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The remote emergency care course and the multidisciplinary approach to emergency care in the bush
Abstracts The remote emergency care course and the multidisciplinary approach to emergency care in the bush Libby Bowell CRANAplus Education Manager, PO box 2148, Hilton Plaza, SA, Australia Keywords: Remote area nurses; Aboriginal health workers; Remote emergency care course E-mail address: fl[email protected]. CRANAplus is the peak professional body for remote health practitioners in Australia. One of our core responsibilities is to provide short courses in emergency and maternity emergency response for remote practitioners. Remote health practitioners work in a unique and challenging environment and are often the first responders to trauma and medical emergencies with limited on the ground back up. Teams consist of Remote Area Nurses (RANs) and Aboriginal Health Workers (AHWs) with varying levels of knowledge and experiences. The main focus for RANs and AHWs working in health centres is primary health care, with trauma making up anywhere between 5 and 20% of their workload . . . but when it happens, all hands are needed and team work is essential! The remote emergency course was developed in response to RANs recognising that there was more to emergencies than just trauma and that their scope of practice was broader and often necessitated advanced levels of treatment. Often patients are cared for many hours whilst waiting for a retrieval service to fly in and consultation takes place via phone. This presentation will look at the differences and expectations around ‘emergency response in the bush’ and the need for RANs and AHWs to respond to emergencies with the same standard of care as in a metropolitan setting. The course has been developed to assist remote practitioners in developing the advanced skills and assessment techniques to deliver safe and quality emergency care irrespective of the setting they are working in. doi:10.1016/j.aenj.2011.09.038 Patients who present to the emergency department and leave without being seen: Prevalence and predictors J. Crilly 1,∗ , N. Bost 1 , L. Thalib 2 , J. Timms 1 , H. Gleeson 1 1
Emergency Department, Gold Coast Hospital & Griffith University, 108 Nerang St, Southport, Qld. 4215, Australia 2 Biostatistics Department of Community Medicine, Faculty of Medicine, Kuwait University, Safat, PO Box 24923, Kuwait Keywords: Did not wait; Outcomes; Emergency department
E-mail addresses: Julia [email protected] (J. Crilly), Nerolie [email protected] (N. Bost), [email protected] (L. Thalib), Jo [email protected] (J. Timms), Heidi [email protected] (H. Gleeson). Objective: To identify the prevalance and predictors of patients who leave without being seen (LWBS) in one hospital emergency department (ED).
S15 Design: A descriptive, retrospective cohort study design was employed. All patient presentations made to one ED over a 12 month period were included. Data were extracted from the ED Information System. Multivariate logistic regression identified predictors of patients who LWBS. Setting: A large regional teaching hospital ED in South East Queensland, Australia. Sample: 64,292 patient presentations made to the ED from August 2008 to August 2009. Results: The prevalence of patients who LWBS was 10.7%. Predictors of DNW included: all age groups younger than 65 years; lower triage allocation, arrival by means other than ambulance, evening and night shift presentations, winter season, weekend presentations, and presenting complaints of gastro-intestinal or paediatrics. Conclusions: Lower triage allocation and late and night shift presentations were the most powerful predictors of LWBS. This suggests that service improvements could be targeted during ‘out of business hours’ for those with less emergent conditions and lengthy waits. Evaluations of service improvements are required. doi:10.1016/j.aenj.2011.09.039 Emergency nurses’ practices in assessing and monitoring continual intravenous sedation for critically ill adult patients: A retrospective audit. ‘‘Are you sleeping comfortably? Then we shall begin’’ Wayne Varndell 1,∗ , Marg Fry 2 , Doug Elliott 2 1
