- Email: [email protected]
Length of stay and the four hour target: A retrospective audit of emergency department presentations by Residential Aged Care patients
S4 Conclusions: Preliminary evaluation of the revised Extended Practice Nurse model suggested practice benefits within early care delivery and patient flow. The evaluative framework enabled greater understanding of this role. Further patient flow data will be pursued to see if initial indications are confirmed through assessment of ongoing practice. doi:10.1016/j.aenj.2011.09.011 Q-STAT (Quick Stroke/TIA Assessment @ Triage) Modbury Hospital’s experience Tracy Edwards 1,∗ , Kathryn O’Toole 2 1 Modbury Hospital, Emergency Department, Smart Rd, Modbury, SA 5092, Australia 2 Modbury Hospital, Critical Care Unit, Smart Rd, Modbury, SA 5092, Australia Keywords: Stroke; Transient Ischaemic Attack (TIA); Rosier Stroke Scale; Clinical Stroke Network
E-mail addresses: [email protected] (T. Edwards), kathryn.o’[email protected] (K. O’Toole). Cerebrovascular disease is one of the nation’s leading cases of cardiovascular disease with stroke being Australia’s second single greatest killer after coronary heart disease and a leading cause of disability. In 2010 60,000 Australians will suffer new a recurrent strokes, this equals one stroke every 10Ymin. An audit of patients who presented to Modbury Hospital’s emergency department triage with symptoms suggestive of TIA/CVA, demonstrated that this cohort of patients were inadequately triaged and at times experienced long waiting periods for the commencement of treatment. The data also revealed that these patients were receiving the wrong triage priority as per the ATS (Australian Triage Score) and clearly not meeting the National Stroke Clinical Guidelines. By participating in and completing a Clinical Practice Improvement programme we were able to implemented methodologies learnt to identify, interpret and implement to clinical changes and highlighted that there was a clear gap in service and that current practice of the medical and nursing staff in ED needed to be addressed and improved to provide the best and most effective timely treatment for these patients to improve the treatment and management for these patients. Following commencement of CPI project, there was approximately 20% reduction in patients receiving the incorrect ATS priority and also 20% reduction in time to be seen and treatment initiated by a medical officer. doi:10.1016/j.aenj.2011.09.012
Mandatory reporting in the emergency department: Case study reviews of head injuries in young children Kate Gargiulo Emergency Department, Bendigo Health, PO Box 126, Bendigo, Victoria 3552, Australia Keywords: Health care professionals; Nurses; Emergency department; Child abuse and neglect; Mandatory reporting; Head injuries E-mail address: [email protected]. Health care professionals such as doctors and nurses are mandated to report all suspected cases of child abuse. A nurse working in the emergency department often witnesses possible signs and symptoms of child abuse and neglect, while working in a diverse and demanding environment. Each and every situation is different, where the child may have been a victim of physical, sexual or psychological abuse and/or neglect. Real life case studies of a 5 month old and a 16 month old child presenting with suspected head injuries will be discussed in this presentation. Included in the review will be the triage presentation and assessment, investigations undertaken, clinical findings, treatment commenced, the outcome of the patient, and most importantly were these cases an alert for the health care professional to report as a suspected case of child abuse? And if so, are we reporting? Nursing staff, who are often the ones who have first contact with the child, as studies have shown; do not make the top five people who notify. While nurses are in an important position to notify and report suspected cases of abuse, barriers may exist that deter the process. These can be related to limited education and experience on recognition of child abuse signs and symptoms, and more importantly fear of perceived consequences and lack of emotional support for nurses throughout the reporting process. Further research regarding current education standards needs to be undertaken to reduce the identified barriers of reporting, thus offering greater protection for the most vulnerable people of our population; children. doi:10.1016/j.aenj.2011.09.013 Length of stay and the four hour target: A retrospective audit of emergency department presentations by Residential Aged Care patients Maryann Marriott 3
Street 1,2,∗ , Patricia
Livingston 1 , Jonathan
1
Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, VIC 3125, United States 2 Nursing Research Unit, Eastern Health, Level 2, 5 Arnold Street, Box Hill, VIC 3128, United States 3 Eastern Health and Northern Health, Bundoora Extended Care Centre, 1231 Plenty Road, Bundoora, VIC 3083, United States Keywords: Emergency department; Residential Aged Care; Length of stay; Four-hour target; Older patients Background: Residential Aged Care (RAC) residents have a high incidence of emergency department (ED) presentations and may be seriously impacted by the Federal Government
