Initial destination hospital of paediatric prehospital patients in rural Victoria

Paramedics are required to make a variety of decisions regarding their patient, not only on the patient’s condition and course of treatment but also on the destination medical facility for further care.

The objective of this study by Kate Kloot was to describe the initial destination hospital of paediatric patients transported by Ambulance Victoria paramedics within the South Western area of Victoria to determine the proportion of patients that bypassed their closest hospital.

It found that almost 20% of paediatric patients were not transported to the closest hospital,  paramedics focused on patient condition and the distance to a larger hospital when choosing destination, and uncertainty regarding 24 hour availability of resources at smaller hospitals contributed to longer transports.

Access article on publisher site

Kloot K, Salzman S, Kilpatrick S, Baker T, Brumby SA. Initial destination hospital of paediatric prehospital patients in rural Victoria. Emerg Med Australas. 2016;28(2):205-10.

Early MRI versus conventional management in the detection of occult scaphoid fractures: what does it really cost? A rural pilot study

The scaphoid is the most frequently fractured carpal bone and accounts for a significant portion of presentations in the emergency department. Managing the patient in the emergency department with the help of an acute magnetic resonance imaging (MRI) allows early correct treatment and saves the patient wearing a splint unnecessarily if the scaphoid is not actually fractured.

This study by Tamika Kelson from South West Healthcare, Rob Davidson of the University of Canberra, and Tim Baker of CREM compared cost-effectiveness and patient impact for early MRI-based management and conventional management of occult scaphoid fractures in a rural setting.

The study found that MRI dramatically reduces the amount of unnecessary immobilisation, time of treatment and healthcare usage in a rural setting. It decreased societal cost, while the cost to the rural healthcare service was equivalent with either MRI or traditional approaches.

Access article on publisher’s site

Kelson T, Davidson R, Baker T. Early MRI versus conventional management in the detection of occult scaphoid fractures: what does it really cost? A rural pilot study. J Med Radiat Sci. 2016;63(1):9-16.

Small rural emergency services can electronically collect accurate episode-level data: A cross-sectional study

Small rural emergency services (SRES), unlike larger emergency departments, seldom collect clinical and administrative data about every patient they manage.

Samantha Dawson, Tim Baker, and Scott Salzman studied six SRES that collected this type of detailed data for 12 months.

The SRES were able to collect accurate and mostly complete electronic episode-level data for 12-months with four hours per week of support. This study provides starting data accuracy benchmarks for specific fields collected in SRES and could be used to inform decisions about widespread electronic data collection across these services.

Access article on publisher’s site

Dawson SL, Baker T, Salzman S. Small rural emergency services can electronically collect accurate episode-level data: A cross-sectional study. Aust J Rural Health. 2015, Apr;23(2):107-11.

Last drinks: A study of rural emergency department data collection to identify and target community alcohol-related violence

Alcohol-related violence and injury is a significant public health problem and a substantial burden on hospital EDs, especially on weekends during ‘high-alcohol hours’.

In this study by Peter Miller and Nic Droste, from Deakin School of Psychology, and Tim Baker from CREM, all patients aged 15 years or older presenting to a regional emergency department  were asked whether alcohol was consumed in the 12 hours prior to injury, how many standard drinks were consumed, where they purchased most of the alcohol and where they consumed the last alcoholic drink.

The study found that this ED data collection was feasible, alcohol injuries were linked to identifiable venues and public areas, and packaged liquor sales substantially contribute to emergency department attendances.

Access article on publisher’s site

Miller P, Droste N, Baker T, Gervis C. Last drinks: A study of rural emergency department data collection to identify and target community alcohol-related violence. Emergency Medicine Australasia 2015, Jun;27(3):225-31.

Emergency department data sharing to reduce alcohol-related violence

This paper reviews the current evidence for reducing alcohol related injuries by sharing data collected by emergency departments, with agencies such as police, local council, liquor licensing regulators and venue management.

Nicolas Droste and Peter Miller from the School of Psychology at Deakin University, along with Tim Baker from CREM, performed a quantitative and narrative synthesis on 8 articles selected from an original search of 19,506 articles.

