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Stanford D, Dinh MM, Eastwood JG, Korczak V, Seimon RV, Moore C, Liu H, Bein KJ. Clinical and longitudinal patterns of frequent presenters to emergency departments: A multi-centre data linkage analysis. Emerg Med Australas 2024; 36:277-282. [PMID: 38172087 DOI: 10.1111/1742-6723.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/21/2023] [Accepted: 11/04/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To describe clinical characteristics and longitudinal patterns of representation in a cohort of patients who frequently present to EDs for care. METHODS A retrospective data analysis linking routinely collected ED data across three hospitals. The study population consisted of patients who presented to any ED on 10 or more occasions in any continuous 365-day period from 1 July 2015 to 30 June 2021. Presenting complaints were divided into those with any mental health, drug and alcohol, or social presentations (MHDAS group) and those without (non-MHDAS group). Outcomes of interest were number of presentations as well as temporal and facility clustering of presentations. A per patient regression analysis was performed to identify independent risk factors for increased presentations. RESULTS Presentations by 1640 frequent ED presenters in the study constituted 4.6% of total ED presentations. MHDAS study group were younger, predominantly English speaking, twice as likely to be married, had lower hospital admission rates and almost three times as many of them did not wait for treatment. Statistically significant differences were also found between these groups regarding presentation clustering, facility entropy, each of the four categories of the number of ED presentations, and Index of Relative Socio-Economic Advantage and Disadvantage. CONCLUSION Representations associated with MHDAS have a different trajectory of representation episodes compared to non-MHDAS group. Escalating number of presentations and clustering are important predictors of future representation numbers. Those 'did not waits' who appear to be representing would be the highest risk of ongoing and persistent representations in the future and should be the target of early interventions to ensure they are accessing appropriate care before this happens.
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Affiliation(s)
- Dorota Stanford
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - John G Eastwood
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Viola Korczak
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Corey Moore
- Public Health Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Hueiming Liu
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
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2
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Berendsen Russell S, Seimon RV, Dixon E, Murphy M, Vukasovic M, Bohlken N, Taylor S, Cooper Z, Scruton J, Jain N, Dinh MM. Applying Sydney Triage to Admission Risk Tool (START) to improve patient flow in emergency departments: a multicentre randomised, implementation study. BMC Emerg Med 2024; 24:39. [PMID: 38454324 PMCID: PMC10921805 DOI: 10.1186/s12873-024-00956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND To determine the effectiveness of applying the Sydney Triage to Admission Risk Tool (START) in conjunction with senior early assessment in different Emergency Departments (EDs). METHODS This multicentre implementation study, conducted in two metropolitan EDs, used a convenience sample of ED patients. Patients who were admitted, after presenting to both EDs, and were assessed using the existing senior ED clinician assessment, were included in the study. Patients in the intervention group were assessed with the assistance of START, while patients in the control group were assessed without the assistance of START. Outcomes measured were ED length of stay and proportion of patients correctly identified as an in-patient admission by START. RESULTS A total of 773 patients were evaluated using the START tool at triage across both sites (Intervention group n = 355 and control group n = 418 patients). The proportion of patients meeting the 4-hour length of stay thresholds was similar between the intervention and control groups (30.1% vs. 28.2%; p = 0.62). The intervention group was associated with a reduced ED length of stay when compared to the control group (351 min, interquartile range (IQR) 221.0-565.0 min versus 383 min, IQR 229.25-580.0 min; p = 0.85). When stratified into admitted and discharged patients, similar results were seen. CONCLUSION In this extension of the START model of care implementation study in two metropolitan EDs, START, when used in conjunction with senior early assessment was associated with some reduced ED length of stay.
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Affiliation(s)
- Saartje Berendsen Russell
- Emergency Department, RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia.
| | - Radhika V Seimon
- Emergency Department, RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia
| | - Emma Dixon
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | - Margaret Murphy
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | | | - Nicole Bohlken
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | - Sharon Taylor
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Zoe Cooper
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Jennifer Scruton
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Nitin Jain
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Michael M Dinh
- Emergency Department, RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia
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3
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Curtis K, Dinh MM, Shetty A, Kourouche S, Fry M, Considine J, Li L, Lung T, Shaw T, Lam MK, Murphy M, Alkhouri H, Aggar C, Russell SB, Seimon RV, Hughes JA, Varndell W, Shaban RZ. The Emergency nurse Protocols Initiating Care-Sydney Triage to Admission Risk Tool (EPIC-START) trial: protocol for a stepped wedge implementation trial. Implement Sci Commun 2023; 4:70. [PMID: 37340486 DOI: 10.1186/s43058-023-00452-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Emergency department (ED) overcrowding is a global problem and a threat to the quality and safety of emergency care. Providing timely and safe emergency care therein is challenging. To address this in New South Wales (NSW), Australia, the Emergency nurse Protocol Initiating Care-Sydney Triage to Admission Risk Tool (EPIC-START) was developed. EPIC-START is a model of care incorporating EPIC protocols, the START patient admission prediction tool, and a clinical deterioration tool to support ED flow, timely care, and patient safety. The aim of this study is to evaluate the impact of EPIC-START implementation across 30 EDs on patient, implementation, and health service outcomes. METHODS AND ANALYSIS This study protocol adopts an effectiveness-implementation hybrid design (Med Care 50: 217-226, 2012) and uses a stepped-wedge cluster randomised control trial of EPIC-START, including uptake and sustainability, within 30 EDs across four NSW local health districts spanning rural, regional, and metropolitan settings. Each cluster will be randomised independently of the research team to 1 of 4 dates until all EDs have been exposed to the intervention. Quantitative and qualitative evaluations will be conducted on data from medical records and routinely collected data, and patient, nursing, and medical staff pre- and post-surveys. ETHICS AND DISSEMINATION Ethical approval for the research was received from the Sydney Local Health District Research Ethics Committee (Reference Number 2022/ETH01940) on 14 December 2022. TRIAL REGISTRATION Australian and New Zealand Clinical trial, ACTRN12622001480774p. Registered on 27 October 2022.
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Affiliation(s)
- Kate Curtis
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia.
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia.
| | - Michael M Dinh
- New South Wales Institute of Trauma and Injury Management, Chatswood, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Camperdown, Australia
| | - Amith Shetty
- System Sustainability and Performance, NSW Ministry of Health, St Leonards, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Sarah Kourouche
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
| | - Margaret Fry
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
- Sydney Faculty of Health, University of Technology, Ultimo, NSW, Australia
- Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, VIC, Australia
| | - Ling Li
- Macquarie University, Sydney, Australia
| | - Thomas Lung
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Timothy Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Mary K Lam
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Margaret Murphy
- Western Sydney Local Health District, North Parramatta, NSW, 2145, Australia
| | - Hatem Alkhouri
- Agency for Clinical Innovation, NSW Emergency Care Institute, St Leonards, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Christina Aggar
- Nothern NSW Local Health District, Southern Cross University, Lismore, Australia
| | | | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Camperdown, Australia
| | - James A Hughes
- School of Nursing, Centre for Healthcare Transformation, Brisbane, QUT, Australia
| | - Wayne Varndell
- Prince of Wales Hospital Emergency Department, Randwick, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- College of Emergency Nursing Australasia (CENA), Hobart, Australia
| | - Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, Sydney Institute for Infectious Diseases, The University of Sydney, Camperdown, NSW, 2006, Australia
- Communicable Diseases Branch, Public Health Unit, Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW, 2141, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Westmead, NSW, 2145, Australia
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Dinh MM, Bein KJ, Alkhouri H, Ní Bhraonáin S, Seimon RV. 24 hours - Life in the E.R.: A state-wide data linkage analysis of in-patients with prolonged emergency department length of stay in New South Wales, Australia. Emerg Med Australas 2023. [PMID: 36854419 DOI: 10.1111/1742-6723.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/22/2022] [Accepted: 01/29/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Describe the characteristics and predictors of mortality for patients who spend more than 24 h in the ED waiting for an in-patient bed and compare baseline clinical and demographic characteristics between tertiary and non-tertiary hospitals. METHODS This was a state-wide analysis data linkage analysis of adult (age >16 years) ED presentations across New South Wales from 2019 to 2020. Cases were included if their mode of separation from ED indicated admission to an in-patient unit including critical care ward and their ED length of stay was greater than or equal to 24 h. Cases were categorised by service-related groups based on principle diagnosis. RESULTS A total of 26 854 eligible cases were identified. The most common diagnosis groups were psychiatry, cardiology and respiratory. The odds ratio (OR) for 30-day all-cause mortality in admitted patients with an ED length of stay greater than 24 h were highest in those aged >75 years (OR 15.18, 95% confidence interval [CI] 9.99-23.07, P < 0.001), oncology (OR 10.45, 95% CI 7.93-13.77, P < 0.001) and haematology patients (OR 2.95, 95% CI 2.01-4.33, P < 0.001). CONCLUSION Interventions and models of care to address ED access block need to focus on mental health patients, older patients particularly those with cardiorespiratory illness and oncology and haematology patients for whom risk of mortality is disproportionately higher.
