Australasian Emergency Medicine Conference for Monday

*Media release Embargoed Before 12.01 Am Monday November 22*
*Emergency medicine conference, Canberra Convention Centre, 22-25 November 2010*

*Highlights for MONDAY November 22*

9.00-10.30 session

Australia's Governor-General Quentin Bryce will open this year's annual scientific meeting of the Australasian College for Emergency Medicine at the Canberra Convention Centre.

The opening will be followed by keynote addresses by Professor Art Kellerman (Emory University School of Medicine in Atlanta) and Professor Jonathan Benger (University of West of England) on health system reform and emergency medicine, which has been the focus of governments around the world.

Ms Kerry Flanagan, Deputy Secretary (Acting) in the Australian Government Department of Health and Ageing, will provide the first overview from the perspective of health reform in Australia. In April 2010, the Council of Australian Governments signed the National Health and Hospitals Network Agreement. This will lead to some of the most far-reaching reforms to the health system in Australia. Changes include the major role that the Australian Government will take in healthcare funding through a direct 60% stake in care provided to public patients in public hospitals, a 100% stake in the funding of primary care. There will also be changes to the structure of the governance of healthcare, with the creation of Local Hospital Networks for public hospitals and Medicare Locals for primary care, as well as changes to encourage better engagement by clinicians in the way the system is run. There are strategies aimed at improving the performance of the healthcare system, such as new targets for the provision of elective surgery and the 4-hour national access target for care in Emergency Departments.

Professor Arthur Kellerman, Senior Principal Researcher and Paul O'Neill-Alcoa Chair in Policy Analysis at RAND Corporation will provide an overview of healthcare reform in the United States. The US has introduced sweeping reforms in the provision and financing of health insurance for its population, and Professor Kellerman will discuss this and other reforms affecting the delivery of emergency medicine in that country.

Finally, Professor Jonathan Benger, from the University of the West of England will give an overview of healthcare system reform in United Kingdom. The recently elected coalition government in the UK faces a number of challenges, including recent reforms to the National Health Service and the 'Four Hour Rule' that has been in UK emergency departments for a number of years.

1.30-3.00 session

*Access block and overcrowding: first-ever NZ data*

Access block continues to be a problem in tertiary hospitals in New Zealand, and contributes significantly to the ability of these hospitals to meet the “Shorter Stays in ED” target.

Access block – a wait for an inpatient bed longer than 8 hours – is associated with adverse outcomes for patients, including death.

Dr Peter Jones, director of emergency research at Auckland City Hospital, will present the first-ever New Zealand data from 2010 point prevalence surveys.

“Data collected in May and August of all 27 hospitals in New Zealand was the same as in previous surveys conducted in Australia.

“The study found that access block was seen more in tertiary than secondary hospitals (64% compared with 23%), and that no hospitals with access block were able to meet the Shorter Stays in ED target of 95% discharged or admitted within six hours.”

*Access block and overcrowding: latest Australian data*

Even though politicians and health departments have been shown the facts and even though patients are still dying while waiting for beds, there has been no significant improvement in access block.

Patients waiting for an inpatient bed continue to make up a significant proportion of ED workload.

Associate Professor Drew Richardson, chair of road trauma and emergency at Australian National University Medical School, will present data from two point prevalence surveys conducted this year, the latest in September.

Of 77 Australian accredited EDs surveyed on May 31 this year, 73% were experiencing access block, that is, patients had already been in the ED waiting for an inpatient bed for more than 8 hours.

The situation was best in paediatric hospitals and worst in urban district hospitals.

In tertiary hospitals, Queensland had most overcrowding and least access block, with 4.0 access block patients out of 57.3 under treatment and 16 waiting to be seen.

Western Australia performed worst, with 13.3 access block patients out of 39.0 but with only 6.7 waiting.

Nationwide, 62 patients had been in the ED more than 24 hours, the longest over 60 hours since an inpatient bed had been requested.

During his address, Professor Richardson will release for the first time data collected from the September survey.

*Ambulance use in Queensland changing, including between men and women *

Gender and age characteristics of ambulance users in Queensland are changing, most noticeably in the youngest and oldest groups.

This is the finding of a study based on ulilisation data from the Queensland Ambulance Service 2002-2009.

Dr Sam Toloo, research fellow in the School of Public Health at Queensland University of Technology, will tell the conference that physical and mental health, attitudinal, lifestyle, parenting, financial, and sociocultural reasons may account for these trends.

During the study period, the number of ambulance patients per 1,000 population increased by 17% in females and 18% in males.

The utilisation rate was highest among the elderly, but grew differently across age groups.

For example, in 15-29-year-old users there was a 73% increase in females and 59% in males, while in those aged 70 or over there was a 6% reduction in females and 2% reduction in males.

3.30-5.00 session

*Hi-tech patient tracking: using barcodes to track patients in a simulated mass casualty incident*

Barcodes may have a new use for keeping track of patients in a mass casualty incident. This is the finding of a study conducted in Darwin of a simulated mass casualty incident.

During a mass casualty incident, patient information is currently recorded by first responders and then relayed through radio and verbal reports to the incident commander and emergency response centres.

Dr Ian Norton, director of Disaster Preparedness and Response at the National Critical Care and Trauma Research Centre at Royal Darwin Hospital, and his colleagues used barcode scanners attached to PDAs to electronically track patients at a simulated mass casualty incident.

First responders were shadowed as they triaged 71 patients, the triage tags being electronically scanned and the data collected transmitted to a protected website, available to both the Incident Command Centre and a remote Emergency Response Centre.

The accuracy of the information collected by the PDAs was then compared to that reported by first responders.

Information on patient numbers was available electronically 86 seconds after the arrival of first responders on the scene, compared to 17 minutes by conventional methods.

A total of 54 patients and 17 dead were scanned, whilst a total of 52 patients were reported to the incident command centre, with no information available on numbers dead.

The average scan time was 6 seconds. The error rate in scanning was 0.84%.

The results indicate that the electronic tagging of patients improves upon the accuracy and availability of information to the emergency services as compared to conventional methods, Dr Norton said.

The electronic system was less prone to human error and provided identical information to the command site and at remote locations. Also, the PDA software proved to be intuitive and simple to use.

Dr Norton will also address the potential implementation of the system nationally.

ENDS

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