate of ED presentations was highest in those aged 85 years and older and appears to increase across all age groups between 2010 and 2014. The most common ED diagnosis categories were injury/musculoskeletal (27.5%) followed by abdominal/gastrointestinal (12.3%), respiratory (9%) and cardiovascular (8%). Both the Systematised Nomenclature of Medicine Clinical Terms (66%) and the International Classification of Diseases (24%) were used to code ED diagnoses. Conclusions: The elderly population had the highest rate of ED attendances. The use of diverse diagnosis classifications and source information systems may present problems with further analysis. Patterns and characteristics of ED presentations in NSW were broadly consistent with those reported in other states in Australia.
    No preview · Article · Feb 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: The objective of the study was to compare QT intervals measured on the original bedside electrocardiographs (ECG), facsimile, iPhone, iPad and 17 inch computer monitor. Methods: This was a prospective, observational study conducted within a tertiary referral metropolitan ED. Thirteen doctors measured the QT intervals of 15 non-identifiable, routinely recorded ECGs using randomly allocated modalities over five sessions. The QT intervals of lead I, II, V2, V4, V6 and one other were measured. Variations between modalities and between doctors were examined (χ(2) and Kruskal-Wallis tests). Results: QT intervals measured on the iPad were significantly lower than the other modalities (P = 0.02). For each lead, there were no differences in QT interval measurement between the modalities (P > 0.05). However, there were significant differences between the QT interval measurements of the participating doctors (range of median QT intervals 480-530 msec, P < 0.001). There were also significant differences between the QT intervals measurement of the leads examined (range of median QT intervals 480-520 msec, P < 0.001). Lead V2 was the most consistent lead (smallest interquartile range), and lead I was the least (QT interval consistently under-estimated). Conclusion: The QT interval can be reliably measured using facsimile, iPhone and computer, but not the iPad. However, it varies between doctors. Lead V2 is recommended for QT interval measurement if only a single lead is to be used for clinical purposes.
    No preview · Article · Feb 2016 · Emergency medicine Australasia: EMA

  • No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: The majority of ureteric calculi pass spontaneously and are uncomplicated, yet use of computed tomography urography (CTU) has increased in recent years. This study describes a cohort of ED patients undergoing CTU for renal colic and assesses the predictors of urologic intervention. Methods: A retrospective cohort study enrolled patients who underwent CTU at three Melbourne EDs. Demographic data, clinical assessments, laboratory and radiological findings and interventions were abstracted. Univariate analysis was performed and significant predictors were entered into a multivariate logistic regression model to calculate adjusted odds ratios for associations with urologic intervention. Results: Six hundred and seventeen patients underwent 626 CTUs; mean age was 48 and 67.7% were male. 58.2% of scans found calculi, of which median size was 4 mm. 9.2% of scans revealed an alternate diagnosis, of which 2.7% were acutely important. 14.6% of patients with calculi received an intervention. Multivariate analysis found the factors associated with intervention were female sex (OR 3.9, 95% CI 1.8-8.7), proximal calculus site (OR 4.1, 95% CI 1.5-11.7), single kidney (OR 9.0, 95% CI 1.7-49.0) and calculus size > 5 mm (OR 7.0, 95% CI 3.3-14.7). Conclusion: Factors associated with urologic intervention included female sex, single kidney, calculus size >5 mm and proximal calculus. Information on acute alternate diagnoses was uncommon. A prospective study is needed to further clarify clinical parameters that could predict intervention to allow targeting of CTU to those most likely to benefit.
