OBJECTIVE:Pressure on emergency departments is increasing, perpetuating the phenomenon known as ramping or ambulance ramping, where patients are forced to wait on stretchers in corridors until they are allocated a suitable treatment space. This once temporary response to emergency department crowding has now become the norm for many emergency departments. The ramping environment impacts the patient experience well beyond the undesirability of extended waiting times. Nevertheless, there remains little research regarding how patients experience the ramping environment and what might make their wait more comfortable. METHODS:Semi-structured interviews were performed with patients who had waited at least an hour on the ramp at two Australian emergency departments. An inductive thematic analysis was undertaken to explore the patient experience while ramped and aspects of the built environment and care that participants perceived could better support their health and waiting experience. RESULTS:Twenty-six patients participated in the study. Four major themes and 13 subthemes were developed from the data. Participants described psychological distress, physical discomfort, an unsuitable built environment, and challenges to maintain physical health. They suggested modifications to the built environment and care received that may ameliorate some of their concerns. CONCLUSION:Ramping can create additional stresses to the patient experience. Making changes to the physical aspects of the built environment may be challenging in the short term; however, other aspects of the ramp were identified that could be considered to maximise patient-centred care.

BACKGROUND:First-line pharmacological management of acute renal colic pain may vary influenced by preference, structural and staffing issues with emergency departments. The aim of this study was to explore the variation in renal colic pain management and contributing factors within emergency departments in Australia METHODS: A specifically designed survey was sent to relevant national professional colleges and organisations for distribution. The survey presented respondents with four acute renal colic scenarios. Descriptive statistics summarised quantitative data, while free text responses were explored using content analysis. RESULTS:Responses from 180 nurses, paramedics and medical doctors were analysed. Opioids were the most commonly prescribed analgesia (4 scenarios) in combination with either paracetamol (3 scenarios) or rectal NSAIDs (1 scenario). Free text responses provided context to the preference of opioids and identified workload, clinician availability and scope of practice limitations to timely analgesia provision. Most respondents (91.2 %) would support research into non-pharmacological alternatives to opioids. CONCLUSION:Opioids remain the first line preference for many clinicians in managing acute renal colic pain despite current guideline recommendations for NSAIDs. Departmental and clinician capacity, and practice limitations contribute to delays in providing analgesia. Greater consistency and predictability in prescribing, review of limitations on nurse prescribing and exploring novel low risk first line non-pharmacological analgesics may improve management of acute renal colic.

Ambulance ramping is the situation where patients who arrive by ambulance are forced to queue for access to an emergency department (ED) cubicle. Despite efforts to address the problem of ambulance ramping, it continues to present a ubiquitous challenge for health services. While facility guidelines consider general healthcare and ED environments, evidence is lacking regarding necessary requirements to provide patient-centred care within the ramp environment. This scoping review identifies current research regarding characteristics of waiting environments that provide better experiences for consumers that may be transferable to the ambulance ramp. It utilises sources from both health and non-health literature to support outcomes. A systematic search of five electronic databases was conducted, reference chaining was undertaken, and grey literature was searched. Levels of evidence were assessed using the Mixed Methods Appraisal Tool. No study was found that specifically addressed the spatial layout of the ED ramp environment in relation to patient experience. Fifty-nine papers were included in the review. Papers underwent an inter-rater assessment regarding translatability of the outcomes to the ramp environment, including perceived complexity and cost. Outcomes with high inter-rater agreement were then discussed according to the domains of psychological, self-efficacy, social and functional. Elements categorised within these domains include privacy, availability of external views and natural elements, proximity of staff and communication, aspects of the physical environment, elements of hospitality, preferred furniture and environmental temperature. This review identifies environmental elements that may support person-centred care while on the ED ramp and informs future facility planning.

