Michael Sinnott

Malnutrition associated with increased risk of frail mechanical falls among older people presenting to an emergency department.

Objective:  To identify associations between malnutrition falls risk and hospital admission among older people presenting to ED.

Incorporating teledermatology into emergency medicine

Objective: The aim of the present study was to investigate the feasibility of using a store‐and‐forward Skin Emergency Telemedicine Service (SETS) to provide rapid specialist diagnostic and management advice for dermatological cases in an ED.

S100B protein as a screening tool for computed tomography findings after mild traumatic brain injury: Systematic review and meta-analysis.

Abstract Primary objective: To determine whether S100B protein in serum can predict intracranial lesions on computed tomography (CT) scan after mild traumatic brain injury (MTBI). Research design: Systematic review and meta-analysis Methods and procedures: A literature search was conducted using Medline, Embase, Cochrane, Google Scholar, CINAHL, SUMSearch, Bandolier, Trip databases, bibliographies from identified articles and review article references. Eligible articles were defined as observational studies including patients with MTBI who underwent post-traumatic head CT scan and assessing the screening role of S100B protein. Main outcomes and results: There was a significant positive association between S100B protein concentration and positive CT scan (22 studies, SMD = 1.92, 95% CI = 1.29–2.45, I2 = 100%; p < 0.001). The pooled sensitivity and specificity values for a cut-point range = 0.16–0.20 µg L−1 were 98.65 (95% CI = 95.53–101.77; I2 = 0.0%) and 50.69 (95% CI = 40.69–60.69; I2 = 76.3%), respectively. The threshold for serum S100B protein with 99.63 (95% CI = 96.00–103.25; I2 = 0.0%) sensitivity and 46.94 (95% CI = 39.01–54.87; I2 = 95.5%) specificity was > 0.20 µg L−1. Conclusions: After MTBI, serum S100B protein levels are significantly associated with the presence of intracranial lesions on CT scan. Measuring the protein could be useful in screening high risk MTBI patients and decreasing unnecessary CT examinations.

Scalpel injuries in the operating theatre.

International evidence based guidelines are needed to standardise approaches to reducing risk

Audit of a State-wide store and forward teledermatology service in Australia

In 2008, the Skin Emergency Telemedicine Service was established at the Princess Alexandra Hospital (PAH) in Brisbane. We conducted an audit by evaluating all email communication during 2012, and administering a clinician questionnaire. A total of 167 cases were discussed via 685 email communications (46 being in-house PAH referrals). The highest number of external referrals came from Mt Isa (27%), located 1200 km from the nearest dermatology clinic, with a further 25% sent from centres located 50-600 km from a clinic. The main referring condition was rash (65%), followed by skin lesions (13%). The most commonly provided telemedicine diagnoses were dermatitis/eczema (23%), infection (20%) and drug eruption (17%). Most external referrals received a reply within 3 hours of the enquiry. Junior doctors (2nd-4th postgraduate year) represented the majority of referring clinicians (62% of questionnaire respondents). There were 111 potential questionnaire recipients. Responses were received from 34 clinicians, a response rate of 31%. Overall 100% of respondents stated that the service was useful to them and 97% said they would use it again in the future with one respondent stating ‘possibly’. It seems likely that teledermatology will serve an important role in the provision of healthcare to Queensland, and other remote Australian communities in the future.

Can we have a culture of patient safety without one of staff safety

The patient safety movement reached its tipping point in 2000 after the publication, in the 1999 US Institute of Medicine Report, To Err is Human , of the extraordinary finding that there were up to 100 000 preventable deaths in US hospitals every year . 1 The patient safety movement used James Reason’s paradigm of accident causation, the so called “Swiss Cheese Model”, to explain why systems failures cause most adverse events among patients, and identified the “no blame” culture as a way to improve outcomes among patients.2 Removing the fear of reporting errors means that systems failures can be identified and remedied before bad patient outcomes occur. Despite the development of the no blame approach to patient safety, we have observed the opposite culture in relation to staff safety. While demonstrating two safety products to operating room nurses in the United States and Australia, one of the authors (MS) observed reactions that initially caused him concern. The first safety product was a new, sterile version of the popular single handed scalpel blade remover, which, when used with a hands free passing technique, can prevent up to 50% of all scalpel injuries.3 Scalpel injuries—the second most common cause of sharps injuries in the operating room—can cause infection with HIV, hepatitis B, C, and D, and other serious illnesses. They can also damage digital nerves, arteries, or tendons, requiring microsurgery and up to three months off work to undergo extensive rehabilitation. Psychosocial distress, inability to …

Decimal numbers and safe interpretation of clinical pathology results

Objective To determine the understanding of decimal numbers by medical laboratory scientists, doctors and nurses. Methods A Decimal Comparison Test determined the comprehension of decimals numbers. Additional questions sought the participants’ understanding of concentrations and reference ranges, and their preferences for the presentation of clinical pathology results. Results Of the 108 participants, 40% exhibited poor comprehension of decimal numbers. One-third of the medical laboratory scientists, a quarter of doctors, and half the nurses were characterised as lacking numeracy skills. The majority of participants (60%) thought it would be safer for results to be presented as whole numbers rather than as decimals with leading zeros. Conclusions The number of laboratory and clinical staff who show numeracy issues that could lead to misinterpretation of clinical pathology results and contribute to medical error strongly supports recommendations that pathology results should be presented as whole numbers.

It is not your fault: suggestions for building ethical capacity in individuals through structural reform to health care organisations : comment on "moral distress in uninsured health care" by Anita Nivens and Janet Buelow.

Moral distress is known to cause skilled nurses to exit the profession (Schluter et al. 2008), resulting in lessthan-optimal patient outcomes (Aiken et al. 2002). For the case presented by Nivens and Buelow (2013), two broad responses are required. First, management should recognise this field of nursing may cause moral distress. This has implications both for nurse and patient safety. A timely and focussed review or implementation of structures to support staff to maintain moral momentum is required. Second, all nurses need to recognise that moral distress is an occupational hazard and accept support and training in managing the ethical implications of these very difficult cases. We will now explore these recommendations in detail. Health care managers have a clear responsibility to keep their staff safe. This is both an ethical obligation and in some practice environments legally mandated. While concern should be for staff members, the logic of staff safety as requisite for patient safety has been acknowledged (Sinnott and Shaban 2011). Much work has been done to improve staff safety in the physical sense. Yet safeguarding the moral health of nurses who are repeatedly exposed to traumatic and difficult cases, where their best response will be constrained by circumstances beyond their control, is only recently gaining recognition. This is despite a well-established literature on moral distress and the related concepts of compassion fatigue in nursing, stretching across several decades (Jameton 1977). Recognition of the moral impact of particular forms of health care work leads to managerial responsibility for creating and sustaining ethical work environments that Bioethical Inquiry (2013) 10:423–424 DOI 10.1007/s11673-013-9460-9

Admission of medical patients from the emergency department: an assessment of the attitudes, perspectives and practices of internal medicine and emergency medicine trainees

We sought to obtain a deeper understanding of the differing needs and expectations of inpatient and ED medical staff regarding the admission process for medical patients.

Exploration of the perceptions of emergency physicians and interns regarding the medical documentation practices of interns.

The primary objective of the present study was to learn the factors that influence the documentation practices of ED interns. A second objective was to identify the expectations of emergency physicians (EPs) towards the medical record documentation of ED interns.