    No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Employees in EDs report increasing role overload because of critical staff shortages, budgetary cuts and increased patient numbers and acuity. Such overload could compromise staff satisfaction with their working environment. This integrative review identifies, synthesises and evaluates current research around staff perceptions of the working conditions in EDs. A systematic search of relevant databases, using MeSH descriptors ED/EDs, Emergency room/s, ER/s, or A&E coupled with (and) working environment, working condition/s, staff perception/s, as well as reference chaining was conducted. We identified 31 key studies that were evaluated using the mixed methods assessment tool (MMAT). These comprised 24 quantitative-descriptive studies, four mixed descriptive/comparative (non-randomised controlled trial) studies and three qualitative studies. Studies included varied widely in quality with MMAT scores ranging from 0% to 100%. A key finding was that perceptions of working environment varied across clinical staff and study location, but that high levels of autonomy and teamwork offset stress around high pressure and high volume workloads. The large range of tools used to assess staff perception of working environment limits the comparability of the studies. A dearth of intervention studies around enhancing working environments in EDs limits the capacity to recommend evidence-based interventions to improve staff morale. © 2016 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
    No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA

  • No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA

  • No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA

  • No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Several health, social and professional factors are forcing Emergency Physicians to rethink their role in the health system. Despite these challenges, there are a number of ways that we can evolve, including an increasing role for academic and subspecialty emergency medicine, which will ensure our specialty, remains vital and viable in the 21st century and beyond.
    No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA

  • No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA

  • No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: There is debate whether targets for ED length of stay introduced to reduce ED overcrowding are helpful or harmful, as focus on a process target may divert attention from clinical care. Our objective was to investigate the effect of a national ED target in Aotearoa New Zealand on the recommended care for acute asthma as this is known to suffer in overcrowded departments. Methods: We conducted a retrospective chart review study across four sites from 2006 to 2012 (target introduced mid 2009). The primary outcome was time to steroids in the ED. The secondary outcomes were other aspects of asthma care in ED. We used general linear models or logistic regression as appropriate to assess care before and after the target. Results: Among the 570 (of 1270 randomly selected cases) eligible for analysis, no difference was demonstrated in time to steroids: least square mean (95% CI) = 58.1 (49-67.5) min before and 50.4 (42.9-55.8) min after the target (P = 0.15). More patients received steroids in ED after the target, OR (95% CI) = 2.1 (1.2-4.3). No differences were demonstrated in those receiving steroid prescriptions or re-presentations: OR (95% CI) = 1.3 (0.9-1.96) and 1.1 (0.5-2.3), respectively. Changes in pre-target and post-target ED and hospital length of stay varied between hospitals. Conclusion: Introduction of the target was not associated with a change in times to steroids in ED, although more patients received steroids in ED indicating closer adherence to recommended practice.
    No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: To describe a simple protocol for ventilator-assisted preoxygenation (VAPOX) prior to rapid sequence intubation in the ED using a Hamilton T1 ventilator in an effort to further reduce the incidence of transient and critical hypoxaemia. Methods: Ventilator-assisted preoxygenation includes the following steps; preparation for rapid sequence intubation as per institutional protocols, including departmental checklists. Hamilton T1 ventilator is setup in non-invasive spontaneous/timed mode with settings as described. The patient is optimally positioned and nasal cannula applied with an oxygen flow rate of 15 L/min. A face mask is applied with the jaw pulled forward using a two-handed thenar eminence grip and the ventilator is started. Preoxygenation occurs for 3 min. Drugs including neuromuscular blockers are administered, while the operator ensures the airway remains patent. The ventilator transitions into Pressure Controlled Ventilation once apnoea ensues. Nasal oxygen continues until endotracheal tube is successfully secured. Results: We describe a case series of the first eight consecutive adult patients on who VAPOX was applied. All eight patients were clinically deemed at high risk of oxygen desaturation. No clinically significant hypoxia occurred, and the lowest oxyhaemoglobin desaturation was 92%. Conclusion: Preoxygenation using a ventilator with an open valve system may allow safe combination of non-invasive ventilation, pressure controlled ventilation and apnoeic oxygenation using nasal cannula. VAPOX may be the technique of choice to preoxygenate and apnoeic oxygenate many patients who undergo rapid sequence intubation in the ED equipped with these ventilators.