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Affiliation(s)
- Michael M Dinh
- Sydney Local Health District, RPA Green Light Institute for Emergency Care, Sydney, New South Wales, Australia
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Sydney Local Health District, RPA Green Light Institute for Emergency Care, Sydney, New South Wales, Australia
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hatem Alkhouri
- Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sinéad Ní Bhraonáin
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- Sydney Local Health District, RPA Green Light Institute for Emergency Care, Sydney, New South Wales, Australia
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5
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Stephens AS, Dinh MM, Kinsman L. Patterns of emergency department use in rural and metropolitan New South Wales by socioeconomic status: A population-based study. Emerg Med Australas 2022; 35:489-495. [PMID: 36571146 DOI: 10.1111/1742-6723.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/24/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the patterns of ED use in metropolitan and rural New South Wales (NSW) by socioeconomic status (SES). METHODS We undertook a retrospective, population-based study of de-identified data from the NSW Emergency Department Data Collection (EDDC). The study population comprised of NSW residents who presented to an NSW public hospital ED in 2013-2019 and were registered in the NSW EDDC. Total ED presentations, negative binomial regression modelled annual changes in ED presentations over 2013-2019, and age- and sex-standardised rates of ED presentations in 2019 were assessed. RESULTS Overall, between 2013 and 2019, ED presentations increased in metropolitan and rural NSW, with mean annual percentage increases of 3.1% (95% confidence interval [CI] 2.8-3.5) and 2.5% (95% CI 2.0-2.9), respectively. This growth varied by SES, with larger increases observed in higher SES groups. The bulk of presentations in rural NSW were from individuals living in disadvantaged areas. Standardised rates of ED presentations were highest in the most disadvantaged quintiles (SES 1) and progressively decreased with increasing SES in both rural and metropolitan NSW (negative gradients). Rates were higher in rural NSW compared to metropolitan NSW across all SES quintiles for total, low acuity and non-low acuity presentations. CONCLUSIONS Negative gradients in rates of ED presentations with increasing SES were observed in both metropolitan and rural NSW. At each SES quintile, rates of ED presentations were higher in rural compared to metropolitan areas. Further research exploring the underlying causal mechanisms leading to increased ED demand in rural NSW and socioeconomically disadvantaged populations is warranted.
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Affiliation(s)
- Alexandre S Stephens
- Northern New South Wales Local Health District, Lismore, New South Wales, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leigh Kinsman
- Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia.,School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Newcastle, Newcastle, New South Wales, Australia
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6
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Hoang BH, Do PG, Le LD, Bui TTH, Bui TN, Nguyen QM, To DH, Nguyen AD, Dinh MM, Goldhaber SZ, Day R, Nguyen HL. Safety, Efficacy of an Accelerated Regimen of Low-Dose Recombinant Tissue-Type Plasminogen Activator for Reperfusion Therapy of Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2021; 27:10760296211037920. [PMID: 34514865 PMCID: PMC8444275 DOI: 10.1177/10760296211037920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Controversy persists regarding the safety and efficacy of an accelerated low-dose recombinant tissue-type plasminogen activator (rt-PA) regimen for reperfusion therapy in acute pulmonary embolism. This study describes the outcomes of an accelerated low-dose rt-PA regimen for the treatment of acute pulmonary embolism in Vietnamese patients. This was a case series from October 2014 to October 2020 from 9 hospitals across Vietnam. Patients presenting with acute pulmonary embolism with high to intermediate mortality risk were administered alteplase 0.6 mg per kilogram (maximum of 50 mg) over 15 min. The main outcomes were the proportion who survived to hospital discharge and at 3 months as well as in-hospital hemorrhage (major and minor according to International Society of Thrombosis and Hemhorrage definitions). A total of 80 patients were enrolled: 48 (60%) with high risk for mortality and 32 patients (40%) with intermediate risk for mortality. A total of 7 (8.8%) died in hospital. All deaths occurred in the high-risk mortality group. The 73 patients who were discharged alive remained alive at 3 months follow up. During hospitalization, 1 patient (1.3%) suffered major bleeding, and 7 (8.8%) had minor bleeding. An accelerated thrombolytic regimen with alteplase 0.6 mg/kg (maximum of 50 mg) over 15 min for acute pulmonary embolism appeared be effective and safe in a case series of Vietnamese patients.
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Affiliation(s)
- Bui Hai Hoang
- Hanoi Medical University Hospital, Hanoi, Vietnam.,106156Hanoi Medical University, Hanoi, Vietnam
| | | | - Lac Duy Le
- 571069Thu Duc District Hospital, Hochiminh city, Vietnam
| | | | | | | | | | | | - Michael M Dinh
- The University of Sydney, 7799Sydney Medical School, Sydney, New South Wales, Australia
| | - Samuel Z Goldhaber
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Day
- UNSW Medicine & St Vincent's Clinical School, Sydney, New South Wales, Australia
| | - Hieu Lan Nguyen
- Hanoi Medical University Hospital, Hanoi, Vietnam.,106156Hanoi Medical University, Hanoi, Vietnam
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7
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Dinh MM, Balogh ZJ, Sisson G, Levesque JF. The New South Wales Trauma Quality Improvement Program: Structure, process, outcomes and the role of trauma verification. ANZ J Surg 2021; 91:1331-1332. [PMID: 34402170 DOI: 10.1111/ans.16988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Michael M Dinh
- NSW Institute of Trauma and Injury Management.,Agency for Clinical Innovation.,RPA Green Light Institute for Emergency Care, Sydney Local Health District
| | - Zsolt J Balogh
- Trauma Verification Subcommittee, Royal Australasian College of Surgeons.,School of Medicine and Public Health, The University of Newcastle
| | - Glenn Sisson
- NSW Institute of Trauma and Injury Management.,Agency for Clinical Innovation
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8
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Hoang BH, Do NS, Vu DH, Do GP, Dao XD, Nguyen HH, Luu QT, Le VC, Nguyen HT, Dinh MM, Nakahara S. Outcomes for out-of-hospital cardiac arrest transported to emergency departments in Hanoi, Vietnam: A multi-centre observational study. Emerg Med Australas 2021; 33:541-546. [PMID: 33706418 DOI: 10.1111/1742-6723.13750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the outcomes of patients with out-of-hospital cardiac arrest (OHCA) transported to hospital in Hanoi, Vietnam. METHODS This was a multi-centre observational study of patients presenting with OHCA to one of five tertiary care hospital EDs in Hanoi from 2017 to 2019. RESULTS We analysed data from 239 OHCA cases of which 70.7% were witnessed, and 8.4% received bystander cardiopulmonary resuscitation (CPR). The emergency medical services (EMS) transported 20.5% of cases to hospital with the remaining being transported by private vehicle. No patients received external defibrillation before arriving to hospital. Return of spontaneous circulation in hospital was 33.1%, with 3.8% of patients survived to hospital discharge and only one patient (0.4%) discharged from hospital with a favourable neurological outcome. CONCLUSIONS In cases of OHCA in Hanoi, both the proportion of cases receiving bystander CPR and EMS transportation were small. Urgent investments in pre-hospital capacity, training and capabilities are required to improve outcomes for OHCA in Hanoi.