Abstracts time targets to reduce waiting times in ED, introduced from January 2011. Objective: This study aimed to examine emergency presentations for people living in RAC in relation to recently changed Australian Government time targets. Design: A retrospective audit of all Emergency presentation and admission data for RAC patients in 2009 across three metropolitan hospitals. Outcome measures were: length of stay in ED (less than 4 h, 4—8 h, more than 8 h), Discharge destination, ATS (triage) category, Length of Admission. Results: A total of 4637 Emergency presentations by 3183 RAC patients were identified in 2009, representing 3.4% of all Emergency presentations at this health service. Patients from RAC were more likely to present to ED in a confused state, be triaged as more urgent, have a longer stay in ED and had twice the rate of admission than the general population. Sixteen percent of RAC patients remained in ED for less than 4 h; 26% were discharged within 4 h and 56% were admitted to care within 8 h. Those discharged from ED back to residential care had significantly shorter length of stay in ED compared to those admitted to care (p < 0.001). Conclusion: These findings have significant implications for Federal Government performance indicators as these strict parameters may lead to a reduction in quality of care for RAC patients who attend ED. doi:10.1016/j.aenj.2011.09.014 Acute Coronary Syndromes: A case based review of new guidelines in practice Jayne Harris Flinders Medical Centre, Centre for Nursing and Midwifery Education & Research (CNMER), Level 7, Flinders Drive, Bedford Park, South Australia 5042, Australia E-mail address: [email protected]. Aim: The aim of this presentation will be to provide a review of the pathological process involved in Acute Coronary Syndromes (ACS) and an overview of the 2011 ACS management guidelines, embedded within patient case studies. Outcome: To increase clinical management and confidence of nursing / midwifery staff in caring for the patient with an Acute Coronary Syndrome and improving patient outcomes by ensuring appropriate (guideline recommendations) and timely care is provided. Content: In 2011 the American Heart Association/American College of Cardiology will release, followed by the National Heart Foundation of Australia, new guidelines recommending current best practice management and treatment strategies for all patients presenting with an ACS. These recommendations include early identification, risk stratification, pharmacological and interventional techniques to promote optimal outcomes for the patient. It is vital that nurses/midwives working within the Emergency Department, often the first point of contact for the ACS patient, are aware of the content of the guidelines and recommendations to guide care plans and facilitate treatments. This session will be presented utilising client case studies to review the pathology of acute coronary syndromes and
S5 discuss the treatments recommended within a strong clinical context. doi:10.1016/j.aenj.2011.09.015 Focus on cardiac rhythms and those that will kill you Jayne Harris Aim: Review normal anatomy and (electro) physiology of the heart; review of the action potential and fundamentals of normal electrophysiology within normal sinus rhythm; understand the common arrhythmias that can present in the ED and management of each (significance, treatments, outcomes); review lethal arrhythmias confidently and discuss significance and management according to guidelines and recommendations. Outcomes: Discuss the electrophysiology principles that underpin sinus rhythm including the action potential and mechanical function; identify commonly seen arrhythmias in the ED and discuss significance and treatments associated with each; recognise lethal arrhythmias confidently and recommend appropriate treatments according to current guidelines for resuscitation. Relevance: With an aging population patients presenting with varying cardiac arrhythmias are only going to increase in number. Nurses working within an ED must be able identify normal vs abnormal cardiac rhythms as part of a primary survey — core business for all staff from novice to experienced. This not only can direct treatment goals and risk stratify quickly but can be life saving in the event of a lethal arrhythmia. This workshop is a must for all nurses that need education (or an update) in cardiac rhythms and arrhythmia interpretation. doi:10.1016/j.aenj.2011.09.016 Chest pain assessment and management in the ED Jayne Harris Aim: To understand the varying physiology and pathology associated with chest pain and to be able to risk stratify according to acuity and risk factors; to review diagnostic tools utilised in the management of the patient with chest pain including the ECG, cardiac enzymes and Troponins; to understand the management options (and expected outcomes) of the patient with chest pain; including opiods, oxygen, anticoagulation, antiplatelets (including GP IIb/IIIa inhibitors) according to current guidelines. Outcomes: Describe varying causes of chest pain and differences in presentation and subsequent management; explain modifiable and non-modifiable risk factors and stratify patients according to risk, therefore planning management appropriately; discuss the appropriate use and interpretation of diagnostic testing in the patient with cardiovascular pain; explain treatments and medications in managing the patient with an acute presentation of chest pain. Relevance: Patients presenting with chest pain are amongst the largest cohort of patients within the ED. Therefore it is vital that nurses working within this environment are able to effectively assess, risk stratify and commence
