Impact of a pilot pathway for the management of gastroenteritis-like symptoms in an emergency department: A case study following a Salmonella outbreak

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ABSTRACT

Objective: This research aims to describe the effect of standard care (control) versus a clinical management pathway (intervention) on patient length of stay and admission rates during a public health emergency at one Australian Emergency Department.

Method: A retrospective audit of hospital records for patients who presented in May 2013 with gastroenteritis-like symptoms was undertaken following a surge in patient presentations from a Salmonella outbreak. Patients who presented with gastroenteritis-like symptoms between 15th and 19th May 2013 received care according to a clinical management pathway (intervention). The focus of the intervention was based on symptom management, including a standardised approach to analgesia, anti-emetics and rehydration. 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.

Results: Over an eight-day period, 110 patients presented with gastroenteritis-like symptoms. The median length of stay was statistically different between the two groups (P< 0.001). More patients were admitted to hospital from the control group (n = 5) when compared with the intervention group (n = 0); however, given the small number of patients in these groups, inferential statistical analysis was not a reasonable consideration.

Conclusion: The length of stay for patients between the two groups was statistically different, suggesting that the implementation of a clinical management pathway for patients with gastroenteritis-like symptoms reduced the ED length of stay. This finding is useful in future planning for similar public health emergency responses and/or for use when patients present with gastroenteritis-like symptoms on a daily basis.



Ranse J, Luther M, Ranse K. (2015). Impact of a pilot pathway for the management of gastroenteritis-like symptoms in an emergency department: A case study following a Salmonella outbreak. Emergency Medicine Australasia. [in-press].

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A stethoscope, a patient and me

The anecdote in this manuscript is taken directly from my thesis. The anecdote provides insight into the phenomenological natural attitude of the stethoscope and what it may be like to experience a stethoscope as a nurse or as a patient.


Ranse J. (2015). A stethoscope, a patient and me. Journal of Advanced Nursing Interactive. [http://journalofadvancednursing.blogspot.com.au/2015/09/the-stethoscope-patient-and-me.html]

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Pandemics and environmental emergencies

This chapter has a primary focus on environmental emergencies, such as heat-related emergencies, cold-related emergencies, drowning, and atmospheric-pressure-related emergencies. Each section within this chapter provides a good overview of anatomy, physiology, patient assessment and interventions, with an emphasis on both the pre-hospital and in-hospital care of the patient.

 My contribution to this chapter was particularly in the areas of

• Pandemics, and 
• Mass gathering health 

 The pandemic section highlights the historical background to pandemics. However, much of this section focuses on the challenges for health professionals, drawing on recent literature and examples from H1N1 2009 influenza. Mass gathering health presents unique challenges for the health system and health professionals. This section of the chapter highlights these challenges. Additionally, this section outlines the characteristics of mass gatherings that influence the demand for health services (such as temperature, crowd mood, venue type). In particular, this section outlines the public health considerations for mass gatherings.


Mateer J, Cusack L, Ranse J. (2015). Chapter 28: Pandemics and environmental emergencies in Curtis K, Ramsden C (eds). Emergency and trauma care: For nurses and paramedics 2nd ed. Elsevier Australia.

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Planning Healthcare for a Mass Gathering

 

I had a conversation with Craig Hooper from Operational Health about mass gathering health. To listen to the podcast, visit http://www.operationalhealth.com/#!204-planning-mass-gathering-healthcare/c1srl


The following is taken directly from the Operational Health website.

----START----

Craig chats with Assistant Professor Jamie Ranse about the clinical and operational planning that sits behind mass gatherings. Using World Youth Day 2008 as a case study, Jamie discusses the need to engage a cross section of health and healthcare providers. International perspectives are also discussed with the underlying messaging being that progress toward improved health planning at mass gathers relies on shared definitions and data points and moving away from purely descriptive journal articles to articles.

About my guest:
Assistant Professor Jamie Ranse of the University of Canberra has a keen professional and personal interest in the area of disaster and mass gathering health. He is currently undertaking a PhD exploring the experience of nurses who participate in disasters. He is an Associate Editor for the Australasian Emergency Nursing Journal, holding the disaster portfolio and peer-reviews a number of national and international journals relating to disaster and primary health care. Jamie remains engaged in the clinical setting as a casual RN at the Emergency Department of Calvary Health Care ACT.

About the Podcast Host:
Craig is a health and emergency service management specialist with more than 30 years experience in operational management, emergency planning, health service delivery and service redevelopment. More information can be found at www.cahooper.com

Academic Publications
Jamie Ranse has a large number of publications and presentations relating to Mass Gathering and Major Event health on his website, www.jamieranse.com Some of those discussed on this episode include;

Data Sets

• Ranse J, Hutton A. (2012). Minimum data set for mass gathering health research and evaluation: A discussion paper. Prehospital and Disaster Medicine. 27(6):1-8. doi:10.1017/S1049023X12001288 (Direct Link)
• Ranse J, Hutton A. (2013). Minimum data set for mass-gatherings health research and evaluation: The beginning of an international dialogue. Prehospital and Disaster Medicine. [author reply]. 28(2):3 (Direct Link)
• Lund A, Turris S, Bowles R, Gutman S, Hutton A, Ranse J, Arbon P. (2013). Progressing towards an international consensus on data modelling for mass gathering and mass participation events; paper presented at the 18th World Congress on Disaster and Emergency Medicine, Manchester, UK, May. (Direct Link)

Hutton A*, Ranse J, Arbon P. (2012). Understanding and identifying potential risks for participants at music festivals; paper presented at the St John Ambulance Australia Member Convention, Sydney, New South Wales, Australia, 19th May. (Direct link)

