Ged Williams

Review article: Emergency department models of care in the context of care quality and cost: A systematic review

To identify current ED models of care and their impact on care quality, care effectiveness, and cost. A systematic search of key health databases (Medline, CINAHL, Cochrane, EMbase) was conducted to identify literature on ED models of care. Additionally, a focused review of the contents of 11 international and national emergency medicine, nursing and health economic journals (published between 2010 and 2013) was undertaken with snowball identification of references of the most recent and relevant papers. Articles published between 1998 and 2013 in the English language were included for initial review by three of the authors. Studies in underdeveloped countries and not addressing the objectives of the present study were excluded. Relevant details were extracted from the retrieved literature, and analysed for relevance and impact. The literature was synthesised around the studys main themes. Models described within the literature mainly focused on addressing issues at the input, throughput or output stages of ED care delivery. Models often varied to account for site specific characteristics (e.g. onsite inpatient units) or to suit staffing profiles (e.g. extended scope physiotherapist), ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Only a few studies conducted cost‐effectiveness analysis of service models. Although various models of delivering emergency healthcare exist, further research is required in order to make accurate and reliable assessments of their safety, clinical effectiveness and cost‐effectiveness.

Systematic Review of Gender- dependent outcomes in sepsis

BACKGROUND Men and women appear to exhibit different susceptibilities to sepsis and possibly divergent outcomes. However, the effect of sex and gender in critical illness outcomes is still controversial and the underlying mechanisms appear to be complex. OBJECTIVES We aimed to systematically review and synthesize evidence on the influence of sex on outcomes in critically ill adult patients with sepsis, as reported in published studies specifically including investigation of the effect of sex among their aims. Primary outcome measures include in-hospital mortality, intensive care unit (ICU) mortality and length of stay (LOS) in the ICU. SEARCH STRATEGY The review was based on focused literature searches (CINAHL, PUBMED, EMBASE and COCHRANE). Methodological quality was assessed through the STROBE checklist and the Cochrane Tool for Bias in Cohort Studies. Meta-analysis was performed using STATA. Published observational studies addressing outcomes of sepsis among their primary aims and having included gender comparisons among primary outcomes in critically ill adult patients were included. RESULTS A total of eight eligible studies were included. With the exception of mortality, it was not possible to perform meta-analysis for other outcomes. Included studies reported data on 25,619 patients with sepsis (14 309 male/11 310 female). There is a paucity of well-designed studies addressing the effect of sex on mortality among patients with sepsis, and absence of studies addressing the effects of sex on multiple organ dysfunction of non-infectious origin. There was significant heterogeneity among study estimates (p = 0·001; I2 =78·1%). CONCLUSIONS Although results of data syntheses appear to point towards a small disadvantage for survival among women, our results suggest that data on the impact of sex on sepsis outcomes remain equivocal. Implications for future research include approaches to adjustment for confounders and prospective designs. RELEVANCE TO CLINICAL PRACTICE Clarifying sex-related differences in sepsis, if any, is crucial for informing evidence-based care.

A state wide validation and utilisation study of the Queensland emergency nursing workforce tool

AIM To describe and compare standard practice with a revised, assisted method for calculating emergency department nursing workforce requirements (using the emergency nursing workforce tool, ENWT) within 27 Queensland public hospital emergency departments (ED). BACKGROUND Despite the presence of several methodologies used for staffing calculations, there is a necessity to refine measures of emergency department complexity and workload to determine appropriate staffing in order to meet patient safety needs and health service key priority indicators. METHODS A descriptive comparative study design was employed. Of the 27 ED nurse unit managers (NUM) invited, 18 (67%) participated. RESULTS No significant difference was noted in the full time equivalent (FTE) nursing requirement when standard vs. new (ENWT) methods were compared. The ENWT was more efficient (i.e. timely) and had better predictability than existing methods for calculating FTE nursing requirement. CONCLUSION The methodology underpinning the ENWT may be useful to apply or adapt to settings other than the ED (e.g. intensive care, operating room) and disciplines within the ED other than nursing (e.g. medicine, allied health, porterage) to inform staffing requirements. IMPLICATIONS FOR NURSING MANAGEMENT Findings from this research can be used to inform ED managers and health service planners regarding a standardized approach to calculating emergency nursing workforce needs.

Funding emergency care: Australian style

The ongoing challenge for ED leaders is to remain abreast of system‐wide changes that impact on the day‐to‐day management of their departments. Changes to the funding model creates another layer of complexity and this introductory paper serves as the beginning of a discussion about the way in which EDs are funded and how this can and will impact on business decisions, models of care and resource allocation within Australian EDs. Furthermore it is evident that any funding model today will mature and change with time, and moves are afoot to refine and contextualise ED funding over the medium term. This perspective seeks to provide a basis of understanding for our current and future funding arrangements in Australian EDs.

I love a sunburnt country: critical care nursing practice in Australia.