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Affiliation(s)
- Bui Hai Hoang
- Emergency and Critical Medicine Department, Hanoi Medical University Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | - Ngoc Son Do
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Dinh Hung Vu
- Emergency and Critical Medicine Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Giang Phuc Do
- Emergency and Critical Medicine Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Xuan Dung Dao
- Emergency and Critical Medicine Department, Hanoi Heart Hospital, Hanoi, Vietnam
| | - Huu Huan Nguyen
- Emergency and Critical Medicine Department, Ministry of Agriculture Hospital, Hanoi, Vietnam
| | | | - Van Cuong Le
- Critical Care Unit and Cardiovascular Intervention Center, Thanh Hoa General Hospital, Hanoi, Vietnam
| | - Huu Tu Nguyen
- Hanoi Medical University, Hanoi, Vietnam
- Anaesthesia and Intensive Care Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Michael M Dinh
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Discipline of Emergency Medicine, Hoc Mai Foundation, RPA Green Light Institute, Sydney, New South Wales, Australia
| | - Shinji Nakahara
- Teikyo University School of Medicine, Tokyo, Japan
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
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9
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Bein KJ, Berendsen Russell S, Ní Bhraonáin S, Seimon RV, Dinh MM. Does volume or occupancy influence emergency access block? A multivariate time series analysis from a single emergency department in Sydney, Australia during the COVID-19 pandemic. Emerg Med Australas 2021; 33:343-348. [PMID: 33387421 DOI: 10.1111/1742-6723.13717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study aims to determine whether ED presentation volume or hospital occupancy had a greater impact on ED performance before and during the COVID-19 health response at a tertiary referral hospital in Sydney, Australia. METHODS Single centre time series analysis using routinely collected hospital and ED data from January 2019 to September 2020. The primary outcome was ED access block measured by emergency treatment performance (ETP; i.e. percentage of patients who were discharged or transferred to a ward from ED within 4 h of ED arrival time). Secondary outcomes were hospital occupancy, elective theatre cases and ambulance ramping. Multivariate time series analysis was performed using vector autoregression, to model effects of changes in various endogenous and correlated variables on ETP. RESULTS There was an increase in ETP, drop in ED presentations and decrease in hospital occupancy between April and June 2020. Elective surgery and hospital occupancy had significant effects up to 2 days prior on ETP, while there were no significant effects of either ED or ambulance presentations on ETP. Hospital occupancy itself increased with ED presentations after 2-4 days and decreased with elective surgery after 1 day. Shocks (a one standard deviation increase) in hospital occupancy had a peak impact nearly two times greater compared to ED presentations (-1.43, 95% confidence interval -1.92, -0.93 vs -0.73, 95% confidence interval -1.21, -0.25). CONCLUSION The main determinants of the reduction of ED overcrowding and access block during the pandemic were associated with reductions in hospital occupancy and elective surgery levels, and more research is required to assess more complex associations beyond the scope of this manuscript.
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Affiliation(s)
- Kendall J Bein
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Saartje Berendsen Russell
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sinéad Ní Bhraonáin
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael M Dinh
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
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10
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Affiliation(s)
- Michael M Dinh
- The RPA Green Light Institute for Emergency Care Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- The RPA Green Light Institute for Emergency Care Royal Prince Alfred Hospital Sydney New South Wales Australia
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11
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Lower T, Kinsman L, Dinh MM, Lyle D, Cheney R, Allan J, Munro A, Taylor B, Wiggers JH, Bailey A, Weller L, Jacob A, Stephens AS. Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018. Aust J Rural Health 2020; 28:490-499. [DOI: 10.1111/ajr.12668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Tony Lower
- Mid North Coast Local Health District Port Macquarie NSW Australia
| | - Leigh Kinsman
- Mid North Coast Local Health District Port Macquarie NSW Australia
- Faculty of Medicine and Health School of Nursing and Midwifery University of Newcastle Newcastle NSW Australia
| | - Michael M. Dinh
- New South Wales Institute of Trauma and Injury Management Sydney NSW Australia
- Faculty of Medicine and Health Sydney Medical School The University of Sydney Sydney NSW Australia
| | - David Lyle
- Broken Hill University Department of Rural Health Faculty of Medicine and Health School of Medicine The University of Sydney Sydney NSW Australia
| | - Richard Cheney
- Western New South Wales Local Health District Orange NSW Australia
| | - Julaine Allan
- Western New South Wales Local Health District Orange NSW Australia
| | - Alice Munro
- Western New South Wales Local Health District Orange NSW Australia
| | - Barbara Taylor
- Murrumbidgee Local Health District Wagga Wagga NSW Australia
| | - John H. Wiggers
- Faculty of Medicine and Health School of Medicine, and Public Health University of Newcastle Newcastle NSW Australia
- Hunter New England Local Health District New Lambton NSW Australia
| | - Andrew Bailey
- Mid North Coast Local Health District Port Macquarie NSW Australia
| | - Lauren Weller
- New South Wales Rural Health Research Alliance Port Macquarie NSW Australia
| | - Alycia Jacob
- Faculty of Medicine and Health School of Nursing and Midwifery University of Newcastle Newcastle NSW Australia
| | - Alexandre S. Stephens
- Northern New South Wales Local Health District Lismore NSW Australia
- Faculty of Medicine and Health School of Public Health The University of Sydney Sydney NSW Australia
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12
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Dinh MM, Bein KJ, Delaney J, Berendsen Russell S, Royle T. Incidence and outcomes of aortic dissection for emergency departments in New South Wales, Australia 2017–2018: A data linkage study. Emerg Med Australas 2020; 32:599-603. [DOI: 10.1111/1742-6723.13472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/04/2019] [Accepted: 01/07/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - John Delaney
- Emergency Department, Royal Prince Alfred Hospital Sydney New South Wales Australia
| | | | - Tim Royle
- Emergency Department, Royal Prince Alfred Hospital Sydney New South Wales Australia
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13
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Dinh MM, Arce CP, Berendsen Russell S, Bein KJ. Predictors and in‐hospital mortality associated with prolonged emergency department length of stay in New South Wales tertiary hospitals from 2017 to 2018. Emerg Med Australas 2020; 32:611-617. [DOI: 10.1111/1742-6723.13477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Michael M Dinh
- Emergency DepartmentRoyal Prince Alfred Hospital, RPA Green Light Institute for Emergency Care Sydney New South Wales Australia
| | - Chantel P Arce
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- Emergency DepartmentRoyal Prince Alfred Hospital, RPA Green Light Institute for Emergency Care Sydney New South Wales Australia
| | - Kendall J Bein
- Emergency DepartmentRoyal Prince Alfred Hospital, RPA Green Light Institute for Emergency Care Sydney New South Wales Australia
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Dinh MM, Singh H, Sarrami P, Levesque JF. Correlating injury severity scores and major trauma volume using a state-wide in-patient administrative dataset linked to trauma registry data-A retrospective analysis from New South Wales Australia. Injury 2020; 51:109-113. [PMID: 31547965 DOI: 10.1016/j.injury.2019.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma registries are used to analyse and report activity and benchmark quality of care at designated facilities within a trauma system. These capabilities may be enhanced with the incorporation of administrative and electronic medical record datasets, but are currently limited by the use of different injury coding systems between trauma and administrative datasets. OBJECTIVES Use an Abbreviated Injury Scale to International Classification of Disease (AIS-ICD) mapping tool to correlate estimated injury severity scores and major trauma volume based on administrative data collections with trauma registry data. METHODS Adult trauma cases were identified from the New South Wales Trauma Registry between 2012 and 2016 and linked probabilistically using age, facility and date of facility arrival to the Admitted Patient Data Collection (APDC). Estimated Injury Severity Scores (ISS) were derived using the AIS-ICD mapping tool applied to diagnoses contained in the APDC. RESULTS A total of eligible 13,439 cases were analysed. The overall correlation between trauma registry ISS and ISS estimated from APDC using the AIS-ICD mapping tool was low to moderate (Spearman Rho 0.41 95%CI 0.40, 0.43). Based on an estimated ISS cut-off value of 8, there was high correlation between estimated trauma volume and the number of major trauma cases at each facility (Spearman Rho 0.98, 95%CI 0.95, 0.99). Trauma Revised Injury Severity Score (TRISS) was associated with only slightly higher mortality prediction performance compared to estimated ISS (AUROC 0.76 95%CI 0.75, 0.78 versus AUROC 0.74 95%CI 0.73, 0.76). CONCLUSION A low to moderate correlation exists between individual patient ISS scores based on AIS to ICD mapping of in-patient data collection, but a high correlation for overall major trauma volume using the AIS-ICD mapping at facility level with comparable TRISS mortality prediction.
