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Article ; Online: Factors associated with choice of health service delivery for after-hours, urgent, non-life-threatening conditions: a patient survey.

Adie, John William / Graham, Wayne / Wallis, Marianne

2022 Volume 28, Issue 2, Page(s) 137–142

Abstract: The objective of this study was to determine factors associated with patient or carer choice of presentation to an emergency department, an urgent care clinic and an after-hours general practice on Sundays in south-east Queensland. The design of the ... ...

Abstract	The objective of this study was to determine factors associated with patient or carer choice of presentation to an emergency department, an urgent care clinic and an after-hours general practice on Sundays in south-east Queensland. The design of the study was a cross-sectional survey of patients or carers. The study setting was an emergency department, an urgent care clinic and an after-hours general practice. Patients or carers of patients were invited to take part in the study while they were waiting to consult the doctor. Patients were more likely to present to community clinics (i.e. urgent care clinic and an after-hours general practice) if they usually came to the facility (P < 0.001), were concerned about cost (P < 0.001), were influenced by the perceived severity of the sickness (P < 0.001), were unable to get an appointment elsewhere (P < 0.001), thought that there would be less waiting time (P < 0.001) and thought there was better doctor explanation (P = 0.007). This research was limited to 337 surveys. Larger studies could further explore insights gained from this study. The results suggest that public health campaigns could focus on promoting community clinic care for urgent non-life-threatening conditions. These campaigns should include information on waiting times, need for referral, conditions safely managed, range of services provided and quality of service. Designing community facilities for hospital avoidance of patients with non-life-threatening urgent conditions could involve public health campaigns, facility upgrades, and subsidies for transport and attendance.
MeSH term(s)	Cross-Sectional Studies ; Emergency Service, Hospital ; Health Services ; Humans ; Referral and Consultation ; Surveys and Questionnaires
Language	English
Publishing date	2022-01-31
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2566332-X
ISSN	1836-7399 ; 1448-7527
ISSN (online)	1836-7399
ISSN	1448-7527
DOI	10.1071/PY21078
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Article: Use of low-frequency contact ultrasonic debridement with and without polyhexamethylene biguanide in hard-to-heal leg ulcers: an RCT.

Vallejo, Alison / Wallis, Marianne / McMillan, David

Journal of wound care

2022 Volume 31, Issue 8, Page(s) 670–681

Abstract: Objective: The primary aim of this research was to investigate the combination effect of polyhexamethylene biguanide (PHMB) and low-frequency contact ultrasonic debridement (LFCUD) on the bacterial load in hard-to-heal wounds in adults, compared with ... ...

Abstract	Objective: The primary aim of this research was to investigate the combination effect of polyhexamethylene biguanide (PHMB) and low-frequency contact ultrasonic debridement (LFCUD) on the bacterial load in hard-to-heal wounds in adults, compared with ultrasonic debridement alone. Secondary outcomes included wound healing, quality of life (QoL) and pain scores. Method: In this single-blinded, randomised, controlled trial participants were randomised to two groups. All participants received LFCUD weekly for six weeks, plus six weeks of weekly follow-up. The intervention group received an additional 15-minute topical application of PHMB post-LFCUD, at each dressing change and in a sustained dressing product. The control group received non-antimicrobial products and the wounds were cleansed with clean water or saline. Wound swabs were taken from all wounds for microbiological analysis at weeks 1, 3, 6 and 12. Results: A total of 50 participants took part. The intervention group (n=25) had a lower bacterial load at week 12 compared with the control group (n=25) (p<0.001). There was no difference in complete wound healing between the groups (p=0.47) or wound-related QoL (p=0.15). However, more wounds deteriorated in the control group (44%) compared with the intervention group (8%, p=0.01). A higher proportion of wounds reduced in size in the intervention group (61% versus 12%, p=0.019). Pain was lower in the intervention group at week six, compared with controls (p=0.04). Conclusion: LFCUD without the addition of an antimicrobial agent such as PHMB, cannot be recommended. Further research requires longer follow-up time and would benefit from being powered sufficiently to test the effects of multiple covariates.
MeSH term(s)	Adult ; Biguanides ; Debridement ; Humans ; Leg Ulcer/therapy ; Pain/drug therapy ; Quality of Life ; Ultrasonics ; Wound Healing
Chemical Substances	Biguanides ; polihexanide (322U039GMF)
Language	English
Publishing date	2022-08-24
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1353951-6
ISSN	0969-0700
ISSN	0969-0700
DOI	10.12968/jowc.2022.31.8.670
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Article ; Online: Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model.