E-mail addresses: [email protected] (T. Edwards), kathryn.o’[email protected] (K. O’Toole). Cerebrovascular disease is one of the nation’s leading cases of cardiovascular disease with stroke being Australia’s second single greatest killer after coronary heart disease and a leading cause of disability. In 2010 60,000 Australians will suffer new a recurrent strokes, this equals one stroke every 10Ymin. An audit of patients who presented to Modbury Hospital’s emergency department triage with symptoms suggestive of TIA/CVA, demonstrated that this cohort of patients were inadequately triaged and at times experienced long waiting periods for the commencement of treatment. The data also revealed that these patients were receiving the wrong triage priority as per the ATS (Australian Triage Score) and clearly not meeting the National Stroke Clinical Guidelines. By participating in and completing a Clinical Practice Improvement programme we were able to implemented methodologies learnt to identify, interpret and implement to clinical changes and highlighted that there was a clear gap in service and that current practice of the medical and nursing staff in ED needed to be addressed and improved to provide the best and most effective timely treatment for these patients to improve the treatment and management for these patients. Following commencement of CPI project, there was approximately 20% reduction in patients receiving the incorrect ATS priority and also 20% reduction in time to be seen and treatment initiated by a medical officer. doi:10.1016/j.aenj.2011.09.012
Mandatory reporting in the emergency department: Case study reviews of head injuries in young children Kate Gargiulo Emergency Department, Bendigo Health, PO Box 126, Bendigo, Victoria 3552, Australia Keywords: Health care professionals; Nurses; Emergency department; Child abuse and neglect; Mandatory reporting; Head injuries E-mail address: [email protected]. Health care professionals such as doctors and nurses are mandated to report all suspected cases of child abuse. A nurse working in the emergency department often witnesses possible signs and symptoms of child abuse and neglect, while working in a diverse and demanding environment. Each and every situation is different, where the child may have been a victim of physical, sexual or psychological abuse and/or neglect. Real life case studies of a 5 month old and a 16 month old child presenting with suspected head injuries will be discussed in this presentation. Included in the review will be the triage presentation and assessment, investigations undertaken, clinical findings, treatment commenced, the outcome of the patient, and most importantly were these cases an alert for the health care professional to report as a suspected case of child abuse? And if so, are we reporting? Nursing staff, who are often the ones who have first contact with the child, as studies have shown; do not make the top five people who notify. While nurses are in an important position to notify and report suspected cases of abuse, barriers may exist that deter the process. These can be related to limited education and experience on recognition of child abuse signs and symptoms, and more importantly fear of perceived consequences and lack of emotional support for nurses throughout the reporting process. Further research regarding current education standards needs to be undertaken to reduce the identified barriers of reporting, thus offering greater protection for the most vulnerable people of our population; children. doi:10.1016/j.aenj.2011.09.013 Length of stay and the four hour target: A retrospective audit of emergency department presentations by Residential Aged Care patients Maryann Marriott 3
Street 1,2,∗ , Patricia
Livingston 1 , Jonathan
1
Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, VIC 3125, United States 2 Nursing Research Unit, Eastern Health, Level 2, 5 Arnold Street, Box Hill, VIC 3128, United States 3 Eastern Health and Northern Health, Bundoora Extended Care Centre, 1231 Plenty Road, Bundoora, VIC 3083, United States Keywords: Emergency department; Residential Aged Care; Length of stay; Four-hour target; Older patients Background: Residential Aged Care (RAC) residents have a high incidence of emergency department (ED) presentations and may be seriously impacted by the Federal Government