Hutton A, Ranse J, Verdonk N, Ullah S, Arbon P. Understanding the characteristics of patient presentations of young people at outdoor music festivals. Prehospital Disaster Medicine. 2014;29(2):1-7. (Direct Link)

Ranse J, Arbon P. Evaluating the influential factors in mass gathering casualty presentation characteristics – World Youth Day, Sydney, Australia, 2008; paper presented at the 7th International Conference for Emergency Nurses, Gold Coast, Australia, 8th October 2009. (Direct link)

----FINISH-----

Ranse J (Interviewee), Hooper C (Producer). (2015). Mass gathering health; audio podcast for Operational Health, 23rd July. Series 2, Episode 4. Retrieved from http://www.operationalhealth.com/#!204-planning-mass-gathering-healthcare/c1srl

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Leadership opportunities for Mental Health Nurses in the field of disaster preparation, response, and recovery.

Free full-text article is available here (PDF)


ABSTRACT

Disasters occur internationally and are nondiscriminatory. The loss resulting from the destruction associated with disasters leads to the development of various levels of psychological trauma in survivors. Health teams provide assistance to survivors before, during and after disasters, and mental health nurses make an important contribution to these teams. However, the leadership role of mental health nurses in disaster situations has not been extensively explored in the literature. This article discusses aspects of mental health nursing leadership in preparation for, response to and recovery from disasters. In particular, recommendations are made to enhance the leadership of mental health nurses in the context of disasters.



Ranse J, Hutton A, Wilson R, Usher K. (2015). Leadership opportunities for Mental Health Nurses in the field of disaster preparation, response and recovery. Issues in Mental Health Nursing.36(5):391-394.

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The realities of assisting in a disaster: An Australian perspective

I presented on the topic of disaster health, with a particular focus on an Australian perspective, to students and faculty staff of the University of Santo Tomas, Philippines.

The focus of this presentation included:

• Disaster health arrangements,
• Willingness of nurses to assist in a disaster,
• Educational preparedness of nurses,
• Role of nurses in a disaster,
• Leadership and teamwork,
• Hospital surge capacity,
• Disaster triage,
• Nursing student role in a disaster, and
• Future research priorities 

Ranse J. (2015). The realities of assisting in a disaster: An Australian perspective; presentation to Student and Faculty staff of the University of Santo Tomas, Philippines, Canberra, ACT, 3rd June.

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Disaster health: what emergency nursing students need to know

I was invited by the Canberra Emergency Nursing Student Society to discuss aspects of disaster health, particularly as it relates the the realities of nursing in a disaster and the role of student nurses.

This presentation discussed research related to:

• Willingness,
• Education,
• Nursing roles,
• Leadership and teamwork,
• Hospital surge capacity,
• Triage,
• Disaster tourism, and
• Future research priorities.

Ranse J. (2015). Disaster health: what emergency nursing students need to know; presentation to Canberra Emergency Nursing Student Society, Canberra, ACT, 12th May.

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The use of Haddon’s matrix to plan for injury and illness prevention at Outdoor Music Festivals

Free full-text article is available here (PDF)


ABSTRACT

Introduction: Mass-gathering music events, such as outdoor music festivals (OMFs), increase the risk of injuries and illnesses among attendees. This increased risk is associated with access to alcohol and other drugs by young people and an environment that places many people in close contact with each other.

Aim: The purpose of this report was to demonstrate how Haddon’s matrix was used to examine the factors that contributed to injuries and illnesses that occurred at 26 OMFs using data from the Ranse and Hutton’s minimum data set.

Methods: To help understand the kinds of injuries and illnesses experienced, Hutton et al identified previous patterns of patient presentations at 26 OMFs in Australia. To develop effective prevention strategies, the next logical step was to examine the risk factors associated with each illness/injury event. The Haddon matrix allows event practitioners to formulate anticipatory planning for celebratory-type events.

Results: What was evident from this work was that the host, the agent, and the physical and social environments contributed to the development of injuries and illness at an event. The physical environment could be controlled, to a certain extent, through event design, safety guidelines, and legislation. However, balancing cultural norms, such as the importance placed on celebratory events, with the social environment is more difficult.

Discussion: The use of the Haddon matrix demonstrates that interventions need to be targeted at all stages of the event, particularly both pre-event and during the event. The opportunity to promote health is lost by the time of post event. The matrix provided vital information on what factors may contribute to injury at OMFs; form this information, event planners can strategize possible interventions.


COMMENTS:

The publication of this work has generated international interest in applying the Haddon's matrix to other mass gathering events, such as the Hajj.

Hutton A, Savage C, Ranse J, Finnell D, Kub J. (2015). The use of Haddon’s matrix to plan for injury and illness prevention at Outdoor Music Festivals. Prehospital Disaster Medicine.

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Patient presentations and health service impact: A case study from a mass gathering.

This is a preliminary report relating to research undertaken with an aim to enhance the understanding of the health service requirements at an outdoor music festival by describing the health service usage in one Australian jurisdiction. In particular, this research aims to describe the patient characteristics for the following patient populations:

1. Those patients who presented for onsite care at the event, provided by St John Ambulance Australia (ACT), 
2. Those patients whose care was escalated to onsite doctors, nurses and paramedics volunteering at the event with St John Ambulance Australia (ACT), 
3. Those patients whose care was escalated to the care of ACT Ambulance Service, and 
4. Those patients who had care provided at either the Canberra Hospital or Calvary Hospital in the ACT.

Ranse, J., Lenson, S., Keene, T., Luther, M., Burke, B., Hutton, A., & Jones, N. 2015.Patient presentations and health service impact: A case study from a mass gathering.[Report]

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