Objective: Identify the incidence of intracranial haemorrhage in people from residential aged care facilities following falls who had a CT head performed. The secondary objectives were to identify predictor variables for intracranial haemorrhage to inform person-centred shared decision making. Methods: Retrospective chart review of aged care residents who presented to ED with a triage of fall. Documented evidence of vomiting, headache, external signs of head injury, deviation from baseline neurology and the presence of anticoagulation or antiplatelet agents was reviewed. The rates of CT head, intracranial haemorrhage, emergent interventions, disposition and mortality were assessed. Results: Of the 2546 presentations, 1732 (68.0%) had a CT head and intracranial haemorrhage was found in 76 (4.4%) patients. External signs of head injury and deviation from neurological baseline have a strong association with intracranial haemorrhage in 26 (22.2%) patients, only 4 (0.61%) patients with intracranial haemorrhage had neither. There was a strong association between these clinical features and identification of intracranial haemorrhage on CT head. Anticoagulation and antiplatelet use had no association with intracranial haemorrhage. A 30-day mortality was increased in patients with deviation from neurological baseline. No neurosurgical intervention was performed, and there was inconsistent advice regarding anticoagulation or antiplatelet agents. Conclusions: Deviation from neurological baseline or external signs of head injury may be predictors of intracranial haemorrhage. Vomiting, headache, anticoagulation or antiplatelets were not associated with intracranial haemorrhage. A person-centred decision-making approach, that is informed by treatment options could better guide clinicians on when to order a CT head after a fall.

Digital health data quality is a critical concern in the healthcare industry, jeopardizing the secondary use of data for revolutionizing population health, and hindering patient care and organizational outcomes. Limited published evidence exists for explaining why these data quality issues emerge. The Odigos framework is a notable exception asserting that data quality issues emerge from three worlds: material world (e.g., technology artifact), personal world (e.g., technology users/use), and social world (e.g., organizations/ institutions) but has yet to systematically unpack the elements within these worlds. Through deductive and inductive analysis of interview data from a case study of the Emergency Department of Australia's first large digital hospital, we apply and extend the Odigos framework by identifying elements emanating from the three worlds and their interrelationships as root causes of data quality issues. These elements can then be used by hospitals to develop strategies to proactively improve their digital health data quality.

Objective Many factors influence patient flow through an ED, including streaming, treatment spaces and staff resources. This pilot study explored and compared real time patient flow using a single-stream system versus varying configurations of possible two-stream systems using computer simulation.Methods Simulation modelling was used to assess the delay in treatment of a rapid-antigen-tested-based, two-stream model for patient flow through ED during the peak phase of the COVID pandemic.Results Modelling two-stream configuration for all patients (minimum time to be seen for both COVID-positive and COVID-negative patients) showed that in the case study ED, a two-stream system and linked changes in bed configuration for managing the risks of infection can impact delays in treatment.Conclusions Data-driven modelling within specific clinical settings can inform the (in)efficiency of patient flow processes and help clinicians and managers make evidence-based decisions about patient transition through EDs. This can assist with reconfiguration of ED patient streaming particularly during periods of unique need, such as the recent COVID-19 pandemic.

INTRODUCTION:Occupational violence in emergency departments is prevalent and detrimental to staff and health services. There is an urgent call for solutions; accordingly, this study describes the implementation and early impacts of the digital Queensland Occupational Violence Patient Risk Assessment Tool (kwov-pro).METHODS:Since December 7, 2021, emergency nurses have been using the Queensland Occupational Violence Patient Risk Assessment Tool to assess 3 occupational violence risk factors in patients: aggression history, behaviors, and clinical presentation. Violence risk then is categorized as low (0 risk factors), moderate (1 risk factor), or high (2-3 risk factors). An important feature of this digital innovation is the alert and flagging system for high-risk patients. Underpinned by the Implementation Strategies for Evidence-Based Practice Guide, from November 2021 to March 2022 we progressively mobilized a range of strategies, including e-learning, implementation drivers, and regular communications. Early impacts measured were the percentage of nurses who completed their e-learning, the proportion of patients assessed using the Queensland Occupational Violence Patient Risk Assessment Tool, and the number of reported violent incidents in the emergency department.RESULTS:Overall, 149 of 195 (76%) of emergency nurses completed their e-learning. Further, adherence to Queensland Occupational Violence Patient Risk Assessment Tool was good, with 65% of patients assessed for risk of violence at least once. Since implementing the Queensland Occupational Violence Patient Risk Assessment Tool, there has been a progressive decrease in violent incidents reported in the emergency department.DISCUSSION:Using a combination of strategies, the Queensland Occupational Violence Patient Risk Assessment Tool was successfully implemented in the emergency department with the indication that it could reduce the number of incidents of occupational violence. The work herein provides a foundation for future translation and robust evaluation of the Queensland Occupational Violence Patient Risk Assessment Tool in emergency departments.

