Best Paper Prizes 2012

SSEM 2012 held in Port Douglas, Queensland

ED Staff Orientation: Comparing Traditional and Modern Methods


Author - Dr Ian Turner
Contributors - Drs James Taylor, Paul Beigler, and Gerard O’Reilly

Background: Staff orientation to the emergency department (ED) is important for efficiency and safety.
Traditionally, staff orientation in EDs is provided by a senior clinician talking time “off the
floor” to tour staff around the workspace. The study ED employs locum and rotating staff
with orientations occurring most weeks.

Aims: To evaluate a handheld interactive video-based orientation (VBO) by measurement
against a traditional in-person orientation (IPO).

Methods: A prospective randomised trial of two orientation methods for doctors commencing work in
an urban ED. Participants were randomised to the IPO group (orientated by senior clinician) or the VBO group (handheld device). Orientation took place prior to the first clinical shift. Each participant then completed a questionnaire. Outcome measures were knowledge retention and satisfaction with the orientation. Investigators were blinded to participant allocation.

Results: 60 participants were enrolled, with 30 randomised to each group. Respondents were residents, registrars, consultant, and locum staff. The mean knowledge retention scores were 16.4/21 and 17.8/21 for the IPO and VBO groups respectively, with a difference of 1.4 (95% CI -0.3 to -1.5; p = 0.029). This difference was less than what was expected to be found based on the original sample size calculation used to detect a difference of one standard deviation (1.7) between each group. Satisfaction scores were comparable but did not reach significance.

Conclusions: VBO is as effective as IPO in the orientation of new ED staff.

Annual Scientific Meeting Hobart 2012

Evaluation of a rapid adenoviral detection test for confirmation of adenoviral conjunctivitis

Anita Ng1,3, Pat Usher,1 Lucy Busija,1,4,5,6 Carmel Crock1 and Atul B. Shah1,2
1. Royal Victorian Eye and Ear Hospital (RVEEH), Melbourne
2. West of England Eye Unit, RD&E Hospital, Exeter, UK
3. Melbourne Health
4. Centre for Eye Research Australia (CERA), Melbourne
5. Centre for Research Excellence in Translational Neuroscience at Melbourne Brain Centre, the University of Melbourne
6. Melbourne Centre for Clinical Epidemiology, Biostatistics and Health Services Research, the University of Melbourne

Key words: adenoviral conjunctivitis, point-of-care test, Rapid Pathogen Screening Adeno Detector, RPS

Objective: Feasibility study for incorporation of the Rapid Pathogen Screening (RPS) Adeno Detector™ test, an immunochromatographic test that detects adenoviral antigens directly from eye fluids, (RPS, Inc., South Williamsport, PA, USA) into regular clinical practice for confirmation of adenoviral conjunctivitis and evaluation of the sensitivity and specificity of the test using adenoviral polymerase chain reaction (PCR) as the gold standard.

A total of 116 patients with presumptive diagnoses of viral conjunctivitis were recruited from the Royal Victorian Eye and Ear Hospital (RVEEH) Emergency Department. Participants were first swabbed for the RPS Adeno Detector™ test (as per manufacturer instructions) then again for the viral PCR test. The RPS Adeno Detector™ test result was read and recorded on the provided proforma by the recruiter. The viral PCR test result was followed up by the investigator and recorded on the same proforma.

Results from the study show that the RPS Adeno Detector™ test is 54.2% sensitive (95% CI 41.1% - 69.6%) and 83.8% (95% CI 68.7% - 88.9%) specific. The test has a positive predictive value of 68.6% and a negative predictive value of 72.6%. These results are substantially lower than previously reported values of a sensitivity of 89% and specificity of 94% for the RPS Adeno Detector™ test1.

The results suggest that the RPS Adeno Detector™ test has moderately high specificity but low sensitivity for use as a sole test to confirm adenoviral conjunctivitis in the emergency department or physician’s office.

1Sambursky, R., Tauber, S., Schirra, F., Davidson, R., and Cohen, E. The RPS adeno detector for diagnosing adenoviral conjunctivitis. American Academy of Ophthalmology 2006, 113(10): 1758–1764.