All studies found that data collection could be cheaply and easily implemented into modern ED triage systems. All but on study study reported substantial reductions to assault or injury. One reported no change.

Access article on publisher’s site

Droste, N., Miller, P., & Baker, T. (2014). Review article: Emergency department data sharing to reduce alcohol-related violence: A systematic review of the feasibility and effectiveness of community-level interventions. Emergency Medicine Australasia, 26(4), 326-35. doi:10.1111/1742-6723.1224

Small rural emergency services still manage acutely unwell patients

Australian small rural emergency services need to be prepared to manage diverse problems and urgent patients.

Dr Tim Baker and Samantha Dawson conducted a study that collected 12-months worth of episode-level data from 6 small rural emergency departments in Victoria’s south-west.

They found that a wide range of problems presented and that most of the common procedures were performed. Most importantly, almost 6% of 14318 emergency patients were in the two most urgent triage categories.

Read more: Access article on publisher’s site

Baker T, and Dawson SL. Small rural emergency services still manage acutely unwell patients: A cross-sectional study [Internet]. Emergency Medicine Australasia. 2014;26(2):131-138.Available from: http://dx.doi.org/10.1111/1742-6723.12229

How many emergency departments?

How many ‘EDs’ does Australia have: 122, 126, 162, 181 or 203? How many rural hospitals have an emergency area that fails to make the grade: 483 or 406? We do not know because national organisations cannot agree when a rural hospital’s emergency service meets the criteria to be called an ‘ED’.

This brief article outlines the various counts and classifications of emergency departments and other hospital-based emergency care facilities in Australia.

http://onlinelibrary.wiley.com/doi/10.1111/1742-6723.12199/abstract

Baker T, Dawson S. How many emergency departments? Emergency Medicine Australasia 2014, Apr;26(2):212-3.

 

What do small rural emergency departments do?

There is a vast difference in settings and scales used by rural emergency departments reported in studies over the last 30 years that it is difficult to compare them.

Dr Tim Baker and Samantha Dawson from CREM reviewed 19 studies from Australia, Canada and the United States that described rural emergency department activity and performance, and identified common characteristics.

They found that the most common presentation was for injury or poisoning, and that a lot of patients presented outside of business hours. There were some urgent patients but this was only a small proportion of presentations.  Nurses also managed many patients without medical input.

This study highlighted the need to support nurses as practitioners, and called for the use of common classification systems within the ED for ease of comparison.

Read more: Access article on publisher’s site

Baker T, and Dawson SL. What small rural emergency departments do: A systematic review of observational studies. Aust J Rural Health. 2013;21(5):254-261.

Farmers with acute chest pain are uncertain how and when to seek help

A pilot study of the prevalence of cardiac risk factors in a group of agricultural workers and of their decision-making abilities with regard to when and how they would seek help when experiencing chest pain has found that most put themselves at risk of dying.

Researchers Dr Tim Baker, (Centre for Rural Emergency Medicine), and Scott McCombe, Cate Mercer-Grant, and Susan Brumby, from the National Centre for Farmer Health and Western District Health Service, studied almost 200 farm men and women recruited from 20 rural Victorian sites. The farmers underwent health assessments for total cholesterol, blood glucose, weight, height and blood pressure, and they completed a survey to determine their knowledge of chest pain treatment, local emergency services, and likely response to chest pain.

In this study, researchers found that 61% of the farmers had cardiac risk factors, with 61% of men and 74% of women either overweight or obese. When asked to name their nearest ED, 10% of participants nominated health services or towns where no ED exists. Sixty seven percent of respondents believed it was safe to travel to hospital by car while potentially having a myocardial infarction.

Improving health literacy among farm men and women is of the utmost importance as they have higher rates of clinical risk factors and appear to be lagging in emergency knowledge and services when compared with their urban and regional counterparts, the researchers maintain.

Read more: Access article on publisher’s site

Baker, T., McCoombe, S., Mercer-Grant, C. and Brumby, S. (2011), Chest pain in rural communities; balancing decisions and distance. Emergency Medicine Australasia, 23: 337–345. doi: 10.1111/j.1742-6723.2011.01412.x