EMA June 2012

Issue 3 (Vol. 24) of Emergency Medicine Australasia published online on 4 June 2012

Have medical journals missed the Web 2.0 rollercoaster? (#FOAMed) The use of Web 2.0 resources by medical professionals is changing the ways in which modern medical information is created and the speed at which it can be accessed and distributed, particularly in the field of Emergency Medicine. This though-provoking editorial by Buck, argues the College and its journal, EMA, should consider implementing well designed social media practices that are responsive to the needs of members and readers

Disaster triage: Evidence, consistency and standard practice (#FOAMed) While the concepts of triage are straightforward, this editorial by Aitken & Fitzgerald outlines the range of issues to be resolved in order to standardise disaster triage and ensure both the prioritisation of care and appropriate management of available resources. Documentation of patients in a disaster is one such issue and recent papers by Field & Norton and Varshney et al have evaluated use of triage tags. While best evidence is equivocal in terms of the ‘perfect’ tag, the SMART tag, identified as one of the preferred tags in these studies, has been adopted by the majority of ambulance services in Australia and so is likely to become a surrogate national standard

Management of Cyanide Poisoning (Abstract) This is an uncommon but important topic.  Reade et al, for the Australian Resuscitation Council, conducted a systematic review on use of various proposed cyanide antidotes, and a narrative review of relevant pharmacological and animal studies. Recommendations are presented for patient management: antidote usage and requirements for supportive care, along with workplace planning and practices where there is a risk of cyanide poisoning

One hundred tasks an hour (Abstract) A time-motion study by Kee and colleagues, demonstrated that ED consultants have very high hourly task rates dominated by communication, ICT use and clinical activities, involving frequent multitasking. However the majority of their time was spent on tasks which were not direct clinical care.  This activity level was relatively constant throughout the week but was influenced by gender and clinical role. Appreciation of this activity distribution may assist informed interventions to realign workload or divert tasks to supporting staff, so that ED consultants can spend more time on clinical care and supervision of junior staff, with potential improvements in productivity and better delivery of patient-care

Improving timeliness while improving the quality of emergency department care (#FOAMed) This editorial by Lowthian and Cameron addresses the role of clinical quality indicators (CQI) in monitoring the impact of time-based performance targets for emergency medicine. They argue that the CQI set selected for New Zealand (as described in the paper by Jones et al will, with standardised definitions and appropriate benchmarking, assist in driving better patient care, provided the indicators are integrated into comprehensive quality framework

Selection and Validation of Quality Indicators for the Shorter Stays in Emergency Departments National Research Project (Abstract) Jones and Colleagues describe the work of Shorter Stays in Emergency Departments (SSED) National Research Project Team in compiling an evidence-based and clinically relevant set of indicators to measure the effect of the SSED target. Through literature review and consultation with stakeholders, 14 indicators were identified: hospital and ED LOS, re-presentation within 48 hours, mortality, times to: reperfusion, antibiotics, asthma treatment, analgesia, CT for head injury, and to theatre (appendicitis and fractured neck of femur), triage time compliance, proportion leaving ED without being seen, quality of discharge information and ED overcrowding/access block. This indicator set is consistent with recent international recommendations for measuring quality of care in EDs and highly relevant for monitoring impact of the recently introduced time-based targets in New Zealand and Australia

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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