Wallis, Marianne / Craswell, Alison / Marsden, Elizabeth / Taylor, Andrea

BMC health services research

2022 Volume 22, Issue 1, Page(s) 692

Abstract: Background: Frail older adults require specific, targeted care and expedited shared decision making in the emergency department (ED) to prevent poor outcomes and minimise time spent in this chaotic environment. The Geriatric Emergency Department ... ...

Abstract	Background: Frail older adults require specific, targeted care and expedited shared decision making in the emergency department (ED) to prevent poor outcomes and minimise time spent in this chaotic environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to help limit these undesirable consequences. This qualitative study aimed to explore the ways in which two hospital implementation sites implemented the structures and processes of the GEDI model and to examine the ways in which the i-PARIHS (innovation-Promoting Action on Research Implementation in Health Services) framework influenced the implementation. Methods: Using the i-PARIHS approach to implementation, the GEDI model was disseminated into two hospitals using a detailed implementation toolkit, external and internal facilitators and a structured program of support. Following implementation, interviews were conducted with a range of staff involved in the implementation at both sites to explore the implementation process used. Transcribed interviews were analysed for themes and sub-themes. Results: There were 31 interviews with clinicians involved in the implementation, conducted across two hospitals, including interviews with the two external facilitators. Major themes identified included: (i) elements of the GEDI model adopted or (ii) adapted by implementation sites and (iii) factors that affected the implementation of the GEDI model. Both sites adopted the model of care and there was general support for the GEDI approach to the management of frail older people in the ED. Both sites adapted the structure of the GEDI team and the expertise of the team members to suit their needs and resources. Elements such as service focus, funding, staff development and service evaluation were initially adopted but adaptation occurred over time. Resourcing and cost shifting issues at the implementation sites and at the site providing the external facilitators negatively impacted the facilitation process. Conclusions: The i-PARIHS framework provided a pragmatic approach to the implementation of the evidenced-based GEDI model. Passionate, driven clinicians ensured that successful implementation occurred despite unanticipated changes in context at both the implementation and host facilitator sites as well as the absence of sustained facilitation support.
MeSH term(s)	Aged ; Emergency Medical Services ; Emergency Service, Hospital ; Frail Elderly ; Humans ; Qualitative Research ; Queensland
Language	English
Publishing date	2022-05-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-08081-4
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Article: Mitral Valve Replacement Under Venoarterial Extracorporeal Membrane Oxygenation Support for Severe Streptococcus Mitis Endocarditis.

Ahmed, Talha / Wallis, Marianne

Cureus

2020 Volume 12, Issue 4, Page(s) e7556

Abstract: Streptococcus mitis is an alpha-hemolytic species of Streptococcus and is the most prevalent organism of the oral flora. In patients with dental procedures or trauma and underlying damaged heart valves, it can cause infection of the valves (endocarditis). ...

Abstract	Streptococcus mitis is an alpha-hemolytic species of Streptococcus and is the most prevalent organism of the oral flora. In patients with dental procedures or trauma and underlying damaged heart valves, it can cause infection of the valves (endocarditis). It has a propensity to affect the left-sided heart valves (mitral and aortic valves) in non-intravenous drug users (IVDU), whereas right-sided heart valves (tricuspid and pulmonic valves) in IVDU. We describe a case of a patient who presented with mitral valve endocarditis that was treated with antibiotics. He was lost to follow-up and then presented four years after his index presentation in cardiogenic shock from severe streptococcal mitis endocarditis causing severe mitral regurgitation. His course deteriorated to the point where the patient required a valve replacement surgery under hemodynamic support.
Language	English
Publishing date	2020-04-06
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.7556
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Article ; Online: Educational considerations for health professionals to effectively work with clients with complex regional pain syndrome.

Johnston-Devin, Colleen / Oprescu, Florin / Wallis, Marianne / Gray, Marion

PloS one

2022 Volume 17, Issue 6, Page(s) e0269337

Abstract: Introduction: People living with complex regional pain syndrome (CRPS), a rare chronic pain disorder, must become experts in their own self-management. Listening to the voice of the patient is often advocated in the pain literature. However, the patient' ...

