Amith Shetty

Amith Shetty
The New South Wales Department of Health | NSW · Patient Experience System Performance Division

MBBS FACEM PhD
Models of care implementation and evaluation, Sepsis Screening and management, Big Data research, Learning Systems

About

62
Publications
9,001
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525
Citations
Citations since 2017
46 Research Items
477 Citations
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2017201820192020202120222023020406080100120
2017201820192020202120222023020406080100120
Introduction
Amith Shetty currently works at NSW ministry of Health as a Clinical Director in the Patient Experience System performance Support division. Amith conducts research in Emergency Medical Care, Emergency Medicine, Sepsis and medical Informatics.
Additional affiliations
January 2002 - March 2017
Westmead Hospital
Position
  • Managing Director
February 2000 - present
Westmead Hospital
Position
  • Consultant
Education
January 2015 - October 2020
The University of Sydney
Field of study
  • Medicine
January 2001 - February 2012
Australasian College for Emergency Medicine
Field of study
  • Emergency Medicine
January 1992 - December 1997
University of Mumbai
Field of study
  • Medicine

Publications

Publications (62)
Preprint
Full-text available
Background: The widespread adoption of Electronic Medical Records (EMR) and digital technologies provides an opportunity to tailor online learning for healthcare providers. This is because EMRs contain a rich source of information on an individual’s clinical activities, providing an opportunity to tailor online learning for healthcare providers. Th...
Article
Objectives: To investigate the association between the timing and adequacy of antibiotics administered to patients presenting with culture-positive sepsis and septic shock to the ED and in-hospital mortality and/or intensive care unit (ICU) admission. Methods: Multicentre retrospective cohort study of ED presentations at four metropolitan hospit...
Article
Objective: To compare presentation numbers, class of exposure, poison severity score (PSS) and drugs ingested by patients in a tertiary toxicology service during the first wave of the COVID-19 pandemic to the corresponding time periods in 2018 and 2019. Methods: A retrospective cohort observational study of patients admitted or consulted to the...
Article
Full-text available
Background: Appropriate and timely administration of intravenous fluids to patients with sepsis-induced hypotension is one of the mainstays of sepsis management in the emergency department (ED), however, fluid resuscitation remains an ongoing challenge in ED. Our study has been undertaken with two specific aims: firstly, for patients with sepsis,...
Article
Full-text available
Background: Early intravenous fluids for patients with sepsis presenting with hypoperfusion or shock in the emergency department remains one of the key recommendations of the Surviving Sepsis Campaign guidelines to reduce mortality. However, compliance with the recommendation remains poor. While several interventions have been implemented to impro...
Article
Full-text available
Objectives Hospitalized patients who presented within the last 24 h with a bacterial infection were recruited. Participants were assigned into sepsis and uncomplicated infection groups. In addition, healthy volunteers were recruited as controls. RNA was prepared from whole blood, depleted from beta-globin mRNA and sequenced. This dataset represents...
Article
Objective To investigate the association between timing and volume of intravenous fluids administered to ED patients with suspected infection and all-cause in-hospital mortality. Methods Retrospective cohort study of ED presentations at four metropolitan hospitals in Sydney, Australia, between October 2018 and May 2019. Patients over 16 years of a...
Article
Full-text available
Introduction: The objective of this study was to explore the demographic characteristics, disease specifics and outcomes of adult patients with suspected sepsis presenting to a remote Australian emergency department (ED). A retrospective, uninterrupted time series audit of ED patients presenting with suspected sepsis was conducted. A total of 189...
Article
Background Using electronic data for cardiovascular risk stratification could help in prioritising healthcare access and optimise cardiovascular prevention. Aims To determine whether assessment of absolute cardiovascular risk (Australian Absolute Cardiovascular Disease Risk, ACVDR) and short-term ischaemic risk (HEART Score) are possible from avai...
Article
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Background ABG samples are often obtained in trauma patients to assess shock severity. Venous blood gas (VBG) sampling, which is less invasive, has been widely used to assess other forms of shock. The study aim was to determine the agreement between VBG and ABG measurements in trauma. Methods Patients were enrolled at an Australian trauma centre b...
Article
Objective Electronic medical records‐based alerts have shown mixed results in identifying ED sepsis. Augmenting clinical patient‐flagging with automated alert systems may improve sepsis screening. We evaluate the performance of a hybrid alert to identify patients in ED with sepsis or in‐hospital secondary outcomes from infection. Methods We extrac...
Article
PurposeThe current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency trauma patients.MethodsA retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared fo...
Article
Objective With most paediatric emergency research in Australia conducted at tertiary EDs, it is important to understand how presentations differ between those at tertiary paediatric EDs and all other EDs. Methods Retrospective epidemiological study assessing paediatric case‐mix and time‐based performance metrics (aged 0–14 years) obtained from a n...
Preprint
Full-text available
Purpose Dysregulated immune response is a key driver of disease progression in sepsis and known to be associated with impaired cellular metabolism. This association has been studied mostly in the late stage sepsis patients. Here, we investigate whether such impairment in cellular metabolism is present in uncomplicated infection patients who do not...