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Affiliation(s)
- Michael M Dinh
- New South Wales Institute of Trauma and Injury Management, Australia; Sydney Medical School, the University of Sydney, Australia.
| | - Hardeep Singh
- New South Wales Institute of Trauma and Injury Management, Australia
| | - Pooria Sarrami
- New South Wales Institute of Trauma and Injury Management, Australia; South Western Sydney Clinical School, University of New South Wales, Australia
| | - Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Australia; Agency for Clinical Innovation, Australia
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15
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Ebker-White A, Bein KJ, Berendsen Russell S, Dinh MM. The Sydney triage to admission risk tool (START) to improve patient flow in an emergency department: a model of care implementation pilot study. BMC Emerg Med 2019; 19:79. [PMID: 31805874 PMCID: PMC6896669 DOI: 10.1186/s12873-019-0290-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022] Open
Abstract
Background The Sydney Triage to Admission Risk Tool (START) is a validated clinical analytics tool designed to estimate the probability of in-patient admission based on Emergency Department triage characteristics. Methods This was a single centre pilot implementation study using a matched case control sample of patients assessed at ED triage. Patients in the intervention group were identified at triage by the START tool as likely requiring in-patient admission and briefly assessed by an ED Consultant. Bed management were notified of these patients and their likely admitting team based on senior early assessment. Matched controls were identified on the same day of presentation if they were admitted to the same in-patient teams as patients in the intervention group and same START score category. Outcomes were ED length of stay and proportion of patients correctly classified as an in-patient admission by the START tool. Results One hundred and thirteen patients were assessed using the START-based model of care. When compared with matched control patients, this intervention model of care was associated with a significant reduction in ED length of stay [301 min (IQR 225–397) versus 423 min (IQR 297–587) p < 0.001] and proportion of patients meeting 4 h length of stay thresholds increased from 24 to 45% (p < 0.001). Conclusion In this small pilot implementation study, the START tool, when used in conjunction with senior early assessment was associated with a reduction in ED length of stay. Further controlled studies are now underway to further examine its utility across other ED settings.
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Affiliation(s)
- Anja Ebker-White
- Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW, Sydney, 2050, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW, Sydney, 2050, Australia.,RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Saartje Berendsen Russell
- Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW, Sydney, 2050, Australia.,RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW, Sydney, 2050, Australia. .,RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia.
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Dinh MM, Berendsen Russell S, Bein KJ. Diagnoses, damned diagnoses and statistics: Dealing with disparate diagnostic coding systems within the New South Wales Emergency Department Data Collection. Emerg Med Australas 2019; 31:830-836. [DOI: 10.1111/1742-6723.13371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Michael M Dinh
- Emergency DepartmentRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | | | - Kendall J Bein
- Emergency DepartmentRoyal Prince Alfred Hospital Sydney New South Wales Australia
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17
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Bath S, Dinh MM, Casley S, Sarrami P. Predictors of mortality in older patients with isolated severe head injury: a data linkage study from New South Wales, Australia. AUST HEALTH REV 2019; 46:107-114. [DOI: 10.1071/ah21131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022]
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18
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Rendell K, Koprinska I, Kyme A, Ebker-White AA, Dinh MM. The Sydney Triage to Admission Risk Tool (START2) using machine learning techniques to support disposition decision-making. Emerg Med Australas 2018; 31:429-435. [PMID: 30469164 DOI: 10.1111/1742-6723.13199] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/05/2018] [Accepted: 10/05/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To further develop and refine an Emergency Department (ED) in-patient admission prediction model using machine learning techniques. METHODS This was a retrospective analysis of state-wide ED data from New South Wales, Australia. Six classification algorithms (Bayesian networks, decision trees, logistic regression, naïve Bayes, neural networks and nearest neighbour) and five feature selection techniques (none, manual, correlation-based, information gain and wrapper) were examined. Presenting problem was categorised using broad (n = 20) and specific (n = 100) representations. Models were evaluated based on Area Under the Curve (AUC) and accuracy. The results were compared with the Sydney Triage to Admission Risk Tool (START), which uses logistic regression and six manually selected features. RESULTS Sixty admission prediction models were trained and validated using data from 1 721 294 patients. Under the broad representation of presenting problem, the nearest neighbour algorithm with manual feature selection had the best AUC of 0.8206 (95% CI ±0.0006), while the decision tree with no feature selection had the best accuracy of 74.83% (95% CI ±0.065). Under the specific representation, almost all models improved; the nearest neighbour with information gain feature selection had the best AUC of 0.8267 (95% CI ±0.0006), while the decision tree with wrapper or no feature selection had the best accuracy of 75.24% (95% CI ±0.064). Eleven of the machine learning models had slightly better AUC than the START model. CONCLUSION Machine learning methods demonstrate similar performance to logistic regression for ED disposition prediction models using basic triage information. This should be investigated further, especially for larger data sets with more complex clinical information.
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Affiliation(s)
- Kathryn Rendell
- School of Aerospace, Mechanical and Mechatronic Engineering, Faculty of Engineering and Information Technologies, The University of Sydney, Sydney, New South Wales, Australia
| | - Irena Koprinska
- School of Information Technologies, Faculty of Engineering and Information Technologies, The University of Sydney, Sydney, New South Wales, Australia
| | - Andre Kyme
- School of Aerospace, Mechanical and Mechatronic Engineering, Faculty of Engineering and Information Technologies, The University of Sydney, Sydney, New South Wales, Australia
| | - Anja A Ebker-White
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Nursing, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Emergency Medicine, School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Oliver M, Adonopulos AA, Haber PS, Dinh MM, Green T, Wand T, Vitte A, Chalkley D. Impact of acutely behavioural disturbed patients in the emergency department: A prospective observational study. Emerg Med Australas 2018; 31:387-392. [PMID: 30230230 DOI: 10.1111/1742-6723.13173] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study describes patients with acute behavioural disturbance presenting to the ED, the impact they have on the department and any complications that occur. METHODS We performed a prospective observational study of adult patients (>17 years old) requiring parenteral sedation for acute behavioural disturbance over a 13 month period. Demographic data, mode of arrival, indication, drug type and dosing used for sedation were collected. Departmental data were recorded including the staff type and numbers involved and the condition of the department. The main outcomes were complications from sedative medication and injury sustained to patients or staff. RESULTS Over the study period 173 patients met inclusion criteria, the majority (n = 104, 60%) were men with a mean age of 38.5 years (standard deviation 14.4); 51% of patients had more than one indication for sedation (n = 89), the commonest being mental health related plus drug intoxication (n = 30, 33.7%). Intoxication was frequently from either alcohol (n = 62, 47%) or methamphetamine (n = 41, 31%). The median number of staff involved was 10 (interquartile range 8-12). Staff members received an injury in 12% (n = 20) of sedations, with only 1% (n = 2) of patients receiving any physical injury; 12% (n = 20) had a minor complication from the sedation medication. No patient had any major complication (apnoea, intubation, arrhythmias or cardiac arrest). CONCLUSION Patients with acute behavioural disturbance often have a history of mental illnesses and are commonly intoxicated. These patients have impacts on healthcare resources and pose risks to staff safety, but significant complications to patients do not occur frequently.
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Affiliation(s)
- Matthew Oliver
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Aaron A Adonopulos
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul S Haber
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Drug Health, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Tim Green
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Tim Wand
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandre Vitte
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dane Chalkley
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Ebker-White A, Bein KJ, Dinh MM. Extending the Sydney Triage to Admission Risk Tool (START+) to predict discharges and short stay admissions. Emerg Med J 2018; 35:471-476. [PMID: 29914922 DOI: 10.1136/emermed-2017-207227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/22/2018] [Accepted: 05/09/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aims to validate previously reported triage tool titled Sydney Triage to Admission Risk Tool (START+) and investigate whether an extended version of the tool could be used to identify and stream appropriate short stay admissions to ED observation units or specialised short stay inpatient wards. METHODS This was a prospective study at two metropolitan EDs in Sydney, Australia. Consecutive triage encounters were observed by a trained researcher and START scores calculated. The primary outcome was length of stay <48 hours. Multivariable logistic regression was used to estimate area under curve of receiver operator characteristic (AUROC) for START scores. The original START tool was then extended to include frailty and multiple or major comorbidities as additional variables to assess for further predictive accuracy. RESULTS There were 894 patients analysed during the study period. Of the 894 patients, there were 732 patients who were either discharged from ED or admitted for <2 days. The AUROC for the original START+ tool was 0.80 (95% CI 0.77 to 0.83). The presence of frailty was found to add a further five points and multiple comorbidities added another four points on top of the START score, and the AUROC for the extended START score 0.84 (95% CI 0.81 to 0.88). CONCLUSION The overall performance of the extended ED disposition prediction tool that included frailty and multiple medical comorbidities significantly improved the ability of the START tool to identify patients likely to be discharged from ED or require short stay admission <2 days. TRIAL REGISTRATION NUMBER ACTRN12618000426280.