Abstract	Introduction: People living with complex regional pain syndrome (CRPS), a rare chronic pain disorder, must become experts in their own self-management. Listening to the voice of the patient is often advocated in the pain literature. However, the patient's option is rarely asked for or considered by clinicians, even when they live with a condition that health professionals have rarely heard of. Purpose: To explore what people living with complex regional pain syndrome (CRPS) think health professionals should know about their condition to provide appropriate care. Design: A heuristic, hermeneutic phenomenological study was conducted asking people about their experiences living with CRPS. This paper reports on the findings of an additional question asked of all participants. Participants: Seventeen people living with complex regional pain syndrome were interviewed. Findings: Overwhelmingly, participants felt that health professionals do not know enough about CRPS, or chronic pain and believe their health outcomes are affected by this lack of knowledge. Sub-themes identified were don't touch unless I say it is okay; be patient with the patient/ it is important to develop a relationship; educate yourself and educate the patient; choose your words carefully and refer to others as needed. An additional theme, it is very hard to describe CRPS was also identified. Conclusions: Including patients as a member of the healthcare team is recommended to help people take control and self-manage their pain. For true patient centered care to be achieved, health professionals must accept and respect patients' descriptions of pain and their pain experience. This may require additional health professional education at both undergraduate and post-graduate levels in pain and communication to increase their bedside manner and therapeutic communication to deliver care in partnership with the patient.
MeSH term(s)	Chronic Pain ; Communication ; Complex Regional Pain Syndromes/therapy ; Health Personnel ; Humans ; Patient-Centered Care
Language	English
Publishing date	2022-06-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0269337
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Article ; Online: An observational study of peripheral intravenous and intraosseous device insertion reported in the United States of America National Emergency Medical Services Information System in 2016.

Mason, Matt / Wallis, Marianne / Barr, Nigel / Bernard, Anne / Lord, Bill

Australasian emergency care

2022 Volume 25, Issue 4, Page(s) 361–366

Abstract: Objective: To investigate the prevalence of intravenous and interosseous device insertion in the prehospital setting by prehospital clinicians, and the characteristics of patients receiving these devices as reported to the United States of America ... ...

Abstract	Objective: To investigate the prevalence of intravenous and interosseous device insertion in the prehospital setting by prehospital clinicians, and the characteristics of patients receiving these devices as reported to the United States of America National Emergency Medical Services Information System. Methods: A retrospective analysis of the United States of America National Emergency Medical Services Information System public release dataset for the 2016 calendar year. Results: A total of 20,454,975 events involving 40,438,959 procedures were analysed. One or more peripheral intravenous catheters were inserted during 27.4 % of events, and one or more intraosseous devices in 0.4 % of events. Insertion was completed with one attempt in 71.6 % of peripheral intravenous catheter insertions and 86.9 % of intraosseous devices insertions. Insertion was successful for 74.7 % of peripheral intravenous catheter insertions and 85.4 % of intraosseous device insertions. High rates of peripheral intravenous catheter insertion were found with: being female (51.6 %), aged 40-90 years (80.2 %), having a cardiac rhythm disturbance (70.3 %), having a primary symptom of change in responsiveness (58.7 %), or when there was initiation of chest compressions (50.4 %). There were high rates of intraosseous device insertion if the patient was male (57.8 %), aged 40-90 years (77.2 %), experienced a cardiac arrest (29.2 %), had chest compressions initiated (33.6 %), or died (16.4 %). Scene time was longest for events with intraosseous devices inserted (19.7 min, IQR 13.2-28.6) but transport time shortest (9.0 min, IQR 5.0-15.0). Conclusions: The distribution of patient factors and the insertion of peripheral intravenous catheters and intraosseous devices is described at a national level for the first time. The results provide prehospital clinicians and Emergency Medical Services rigorous data to compare, and possibly improve, practice.
MeSH term(s)	Catheterization, Peripheral ; Emergency Medical Services/methods ; Female ; Humans ; Information Systems ; Infusions, Intraosseous ; Male ; Retrospective Studies ; United States
Language	English
Publishing date	2022-06-07
Publishing country	Australia
Document type	Journal Article ; Observational Study
ISSN	2588-994X
ISSN (online)	2588-994X
DOI	10.1016/j.auec.2022.05.003
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Article ; Online: Peripheral intravenous catheter and intraosseous device insertions reported from the 1

Mason, Matt / Wallis, Marianne / Barr, Nigel / Matagian, Nicholas / Lord, Bill

Australasian emergency care

2022 Volume 25, Issue 4, Page(s) 302–307

Abstract: Objective: To overcome the lack of larger, population-based studies reporting the prevalence of insertion of PIVCs and IO devices, and to describe the patient-related and service-related characteristics of these devices, inserted by paramedics, in an ... ...

