Telephone triage (Full text)
Despite government media releases to the contrary, the National Health Call Centre Network (healthdirect Australia, after-hours GP helpline) is not helping to ease demand on emergency departments, according to this editorial by Nagree and colleagues. Access block, not low acuity patients, is the key driver of ED over-crowding.
Resuscitation targets to facilitate the early detection and appropriate management of circulatory shock are considered in a two-part review series. In Part 2 of this series Holley at al review the methodology and evidence for current technologies used in directing resuscitation at the microcirculation and cellular level. This follows on from Part 1 (in the February issue) which explored global haemodynamic end-points for guiding resuscitation and their potential limitations.
This qualitative study by Bennetts et al identified important barriers and enablers to implementing best-practice pain management guidelines in the Australian EDs. High workload and insufficient resources are major barriers that need to be overcome. Staff engagement, a clinical culture of learning best practice and strong leadership by senior staff are key enablers. The findings of this study informed the design of the National ED pain management initiative (2008-2010).
Reflections on professional longevity (Full text)
Twenty-five years after gaining Fellowship, Jelinek reflects on career progression in emergency medicine. He contends that, as a result of the pressures of working in the ED, unique solutions may be required if the emergency physicians are to continue in clinical practice in the later stages of their professional lives. Otherwise the accumulated expertise of this group of experienced and capable clinicians may be lost to the healthcare system.