Volume 19

Patient and Caregiver Experience of Hospital Discharge from an Acute Medicine Unit via the Discharge Lounge: A Qualitative Case Study

Original Articles, Volume 19, Issue 1, Pages 1 - 60 (2020)

Discharge lounges enable the swift movement of patients imminently awaiting hospital discharge, to free beds without delay. This Qualitative Yin-Style Case Study describes the patient and caregivers experience of transition from an Acute Medicine Unit (AMU) to a discharge lounge and staff perspectives, as organisers of this process. Audiorecorded, interviews and focus groups were undertaken. Data were analysed using Framework Analysis. Lack of patientcenteredness in moving patients to the discharge lounge emerged with three themes: ‘moving the problem’; ‘being moved’ and ‘feeling removed’. Patients were transferred at accelerated speed. Communications between staff, patients and carers were abruptly curtailed. Patient transfer from AMU to a discharge lounge is a transitional stage in the acute discharge process and must be adequately communicated.

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Can the examination time in CT and conventional x-ray be reduced in an emergency department with integrated radiology unit? A retrospective study

Original Articles, Volume 19, Issue 1, Pages 1 - 60 (2020)

Quick radiological diagnosis is often needed in order to allow the clinicians to make a diagnosis. The purpose of this study was to measure examination time for radiology procedures before and after physical integration of a radiology unit in the ED. We retrospectively acquired data from the radiology information system and compared time from referral to end of radiological examination before and after physical integration of the radiology unit in the ED for 19,897 X-ray and 6,940 CT examinations. After integration examination time for X-ray examinations was reduced by 5 to 14 minutes (p<0.001). For CT head and chest examination time was reduced by 7 to 15 minutes (p<0.003) while examination time for CT abdomen was prolonged by 4 minutes (p=0.78).

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Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission

Original Articles, Volume 19, Issue 1, Pages 1 - 60 (2020)

Background: counting respiratory rate over 60 seconds can be impractical in a busy clinical setting.

Methods: 870 respiratory rates of 272 acutely ill medical patients estimated from observations over 15 seconds and those calculated by a computer algorithm were compared.

Results: The bias of 15 seconds of observations was 1.85 breaths per minute and 0.11 breaths per minute for the algorithm derived rate, which took 16.2 SD 8.1 seconds. The algorithm assigned 88% of respiratory rates their correct National Early Warning Score points, compared with 80% for rates from 15 seconds of observation.

Conclusion: The respiratory rates of acutely ill patients are measured nearly as quickly and more reliably by a computer algorithm than by observations over 15 seconds.

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Respiratory rates observed over 15 seconds compared with rates measured using the RRate app. Practice-based evidence from an observational study of acutely ill adult medical patients during their hospital admission Read More

Clinical Reliability of point-of-care tests to support community based acute ambulatory care

Original Articles, Volume 19, Issue 1, Pages 1 - 60 (2020)

Objective: To ensure clinicians can rely on point-of-care testing results, we assessed agreement between point-of-care tests for creatinine, urea, sodium, potassium, calcium, Hb, INR, CRP and subsequent corresponding laboratory tests.

Participants: Community-dwelling adults referred to a community-based acute ambulatory care unit.

Interventions: The Abbott i-STATTM (Hb, clinical chemistry, INR) and the AfinionTM Analyser (CRP) and corresponding laboratory analyses.

Outcomes: Agreement (Bland-Altman) and bias (Passing-Bablok regression).

Results: Among 462 adults we found an absolute mean difference between point-of-care and central laboratory analyses of 6.4g/L (95%LOA -7.9 to +20.6) for haemoglobin, -0.5mmol/L (95%LOA -4.5 to +3.5) for sodium, 0.2mmol/L (95%LOA -0.6 to +0.9) for potassium, 0.0mmol/L (95%LOA -0.3 to +0.3) for calcium, 9.0 μmol/L (95%LOA -18.5 to +36.4) for creatinine, 0.0mmol/L (95%LOA -2.7 to +2.6) for urea, -0.2 (95%LOA -2.4 to +2.0) for INR, -5.0 mg/L (95%LOA -24.4 to +14.4) for CRP.

Conclusions: There was acceptable agreement and bias for these analytes, except for haemoglobin and creatinine.

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Editorial Volume 19 Issue 1 – “Eternal Winter”: Acute Medicine the key to providing longer periods of summer

Editorials, Volume 19, Issue 1, Pages 1 - 60 (2020)

As another winter season passes, many colleagues will continue to be working under immense pressures striving to provide high quality care for increasingly larger numbers of patients. The work of Acute Medicine teams to keep the “front door” safe are fundamental to the delivery and sustainability of acute care services. The challenges of innovating and enacting positive changes at times of such high service demand are not insignificant; but the specialty is blessed with rapidly expanding driven and dedicated international, national and local leaders.

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