Abstracts time targets to reduce waiting times in ED, introduced from January 2011. Objective: This study aimed to examine emergency presentations for people living in RAC in relation to recently changed Australian Government time targets. Design: A retrospective audit of all Emergency presentation and admission data for RAC patients in 2009 across three metropolitan hospitals. Outcome measures were: length of stay in ED (less than 4 h, 4—8 h, more than 8 h), Discharge destination, ATS (triage) category, Length of Admission. Results: A total of 4637 Emergency presentations by 3183 RAC patients were identified in 2009, representing 3.4% of all Emergency presentations at this health service. Patients from RAC were more likely to present to ED in a confused state, be triaged as more urgent, have a longer stay in ED and had twice the rate of admission than the general population. Sixteen percent of RAC patients remained in ED for less than 4 h; 26% were discharged within 4 h and 56% were admitted to care within 8 h. Those discharged from ED back to residential care had significantly shorter length of stay in ED compared to those admitted to care (p < 0.001). Conclusion: These findings have significant implications for Federal Government performance indicators as these strict parameters may lead to a reduction in quality of care for RAC patients who attend ED. doi:10.1016/j.aenj.2011.09.014 Acute Coronary Syndromes: A case based review of new guidelines in practice Jayne Harris Flinders Medical Centre, Centre for Nursing and Midwifery Education & Research (CNMER), Level 7, Flinders Drive, Bedford Park, South Australia 5042, Australia E-mail address: [email protected]. Aim: The aim of this presentation will be to provide a review of the pathological process involved in Acute Coronary Syndromes (ACS) and an overview of the 2011 ACS management guidelines, embedded within patient case studies. Outcome: To increase clinical management and confidence of nursing / midwifery staff in caring for the patient with an Acute Coronary Syndrome and improving patient outcomes by ensuring appropriate (guideline recommendations) and timely care is provided. Content: In 2011 the American Heart Association/American College of Cardiology will release, followed by the National Heart Foundation of Australia, new guidelines recommending current best practice management and treatment strategies for all patients presenting with an ACS. These recommendations include early identification, risk stratification, pharmacological and interventional techniques to promote optimal outcomes for the patient. It is vital that nurses/midwives working within the Emergency Department, often the first point of contact for the ACS patient, are aware of the content of the guidelines and recommendations to guide care plans and facilitate treatments. This session will be presented utilising client case studies to review the pathology of acute coronary syndromes and
S5 discuss the treatments recommended within a strong clinical context. doi:10.1016/j.aenj.2011.09.015 Focus on cardiac rhythms and those that will kill you Jayne Harris Aim: Review normal anatomy and (electro) physiology of the heart; review of the action potential and fundamentals of normal electrophysiology within normal sinus rhythm; understand the common arrhythmias that can present in the ED and management of each (significance, treatments, outcomes); review lethal arrhythmias confidently and discuss significance and management according to guidelines and recommendations. Outcomes: Discuss the electrophysiology principles that underpin sinus rhythm including the action potential and mechanical function; identify commonly seen arrhythmias in the ED and discuss significance and treatments associated with each; recognise lethal arrhythmias confidently and recommend appropriate treatments according to current guidelines for resuscitation. Relevance: With an aging population patients presenting with varying cardiac arrhythmias are only going to increase in number. Nurses working within an ED must be able identify normal vs abnormal cardiac rhythms as part of a primary survey — core business for all staff from novice to experienced. This not only can direct treatment goals and risk stratify quickly but can be life saving in the event of a lethal arrhythmia. This workshop is a must for all nurses that need education (or an update) in cardiac rhythms and arrhythmia interpretation. doi:10.1016/j.aenj.2011.09.016 Chest pain assessment and management in the ED Jayne Harris Aim: To understand the varying physiology and pathology associated with chest pain and to be able to risk stratify according to acuity and risk factors; to review diagnostic tools utilised in the management of the patient with chest pain including the ECG, cardiac enzymes and Troponins; to understand the management options (and expected outcomes) of the patient with chest pain; including opiods, oxygen, anticoagulation, antiplatelets (including GP IIb/IIIa inhibitors) according to current guidelines. Outcomes: Describe varying causes of chest pain and differences in presentation and subsequent management; explain modifiable and non-modifiable risk factors and stratify patients according to risk, therefore planning management appropriately; discuss the appropriate use and interpretation of diagnostic testing in the patient with cardiovascular pain; explain treatments and medications in managing the patient with an acute presentation of chest pain. Relevance: Patients presenting with chest pain are amongst the largest cohort of patients within the ED. Therefore it is vital that nurses working within this environment are able to effectively assess, risk stratify and commence