Kendall J Bein

Randomised control trial of humidified high flow nasal cannulae versus standard oxygen in the emergency department

The aim of the study was to determine if oxygen delivered through humidified high flow nasal cannulae (HHFNC) reduced the need for escalation in ventilation management and work of breathing in the ED patients presenting with acute undifferentiated shortness of breath compared with standard oxygen therapy.

Whole-body computed tomography in the initial assessment of trauma patients: is there optimal criteria for patient selection?

To describe the use of whole‐body computed tomography (WBCT) at this Major Trauma Centre; to determine independent predictors of multi‐region injury; and to evaluate the accuracy of the decision to perform WBCT in detecting multi‐region injury.

Understanding drivers of Demand for Emergency Service Trends in Years 2010-2014 in New South Wales: An initial overview of the DESTINY project.

This study aims to describe the general characteristics and data definitions used in a population‐based data set of ED presentations in New South Wales (NSW), used to form the basis of future‐trend analyses.

Senior work‐up assessment and treatment team in an emergency department: A randomised control trial

To evaluate the impact of a senior early assessment model of care on performance measures in a single ED.

Effect of the elderly and increasing injury severity on acute hospital resource utilization in a cohort of inner city trauma patients

This study aimed to determine the relative effect of elderly patients and increasing injury severity on acute hospital costs and inpatient length of stay.

Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area

Objective To contrast long-term population-based trends in general practice (GP) presentations and acute inpatient admissions from the emergency department (ED) in the elderly population within the Greater Sydney Area. Methods This was a retrospective analysis of population-based ED presentation data over 11 years, between January 2001 and December 2011, conducted within the Greater Sydney Area in Australia. De-identified data were obtained from the New South Wales Emergency Department Data Collection database on all patients presenting to 30 public hospital EDs located within the Greater Sydney Area. The outcomes of interest were GP presentations to ED (triage category 4 or 5, self-referred and discharged from ED) and of acute inpatient admissions from ED per 1000 population. Results Over 11 million presentations were identified. Around 40% of presentations were classified as a GP presentation and 23% were classified as acute inpatient admissions. There was a 2.9% per annum increase in acute inpatient admissions per 1000 population in those ≥80 years of age and no appreciable change in other age groups. Rates of GP presentations were higher in those <65 years of age. GP presentations increased 1.9% per annum in those aged <65 years of age. Conclusions The increase in ED demand appears to be driven by the elderly presenting with acute problems requiring inpatient admission. There has been a modest increase in the rate of GP presentations to ED.

Demand for emergency department services in the elderly: an 11 year analysis of the Greater Sydney Area.

To describe trends in population‐based rates of ED presentations in the Greater Sydney Area (GSA) and compare these between the elderly and non‐elderly age groups.

Emergency department clinical redesign, team-based care and improvements in hospital performance: A time series analysis.

The objective was to evaluate the impact of an ED clinical redesign project that involved team‐based care and early senior assessment on hospital performance.

A trauma quality improvement programme associated with improved patient outcomes: 21 years of experience at an Australian Major Trauma Centre

INTRODUCTION Quality improvement programmes are an important part of care delivery in trauma centres. The objective was to describe the effect of a comprehensive quality improvement programme on long term patient outcome trends at a low volume major trauma centre in Australia. METHODS All patients aged 15 years and over with major trauma (Injury Severity Score>15) admitted to a single inner city major trauma centre between 1992 and 2012 were studied. The outcomes of interest were in-hospital mortality and transfer to rehabilitation. Time series analysis using integer valued autoregressive Poisson models was used to determine the reduction in adjusted monthly count data associated with the intervention period (2007-2012). Risk adjusted odds ratios for mortality over three yearly intervals was also obtained using multivariable logistic regression. Crude and risk adjusted mortality was compared before and after the implementation period. RESULTS 3856 patients were analysed. Crude in-hospital mortality fell from 16% to 10% after implementation (p<0.001). The intervention period was associated with a 25% decrease in monthly mortality counts. Risk adjusted mortality remained stable from 1992 to 2006 and did not fall until the intervention period. Crude and risk adjusted transfer to in-patient rehabilitation after major trauma also declined during the intervention period. CONCLUSION In this low volume major trauma centre, the implementation of a comprehensive quality improvement programme was associated with a reduction in crude and risk adjusted mortality and risk adjusted discharge to rehabilitation in severely injured patients.

The impact of alcohol intoxication in patients admitted due to assault at an Australian major trauma centre: a trauma registry study from 1999 to 2009

Objective To examine the long term trend in assault admissions at an inner city major trauma centre and determine the association between clinical evidence of alcohol intoxication and major trauma due to assault. Methods Adult trauma patients admitted due to assault between 1999 and 2009 were identified through the hospital based trauma registry at an inner city major trauma centre in Sydney. Demographic data, incident details, clinical evidence of alcohol intoxication, injury severity scores and injury related outcomes were collected. Population based incidences were calculated and outcomes compared between intoxicated and non-intoxicated patients. Major trauma was defined as a composite outcome of severe injury (injury severity score>15), intensive care admission or in-hospital mortality. Results There were 2380 patients analysed. Clinical evidence of alcohol intoxication was documented in 12% (287/2380) of cases. There was a marked peak in incidence of hospital admissions due to assault which occurred between 2000 and 2002. Overall, the rate of hospital admissions due to assault decreased during the study period (incident rate ratios 0.94, 95% CI 0.90 to 0.99, p<0.001). The odds of major trauma were three times higher in patients with clinical evidence of intoxication compared to those that did not (adjusted OR 2.9, 95% CI 2.1 to 4.0, p<0.001). Conclusions There was a peak in hospital admissions due to inner city assault around 2000–2002 associated with an overall decline in hospital admissions at this trauma centre over 10 years. Clinical evidence of alcohol intoxication in patients admitted for assault appears to be associated with more severe injury, including severe head injury.