Objective: The rapid increase in e-mobility globally, including in Australia, has seen a concurrent increase in e-mobility-related injuries. Monitoring and understanding the patterns of injuries is essential to preserving com-munity safety and making responsive and effective policy decisions regarding their safe use.Methods: This study reports on the first phase of the E-MODES study, a proactive injury surveillance initiative to examine the incidence and nature of injuries, their circumstances, contributing factors, and treatment, presenting to three hospital emergency departments (EDs) in Brisbane, the first Australian city to trial shared e-scooters.Results: During the 31-month study period, there were 1048 ED presentations related to e-mobility, the vast majority (90.8%) involving e-scooters, with males accounting for 64.3% of cases, the most common age group being 25-34 years, and weekends being the most common period of the week for presentations. The most common injury was fractures (37%), and the upper extremities and head/face were the most commonly injured body regions. Conclusion: Contributing risk factors of alcohol use, not wearing a helmet, and speeding, were prevalent, though poorly recorded and only alcohol use proportions varied by age and gender, with males being more likely than females to have alcohol use reported. Recommendations to support e-mobility-related injury surveillance and safety outcomes include improved data standardisation and sharing.

Background: The three-item occupational violence (OV) risk assessment tool was developed and validated for use in emergency departments (EDs). It prompts review of each patient's aggression history, behaviours, and clinical presentation. However, confidence around representativeness and generalisability are needed before widescale adoption; hence we measured the inter-rater reliability of the tool among a large group of emergency nurses.Methods: A cross-sectional study was conducted between Sep 2021 and Jan 2022. Nurses were directed to a website that hosted an e-learning module about the tool. They were asked to apply the tool to two video scenarios of typical patient presentations. Demographic data, including years of emergency experience, were collected to contextualise their responses. Gwet's Agreement Coefficients (AC1) were calculated to determine inter-rater reliability.Results: There were 135 participants: typically female, under the age of 40 years, with more than 3 years of emergency nursing experience. Overall, there was excellent inter-rater agreement (AC1 =0.752, p = 0.001). This was consistent when years of ED experience was stratified: 0-2 years, AC1 = 0.764, p = 0.002; 3-5 years, AC1 = 0.826, p = 0.001; 6-10 years, AC1 = 0.751, p < 0.001; 11-15 years, AC1 = 0.659, p = 0.004; >= 16 years, AC1 = 0.799, p < 0.001.Conclusion: The three-item OV risk assessment tool has excellent inter-rater reliability across a large sample of emergency nurses. (c) 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:Cervical collars are used as standard care for neck immobilisation after cervical spine injury. Although evidence for the most effective type of collar is lacking, there is evidence regarding adverse patient outcomes when managed in a semi or rigid collar. In response to the evidence of complications and adverse effects when using a hard collar, a large Australian adult trauma hospital that specializes in spinal care, changed its policy from hard to soft collars when managing acute cervical spine injury.OBJECTIVE:The aim of this study was to investigate patients' experiences and outcomes when wearing a soft collar for acute cervical spine injury management in hospital.METHOD:A single centre mixed method sequential study design was used.RESULTS:Medical records from 136 patients were examined and no adverse events resulting from collar use were recorded. Interviews with 20 patients revealed that they understood the value of wearing a soft collar. The soft collars were considered supportive and well tolerated, with good adherence to recommendations for use.CONCLUSIONS:Understanding the patients' experiences informs better care management. This study suggests that soft collars are well tolerated, do not result in pressure injuries or other adverse events and are suitable for managing acute cervical spine injury.