Article
Objective: COVID-19 has left no healthcare system untouched. In New South Wales (NSW), the most populous state in Australia, COVID-19 case numbers have to date been relatively low. However, that does not mean the state's healthcare system has been unaffected. Preparations to create sufficient capacity to accommodate a COVID-19 surge resulted in wi...
Article
Full-text available
Background: Quick Sepsis-related Organ Failure Assessment (qSOFA) is recommended for use by the most recent international sepsis definition taskforce to identify suspected sepsis in patients outside the Intensive Care Unit (ICU) at risk of adverse outcomes. Evidence of its comparative effectiveness with existing sepsis recognition tools is importa...
Article
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Background: Prognosis of musculoskeletal disorders following injury is essential in determining appropriate treatment and care. A generic validated prognostic tool to stratify risk of poor recovery for people with musculoskeletal injuries after road traffic crash is not available. This study aimed to examine differences in recovery, return to work...
Article
Full-text available
We performed a meta-analysis to assess whether the newly introduced quick Sequential Organ Failure Assessment score could predict sepsis outcomes and compared its performance to systematic inflammatory response syndrome, the previously widely used screening criteria for sepsis. Data sources: We searched multiple electronic databases including MED...
Article
Sepsis remains a significant global health problem. It is a life-threatening, but poorly defined and recognized condition. Early recognition and intervention are essential to optimize patient outcomes. Automated clinical decision support systems (CDS) may be particularly beneficial for early detection of sepsis. The aim of this study was to use ret...
Article
Introduction Mechanical cardiopulmonary resuscitation (M-CPR) is increasingly used in the management of cardiac arrest. There are no previously reported randomised studies investigating M-CPR training. This study of newly trained M-CPR providers hypothesised that a brief simulation-based intervention after 4 months would improve M-CPR performance a...
Article
Objectives: To learn the attitudes of health professionals, health informaticians and information communication technology professionals to using data in electronic health records (eHRs) for performance feedback and professional development. Design: Qualitative research in a co‐design framework. Health professionals’ perceptions of the accessibili...
Article
Objectives To compare patient satisfaction levels, staff perspectives and the time required using Structured Interdisciplinary Bedside Rounds (SIBR; Emory University, Atlanta, GA, USA) versus traditional medical ward rounds (TR) in the ED. Methods We conducted an observational cross‐sectional study. Ward rounds were categorised into a modified SIB...
Article
Objective In existing risk stratification and resuscitation guidelines for sepsis, a hypotension threshold of systolic blood pressure (SBP) below 90–100 mmHg is typically used. However, for older patients, the clinical relevance of a SBP in a seemingly ‘normal’ range (>100 mmHg) is still poorly understood, as they may need higher SBP for adequate t...
Article
Background Literature pertaining to the predictive factors for septic arthritis is limited. Aims The primary objective was to investigate the predictive factors for septic arthritis. The secondary objectives were to investigate the predictive factors for crystal arthritis and to explore current practises in the management of acute arthritis. Meth...
Article
Objective The arterial to end‐tidal carbon dioxide tension difference (CO2 gap) correlates with physiologic dead space. The prognostic value of increased CO2 gap in trauma and respiratory distress patients is documented. Transpulmonary arteriovenous shunting is identified as a predictor of mortality in non‐pulmonary sepsis. We set out to investigat...
Article
Full-text available
Objective: The arterial to end-tidal carbon dioxide tension difference (CO2 gap) correlates with physiologic dead space. The prognostic value of increased CO2 gap in trauma and respiratory distress patients is documented. Transpulmonary arteriovenous shunting is identified as a predictor of mortality in non-pulmonary sepsis. We set out to investiga...
Article
Although comprehensive guidelines for treatment of sepsis exist, current research continues to refine and revise several aspects of management. Imperatives for rapid administration of broad-spectrum antibiotics for all patients with sepsis may not be supported by contemporary data. Many patients may be better served by a more judicious approach all...
Article
Full-text available
Objective Pain management and patient satisfaction are key markers for health systems performance. There is a lack of consensus on the role of analgesia, its adequacy, and its links to patient satisfaction in the ED. The present study aimed to assess the relationship between adequacy of analgesia and patient satisfaction in the ED setting. Methods...
Article
Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplica...
Article
Full-text available
Objectives We investigated specific lactate thresholds for adverse outcomes in patients presenting to emergency departments (EDs) with suspected sepsis identified based on the performance of a sepsis screening algorithm. Design and setting A standardised sepsis bundle was implemented across public hospitals in New South Wales, Australia, as a qual...
Article
Full-text available
Objective: The Sepsis-3 task force recommends the use of the quick Sequential Organ Failure Assessment (qSOFA) score to identify risk for adverse outcomes in patients presenting with suspected infection. Lactate has been shown to predict adverse outcomes in patients with suspected infection. The aim of the study is to investigate the utility of a...
Article