I love a sunburnt country, A land of sweeping plains, Of ragged mountain ranges, Of drought and flooding rains. I love her far horizons, I love her jewel-sea, Her beauty and her terror The wide brown land for me! ‘My Country’ by Dorothea Mackellar (1885–1968) Dorothea Mackellar wrote her iconic patriotic poem about Australia at the age of 22 while homesick in England (Dorothea Mackellar 2009). This quintessential poem of Australia reflects the diversity of the country which could in turn reflect the diversity of critical care nursing practice itself. Mackellar also writes of Australia: All you who have not loved her, You will not understand. . . Hence more statistical information on Australia can be found in Table 1 (Central Intelligence Agency 2009). Intensive care nurses in Australia number approximately 11 000 or about 6% of the active clinical workforce. Men account for 12·4% of the intensive care nursing workforce compared with 8·1% in other areas of clinical practice. The average age of intensive care nurses is 37 years which is slightly younger compared with the average age for the discipline, this being 41·8 years (AIHW 2003). Other vital statistics about Australian intensive care units (ICUs) are found in Table 2 (Drennan et al., 2008). Critical care nursing practice can be defined in many and varied ways. The following provides an overview of critical care practice in Australia using a broad definition.

Nurse participation in legal executions: An ethics round-table discussion

A paper was published in 2003 discussing the ethics of nurses participating in executions by inserting the intravenous line for lethal injections and providing care until death. This paper was circulated on an international email list of senior nurses and academics to engender discussion. From that discussion, several people agreed to contribute to a paper expressing their own thoughts and feelings about the ethics of nurses participating in executions in countries where capital punishment is legal. While a range of opinions were presented, these opinions fell into two main themes. The first of these included reflections on the philosophical obligations of nurses as caregivers who support those in times of great need, including condemned prisoners at the end of life. The second theme encompassed the notion that no nurse ever should participate in the active taking of life, in line with the codes of ethics of various nursing organisations. This range of opinions suggests the complexity of this issue and the need for further public discussion.

The process of establishment of the Latin American Federation of Intensive Care Nurses

Ged Williams RN; Crit. Care Cert., LLM, MHA, FACN, FACHSM, FAAN, Nursing and Allied Health Consultant, Abu Dhabi Health Service Co (SEHA), United Arab Emirates, School of Nursing & Midwifery, Griffith University, Queensland, Australia; Founding President, World Federation of Critical Care Nurses. Laura Alberto RN; BN, Sp. Ed., Master Ed., Dip Com Sc., PhD Candidate, School of Nursing & Midwifery, Griffith University, Queensland, Australia; Adjunct Research Fellow, Centre for Health Practice Innovation, Menzies Health Institute, Griffith University, Queensland, Australia; Honorary Ambassador, World Federation of Critical Care Nurses. Rossana Gonzales De la Cuz BN, N Sp Neu., N Sp. Crit. Care, Master Un Ed. & Res., Head of Academic Nursing Department, Faculty of Nursing, Universidad Peruana Cayetano Heredia, Lima, Peru; Intensive Care Coordinator, Hospital Nacional Edgardo Rebagliaiti – EsSalud, Lima, Peru; Founding President, Latin American Federation of Intensive Care Nurses. María Elena Domínguez Martínez BN, MN, Critical Care Supervisor, Hospital General Dr. Manuel Gea Gonzalez, Ciudad de México, Mexico; President, Latin American Federation of Intensive Care Nurses.

El proceso de establecimiento de la Federación Latinoamericana de Enfermería en Cuidado Intensivo

Ged Williams RN; Crit. Care Cert., LLM, MHA, FACN, FACHSM, FAAN, Consultor de Enfermería y Otros Profesionales de la Salud, Servicio de Salud Abu Dabi, Emiratos Árabes Unidos; Escuela de Enfermería y Partería, Griffith University, Queensland, Australia; Presidente Fundador, Federación Mundial de Enfermería en Cuidados Críticos. Laura Alberto RN; BN, Sp. Ed., Master Ed., Dip Com Sc., PhD Candidate, Escuela de Enfermería y Partería, Griffith University, Queensland, Australia; Fellow de Investigación Adjunto, Centre for Health Practice Innovation, Menzies Health Institute, Griffith University, Queensland, Australia; Embajadora Honoraria, Federación Mundial de Enfermería en Cuidados Críticos. Rossana Gonzales De la Cuz BN, N Sp Neu., N Sp. Crit. Care, Master Un Ed. & Res., Jefe del Departamento Académico de Enfermería de la Facultad de Enfermería de la Universidad Peruana Cayetano Heredia, Lima, Perú; Coordinadora de Cuidados Intensivos Generales, Hospital Nacional Edgardo Rebagliaiti – EsSalud, Lima, Perú; Presidente Fundador, Federación Latinoamericana de Enfermería en Cuidado Intensivo. María Elena Domínguez Martínez BN, MN, Supervisora de Áreas Críticas, Hospital General Dr. Manuel Gea Gonzalez, Ciudad de México, México; Presidente, Federación Latinoamericana de Enfermería en Cuidado Intensivo.