Abstract	Objective: To overcome the lack of larger, population-based studies reporting the prevalence of insertion of PIVCs and IO devices, and to describe the patient-related and service-related characteristics of these devices, inserted by paramedics, in an Australian state ambulance service. Methods: A retrospective analysis of the electronic Ambulance Report Form (medical record) and Computer Aided Dispatch system from the 1st July 2016 until 30th June 2017. Results: 709,217 events were analysed. Of these, 20.4% involved at least one successful PIVC insertion and 0.07% involved at least one successful IO device insertion; most of the time on first attempt (89% and 86.4% respectively). Most PIVCs were inserted into the right antecubital fossa or dorsum of the right hand while IO devices were inserted into the proximal tibia. Of male patients, 21.4% received PIVCs while 19.5% of female patients received PIVCs. Very low numbers of both male and female patients received IOs (0.1%). Medical, non-traumatic presentations were the most common presentation and received the most insertions of both devices, followed by trauma presentations. Advanced Care Paramedics inserted 84.0% of PIVCs while Critical Care Paramedics inserted 94.4% of IO devices. Time treating and transporting patients generally increased with number of attempts at vascular access undertaken. Conclusions: Queensland paramedic practices relating to insertion of PIVCs, and IO devices appears consistent with documented practice internationally. Further study is required to determine whether the antecubital fossa and dorsum of the hand insertions are clinically necessary in this population as areas of flexion and distal extremities are generally to be avoided for PIVC insertion.
MeSH term(s)	Ambulances ; Australia ; Catheters ; Female ; Humans ; Infusions, Intraosseous ; Male ; Retrospective Studies
Language	English
Publishing date	2022-03-08
Publishing country	Australia
Document type	Journal Article ; Observational Study
ISSN	2588-994X
ISSN (online)	2588-994X
DOI	10.1016/j.auec.2022.03.001
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Article ; Online: Impact of COVID-19 state-wide lockdown on older adult presentations to Queensland emergency departments.

Eccleston, Cassanne / Marsden, Elizabeth / Craswell, Alison / Sweeny, Amy / Howell, Naomi / Wallis, Marianne / Crilly, Julia

Emergency medicine Australasia : EMA

2023 Volume 35, Issue 5, Page(s) 799–808

Abstract: Objective: To determine the impact of the COVID-19 state-wide lockdown on ED presentations for older adults in Queensland, Australia.: Methods: A retrospective cohort study pertaining to adults aged 70+ years who presented to Queensland public ... ...

Abstract	Objective: To determine the impact of the COVID-19 state-wide lockdown on ED presentations for older adults in Queensland, Australia. Methods: A retrospective cohort study pertaining to adults aged 70+ years who presented to Queensland public hospital EDs across three separate time periods; 11 March to 30 June 2018 and 2019 (pre-pandemic average), 2020 (COVID-19 state-wide lockdown) and 2021 (post-state-wide lockdown). The primary outcome was change in presentation rates to ED. Secondary outcomes included change in triage category rates, length of stay (LOS), diagnosis and disposition. Results: There was 380 854 older adult presentations. During the COVID-19 state-wide lockdown, ED presentation rates decreased by 12.5% (incidence rate ratio 0.875 [95% confidence interval 0.867-0.883]). All triage category presentation rates decreased, as did ED LOS and reasons for presentation, except sepsis and disorders of the nervous system. In the post-state-wide lockdown period a 22% (incidence rate ratio 1.22 [95% confidence interval 1.21-1.23]) increase in the presentation rate was observed and presentations in all triage categories increased. ED LOS increased to longer than pre-pandemic (P < 0.001). Respiratory presentations increased by 346%. Patients who 'did not wait' increased by 212% and ED mortality rose by 42% compared to during the lockdown. Conclusion: There was a significant decrease in presentation rates to EDs during the COVID-19 state-wide lockdown for the older population, followed by an increase in presentation rates, longer ED LOS, and an increased ED mortality rate, in the post-state-wide lockdown period. It is important to ensure older adults continue to seek appropriate, timely medical care, during a pandemic.
MeSH term(s)	Humans ; Aged ; Queensland/epidemiology ; Retrospective Studies ; COVID-19/epidemiology ; Communicable Disease Control ; Emergency Service, Hospital
Language	English
Publishing date	2023-05-09
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2161824-0
ISSN	1742-6723 ; 1742-6731 ; 1035-6851
ISSN (online)	1742-6723
ISSN	1742-6731 ; 1035-6851
DOI	10.1111/1742-6723.14236
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Article ; Online: The development of a modified comprehensive geriatric assessment for use in the emergency department using a RAND/UCLA appropriateness method.