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Affiliation(s)
| | - Kendall J Bein
- Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
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Perera J, Wand T, Bein KJ, Chalkley D, Ivers R, Steinbeck KS, Shields R, Dinh MM. Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010-2014. Med J Aust 2018; 208:348-353. [PMID: 29669496 DOI: 10.5694/mja17.00589] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 01/09/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate population trends in presentations for mental health problems presenting to emergency departments (EDs) in New South Wales during 2010-2014, particularly patients presenting with suicidal ideation, self-harm, or intentional poisoning. DESIGN, SETTING AND PARTICIPANTS This was a retrospective, descriptive analysis of linked Emergency Department Data Collection registry data for presentations to NSW public hospital EDs over five calendar years, 2010-2014. Patients were included if they had presented to an ED and a mental health-related diagnosis was recorded as the principal diagnosis. MAIN OUTCOME MEASURES Rates of mental health-related presentations to EDs by age group and calendar year, both overall and for the subgroups of self-harm, suicidal ideation and behaviour, and intentional poisoning presentations. RESULTS 331 493 mental health-related presentations to 115 NSW EDs during 2010-2014 were analysed. The presentation rate was highest for 15-19-year-old patients (2014: 2167 per 100 000 population), but had grown most rapidly for 10-14-year-old children (13.8% per year). The combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased in all age groups, other than those aged 0-9 years; the greatest increase was for the 10-19-year-old age group (27% per year). CONCLUSIONS The rate of mental health presentations to EDs increased significantly in NSW between 2010 and 2014, particularly presentations by adolescents. Urgent action is needed to provide better access to adolescent mental health services in the community and to enhance ED models of mental health care. The underlying drivers of this trend should be investigated to improve mental health care.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael M Dinh
- Sydney Medical School, University of Sydney, Sydney, NSW
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22
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Ebker-White AA, Bein KJ, Dinh MM. The Sydney Triage to Admission Risk Tool (START): A prospective validation study. Emerg Med Australas 2018; 30:511-516. [PMID: 29417732 DOI: 10.1111/1742-6723.12940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/07/2017] [Accepted: 01/04/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The present study aims to prospectively validate the Sydney Triage to Admission Risk Tool (START) to predict ED disposition. METHODS This was a prospective validation study at two metropolitan EDs in Sydney, Australia. Consecutive triage encounters were observed by a trained researcher and START scores calculated. The primary outcome was patient disposition (discharge or inpatient admission) from the ED. Multivariable logistic regression was used to estimate area under curve of receiver operator characteristic (AUC ROC) for START scores as well as START score in combination with other variables such as frailty, general practitioner referral, overcrowding and major medical comorbidities. RESULTS There were 894 patients analysed during the study period. The START score when applied to the data had AUC ROC of 0.80 (95% CI 0.77-0.83). The inclusion of other clinical variables identified at triage did not improve the overall performance of the model with an AUC ROC of 0.81 (95% CI 0.78-0.84) in the present study. CONCLUSION The overall performance of the START tool with respect to model discrimination and accuracy has been prospectively validated. Further clinical trials are required to test the clinical effectiveness of the tool in improving patient flow and overall ED performance.
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Affiliation(s)
- Anja A Ebker-White
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Nursing, The University of Sydney, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
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Muscatello DJ, Bein KJ, Dinh MM. Influenza-associated delays in patient throughput and premature patient departure in emergency departments in New South Wales, Australia: A time series analysis. Emerg Med Australas 2017; 30:77-80. [PMID: 28544364 DOI: 10.1111/1742-6723.12808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/28/2017] [Accepted: 04/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Influenza outbreaks cause overcrowding in EDs. We aimed to quantify the impact of influenza on the National Emergency Access Targets and premature patient departure in New South Wales, Australia. METHODS This was a retrospective observational study of 11 million presentations to 115 hospitals during 2010-2014, using routinely collected administrative records. A time series generalised additive regression model was used to assess the correlation between weekly influenza activity and the weekly proportion of patients leaving the ED in >4 h and the proportion that departed before commencing or completing treatment ('did not wait'), after controlling for background winter and holiday effects. RESULTS During 2011-2014, peak annual circulating influenza was associated with the peak weekly proportion of presentations that left in >4 h. The maximum estimated absolute weekly change in that proportion was 3.88 (95% confidence interval 3.02-4.74) percentage points in 2014. For presentations that did not wait, influenza circulation was associated with statistically significant increases in all years, with a maximum weekly value of 2.68 (95% confidence interval 2.31-3.06) percentage points in 2012. CONCLUSIONS Circulating influenza was associated with sustained increases and peaks in delayed patient throughput and premature patient departures. Influenza surveillance information may assist with development of health system and hospital workforce planning and bed management activities.
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Affiliation(s)
- David J Muscatello
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
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Oliver M, Dinh MM, Curtis K, Paschkewitz R, Rigby O, Balogh ZJ. Trends in Procedures at Major Trauma Centres in New South Wales, Australia: An Analysis of State-Wide Trauma Data. World J Surg 2017; 41:2000-2005. [DOI: 10.1007/s00268-017-3993-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Berendsen Russell S, Dinh MM, Bell N. Triage, damned triage… and statistics: Sorting out redundancy and duplication within an Emergency Department Presenting Problem Code Set to enhance research capacity. ACTA ACUST UNITED AC 2017; 20:48-52. [DOI: 10.1016/j.aenj.2016.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/23/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
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Dinh MM, Russell SB, Bein KJ, Vallmuur K, Muscatello D, Chalkley D, Ivers R. Age-related trends in injury and injury severity presenting to emergency departments in New South Wales Australia: Implications for major injury surveillance and trauma systems. Injury 2017; 48:171-176. [PMID: 27542554 DOI: 10.1016/j.injury.2016.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe population based trends and clinical characteristics of injury related presentations to Emergency Departments (EDs). DESIGN AND SETTING A retrospective, descriptive analysis of de-identified linked ED data across New South Wales, Australia over five calendar years, from 2010 to 2014. PARTICIPANTS Patients were included in this analysis if they presented to an Emergency Department and had an injury related diagnosis. Injury severity was categorised into critical (triage category 1-2 and admitted to ICU or operating theatre, or died in ED), serious (admitted as an in-patient, excluding above critical injuries) and minor injuries (discharged from ED). MAIN OUTCOME MEASURES The outcomes of interest were rates of injury related presentations to EDs by age groups and injury severity. RESULTS A total of 2.09 million injury related ED presentations were analysed. Minor injuries comprised 85.0%, and 14.1% and 1.0% were serious and critical injuries respectively. There was a 15.8% per annum increase in the rate of critical injuries per 1000 population in those 80 years and over, with the most common diagnosis being head injuries. Around 40% of those with critical injuries presented directly to a major trauma centre. CONCLUSION Critical injuries in the elderly have risen dramatically in recent years. A minority of critical injuries present directly to major trauma centres. Trauma service provision models need revision to ensure appropriate patient care. Injury surveillance is needed to understand the external causes of injury presenting to hospital.
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Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital, Australia; Discipline of Emergency Medicine, The University of Sydney, Australia.
| | | | | | | | - David Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Australia
| | | | - Rebecca Ivers
- The George Institute for Global Health, The University of Sydney, Australia; School of Nursing and Midwifery, Flinders University, Australia
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Bein KJ, Berendsen Russell S, Muscatello D, Chalkley D, Ivers R, Dinh MM. Feeling the HEAT: Using Hourly Emergency Activity Tracking to demonstrate a novel method of describing activity and patient flow. Emerg Med Australas 2016; 29:173-177. [DOI: 10.1111/1742-6723.12712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, The University of Sydney; Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- Emergency Department, Royal Prince Alfred Hospital, The University of Sydney; Sydney New South Wales Australia
- Faculty of Nursing; The University of Sydney; Sydney New South Wales Australia
| | - David Muscatello
- School of Public Health and Community Medicine; The University of New South Wales; Sydney New South Wales Australia
| | - Dane Chalkley
- Emergency Department, Royal Prince Alfred Hospital, The University of Sydney; Sydney New South Wales Australia
| | - Rebecca Ivers
- The George Institute for Global Health; The University of Sydney; Sydney New South Wales Australia
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, The University of Sydney; Sydney New South Wales Australia
- Discipline of Emergency Medicine; Sydney Medical School, The University of Sydney; Sydney New South Wales Australia
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Dinh MM, Russell SB, Bein KJ, Rogers K, Muscatello D, Paoloni R, Hayman J, Chalkley DR, Ivers R. The Sydney Triage to Admission Risk Tool (START) to predict Emergency Department Disposition: A derivation and internal validation study using retrospective state-wide data from New South Wales, Australia. BMC Emerg Med 2016; 16:46. [PMID: 27912757 PMCID: PMC5135778 DOI: 10.1186/s12873-016-0111-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/26/2016] [Indexed: 11/10/2022] Open
Abstract
Background Disposition decisions are critical to the functioning of Emergency Departments. The objectives of the present study were to derive and internally validate a prediction model for inpatient admission from the Emergency Department to assist with triage, patient flow and clinical decision making. Methods This was a retrospective analysis of State-wide Emergency Department data in New South Wales, Australia. Adult patients (age ≥ 16 years) were included if they presented to a Level five or six (tertiary level) Emergency Department in New South Wales, Australia between 2013 and 2014. The outcome of interest was in-patient admission from the Emergency Department. This included all admissions to short stay and medical assessment units and being transferred out to another hospital. Analyses were performed using logistic regression. Discrimination was assessed using area under curve and derived risk scores were plotted to assess calibration. Results 1,721,294 presentations from twenty three Level five or six hospitals were analysed. Of these 49.38% were male and the mean (sd) age was 49.85 years (22.13). Level 6 hospitals accounted for 47.70% of cases and 40.74% of cases were classified as an in-patient admission based on their mode of separation. The final multivariable model including age, arrival by ambulance, triage category, previous admission and presenting problem had an AUC of 0.82 (95% CI 0.81, 0.82). Conclusion By deriving and internally validating a risk score model to predict the need for in-patient admission based on basic demographic and triage characteristics, patient flow in ED, clinical decision making and overall quality of care may be improved. Further studies are now required to establish clinical effectiveness of this risk score model.