ICEN Conference, Hobart 2012

Recognition of severe infection as a marker of ED performance and quality of care: the prevalence of infective conditions and a four month prospective study of patients receiving antibiotics in one ED

Margaret Fry1, Leanne Horvat2, Michael Roche3, Jacqueline Fong4, Joanne Plowes5

1 Higher Research Degree Program Coordinator, Associate Professor of Nursing, Faculty of Nursing, Midwifery and Health University of Technology, Sydney
Email: $Q$

2 Clinical Nurse Consultant, Emergency Department St George Hospital SESLHD, Email: $Q$, Clinical Lecturer, Sydney University

3 Senior Lecturer, Faculty of Nursing, Midwifery and Health University of Technology, Sydney
Email: $Q$

4 Nurse Practitioner, Emergency Department St George Hospital, SESLHD, Email: $Q$

5 CNS 2, Emergency Department St George Hospital, SESLHD, Email: $Q$

Globally, severe infection cost the healthcare systems billions of dollars (Eber et al., 2010; Sepsis Alliance, 2011b). The early recognition and treatment of patients with severe infection can prevent deterioration and development of sepsis and or septic shock. Triage Nurses are responsible for the initial assessment and allocation of an urgency triage code for all patients presenting to Australasian Emergency Departments (ED). Triage nurses are well positioned to ensure the early recognition of severe infection and or sepsis and thereby improve timely management and patient survival.
A delay in antibiotic administration, in the ED, can also result in patient deterioration and the development of sepsis and/or septic shock. Sepsis mortality rate has been shown to be increased through poor recognition and antibiotic delay (Dellinger et al., 2008; Gao et al., 2005; Guimont et al., 2009; Kumar et al., 2006; Reade et al., 2010; Shapiro et al., 2005). Given the variety of infective presentations, clinical urgency and signs and symptoms, early recognition of severe infection and/or sepsis can often be difficult for ED clinicians. Yet ED clinicians are responsible for the early recognition and prompt treatment of patients with infection both minor and severe.
Therefore the aim of our research was to explore the i) prevalence and triage characteristics of patients presenting to one ED with infection; ii) triage characteristics and time to antibiotic for patients receiving antibiotics, ii) patients physiological characteristics and time to antibiotic, clinical interventions and disposition; and iii) the impact of the introduction of sepsis guidelines.

ICEN Conference, Hobart 2012

Retrieval Nursing Models in Queensland
Leanne Smith1, Jennifer Craig2, 3

1 Retrieval Services Queensland; Queensland Emergency Operations Centre, Kedron 4031
2 Royal Flying Doctor Service Queensland; 12 Casuarina St Brisbane Airport, 4008

This presentation will aim to demonstrate that innovative approaches to nursing scope of practice can be achieved across government and non-government providers.

Hospital based aeromedical retrieval nursing and medical teams ceased across Queensland in 2005 due to a change in Government policy. Retrieval coordination and tasking of aeromedical platforms became centralised to Brisbane and Townsville and retrieval of critical patients is performed by contracted providers Careflight Medical Services (CMS), and Royal Flying Doctors Service Queensland (RFDSQld), and Queensland Ambulance Service paramedics. Retrieval nursing is performed by RFDS flight nurses or nurses from Neonate or Paediatric retrieval teams only, there has not been an alternative option for nurses to pursue flight nursing as a speciality, other than to work for RFDS.

There has been a steady growth in the numbers of neonate, paediatric, high risk obstetric and adult patients retrieved across Queensland and Northern New South Wales with current year figures being 20,000 patients transferred aeromedically. RSQ clinical nurses provide the triage function for all health facility calls via the coordination centre.

In 2010 Retrieval Services Queensland (RSQ) and Royal Flying Doctors Service (RFDS) Queensland joined forces to develop a collaborative retrieval flight nurse model which increases the scope of practice of both the RSQ nurse coordinator and the RFDS flight nurse.

This pioneering model now sees six Queensland Health nursing staff recruited to the new flight nurse role and following a comprehensive orientation program now fly independently, contributing to the 10,000 critical and lower acuity retrievals and transfers RFDS perform each year. RFDS flight nurses now work in QCC coordinating retrieval and transfers Future flight nurse models will include nurse practitioners.

Funding / Acknowledgments

Key Words
Retrieval, nursing, scope of practice

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