Sepsis has recently been redefined as acute organ dysfunction due to infection. The ED plays a critical role in identifying patients with sepsis. This is challenging due to the heterogeneity of the syndrome, and the lack of an objective standard diagnostic test. While overall mortality rates from sepsis appear to be falling, there is an increasing...
Article
Objective: Age-related policies allow adolescents to access paediatric and adult EDs. Anecdotally, paediatric and adult EDs report challenges when caring for older and younger adolescents, respectively. Our aim was to describe the characteristics of an adolescent population attending an adult ED, co-located with a tertiary paediatric ED. Methods:...
Article
Full-text available
Objective: The ED discharge stream short stay units (EDSSUs) aim to facilitate patient flows through EDs. We investigate the relationship between EDSSU census and hospital bed occupancy rates (BORs) on National Emergency Access Target (NEAT) performance and did-not-wait (DNW) rates at a tertiary metropolitan adult ED in Sydney, Australia. Methods...
Article
Objective: To estimate the impact of adopting the proposed new diagnostic criteria for sepsis, based on Sequential Organ Failure Assessment (SOFA) criteria, on the diagnosis and apparent mortality of sepsis in Australian and New Zealand intensive care units. Design, setting and participants: A two-stage, post hoc analysis of prospectively collec...
Article
Objective: Systemic inflammatory response syndrome (SIRS)-based severe sepsis screening algorithms have been utilised in stratification and initiation of early broad spectrum antibiotics for patients presenting to EDs with suspected sepsis. We aimed to investigate the performance of some of these algorithms on a cohort of suspected sepsis patients...
Article
Objective: Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations. Methods: We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were clas...
Article
Aim: To assess trends in medical imaging requests before and after the 4-hour rule commenced and to assess the imaging time component of emergency department (ED) length of stay (LOS). Materials and methods: Retrospective analysis of ED patients and imaging requests 1 year prior to and 3 years after implementation of the 4-hour rule (April to De...
Article
Full-text available
Background: Adolescents access either paediatric or adult emergency departments (EDs) for acute care and other health needs. Anecdotally adolescent management is perceived as burdensome in adult EDs, with complex chronic illness cited as a specific issue. This systematic review aimed to describe what is known of adolescent presentations made to adu...
Article
The incidence of cervical spine injuries (CSI) in people over 65 years of age from low-energy mechanisms is far greater than in younger populations. Algorithms and decision rules exist for selection of trauma patients requiring cervical spine imaging. To determine the validity of the NEXUS criteria in the elderly population with low-mechanism injur...
Article
Objective Discharge-stream emergency short-stay units (ESSU) improve ED and hospital efficiency. Age of patients and time of hospital presentations have been shown to correlate with increasing complexity of care. We aim to determine whether an age and time cut-off could be derived to subsequently improve short-stay unit success rates.Methods We con...
Article
Background Emergency departments (ED) continue to evolve models of care and streaming as interventions to tackle the effects of access block and overcrowding. Tertiary ED may be able to design patient-flow based on predicted dispositions in the department. Segregating discharge-stream patients may help develop patient-flows within the department, w...
Article
Full-text available
Objective To determine whether a narrower gauge needle used in ABG sampling is associated with lower pain scores and complication rates without increasing the level of difficulty of the procedure. Methods We performed a prospective single-blinded randomised control study of patients from a tertiary-level emergency department in Sydney who required...
Article
Full-text available
The study aims to determine the interpretation accuracy of computed tomography of the kidneys, ureters and bladder (CT-KUB) by emergency physicians (EPs) compared with the formal radiology report, as the reference standard, in patients with suspected acute urinary tract calculous disease. A sample of 20 consecutive CT-KUB scans for suspected acute...
Article
Blood pressure (BP) cuffs are potential vectors for transmission of multi-resistant organisms (MROs). The present study aims to determine MRO colonisation rates in BP cuffs from areas of high patient flow as an assessment of the quality of disinfection and infection control practices. BP cuffs in the ED, high dependency unit (HDU) and operating the...
Article
Full-text available
D-dimer is used widely as a diagnostic aid in low- and moderate-risk patients with suspected venous thromboembolism (VTE). While our laboratory utilizes VIDAS D-dimer analyzer (bioMérieux SA, France), our emergency department (ED) recently procured a D-dimer analyzer AQT90 FLEX (Radiometer Medical ApS, Denmark) for point of care testing (POCT) to f...
Article
Access block (AB) and hospital overcrowding adversely affect ED functionality. ED throughput measures have been described in the literature with positive impacts on key performance indicators (KPIs)--time to first seen, did-not-wait rates, off-stretcher times for ambulances and ED length of stay figures. In this study, we aimed to assess the impact...
Article
Full-text available
To determine whether CO₂ GAP [(a-ET) PCO₂] value differs consistently in patients presenting with shortness of breath to the ED requiring ventilatory support. To determine a cut-off value of CO₂ GAP, which is consistently associated with measured outcome and to compare its performance against other derived variables. This prospective observational...

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Projects (3)
Project
Prospective multicentre clinician EMR notified suspected sepsis archive to research on all aspects of Emergency management of sepsis presenting to ED.