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Affiliation(s)
- Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia. .,Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - Saartje Berendsen Russell
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Nursing, The University of Sydney, Sydney, NSW, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kris Rogers
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - David Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Richard Paoloni
- Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Jon Hayman
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Health Education and Training Institute, New South Wales Ministry of Health, Sydney, NSW, Australia
| | - Dane R Chalkley
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.,School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
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Dinh MM, Curtis K, Mitchell RJ, Bein KJ, Balogh ZJ, Seppelt I, Deans C, Ivers R, Berendsen Russell S, Rigby O. Major trauma mortality in rural and metropolitan NSW, 2009–2014: a retrospective analysis of trauma registry data. Med J Aust 2016; 205:403-407. [DOI: 10.5694/mja16.00406] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Michael M Dinh
- Sydney Medical School, University of Sydney, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, Sydney, NSW
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
- Neuroscience Research Australia, Sydney, NSW
| | | | - Zsolt J Balogh
- John Hunter Hospital, Newcastle, NSW
- University of Newcastle, Newcastle, NSW
| | - Ian Seppelt
- Nepean Hospital, Penrith, NSW
- Nepean Clinical School, University of Sydney, Sydney, NSW
| | - Colin Deans
- Ambulance Service of New South Wales, Sydney, NSW
| | - Rebecca Ivers
- The George Institute for Global Health, Sydney, NSW
- Flinders University, Adelaide, SA
| | | | - Oran Rigby
- Institute of Trauma and Injury Management, New South Wales Agency for Clinical Innovation, Sydney, NSW
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30
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Dinh MM, Wu J, Ivers R. Has there been a shift in alcohol-related violence to neighbouring inner city ‘lockout law’ exclusion areas in Sydney? Emerg Med Australas 2016; 28:611-3. [DOI: 10.1111/1742-6723.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Michael M Dinh
- Trauma Services; Royal Prince Alfred Hospital; Sydney, New South Wales Australia
- Sydney Medical School, The University of Sydney; Sydney, New South Wales Australia
| | - Jason Wu
- Emergency Department,; Royal Prince Alfred Hospital; Sydney, New South Wales Australia
| | - Rebecca Ivers
- Sydney Medical School, The University of Sydney; Sydney, New South Wales Australia
- The George Institute for Global Health; Sydney, New South Wales Australia
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Dinh MM, Bein KJ. Response to Re: The end of emergency medicine as we know it. Emerg Med Australas 2016; 28:759. [PMID: 27681993 DOI: 10.1111/1742-6723.12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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32
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Dinh MM, Muecke S, Berendsen Russell S, Chalkley D, Bein KJ, Muscatello D, Nagaraj G, Paoloni R, Ivers R. Demand for Emergency Services Trends in New South Wales Years 2010–2014 (DESTINY): Age and Clinical Factors Associated with Ambulance Transportation to Emergency Departments. PREHOSP EMERG CARE 2016; 20:776-782. [DOI: 10.1080/10903127.2016.1182603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dinh MM, Berendsen Russell S, Bein KJ, Chalkley DR, Muscatello D, Paoloni R, Ivers R. Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why? BMJ Open 2016; 6:e010964. [PMID: 27165649 PMCID: PMC4874101 DOI: 10.1136/bmjopen-2015-010964] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables. DESIGN AND SETTING This was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes. PARTICIPANTS Patients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED. RESULTS There were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84). CONCLUSIONS Low acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients.
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Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital, New South Wales, Australia
- The University of Sydney, Discipline of Emergency Medicine, New South Wales, Australia
| | - Saartje Berendsen Russell
- Royal Prince Alfred Hospital, New South Wales, Australia
- The University of Sydney, School of Nursing, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, New South Wales, Australia
| | | | - David Muscatello
- University of New South Wales, School of Public Health and Community Medicine, New South Wales, Australia
| | - Richard Paoloni
- The University of Sydney, Discipline of Emergency Medicine, New South Wales, Australia
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, The University of Sydney, New South Wales, Australia
- Flinders University, School of Nursing and Midwifery, South Australia, Australia
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34
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Dinh MM, Berendsen Russell S, Bein KJ, Chalkley D, Muscatello D, Paoloni R, Ivers R. Trends and characteristics of short-term and frequent representations to emergency departments: A population-based study from New South Wales, Australia. Emerg Med Australas 2016; 28:307-12. [DOI: 10.1111/1742-6723.12582] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/07/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Discipline of Emergency Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
- School of Nursing; The University of Sydney; Sydney New South Wales Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Dane Chalkley
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - David Muscatello
- School of Public Health and Community Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Richard Paoloni
- Discipline of Emergency Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Rebecca Ivers
- The George Institute for Global Health; The University of Sydney; Sydney New South Wales Australia
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
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35
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Affiliation(s)
- Jenny Miu
- Institute of Trauma and Injury Management, Agency for Clinical Innovation, Sydney, NSW
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36
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Dinh MM, Bein KJ. The end of emergency medicine as we know it. Emerg Med Australas 2016; 28:242-3. [DOI: 10.1111/1742-6723.12540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/15/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Michael M Dinh
- Emergency Department; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Kendall J Bein
- Emergency Department; Royal Prince Alfred Hospital; Sydney New South Wales Australia
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37
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Dinh MM, Berendsen Russell S, Bein KJ, Chalkley D, Muscatello D, Paoloni R, Ivers R. Understanding drivers of Demand for Emergency Service Trends in Years 2010-2014 in New South Wales: An initial overview of the DESTINY project. Emerg Med Australas 2016; 28:179-86. [DOI: 10.1111/1742-6723.12542] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/16/2015] [Accepted: 12/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Discipline of Emergency Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
- School of Nursing; The University of Sydney; Sydney New South Wales Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Dane Chalkley
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - David Muscatello
- School of Public Health and Community Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Richard Paoloni
- Discipline of Emergency Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Rebecca Ivers
- The George Institute for Global Health; The University of Sydney; Sydney New South Wales Australia
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
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38
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Bell N, Hutchinson CL, Green TC, Rogan E, Bein KJ, Dinh MM. Randomised control trial of humidified high flow nasal cannulae versus standard oxygen in the emergency department. Emerg Med Australas 2015; 27:537-541. [PMID: 26419650 DOI: 10.1111/1742-6723.12490] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to determine if oxygen delivered through humidified high flow nasal cannulae (HHFNC) reduced the need for escalation in ventilation management and work of breathing in the ED patients presenting with acute undifferentiated shortness of breath compared with standard oxygen therapy. METHODS This was an unblinded randomised control trial conducted at two hospital EDs in Sydney, Australia. Eligible patients presenting with shortness of breath were randomised to HHFNC or standard oxygen therapy. Primary outcomes were the need to escalate ventilation therapy or a reduction in respiratory rate of 20% or more within 2 h of commencement. RESULTS One hundred patients were enrolled in the trial. The intervention group receiving HHFNC was associated with a higher proportion of patients with a reduced respiratory rate at 2 h (66.7% vs 38.5%, P = 0.005) and a lower proportion of patients requiring escalation in ventilation therapy (4.2% vs 19%, P = 0.02) compared with standard oxygen therapy. CONCLUSIONS The use of high flow nasal cannula oxygenation was associated with improved respiratory state in selected patients presenting to the ED with acute undifferentiated shortness of breath.