    No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: The objectives of this study were to investigate factors that correlate to cardiac events within 30 days in Indigenous and non-Indigenous Australians who present to ED with chest pain and to describe the predictive ability of the HEART Score in these groups. Methods: Patients who presented with chest pain between 1 January 2013 and 16 May 2013 in a university hospital were retrospectively enrolled in the study. HEART Scores were retrospectively assigned to participants. The study's end-point was Major Adverse Cardiac Events (MACE) within 30 days. Results: Participants (678) were enrolled in the study, of which 148 were Indigenous Australian. Twenty-eight percent of Indigenous Australian participants and 19% of non-Indigenous Australian participants were diagnosed with MACE within 30 days. Within the Indigenous Australian participant cohort, 1.6% of those with HEART Scores 0-3, 29% of those with HEART Scores 4-6 and 96% of those with HEART Scores 7-10 were diagnosed with MACE within 30 days. Within the non-Indigenous Australian participant cohort, 0.58% of those with HEART Scores 0-3, 17% of those with HEART Scores 4-6 and 79% of those with HEART Scores 7-10 were diagnosed with MACE within 30 days. The negative predictive value of HEART Scores 0-3 for ruling out MACE within 30 days was 98% for Indigenous participants and 99% for non-Indigenous participants. Conclusion: The HEART Score is a reliable predictor of patient outcome in both Indigenous and non-Indigenous Australians. Modification of the HEART Score may not be required for use in the Indigenous Australian population who present to the ED with chest pain.
    No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: The aim of this study was to gather patients' perceptions regarding their choice between public and private hospital EDs for those who hold private health insurance. The findings of this study will contribute to knowledge regarding patients' decision-making processes and therefore may contribute to the development of evidence based public policies. Methods: An in-depth semi-structured guide was used to interview participants at public and private hospital EDs. Questions sought to identify the issues that were considered by the participants to decide to attend that hospital ED, previous ED experience, expectations of ED services and perceived benefits and barriers to accessing services. Interviews were audio recorded, transcribed verbatim and analysed using content and thematic approaches. Results: Four core themes emerged: prior good experience with the hospital, perceived quality of care, perceived waiting times and perceived costs that may explain patients' choice. Patients' choice between public and private EDs can be explained by the interaction of these core themes. The principal issues appear to be concern for gap payments at private hospital ED and waiting times at public hospital ED. Conclusions: Patients who choose to attend public EDs appear to value financial concern over waiting time; those who choose to attend private EDs appear to value waiting time ahead of financial concerns.
    No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: This study aimed to determine whether initiation of controlled oxygen therapy at ED presentation increased the proportion of patients with chronic obstructive pulmonary disease (COPD) achieving the COPD-X guideline target SpO2 range (88-92%) at 30 min and if it impacted total hospital length of stay or in-hospital mortality. Methods: Retrospective cohort study by medical record review of patients admitted to hospital with an exacerbation of COPD. The primary outcome of interest was the proportion of patients achieving the target SpO2 range at 30 min after ED arrival. Results: The proportion of patients with SpO2 in the target range at 30 min was higher in the controlled oxygen therapy group (32% vs 16%: difference between proportions 16% (95% CI 7-24%); number needed to treat 6) and less likely to be over-oxygenated (SpO2 > 95%), 29% versus 54%, difference between proportions 25% (95% CI 14-35%); number needed to harm 4, without an increased likelihood of hypoxia. Length of stay was not different between the groups. Mortality for the controlled oxygen group was 2.7% (95% CI 1.3-5.5%) versus 5.8% for the uncontrolled oxygen group (95% CI 2.9-11.6%); however, this trend was not statistically significant. Conclusion: Patients with exacerbations of COPD receiving controlled oxygen therapy were more likely to achieve SpO2 within the COPD-X guideline target range without being more likely to be hypoxic. The proportion of patients with SpO2 within the target range was low, suggesting that further work on processes to optimise oxygenation in this group of patients is needed.
