Understanding the effect of clinician dependent versus evidence-based pathway for the management of Salmonella-like symptoms in an emergency department.

ABSTRACT

Introduction: On Monday the 13th of May 2013, a surge in patients with vomiting and diarrhoea presented to an Emergency Department (ED) in Canberra. Contract tracing identified a focal point between patients, and pathology samples identified Salmonella as the responsible agent. On the following Wednesday, upon a hospital based disaster being declared, a just-in-time evidence-based pathway was introduced to ensure consistency in patient management. This research aims to describe the effect of this pathway (intervention) versus clinician dependent (control) management of such patients.

Method: This research was retrospective in design. The sample includes 110 patients who presented in May 2013 to one ED, with Salmonella-like symptoms. Data was collected from the Emergency Department Information System. Patient characteristics, such as age and gender are described using descriptive statistics. A Mann-Whitney test was used to compare continuous data and a Fisher exact test was used to compare categorical data, between the two groups. This research has ethics approval from the health care facility.

Results: Over an eight day period, 110 patients presented with salmonella-like symptoms. Of these, 47 were male and 63 were female, with a median age of 30 years (IQR: 20-42). Both age (p=0.65) and gender (p=0.84) were statistically similar between the two groups. Overall, the mean length of stay in minutes (±SD) was 735 (1112). However, the mean length of stay in minutes was statistically different between the two groups, with the control being 975 (1280) and the intervention being 230 (251) (p=0.0001).

Discussion: The length of stay for patients between the two groups was statistically significantly different, suggesting that the implementation of a just-in-time evidence-based pathway for the management of patients with Salmonella-like symptoms reduced the ED length of stay. This finding is useful in that it may assist in the future planning of similar public health emergencies or for use when patients present with Salmonella-like symptoms on a daily basis.






Ranse J, Luther M, Ranse K. (2014). Understanding the effect of clinician dependent versus evidence-based pathway for the management of Salmonella-like symptoms in an emergency department; paper presented at the 12th International Conference for Emergency Nurses, Perth, Australia, 9th October.

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Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study.

ABSTRACT:

Introduction: Health providers at mass gatherings aim to minimise the disruption to the health services of the surrounding community. The mass gathering literature focuses on patients presenting to onsite care providers at events, and scantly reports on patients presenting to prehospital care providers (ambulance paramedics) and hospital emergency departments (EDs). In 2012, an outdoor music festival with approximately 20,000 participants was held in Canberra. The festival had one first aid post, and a medical assistance team staffed by doctors, nurses and paramedics. This research describes the characteristics of patients and health service usage from this event.

Method: Data was collected retrospectively from the event onsite care provider (St John Ambulance Australia) patient records. These records were linked to both prehospital (ACT Ambulance Service) and hospital EDs (Canberra Hospital and Calvary Health Care ACT) patient records. A preexisting minimum data set was used to code patient characteristics. Data analysis included descriptive statistics, such as frequencies and means of central tendency.

Results: In total, 197 (9.86/1,000) patients presented for clinical assessment and/or management at the event. Two patients who required hospitalisation bypassed the onsite care providers and were transferred directly via the ambulance service to hospital. The onsite medical assistance team managed 22 patients (1.1/1,000), of whom two were referred to police, five transported to hospital and 15 discharged to the event. In total, seven patients were transported to hospital by ambulance (0.35/1,000). Hospital presentation rate and patient characteristics are currently being determined at the time of this abstract submission.

Discussion: This is the first research to describe patient presentations to onsite care providers, prehospital and hospitals from a mass gathering. This research provides insight into the health service usage associated with mass gathering. Strategies to minimising the disruption to the prehospital and hospital health services of the surrounding community will be discussed.

Ranse J, Lenson S, Keene T, Luther M, Burke B, Hutton A. Patient presentations to onsite health providers, ambulance paramedics and hospital emergency departments from a mass gathering: a case study. 12th International Conference for Emergency Nurses.

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Drugs, pills top emergency list for evacuation too

I was interviewed by Natasha Body from the Canberra Times. The interview focused on the health preparedness of the community in a disaster.

The full text article is available here

This article was among the most read articles for the day across Australia as demonstrated below:

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