Emergency department presentations of patients from CALDB receiving chemotherapy in day oncology settings

Objective
The objectives of this research were to compare the emergency department (ED) presentations for cancer patients from culturally and linguistically diverse backgrounds (CALDB) treated with chemotherapy through day oncology units with other cancer patients.

Design
A retrospective audit was conducted. Data collected included demographic factors and ED presentation characteristics. Descriptive statistics and direct logistic regression was used to summarise and compare the ED presentation rates and ED presentation characteristics of patients from CALDB and other patients.

Setting
Primary and secondary care.

Patients
All adult day oncology patients who were treated with chemotherapy and presented to an ED between 1 January and 31 December, 2007. Across the two health sites, 770 day oncology patients attended an ED on at least one occasion. Of these 37.7% were born in a non-English speaking country.

Results
Patients from CALDB were more likely to present (p < 0.001, OR = 1.55, C.I. = 1.29–1.88) and re-present to an ED (p < 0.001, OR = 2.08, C.I. = 1.37–3.16), however there was no association between CALDB and admission to hospital following the ED presentation, triage category or being seen within the clinically recommended time. Patients from CALDB tended to present for potentially preventable conditions such as nausea/vomiting/dehydration and fever.

Conclusions
Our findings suggest that targeted interventions that incorporate education and information to assist with self-care for patients from CALDB may reduce potentially preventable presentations and representations to an ED and the subsequent economic, social and personal costs associated with these ED presentations.

Role of emergency departments in screening for obese and overweight children

Introduction
Childhood obesity is a major and increasing public health issue. The role of Emergency Departments (EDs) in screening for overweight and obese children has not been studied extensively. The main aim of this study was to estimate the prevalence of overweight children in Emergency Department (ED) populations. A secondary objective was to compare the characteristics of overweight and obese children with healthy weight children.

Methods
This prospective exploratory study was conducted in the two district urban EDs in Melbourne, Australia. A total of 87 ED patients aged 2 to 15 years were included in the study. The main outcome measures were body mass index, weight and height percentiles.

Results
The median absolute BMI was 16.8 (IQR = 15.4 to 18.8). The total number of children found to be overweight (BMI > 85th percentile) or obese (BMI > 95th percentile) was 21.8% (n = 19). Of these, 5.7% (n = 5) of children in this study were classified as obese. Comparison of overweight/obese children and healthy weight children showed no differences in triage but a higher incidence of respiratory illness (15.8% compared to 2.9%).

Conclusions
This pilot study showed that 1 in 5 children who presented to EDs were either overweight or obese suggesting a possible role for EDs in the detection and referral of overweight and obese children to intervention programs. Our findings suggest that a sufficiently powered randomised controlled trial is warranted to examine the effectiveness and efficacy of EDs screening for obese and overweight children.

Frequency and nature of reported incidents during emergency department care

Background The aim of this study was to examine reported incidents affecting Emergency Department (ED) episodes of care.
Methods A retrospective audit of ED patients was carried out in an urban district hospital in Melbourne, Australia from 1 January 2008 to 31 December 2008. The main outcome measure was presence or absence of reported patient-related incident(s) during ED care.
Results There were 984 patient-related incidents (n¼984) during 2008.The most common incidents were related to patient behaviour (66.4%), patient management (10.1%) and medications (6.5%). Patients whose ED care involved reported incident(s) were older, had higher triage categories, longer length of ED stay and were more likely to need hospital admission or leave at their own risk. Eighteen per cent of reported incidents occurred in patients aged 65 years and over. Incidents affecting older patients were more likely to be related to breach of skin integrity, patient management, diagnosis and patient identification, and less likely to involve patient behaviour.
Conclusions Reported incident(s) occurred in 0.47% of ED episodes of care. Differences in personal and clinical characteristics of patients whose ED care involved reported incident(s) highlights the need for better understanding of incidents occurring in the ED in order to improve systems for high-risk patients.

Small rural hospital emergency department database

This data includes activity and performance data from the emergency departments at the local hospitals (Rural Category Three Public Health Services) in the Southwest region of Victoria.

Operation of guardianship laws in the emergency ward

Enduring and workable legislative schemes typically include (a) a balanced approach to the rights and duties of all parties under their purview; and (b) consideration of all major consequences that may flow from the codification of underpinning doctrines. This column examines the 1999 amendments to the Guardianship and Administration Act 1986 (Vic) regulating patients’ consent to medical treatment focusing on their application in modern emergency departments. The legislation needs to reconcile the human rights principle that humane and appropriate treatment is a fundamental right of all those who suffer from ill health and disease, with the principle that all patients (including those with impaired, but not totally absent, decisional capacity) have an absolute right to refuse life-saving treatment. Consent and refusal of treatment provisions should be based on the notion of reasonableness, including recognition that the mental and emotional states experienced by physically ill people may, in the short term, adversely affect their decision-making capacity. Unless the consent legislation factors in the realities of modern emergency practice and resources, statutory thresholds for decisional competence, instead of affording protection, may result in much worse outcomes for vulnerable patients.

Stochastic atmospheric assistance and the use of emergency staging sites by migrants

Numerous animals move vast distances through media with stochastic dynamic properties. Avian migrants must cope with variable wind speeds and directions en route, which potentially jeopardize fine-tuned migration routes and itineraries. We show how unpredictable winds affect flight times and the use of an intermediate staging site by red knots (Calidris canutus canutus) migrating from west Africa to the central north Siberian breeding areas via the German Wadden Sea. A dynamic migration model incorporating wind conditions during flight shows that flight durations between Mauritania and the Wadden Sea vary between 2 and 8 days. The number of birds counted at the only known intermediate staging site on the French Atlantic coast was strongly positively correlated with simulated flight times. In addition, particularly light-weight birds occurred at this location. These independent results support the idea that stochastic wind conditions are the main driver of the use of this intermediate stopover site as an emergency staging area. Because of the ubiquity of stochastically varying media, we expect such emergency habitats to exist in many other migratory systems, both airborne and oceanic. Our model provides a tool to quantify the effect of winds and currents en route.

The role of the medical emergency team in end-of-life care : a multicenter, prospective, observational study

Objective: To investigate the role of medical emergency teams in end-of-life care planning.

Design: One month prospective audit of medical emergency team calls.

Setting: Seven university-affiliated hospitals in Australia, Canada, and Sweden.

Patients: Five hundred eighteen patients who received a medical emergency team call over 1 month.

Interventions: None.

Measurements and Main Results: There were 652 medical emergency team calls in 518 patients, with multiple calls in 99 (19.1%) patients. There were 161 (31.1%) patients with limitations of medical therapy during the study period. The limitation of medical therapy was instituted in 105 (20.3%) and 56 (10.8%) patients before and after the medical emergency team call, respectively. In 78 patients who died with a limitation of medical therapy in place, the last medical emergency team review was on the day of death in 29.5% of patients, and within 2 days in another 28.2%. Compared with patients who did not have a limitation of medical therapy, those with a limitation of medical therapy were older (80 vs. 66 yrs; p < .001), less likely to be male (44.1% vs. 55.7%; p .014), more likely to be medical admissions (70.8% vs. 51.3%; p < .001), and less likely to be admitted from home (74.5% vs. 92.2%, p < .001). In addition, those with a limitation of medical therapy were less likely to be discharged home (22.4% vs. 63.6%; p < .001) and more likely to die in hospital (48.4% vs. 12.3%; p < .001). There was a trend for increased likelihood of calls associated with limitations of medical therapy to occur out of hours (51.0% vs. 43.8%, p .089).

Conclusions: Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals, and to confirm our findings in other organizations.