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Quality assurance and quality improvement

Essentials 1 Quality improvement offers the tools to translate knowledge into improved patient care. 2 The six key aims for improvement are safety, effectiveness, patient-centeredness, timeliness, efficiency and equitable care. 3 The commonly used quality cycle known as ‘plan, do, study, act’ involves planning a test, carrying out a change, observing the consequences and putting in place modifications. 4 Standards provide a consistent and uniform set…

Emergency department layout

Essentials 1 The layout of the emergency department should functionally promote efficacy of care, safety and efficient patient flow by maximizing access to every space with the minimum of cross-traffic. 2 The triage location should enable staff directly to observe and gain access to both the ambulance entry and the patient waiting areas. 3 The acute treatment area should be open, with all spaces directly observable…

Emergency department staffing

Essentials 1 An emergency department staff structure that is appropriate in numbers and skill mix is required to provide high-quality and timely clinical care, while maintaining sustainable working conditions for staff. 2 Senior medical and nursing staff have clinical roles that include direct patient care, as well as supervision and teaching of junior staff, coordination of patient flow and liaison with other clinicians. 3 The senior…

Public health and emergency medicine

Essentials 1 Public health is a key component of a sustainable health system. 2 Emergency medicine has a mandate to advocate for public health initiatives. 3 Acute health care has limited opportunity to affect health care outcomes compared to public health. 4 Screening, brief intervention and referral for treatment are the cornerstone of emergency department (ED) prevention. 5 Disease and injury surveillance is an important function…

Rapid response systems and the emergency department

Essentials 1 Serious adverse events (SAEs), including cardiac arrest were previously common in hospitalized ward patients. 2 SAEs were often preceded by signs of physiological derangement for up to 24 hours prior to the event. 3 Rapid response systems (RRSs) are designed to enable early recognition of, and response to, clinical deterioration. 4 Three systematic reviews show that RRSs reduce in-hospital cardiac arrests, and one demonstrates…

Overcrowding

Essentials 1 Overcrowding is the situation where emergency department (ED) function is impeded primarily by the excessive number of patients needing or receiving care. 2 Access block is excessive delay in accessing appropriate inpatient beds and, in Australasia, is defined as the proportion of patients with longer than 8 hours total ED time. 3 Access block is the principal cause of overcrowding but overall demand is…

Emergency department short stay units

Essentials 1 Emergency department short stay units play a key role in modern emergency departments. 2 Staffing is ideally by emergency department staff with defined admission criteria and a plan for disposition within 24 hours. 3 They offer time-limited intensive treatment with clear treatment and follow-up guidelines. 4 They have an increasing role in improving patient flow while maintaining quality of care and safety in the…

Emergency care in a humanitarian crisis

Essentials 1 The worldwide problem of refugees, internally displaced and stateless persons is significant and likely to increase. 2 Overall responsibility for internally displaced persons (IDPs) lies with the governments of the country in which they reside. The international community, including many of the United Nations (UN) agencies, can assist through collaboration and diplomacy ( ). Refugees, on the other hand, have crossed an international…

Triage

Essentials 1 Triage is the ongoing process of sorting patients on the basis of the urgency of their need for medical care. 2 Urgency is distinct from both severity and complexity. 3 Triage categorization has been found to relate strongly to both resource use and patient outcome in the near term. 4 The five-level Australasian Triage Scale (ATS) forms the basis of emergency department triage in…

Medical issues in disasters

Essentials 1 The incidence of globally reported disasters from natural and technological hazards increased exponentially from 1960 to 2000 and has fallen slightly in the period 2006 to 2015 after a peak in 2005. 2 Deaths due to natural hazards has steadily declined over the past five decades—largely due to improvements in multisectoral emergency risk management—but numbers of affected populations continue to rise, encompassing 25% of…

Retrieval

Essentials 1 Mature retrieval systems act as a single point of entry for the referrer, preferably providing services by initiation of a single call to a systemwide phone number. 2 Retrieved patients are often unstable, at the margin of physiological compensation, and in need of specialized investigation and intervention. They are often at that phase of an emergency presentation where diagnosis is incomplete, treatment is problem-focused…

Pre-hospital emergency medicine

Essentials 1 Ambulance call taking and dispatch is increasingly becoming computerized, which allows for the medical determination of the most appropriate response speed and skill set as well as telephone instructions for cardiopulmonary resuscitation and first aid. 2 Ambulance care of the critically ill or injured patient is similar to initial evaluation and management by an emergency physician, with emphasis on basic life-support measures. 3 The…

Ethics in emergency medicine

Essentials 1 Ethics is about doing the right thing for the patient. 2 The morality of the doctor and the morality of the patient will influence decision making. 3 The two most common ethical dilemmas in emergency medicine concern treating patients who do not consent and stopping resuscitation. 4 When these dilemmas are being addressed, the application of pragmatic tools assists ethical decision making. 5 The…

Privacy and confidentiality

Essentials 1 Privacy and confidentiality issues can be related to the physical environment in which care is given or to the personal health information involved in the patient’s care. 2 Breaching confidentiality of personal health information now breaks Australian and New Zealand legislation. Introduction An individual’s right to privacy and confidentiality has gained increasing recognition over the past decade. In an emergency setting, where patients are…

Consent and competence—the Australian, NZ and UK perspectives

Essentials 1 Informed consent is an essential process for medical treatment that has ethical, legal and administrative elements. Complexities of the practical situation may result in deviation from the theoretical ideal. 2 Consent may be implied, verbal or written, and should always be clearly documented. 3 Consent must be informed, specific and freely given, and must cover that which is actually done. 4 The patient must…

The coroner: the Australian, NZ and UK perspectives

Essentials 1 The Coroners Court is a specialist court established to investigate certain types of deaths and fires. The purpose of these investigations is to consider ways that similar events may be prevented in the future. 2 Preparation for a coronial investigation should start as soon as someone dies in reportable circumstances. 3 A coronial inquest is generally a public inquiry into a death to which…

Mental health and the law: the Australian, NZ and UK perspectives

Essentials 1 The emergency department is frequently the point of access to the mental health system. 2 Emergency physicians need to be able to distinguish between patients with physical and those with psychiatric illness. 3 Patients should only be committed involuntarily to an approved hospital if they have a mental illness requiring immediate treatment for their own health or safety or the protection of others and…

Postgraduate emergency medicine teaching and simulation

Essentials 1 Emergency medicine training programs need explicit curricular objectives, effective learning and teaching strategies, and valid and reliable assessment methods. 2 Technology, social media and online collaboration are affecting the way emergency medicine trainees and their supervisors learn and access information, and demand new skills in information retrieval and critique. 3 Simulation offers learning opportunities in clinical and procedural skills, teamwork and communication, and requires…

Teaching medical students emergency medicine

Essentials 1 Emergency medicine as an academic discipline has achieved maturity, with medical student teaching a core business of every emergency department in the country, with structured terms in emergency medicine now considered an essential part of any medical curriculum. 2 The specialty of emergency medicine has a unique and practical body of knowledge that can contribute much to the entire medical curriculum and it is…

Principles of medical education

Essentials 1 The emergency department (ED) provides a rich learning environment despite the constraints of service provision and time pressure. 2 Understanding individual learners by exploring their prior experience and learning goals, then tailoring teaching to address these goals will maximize learning in the ED. 3 Setting clear learning objectives at the beginning and summarizing the learning experience at its conclusion enhances any form of teaching.…