    No preview · Article · Jan 2016 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: To explore GP-referrals and self-referrals to EDs and factors associated with patients seeking low-acuity care at ED. Method: Retrospective analysis of all ED presentations to Mersey Community Hospital and North West Regional Hospital (Tasmania) between 1 January 2009 and 31 December 2013. Cross-sectional survey of patients presenting to the EDs for care triaged as low-acuity. Results: There were 255 365 ED presentations in the retrospective data: 11 252 (4.4%) GP-referrals and 218 205 (85.4%) self-referrals. At ED 49% of GP-referrals were triaged ATS 4 or 5 and 35% of self-referrals were triaged ATS 1-3. There were 138 (84.2%) low-acuity patients who completed the survey; predominantly, all attended for acute injury or illness. Single point-of-care convenience was most commonly selected (71%) as a reason for attending ED. Conclusions: Over 85% of patients who seek emergency care in this region self-refer, so understanding health-seeking behaviour is important. Most low-acuity patients are acutely injured or unwell, and the decision to go to ED is based on their perception of accessibility of expertise aligned with their need. The term 'GP-type' is misleading in this context and should not be used. Providing low-acuity care in parallel with providing a specialised emergency service meets the needs of the local community and is likely to be the lowest cost model in a regional and rural area. Funding models must reflect the actual cost of delivering this important service rather than presentation types.
    No preview · Article · Dec 2015 · Emergency medicine Australasia: EMA
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    ABSTRACT: Detecting the presence of injuries to the cervical spine is an important component of the initial assessment of patients sustaining blunt trauma. A small proportion of cervical spine injuries consists of ligamentous disruption. Accurate detection of ligamentous injury is essential as it may result in sequelae including radiculopathy, quadriplegia and death. Flexion-extension (FE) radiography has traditionally been utilised for the detection of ligamentous injury in patients who have been cleared of bony injury. There are controversies surrounding the use of FE for alert patients with neck pain. There are studies that call into question the diagnostic accuracy of FE, the high proportion of inadequate FE images due to muscle spasm and the adverse effects of prolonged cervical collar immobilisation while awaiting FE. Other literature indicates that FE provides no additional diagnostic information following a multi-detector helical computed tomography. This review evaluates the literature on the utility of FE for the detection of ligamentous injury and explores alternate strategies for clearing the cervical spine of ligamentous injury.
    No preview · Article · Dec 2015 · Emergency medicine Australasia: EMA
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    ABSTRACT: Objective: The provision of 'adequate analgesia' (which reduces the pain score by ≥2 and to <4 [0-10 scale]) is significantly associated with high levels of satisfaction with pain management among adult patients. We aimed to determine the variables (including 'adequate analgesia') associated with parent satisfaction with their child's pain management. Methods: We undertook an observational, pilot study in a mixed, metropolitan ED. Patients aged 4-16 years with a triage pain score of ≥4 were enrolled. Data included demographics, presenting complaint, pain scores every 30 min, analgesia administered, time to first analgesia, provision of nurse-initiated analgesia (NIA), and 'adequate analgesia', and parent satisfaction 48-h post-discharge (6 point scale: very unsatisfied - very satisfied). Results: Complete data were collected on 185 patients: mean (SD) age 10.4 (3.6) years, weight 41.9 (17.8) kg; 93 (50.3%) were male. One hundred and ten (59.4%) parents were very satisfied with their child's pain management. Children of very satisfied parents had shorter times to analgesia than those who did not (median [interquartile range] 14 (33) vs 33 (46) min, respectively, P = 0.003). Parents whose children received NIA or 'adequate analgesia' were more often very satisfied than those whose children did not. However, the differences were not significant (difference in proportions: 13.2% [95% CI -1.9, 28.3], P = 0.07 and 10.2% [95% CI -5.02, 25.34], P = 0.16, respectively). Conclusion: Short times to analgesia are associated with parent satisfaction. There were non-significant trends towards high levels of satisfaction following the provision of NIA and 'adequate analgesia'. These findings will inform a well-powered study to confirm this association.
    No preview · Article · Dec 2015 · Emergency medicine Australasia: EMA