EMA December 2012

Issue 6 (Vol. 24) of Emergency Medicine Australasia published online on 6 December 2012

Editorial: Innovating to build greater relevance to the Australasian emergency medicine community  (#FOAMed) Following on from a strategic planning day in September 2012, in this editorial we provide an overview of future initiatives planned for EMA. These innovations aim to ensure there is improved engagement with the Australasian EM community; a balance between research and educational content in the journal; interactivity with related online content and publishing models (including #FOAMed and GMEP); and a responsive, high-quality service provided to authors.

Comparison of early biomarker strategies with the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (HF-A/CS-ANZ) guidelines for risk stratification of ED patients with chest pain (Abstract) This prospective observational study, from Cullen and colleagues, of cardiac risk stratification for ED patients presenting with chest pain compares point of care (POC) biomarker strategies with the conventional laboratory-based cardiac troponin (cTn) reference standard. POC cTn analysis, at 0 and 2-hours, in combination with HF-A/CS-ANZ guidelines accurately stratified patients at immediate risk of 30-day events. This assessment process allows accelerated care (compared with the 6-hour laboratory standard) for patients at high-risk, who require admission and initiation of targeted management, along with earlier discharge for those patients stratified as lower-risk. Implementation of this POC strategy would enable improvements in timeliness of appropriate care in patients with symptoms of acute coronary syndrome along with assisting in reducing ED overcrowding.

Factors associated with failure to follow-up with a general practitioner after discharge from the Emergency Department (Abstract) Continuity of care is an important issue for many patients following discharge from the ED. Qureshi et al, describe a prospective cohort study of adult patients discharged from the ED with a request for subsequent GP follow up. Patients were more likely to comply with follow-up requests when they were aware of the reasons why follow-up with a GP was needed, had been admitted to a short-stay unit, had private health insurance or had a regular GP. The most common reason given by patients for failing to follow-up with a GP was that they did not think follow-up was necessary or they were not aware they were supposed to have follow-up. These findings highlight the importance of good patient communication in ensuring successful follow-up

Is the increase in emergency short-stay admissions sustainable? Trends across Melbourne, 2000 to 2009 (Abstract) Lowthian and colleagues report a retrospective population-based analysis of linked ED and hospital admission data from metropolitan Melbourne over 10 years ending June 2009. Hospital admissions from the ED had risen substantially over this decade, even after adjustment for population growth and changes in age and gender. In particular there was a dramatic growth in same day/overnight admissions and disproportionate representation of the elderly in admissions from the ED. The growing demand for same day/overnight admissions and an ageing population indicate an urgent need to consider alternative models of care particularly for the acutely unwell older patient.

A Practical communication Guide for Paediatric Procedures (#FOAMed) Strategies to quickly build rapport with children and their families are vital in the ED, where children are often confronted with many diagnostic and treatment procedures in a time-pressured situation. This perspective from Stock and colleagues encourages the use of non-threatening, age appropriate, plain language by all clinicians as a key strategy in preparing and guiding children through these medical procedures. A practical plain language reference guide for common emergency medicine procedures and equipment is presented, for use by clinicians in the ED before, during and after such procedures

The introduction of an extended care paramedic model in New Zealand (Abstract) This retrospective descriptive analysis by Larsen et al evaluates the initial 1000 patients to be treated by the first extended care paramedic (ECP) model of care (MOC) in New Zealand. Study findings suggest ECPs may be able to safely reduce ED attendances through clinical protocols enabling low risk patients to be treated in the community. Prioritising ECP dispatch to specific patient types could maximise the effectiveness of this MOC. However an RCT would be required to accurately determine the real reductions in patients transported to EDs. Furthermore, the extent of ECP compliance to clinical protocols and the safety of expanding this MOC to a larger proportion of patients require careful consideration