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New South Wales News
October 2011
Dear ASEM Member (NSW),
This year is passing much too quickly!
The big news in Health is the change from the Department of health to the Ministry of Health. I must admit
that when I heard the announcement my thoughts flew to the Monty Python Ministry of Silly Walks. A colleague asked if the Ministry of Health would work in the same way as Harry Potter's Ministry of Magic. However, I have it on good authority that more will change than the Letter Heads. Perhaps this re-organisation is a step in the right direction.
As you might remember, the Minister for Health commissioned an independent review of Cerner FirstNet in June 2011. The results of the review were sent to the Minister in July 2011. There is no further progress to report. I hope that the report does not get lost in the current responsibility shuffle.
The old NSW Health Department supported the recent conference , "Improving The Health Care Experience". During the Master Class conducted by Dr. Dan Smith from the StuderGroup, an efficient electronic medical record system was mentioned. I nearly bit my tongue. I had used that system successfully for about nine years
before I was compelled to replace it with FirstNet.
The Spring Seminar in Launceston was a great success. The workshops were well attended. I was able to
participate in Advanced Suturing Techniques, Ultrasound Guided Regional Blocks, Management of Hands and Hypothetical-Critical Geriatrics.The presentations all held audience interest and in some cases raised
heated controversy.This was particularly evident in discussions regarding end of life and "not for resuscitation" decisions.
The next Spring Seminar on Emergency Medicine will be held in Queensland. ASEM offers vouchers for $100 off
the cost of registration to financial members. Could you interest a mate in joining ASEM? The voucher is a "good deal" . ASEM is a worthwhile group.
"Take Home Tips from SSEM" 2011
I think a useful take home tip from my talk is: There are significant gaps in the care being provided to patients in hospitals. Using a simple checklist of processes to be followed in the treatment of specific clinical conditions, reduces the reliance by clinical staff on memory when treating patients; and when followed, can substantially improve the quality of patient care.
Professor Alan Wolff
My take home tip would be: "Don't be prescriptive! Engage clinicians in identifying the communication problems and developing solutions to those problems."
To view Sarah Whites presentation at the 2011 SSEM gathering please click here
Thank you for your contribution Sarah!
Sarah White
My take home tip :- Every DEM / Casualty Dept. should have an iCare tonometer, intraocular pressures should then be done on every patient with who presents with an eye complaint. These tonometers are accurate, very easy to use with minimal training, no drops are required and can be used on kids and adults.
Mike Haybittel
My take-home tip is: "When someone is dying, one organ system has to fail first. It's not necessarily kind to the patient to treat just that system and prolong the dying process."
Sue Ieraci
Take home tips from "Journal Club... What is New and Important?"
Tranexamic Acid in Trauma- The CRASH 2 Trial:
Large well done RCT showed a 1.5% absolute mortality reduction when given to sick bleeding trauma patients within 8 hours. The biggest issue with the
study was external validity. Most patients enrolled were from developing countries and 1/3 had penetrating trauma. Nevertheless, our audience took a less cynical view of this study. Tranexamic acid is cheap,
probably won't hurt and likely will have some minor benefit. Certainly our practice has changed in EM based on less rigorous data (i.e. thrombolysis of stroke). Subgroup analysis showed it is most beneficial if given within 3 hours. The jury is still out in modern health care environments but another study of similar quality is thought to be unlikely.
Dabigatran vs. Warfarin in Patients with Atrial Fibrillation.
This study was the phase III trail by Boehringer Ingelheim that got TGA approval for this drug. Dabigatran was marginally better than warfarin (by 0.16%) at preventing stroke with similar bleeding risk. It is not yet PBS listed and will cost about $3000/year. There is currently no reversal agent for dabigatran and experience with bleeding issues should become apparent in the next few years. There are a number of other anticoagulants being developed. The anticoagulants are going to explode on the market (when PBS listed) as they will be heavily promoted by the pharmaceutical industry... Will there come a day when we say, "Remember when we used to give patients warfarin?"
New High Sensitive Troponin Assays (Keller NEJM 27 August 2009).
The general consensus from the audience was that the new troponin assays have created a lot of headaches. We have lost a lot of specificity at the expense of gaining sensitivity. Some participants wished we could go back to the old assay.
Brian Doyle
If you have any issues to raise via ASEM, please contact me at
gayle_mcinerney@wsahs.nsw.gov.au
Regards
Gayle McInerney
June 2011
Dear ASEM Member (NSW),
Winter 2011 is upon the Emergency Departments. At least we do not have "Swine Flu" to worry about
at this season.
Regarding FirstNet
The following is an extract from a Briefing Note entitled "Independent Review of Cerner FirstNet ED System". This was circulated in June 2011 by the Health System Quality, Performance & Inovation Division eHealth &
ICT Strategy Branch, NSW Health.
"The Minister for Health and the NSW Department of Health have commissioned an independent review of the Cerner FirstNet system and the effectiveness of its implementation.
The purpose of this review is to assess the criticisms raised and advise the Minister and Director-General on the continued use of the Cerner FirstNet system as a core component of the electronic medical
record."