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Affiliation(s)
- Nerida Bell
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Claire L Hutchinson
- Emergency Department, Canterbury Hospital, Sydney, New South Wales, Australia
| | - Timothy C Green
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Eileen Rogan
- Emergency Department, Canterbury Hospital, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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39
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Dinh MM, Bein KJ, Hendrie D, Gabbe B, Byrne CM, Ivers R. Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre. AUST HEALTH REV 2015; 40:385-390. [PMID: 26363826 DOI: 10.1071/ah14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 07/31/2015] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with respect to years of life saved in road trauma patients. What are the implications for practitioners? The results suggest that adequate resourcing of trauma centres to enable quality improvement programs may be a cost-effective measure to reduce in-hospital mortality following road trauma.
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Affiliation(s)
- Michael M Dinh
- Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Kendall J Bein
- Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Delia Hendrie
- Centre for Population Health Research, Curtin University, Bentley, WA 6102, Australia. Email
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Vic. 3004, Australia. Email
| | - Christopher M Byrne
- Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, The University of Sydney, Sydney Medical School, 321 Kent Street, Sydney, NSW 2000, Australia. Email
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40
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Dinh MM, Cornwall K, Bein KJ, Gabbe BJ, Tomes BA, Ivers R. Health status and return to work in trauma patients at 3 and 6 months post-discharge: an Australian major trauma centre study. Eur J Trauma Emerg Surg 2015; 42:483-490. [PMID: 26260069 DOI: 10.1007/s00068-015-0558-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of this study was to describe post-discharge outcomes, and determine predictors of 3 and 6 months health status outcomes in a population of trauma patients at an inner city major trauma centre. METHODS This was a prospective cohort study of adult trauma patients admitted to this hospital with 3 and 6 months post-discharge outcomes assessment. Outcome measures were the Physical Component Scores (PCS) and Mental Component Scores (MCS) of the Short Form 12, EQ-5D, and return to work (in any capacity) if working prior to injury. Repeated measures mixed models and generalised estimating equation models were used to determine predictors of outcomes at 3 and 6 months. RESULTS One hundred and seventy-nine patients were followed up. Patients with lower limb injuries reported lower mean PCS scores between 3 and 6 months (coefficient -4.21, 95 % CI -7.58, -0.85) than those without lower limb injuries. Patients involved in pedestrian incidents or assaults and those with pre-existing mental health diagnoses reported lower mean MCS scores. In adjusted models upper limb injuries were associated with reduced odds of return to work at 3 and 6 months (OR 0.20, 95 % CI 0.07, 0.57) compared to those without upper limb injuries. DISCUSSION Predictors of poorer physical health status were lower limb injuries and predictors of mental health were related to the mechanism of injury and past mental health. Increasing injury severity score and upper limb injuries were the only predictors of reduced return to work. The results provide insights into the feasibility of routine post-discharge follow-up at a trauma service level.
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Affiliation(s)
- M M Dinh
- Department of Trauma Services, Royal Prince Alfred Hospital, Level 10, Missenden Road, Camperdown, NSW, 2050, Australia. .,Sydney Medical School, Sydney, Australia. .,Injury Division, The George Institute for Global Health, Sydney, Australia.
| | - K Cornwall
- Department of Trauma Services, Royal Prince Alfred Hospital, Level 10, Missenden Road, Camperdown, NSW, 2050, Australia
| | - K J Bein
- Emergency Department, Royal Prince Alfred Hospital, Camperdown, Australia
| | - B J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - B A Tomes
- Sydney Medical School, Sydney, Australia
| | - R Ivers
- Injury Division, The George Institute for Global Health, Sydney, Australia
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Dinh MM, Kastelein C, Bein KJ, Green TC, Bautovich T, Ivers R. Use of a syndromic surveillance system to describe the trend in cycling-related presentations to emergency departments in Sydney. Emerg Med Australas 2015; 27:343-7. [PMID: 26072973 DOI: 10.1111/1742-6723.12422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe population-based trends in cycling-related presentations to EDs over the past decade. METHODS A retrospective cohort of road trauma patients (motor vehicle, motor cyclist, cyclist and pedestrian) presenting to EDs in the Sydney Greater Metropolitan Area between 2004 and 2013 was obtained using the Public Health Real-time Emergency Department Surveillance System. The outcomes of interest were the cycling-related ED presentation rate per 1000 population, as well as the proportion of cycling-related presentations that died in ED or were admitted to a critical care ward. Trends in ED presentation rates based on presentation counts and Sydney population data were plotted and described. RESULTS There were 68,438 cycling-related presentations identified, representing 30% of all road trauma patients presenting to EDs in Sydney. There was a 91% increase in cycling-related presentations for the 35 to 64-year-old age group and a 123% increase in cycling-related presentations in the 65-year-old and over age group. All other age groups were associated with a stable or decrease in cycling-related ED presentation rates. The proportion of presentations requiring critical care ward admission or death in ED has decreased by 20%. CONCLUSION Using an ED syndromic surveillance system, cycling-related ED presentation rates in Sydney Australia have increased in those aged 35 years and over the past 10 years, with a relative decrease in the proportion of deaths in ED or those requiring critical care admission.
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Affiliation(s)
- Michael M Dinh
- Department of Trauma Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Injury Division, The George Institute for Global Health, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Kastelein
- Department of Trauma Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Timothy C Green
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Tanya Bautovich
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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42
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Dinh MM, Green TC, Bein KJ, Lo S, Jones A, Johnson T. Emergency department clinical redesign, team-based care and improvements in hospital performance: A time series analysis. Emerg Med Australas 2015; 27:317-22. [DOI: 10.1111/1742-6723.12424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Michael M Dinh
- Emergency Department; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Timothy C Green
- Emergency Department; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Kendall J Bein
- Emergency Department; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Serigne Lo
- Statistics Unit; The George Institute for Global Health; Sydney New South Wales Australia
| | - Aaron Jones
- Emergency Department; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Terence Johnson
- Emergency Department; Royal Prince Alfred Hospital; Sydney New South Wales Australia
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43
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Dinh MM, Kastelein C, Hopkins R, Royle TJ, Bein KJ, Chalkley DR, Ivers R. Mechanisms, injuries and helmet use in cyclists presenting to an inner city emergency department. Emerg Med Australas 2015; 27:323-7. [PMID: 25939667 DOI: 10.1111/1742-6723.12407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of the present study were to describe the injury profiles of cyclists presenting to an ED and determine the risk of significant head injury associated with bicycle helmet use. METHODS This was a retrospective single trauma centre study of all adult cyclists presenting to an inner city ED and undergoing a trauma team review between January 2012 and June 2014. The outcome of interest was significant head injury defined as any head injury with an Abbreviated Injury Scale score of two or more. Variables analysed included demographic characteristics, helmet use at time of incident, location, time and the presence of intoxication. RESULTS The most common body regions were upper limb injuries (57%), followed by head injuries (43%), facial injuries (30%) and lower limb injuries (24%). A lower proportion of people wearing helmets had significant head injury (17% vs 31%, P = 0.018) or facial injury (26% vs 48%, P = 0.0017) compared with non-helmet users. After adjustment for important covariates, helmet use was associated with a 70% decrease in the odds of significant head injury (odds ratio 0.34, 95% confidence interval 0.15, 0.76, P = 0.008). CONCLUSIONS Head injuries were common after inner city cycling incidents. The use of helmets was associated with a reduction in significant head injury.
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Affiliation(s)
- Michael M Dinh
- Department of Trauma Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Christopher Kastelein
- Department of Trauma Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Roy Hopkins
- Division of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Timothy J Royle
- Department of Trauma Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Department of Trauma Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dane R Chalkley
- Department of Trauma Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, Sydney Medical School, Sydney, New South Wales, Australia
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Dinh MM, Bein KJ, Latt M, Chalkley D, Muscatello D. Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area. Emerg Med J 2014; 32:708-11. [PMID: 25532104 DOI: 10.1136/emermed-2014-204174] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/26/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To contrast long-term population-based trends in general practice (GP) presentations and acute inpatient admissions from the emergency department (ED) in the elderly population within the Greater Sydney Area. METHODS This was a retrospective analysis of population-based ED presentation data over 11 years, between January 2001 and December 2011, conducted within the Greater Sydney Area in Australia. De-identified data were obtained from the New South Wales Emergency Department Data Collection database on all patients presenting to 30 public hospital EDs located within the Greater Sydney Area. The outcomes of interest were GP presentations to ED (triage category 4 or 5, self-referred and discharged from ED) and of acute inpatient admissions from ED per 1000 population. RESULTS Over 11 million presentations were identified. Around 40% of presentations were classified as a GP presentation and 23% were classified as acute inpatient admissions. There was a 2.9% per annum increase in acute inpatient admissions per 1000 population in those ≥80 years of age and no appreciable change in other age groups. Rates of GP presentations were higher in those <65 years of age. GP presentations increased 1.9% per annum in those aged <65 years of age. CONCLUSIONS The increase in ED demand appears to be driven by the elderly presenting with acute problems requiring inpatient admission. There has been a modest increase in the rate of GP presentations to ED.