Prince of Wales Hospital Emergency Department, Barker Street, Randwick, NSW 2031, Australia 2 Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, P.O BOX 123, Broadway, NSW 2007, Australia Keywords: Sedation; Emergency department Initial resuscitation and subsequent care of critically ill patients is a core component of emergency nursing practice. While critical care is synonymous with the intensive care unit (ICU), these patients are also being cared for in the emergency department (ED) with increasing frequency and lengths of stay. Sedation in the critically ill patient in ED has not been well studied, despite emergency nurses increasingly being responsible for the continuity of care for these patients, and the significant risks associated with sedation (e.g. unplanned self-extubation, under/over-sedation, agitation, pain, ventilator dysynchrony). The specialised skills, abilities and knowledge necessary to safely assess and monitor ongoing intravenous sedation for these patients remain unclear. Aim: To evaluate documentation of sedation assessment and monitoring activities in the continuously sedated critically ill adult patient in ED. Method: Retrospective audit of medical records of patients admitted to ICU from ED. Results: 63 patients received ongoing intravenous sedation at admission to ICU between 2009 and 2010. Median length of time spent in ED sedated prior to transfer to ICU was 4.2 hrs (range 0.8—9.6 h, IQR 3.21 h), 59% were aged under 65 years and 68% male. Clinical documenta-
Emergency Department, Gold Coast Hospital & Griffith University, 108 Nerang St, Southport, Qld. 4215, Australia 2 Biostatistics Department of Community Medicine, Faculty of Medicine, Kuwait University, Safat, PO Box 24923, Kuwait Keywords: Did not wait; Outcomes; Emergency department
E-mail addresses: Julia [email protected] (J. Crilly), Nerolie [email protected] (N. Bost), [email protected] (L. Thalib), Jo [email protected] (J. Timms), Heidi [email protected] (H. Gleeson). Objective: To identify the prevalance and predictors of patients who leave without being seen (LWBS) in one hospital emergency department (ED).
S15 Design: A descriptive, retrospective cohort study design was employed. All patient presentations made to one ED over a 12 month period were included. Data were extracted from the ED Information System. Multivariate logistic regression identified predictors of patients who LWBS. Setting: A large regional teaching hospital ED in South East Queensland, Australia. Sample: 64,292 patient presentations made to the ED from August 2008 to August 2009. Results: The prevalence of patients who LWBS was 10.7%. Predictors of DNW included: all age groups younger than 65 years; lower triage allocation, arrival by means other than ambulance, evening and night shift presentations, winter season, weekend presentations, and presenting complaints of gastro-intestinal or paediatrics. Conclusions: Lower triage allocation and late and night shift presentations were the most powerful predictors of LWBS. This suggests that service improvements could be targeted during ‘out of business hours’ for those with less emergent conditions and lengthy waits. Evaluations of service improvements are required. doi:10.1016/j.aenj.2011.09.039 Emergency nurses’ practices in assessing and monitoring continual intravenous sedation for critically ill adult patients: A retrospective audit. ‘‘Are you sleeping comfortably? Then we shall begin’’ Wayne Varndell 1,∗ , Marg Fry 2 , Doug Elliott 2 1
Prince of Wales Hospital Emergency Department, Barker Street, Randwick, NSW 2031, Australia 2 Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, P.O BOX 123, Broadway, NSW 2007, Australia Keywords: Sedation; Emergency department Initial resuscitation and subsequent care of critically ill patients is a core component of emergency nursing practice. While critical care is synonymous with the intensive care unit (ICU), these patients are also being cared for in the emergency department (ED) with increasing frequency and lengths of stay. Sedation in the critically ill patient in ED has not been well studied, despite emergency nurses increasingly being responsible for the continuity of care for these patients, and the significant risks associated with sedation (e.g. unplanned self-extubation, under/over-sedation, agitation, pain, ventilator dysynchrony). The specialised skills, abilities and knowledge necessary to safely assess and monitor ongoing intravenous sedation for these patients remain unclear. Aim: To evaluate documentation of sedation assessment and monitoring activities in the continuously sedated critically ill adult patient in ED. Method: Retrospective audit of medical records of patients admitted to ICU from ED. Results: 63 patients received ongoing intravenous sedation at admission to ICU between 2009 and 2010. Median length of time spent in ED sedated prior to transfer to ICU was 4.2 hrs (range 0.8—9.6 h, IQR 3.21 h), 59% were aged under 65 years and 68% male. Clinical documenta-