The Review will report back to the Review Steering Committee and will be completed in July 2011.
Regarding the Emergency Medicine Certificate Course
The Australasian College for Emergency Medicine plans to roll out the Emergency Medicine Certificate (EMC) course in late July 2011. Hospitals that have EMC supervisors are listed on the ACEM website,
www.acem.org.au EMC candidates should approach a supervisor who can sign the application form for the candidate to enter into the course.
Regarding the BloodClinical and Scientific Advisory Committee Meeting, June 2011
An excellent presentation was given by Mr Alex Hofman regarding the need to manage preoperative anaemia in order to avoid the need for blood transfusion.
The Clinical Excellence Commission Blood Watch Program has a wesite at www.cec.health.nsw.gov.au On this site there is a link to the BloodSafe e-learning program. This is a program designed to provide an opportunity to develop knowledge of blood, safe transfusion practice and the appropriate use of blood components.
Mention was made of the article in the MJA (Volume 194 Number 9 2 May (2011) regarding the use of a synthetic haemoglobin -based oxygen carrier (HBOC) in the treatment of a severely injured Jehovah's Witness patient. This product does not have Therapeutic Goods Administration (TGA) approval in Australia.
The Spring Seminar on Emergency Medicine (SSEM) will be held in Launceston, Tasmania (Sept 27th to Sept 30th, 2011). ASEM offers vouchers for $100 off the cost of registration to ASEM members who are
financial after July 2011.The vouchers must be presented to SSEM at the time of registration.
If you have any issues to raise via ASEM, please contact me at
gayle_mcinerney@wsahs.nsw.gov.au
Regards
Gayle McInerney
May 2011
Dear ASEM Member (NSW),
Winter is approaching.
Below is an extract from a letter dated sent by Dr Tim Smyth, Deputy Director-General Health Systems Quality
Performance and Innovation.
"Although there is not usually a significant rise in numbers of patients requiring hospital services during winter, NSW hospitals traditionally see an increased Length of Stay (LOS) for selected groups of patients, particularly those with chronic illness such as cardiac and respiratory conditions. For this reason, managing planned and unplanned seasonal variations, such as during winter, is an important part of predictive planning.
As with previous years, NSW Department of Health requires Health Services to document clear strategies to manage demand across the winter period. There is also a requirement to consider the potential impact that
seasonal influenza may have on Emergency Departments and ICU bed usage, which leads to increased
capacity pressures on the health system."
I am very interested in the report that states that there is " not usually a significant rise in the number of patients requiring hospital services during winter." This does not seem to reflect actual Emergency
Department experience.There has certainly been an impact of "seasonal influenza" in past years.
FirstNet is still a concern. The NSW Health Department has recently launched the "Second wave" of the Personally Controlled Electronic Health Record. This is a major project to electronically link medical
information from all hospital departments, General Practice and Community Health Services. The concept is admirable. However, the system depends on receiving data from FirstNet. As has been previously
discussed, this data is not universally reliable even when an attempt is made to utilize FirstNet as an electronic record. Below is further comment on FirstNet by Professor Jon Patrick
"Since my last report on FirstNet I have received new information from doctors around the state on the use of FirstNet. This has caused me to review my initial recommendations for the worse."
The available document can be found at item 3.12 at the address:
www.sydney.edu.au
Professor Jon Patrick
jon.patrick@sydney.edu.au
Health Information Technologies Research Laboratory"
The Spring Seminar on Emergency Medicine will be held in Launceston, Tasmania
(Sept 27th to Sept 30th 2011). ASEM offers a voucher for $100 off the cost of registration to ASEM members who are financial after July 2011.The voucher must be presented to SSEM at the time of registration.
For further information please see:
Conferences September
If you have any issues to raise via ASEM, please contact me at
gayle_mcinerney@wsahs.nsw.gov.au
Regards
Gayle McInerney
2011
Dear ASEM (NSW) Member,
I am safely back from leave. My husband and I had planned a leisurely cruise down the Nile. We arrived in Cairo just in time to be caught up in the riots. Needless to say, we did not get to cruise down the Nile. However, the burning buildings,the tanks, the armoured cars and the rioters made interesting viewing.
Good news! The Certificate in Emergency Medicine pilot course conducted by the Australasian College
for Emergency Medicine will be completed in April ,2011. The College is busy training Fellows to act as supervising doctors for those who want to do the Certificate.
As you might remember, ASEM members have expressed concerns regarding the use of Cerner FirstNet as
the electronic medical record system currently being rolled out in Emergency Departments in NSW. These concerns have been passed on to Professor Jon Patrick, Health Information Technologies Research Laboratory, Sydney University.
To see Professor Jon Patrick report click here
The Spring Seminar on Emergency Medicine will be held in Launceston, Tasmania (Sept 27th to Sept 30th 2011). ASEM offers a voucher for $100 off the cost of registration to ASEM members who are financial after July
2011. The voucher must be presented to SSEM at the time of registration.
If you have any issues to raise via ASEM, please contact me at
gmcinerney@asem.org.au
Regards
Gayle McInerney
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