Background: Frequent presenters to emergency departments (EDs) pose many challenges around care delivery and health service management. The aim of this study was to investigate the presentation patterns of people with 5 or more ED visits in any calendar month (5+ frequent presenter [FP5+]) to develop a useful methodological framework on which the real impact of interventions may be assessed. Methods: This study is a retrospective analysis of de-identified frequent ED presentation data using segmented regression analysis of an interrupted time series (ITS). Results: A total of 82 FP5+ to this single ED were identified in a year. Of these presenters, 77% had 10 or more presentations in a year. The total FP5+ presentations in the 12 months preceding and after each participant's ≥5 presentations in 1 month (the trigger month for inclusion in the study) accounted for 1,064 and 1,606 visits, respectively. ITS analysis of frequent ED presentations did not show a significant level change or trend change during the data collection period. Monthly review of people who frequently present to a single ED showed that presentations typically occurred in bouts that may span calendar years. Presentation bouts then typically slow, potentially distorting evaluation of the effects of interventions. Conclusion: Rolling monthly examination of presentation data may facilitate timely case review and care delivery, as well as provide a holistic picture of the impacts of interventions targeting patient care needs. This unique analysis demands a reconsideration of the typical before-and-after analysis of interventions for this vulnerable and high-cost group of patients.

To compare time metrics associated with a temporary disruption to ED computed tomography (CT) scanner location from adjacent to the ED with direct access from resuscitation rooms, to a location remote to the ED.

AbstractAimTo develop and psychometrically test an occupational violence (OV) risk assessment tool in the emergency department (ED).DesignThree studies were conducted in phases: content validity, predictive validity and inter‐rater reliability from June 2019 to March 2021.MethodsFor content validity, ED end users (mainly nurses) were recruited to rate items that would appropriately assess for OV risk. Subsequently, a risk assessment tool was developed and tested for its predictive validity and inter‐rater reliability. For predictive validity, triage notes of ED presentations in a month with the highest OV were assessed for presence of OV risk. Each presentation was then matched with events recorded in the OV incident register. Sensitivity and specificity values were calculated. For inter‐rater reliability, two assessors—trained and untrained—independently assessed the triage notes for presence of OV risk. Cohen's kappa was calculated.ResultsTwo rounds of content validity with a total of N = 81 end users led to the development of a three‐domain tool that assesses for OV risk using aggression history, behavioural concerns (i.e., angry, clenched fist, demanding, threatening language or resisting care) and clinical presentation concerns (i.e., alcohol/drug intoxication and erratic cognition). Recommended risk ratings are low (score = 0 risk domain present), moderate (score = 1 risk domain present) and high (score = 2–3 risk domains present), with an area under the curve of 0.77 (95% confidence interval 0.7–0.81, p < .01). Moderate risk rating had a 61% sensitivity and 91% specificity, whereas high risk rating had 37% sensitivity and 97% specificity. Inter‐rater reliability ranged from 0.67 to 0.75 (p < .01), suggesting moderate agreement.ConclusionsThe novel three‐domain OV risk assessment tool was shown to be appropriate and relevant for application in EDs. The tool, developed through a rigorous content validity process, demonstrates acceptable predictive validity and inter‐rater reliability.ImpactThe developed tool is currently piloted in a single hospital ED, with a view to extend to inpatient settings and other hospitals.

