The contemporary growth in medical graduates in Australia is resulting in increasing demands for postgraduate training placements. Two editorials consider the impact on emergency medicine (EM) training for junior doctors, where supervisory capacity in ED’s represents a potential “bottleneck”. Brazil (@SocraticEM) and Mitchell (@robdmitchell) argue that the emphasis for ED-based intern rotations should focus on quality, even if this means limiting the number of ED placements (Balancing quantity and quality in emergency medicine training for interns). Meanwhile Killen and Gosbell (@AGosbell) suggest that ACEM’s Emergency Medicine Education and Training (EMET) network provides a means to increase capacity for EM training for junior doctors and intern placements in regional and rural ED settings (The need to maintain quality and build capacity for emergency medicine training) Both editorials note the widely acknowledged value of EM training for junior doctors and advocate for appropriate recognition and resourcing of the supervisory role required of senior clinicians in the ED that ensures the quality of this highly valued training experience is maintained.
Effective handover is critical to achieving the optimum management for every patient within a healthcare system. Handover from ambulance to hospital ED is a potentially vulnerable point in the care pathway, particularly for the unstable, high-acuity patient. This literature review from Dawson and colleagues identifies professional relationships; respect and barriers to communication; multiple or repeated handovers; identification of appropriately senior staff in the ED; and significance of vital signs as key issues impacting in this clinical handover process. Clearer identification of ED staff and use of a structured handover tool, such as ISBAR (ISBAR PDF) are suggested as solutions to many of these issues. Clinical communications training for paramedics and ED clinicians would also promote more effective teamwork.
An international, multicentre, randomised, controlled trial: the Australasian Resuscitation In Sepsis Evaluation (ARISE) study, is designed to evaluate the effectiveness of early goal-directed therapy compared with standard care for patients with severe sepsis who present to the ED. This special report from Delaney et al, on behalf of the ARISE Investigators, describes the principles and methods for analysing the study results. Details on the trial interventions are provided and primary, secondary and tertiary study outcomes are defined. Publication of this information prior to completion of the study recruitment phase will minimise analytic bias and conforms to best practice in conducting clinical trials
Medical assessment by a dedicated senior physician, soon after triage, in times of peak demand is one potential model of care to improve ED efficiency. The premise of this intervention is senior clinician involvement facilitates early management and disposition decisions thereby expediting the patient journey. This cohort study, from Asha and Ajami, demonstrates that this model of care implemented as a Senior Assessment and Streaming (SAS) protocol, which links early consultant-level assessment of stable ambulant patients with streaming through a dedicated clinical area, results in improvement in the ED’s ability to meet time-based targets (NEAT), particularly in periods of high demand