Taylor, Andrea / Broadbent, Marc / Gurung, Apil / Wallis, Marianne

International emergency nursing

2020 Volume 55, Page(s) 100847

Abstract: Background: The universal screening and comprehensive assessment of older persons presenting to the emergency department is considered useful, yet is difficult to embed. A number of assessment instruments exist however they are not widely used and there ...

Abstract	Background: The universal screening and comprehensive assessment of older persons presenting to the emergency department is considered useful, yet is difficult to embed. A number of assessment instruments exist however they are not widely used and there is a lack of agreement between clinicians as to which tools are best suited to the emergency department. The aim of this study was to develop a modified comprehensive geriatric assessment using consensus methodology for use by the multidisciplinary team in the emergency department. Method: The modified comprehensive geriatric assessment was formulated using the RAND/UCLA appropriateness methodology incorporating consensus opinion from an expert group of clinicians and the best scientific evidence available. A series of pre and post survey and expert group meetings were held with expert multidisciplinary clinicians. Emphasis was placed on a pragmatic approach to the development of a document which reflected consensus opinion. Results: Between nine and 15 expert group members participated in the stages of the process. A tiered approach incorporating different aspects of screening and/or assessments was considered optimal to reflect the stages of decision-making in the emergency department process. Conclusion: A unique approach to the screening and assessment of the frail older person was developed using consensus methodology to develop a modified comprehensive geriatric assessment for use in the emergency department. Associated actions and interventions are an important next step, with pilot site testing.
MeSH term(s)	Aged ; Aged, 80 and over ; Consensus ; Emergency Service, Hospital ; Geriatric Assessment ; Humans ; Research Design
Language	English
Publishing date	2020-03-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2420747-0
ISSN	1878-013X ; 1755-599X
ISSN (online)	1878-013X
ISSN	1755-599X
DOI	10.1016/j.ienj.2020.100847
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Article ; Online: Misreading Injectable Medications-Causes and Solutions: An Integrative Literature Review.

Borradale, Heather / Andersen, Patrea / Wallis, Marianne / Oprescu, Florin

Joint Commission journal on quality and patient safety

2020 Volume 46, Issue 5, Page(s) 291–298

Abstract: Background: This integrative review examines research identifying the misreading of injectable medications as a cause of medication error in hospitals, factors affecting injectable medication visibility leading to medication errors, and interventions to ...

Abstract	Background: This integrative review examines research identifying the misreading of injectable medications as a cause of medication error in hospitals, factors affecting injectable medication visibility leading to medication errors, and interventions to increase the readability of injectable medications. Signal detection theory (SDT) is applied to explain why visual enhancement of injectable medications may improve accuracy of administration. Methods: Academic health databases were searched for articles published between 2000 and 2019. An integrative review methodology permitted exploration and critique of both theoretical and empirical literature. Results: Fifteen studies reported that misreading injectable medications contributed to medication errors. Five studies investigated interventions to improve visualization of injectable medications. SDT suggested three factors may contribute to misreading injectable medications: (1) environmental light levels, (2) medication labels, and (3) clinician factors. Conclusion: Although the literature on this topic was limited and not definitive, results of this review indicated possible ways to improve practice and targets for future research to reduce medication errors due to misreading injectable medication labels.
MeSH term(s)	Databases, Factual ; Humans ; Medication Errors/prevention & control
Language	English
Publishing date	2020-02-04
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1189890-2
ISSN	1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
ISSN (online)	1938-131X ; 1549-425X
ISSN	1553-7250 ; 1070-3241 ; 1549-3741
DOI	10.1016/j.jcjq.2020.01.007
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