High‐occupational stress among ED staff has a detrimental impact on both staff wellness and patient care. The objective of the study is to determine whether 4 weeks of smartphone app‐guided mindfulness practice reduces stress levels of ED staff.

High-occupational stress among ED staff has a detrimental impact on both staff wellness and patient care. The objective of the study is to determine whether 4 weeks of smartphone app-guided mindfulness practice reduces stress levels of ED staff. This two-arm randomised controlled trial was conducted in two Australian EDs in 2019–2020. Eligible participants were randomly assigned (1:1) to either an App group or a Wait to Treat group to practice daily 10 min app-guided mindfulness for 4 weeks. Online surveys were collected for both groups at three time periods: before (T1), immediately after (T2) and 3 months after cessation (T3). Then the Wait to Treat group received the same intervention, followed by surveys immediately after the intervention (T4) and 3 months later (T5). Primary outcome was measured using the Perceived Stress Scale. Secondary outcomes were measured using the Maslach Burnout Inventory (three subscales: emotional exhaustion, depersonalisation and personal accomplishment), Mindfulness Attention Awareness Scale and Warwick-Edinburgh Mental Well-being Scale. Both intention-to-treat and per-protocol analysis were performed. Repeated measurement data were analysed by the linear mixed model. Of 148 enrolled participants 98 completed all the surveys, but only half (48%) reported continuous use of the app. Based on the results of the intention-to-treat analysis, there was a statistically significant improvement of perceived stress levels ( F  = 15.70, P < 0.001), all three components of burnout (emotional exhaustion [ F = 14.22, P < 0.001], depersonalisation [ F  = 3.62, P = 0.030], personal accomplishment [ F  = 7.51, P  < 0.001]), mindfulness ( F  = 8.83, P  < 0.001) and wellbeing levels ( F  = 10.71, P  < 0.001) from pre-intervention to 3 months later with small effect sizes. Results of the present study demonstrate that brief mindfulness training via innovative digital technology had a small positive effect in improving emergency staff stress, burnout, mindfulness and wellbeing.

Background: Occupational stress and burnout in emergency departments (ED) are prominent issues requiring effective solutions. In other health settings use of a smartphone mindfulness app have been shown to be a costeffective strategy for stress management. Aim: To understand ED staff's experiences of practicing mindfulness using a smartphone app. Method: A qualitative study was undertaken with 24 ED staff at two Australian EDs who had used a mindfulness app for 4 weeks. Semi-structured, one-to-one interviews were conducted between late 2019 and early 2020. Interviews were audio recorded and transcribed. Descriptive description was utilised in content analysis. Results: Four main themes were identified: individuality in use of the app, perceived benefits and impacts on life, perceived barriers and enablers to use. Participants reported that mindfulness practice had numerous benefits including better stress and anxiety management, as well as improved general wellbeing. The main barriers to mindfulness practice were poor time management for mindfulness and lack of motivation. Reported enablers included a strong desire for promoting wellbeing and the ability to embed practice into existing routine. Conclusion: Practicing mindfulness with a smartphone app is a useful strategy to promote ED staff wellness and manage stress. Healthcare organisations should consider the implementation of a mindfulness app for staff.

Nonpharmacological strategies are advocated for the management of behavioral disturbance in older adults due to risk of harm from pharmacological therapy; however, limited evidence supports their use in emergency departments (EDs). The current descriptive study was conducted to investigate the use of sensory devices for nonpharmacological management of behavioral disturbance and their perceived impact. Data were collected from the sensory device registry, electronic medical records, and survey. Patient-level data (N = 33) showed that sensory devices, such as tactile blankets or toys and music, can be used in EDs to alleviate behavioral disturbance among older adults. ED staff (n = 22) expressed an interest to increase device supply. A patient and caregiver (n = 2) suggested that the devices be initiated earlier in ED care. Further research is required to strengthen evidence on the impact of these devices on patient outcomes. [Journal of Gerontological Nursing, 47(4), 22-27.].