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Affiliation(s)
- Michael M Dinh
- Discipline of Emergency Medicine, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mark Latt
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dane Chalkley
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Davis RA, Dinh MM, Bein KJ, Veillard AS, Green TC. Senior work-up assessment and treatment team in an emergency department: A randomised control trial. Emerg Med Australas 2014; 26:343-9. [DOI: 10.1111/1742-6723.12256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Rebecca A Davis
- Emergency Department; Royal Prince Alfred Hospital; NHMRC Clinical Trials Centre; The University of Sydney; Sydney New South Wales Australia
| | - Michael M Dinh
- Emergency Department; Royal Prince Alfred Hospital; NHMRC Clinical Trials Centre; The University of Sydney; Sydney New South Wales Australia
| | - Kendall J Bein
- Emergency Department; Royal Prince Alfred Hospital; NHMRC Clinical Trials Centre; The University of Sydney; Sydney New South Wales Australia
| | - Anne-Sophie Veillard
- Emergency Department; Royal Prince Alfred Hospital; NHMRC Clinical Trials Centre; The University of Sydney; Sydney New South Wales Australia
| | - Timothy C Green
- Emergency Department; Royal Prince Alfred Hospital; NHMRC Clinical Trials Centre; The University of Sydney; Sydney New South Wales Australia
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Leonard C, Bein KJ, Latt M, Muscatello D, Veillard AS, Dinh MM. Demand for emergency department services in the elderly: An 11 year analysis of the Greater Sydney Area. Emerg Med Australas 2014; 26:356-60. [DOI: 10.1111/1742-6723.12250] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Claire Leonard
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Mark Latt
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | | | | | - Michael M Dinh
- Discipline of Emergency Medicine, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
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Lee H, Bein KJ, Ivers R, Dinh MM. Changing patterns of injury associated with low-energy falls in the elderly: a 10-year analysis at an Australian Major Trauma Centre. ANZ J Surg 2014; 85:230-4. [DOI: 10.1111/ans.12676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Hugo Lee
- Orthopedic Department; Mona Vale Hospital; Sydney New South Wales Australia
| | - Kendall J. Bein
- Emergency Department; Department of Trauma Services; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Rebecca Ivers
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Injury Division; The George Institute for Global Health; Sydney New South Wales Australia
| | - Michael M. Dinh
- Emergency Department; Department of Trauma Services; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
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Dinh MM, Bein KJ, Gabbe BJ, Byrne CM, Petchell J, Lo S, Ivers R. A trauma quality improvement programme associated with improved patient outcomes: 21 years of experience at an Australian Major Trauma Centre. Injury 2014; 45:830-4. [PMID: 24290523 DOI: 10.1016/j.injury.2013.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 10/08/2013] [Accepted: 11/06/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Quality improvement programmes are an important part of care delivery in trauma centres. The objective was to describe the effect of a comprehensive quality improvement programme on long term patient outcome trends at a low volume major trauma centre in Australia. METHODS All patients aged 15 years and over with major trauma (Injury Severity Score>15) admitted to a single inner city major trauma centre between 1992 and 2012 were studied. The outcomes of interest were in-hospital mortality and transfer to rehabilitation. Time series analysis using integer valued autoregressive Poisson models was used to determine the reduction in adjusted monthly count data associated with the intervention period (2007-2012). Risk adjusted odds ratios for mortality over three yearly intervals was also obtained using multivariable logistic regression. Crude and risk adjusted mortality was compared before and after the implementation period. RESULTS 3856 patients were analysed. Crude in-hospital mortality fell from 16% to 10% after implementation (p<0.001). The intervention period was associated with a 25% decrease in monthly mortality counts. Risk adjusted mortality remained stable from 1992 to 2006 and did not fall until the intervention period. Crude and risk adjusted transfer to in-patient rehabilitation after major trauma also declined during the intervention period. CONCLUSION In this low volume major trauma centre, the implementation of a comprehensive quality improvement programme was associated with a reduction in crude and risk adjusted mortality and risk adjusted discharge to rehabilitation in severely injured patients.
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Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital, Department of Trauma Services, Australia; Sydney Medical School, University of Sydney, Australia.
| | - Kendall J Bein
- Royal Prince Alfred Hospital, Emergency Department, Australia.
| | - Belinda J Gabbe
- Monash University, Department of Epidemiology and Preventive Medicine, Australia.
| | | | - Jeffrey Petchell
- Royal Prince Alfred Hospital, Department of Trauma Services, Australia.
| | - Serigne Lo
- Sydney Medical School, University of Sydney, Australia; The George Institute for Global Health, Injury Division, Australia.
| | - Rebecca Ivers
- Sydney Medical School, University of Sydney, Australia; The George Institute for Global Health, Injury Division, Australia.
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Abstract
OBJECTIVE To investigate factors associated with emergency physician perception of the shift and to determine whether these perceptions were predictors of overall daily emergency department (ED) performance indicators. METHODS This was an observational study conducted at an inner city ED in New South Wales. Shift reports completed by the emergency physician in charge at clinical handover times between February and July 2012 were included. Variables collected by the shift report included (1) total number of patients in ED, (2) number of patients in the ED with length of stay (LOS) greater than 4 h, (3) number of admitted patients, (4) number of patients waiting to be seen by a doctor and (5) medical staffing levels. Outcomes of interest for this study were shift perception scores (1=very poor to 5=very good) and daily ED performance measures. Performance measures were the proportion of patients admitted or discharged from ED within 4 h (National Emergency Access Target, NEAT) and the percentage of inpatient admissions leaving ED within 8 h of ED arrival time. RESULTS The number of patients in ED with LOS >4 h (OR 0.83, 95% CI 0.79 to 0.87, p value <0.001) and number of patients waiting to be seen (OR 0.92, 95% CI 0.88 to 0.95, p value <0.001) were the factors most strongly associated with shift perception score. After adjustment, the mean NEAT performance improved 6% for each incremental increase in average shift perception score (β=0.06 95% CI 0.04 to 0.07, p<0.001). CONCLUSIONS Shift reports and shift perceptions by emergency physicians may be used to predict overall ED performance.
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Affiliation(s)
- Nadia Husain
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Timothy C Green
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Dinh MM, Oliver M, Bein K, Muecke S, Carroll T, Veillard AS, Gabbe BJ, Ivers R. Level of agreement between prehospital and emergency department vital signs in trauma patients. Emerg Med Australas 2013; 25:457-63. [PMID: 24099376 DOI: 10.1111/1742-6723.12126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Describe the level of agreement between prehospital (emergency medical service [EMS]) and ED vital signs in a group of trauma patients transported to an inner city Major Trauma Centre. We also sought to determine factors associated with differences in recorded vital sign measurements. METHODS All adult patients meeting trauma triage criteria and transported directly from scene of injury by New South Wales Ambulance to our institution were included. The primary outcome was the difference in vital signs: heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR) and Glasgow Coma Scale (GCS), between ED and EMS recorded measurements. Agreement was assessed using intraclass correlation coefficients and enhanced Bland-Altman plots. Multivariable linear regression models were used to determine factors associated with vital sign differences. RESULTS The 1181 trauma patients met inclusion criteria. Intraclass correlation coefficients were as follows: GCS 0.74 (95% confidence interval [CI], 0.37, 1.12); HR 0.41 (95% CI, 0.30, 0.53); SBP 0.37 (95% CI, 0.27, 0.46); and RR 0.29 (95% CI, 0.06, 0.51). Bland-Altman derived 95% limits of agreement lay outside a priori limits of clinical agreement for SBP and RR and were within limits of clinical agreement for GCS and HR. SBP and HR differences were associated with prehospital airway and fluid intervention. CONCLUSIONS Agreement was demonstrated between EMS and ED GCS scores but not RR and SBP recordings. Discrepancies appeared to reflect physiological changes in response to EMS initiated interventions. Trauma triage algorithms and risk models might need to take these measurement differences, and factors associated with them, into account.
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Affiliation(s)
- Michael M Dinh
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Department of Trauma Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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