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Background: Supervision of junior doctors in ED is vital but limited literature exists on how it is provided. Objective: To assess Australasian ED supervision and review regional legislature supervision requirements. Methods: Between December 2008 and June 2009 emails containing a link to a cross‐sectional survey were sent to Directors of Emergency Medicine Training in all Australasian ED accredited for advanced training. Non‐responding ED were subsequently contacted by telephone or email. Regional legislature supervision requirements were obtained from postgraduate medical councils. Results: A total of 103 (98.1%) of 105 ED participated. Senior review in person was mandatory in 43.2% of ED for patients of PGY1 (postgraduate year 1 doctors) and 6.1% of ED for patients of PGY2 (P < 0.001). Of ED without mandatory review, 13% had written guidelines detailing which patients required review. When ED consultants were on‐site, they most commonly provided supervision in 60.2% of ED and shared supervision equally with registrars in 35.7% of ED; when consultants were off‐site registrars most commonly provided supervision in 87.6% of ED. Fewer major regional/rural base hospitals had 24 h PGY3 or above supervision than major referral and urban district hospitals (82.6% vs 100% and 100%, P < 0.01). Regional legislature requirements varied with no universal guidelines. Conclusion: There are significant differences between supervision requirements for PGY1 and PGY2. A minority of ED in Australasia do not have 24 h supervision by PGY3 or higher. Few ED have written guidelines for supervising PGY1 and PGY2. The majority of registrar supervision occurs without consultant oversight. Legislature requirements for supervision in ED are variable between regions. 相似文献
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A physician assistant (PA) is a university qualified health professional who's primary role is to provide medical care under the direction and supervision of medical staff. This is a new profession in Australasia. The PA is well suited to working in both rural, regional and urban settings that deliver emergency medical care. A perspective is presented on their role and scope of practice within the Australasian emergency care system supported by some early findings from their use in a tertiary ED. 相似文献
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Violence and aggression in the emergency department 总被引:1,自引:0,他引:1
Objective
To investigate the characteristics of incidents of aggression and violence directed towards staff in an urban UK emergency department.Methods
A retrospective review of incident report forms submitted over a 1 year period that collected data pertaining to the characteristics of assailants, the outcome of incidents, and the presence of possible contributory factors.Results
A total of 218 incident reports were reviewed. It was found that the majority of assailants were patients, most were male, and the median age was 32 years. Assailants were more likely to live in deprived areas than other patients and repeat offenders committed 45 of the incidents reported during the study period. The incident report indicated that staff thought the assailant was under the influence of alcohol on 114 occasions. Incidents in which the assailant was documented to have expressed suicidal ideation or had been referred to the psychiatric services were significantly more likely to describe physical violence, as were those incidents in which the assailant was female.Conclusion
Departments should seek to monitor individuals responsible for episodes of violence and aggression in order to detect repeat offenders. A prospective study comprising post‐incident reviews may provide a valuable insight into the causes of violence and aggression. 相似文献6.
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Simon Craig George Braitberg Caroline Nicolas Geoff White Diana Egerton‐Warburton 《Emergency medicine Australasia : EMA》2010,22(6):537-547
The aim of the present study is to describe ACEM trainees' perspectives on assessment and feedback during their training. From May to July 2009, an anonymous Web‐based survey on training and supervision in emergency medicine was conducted, addressing trainees' perceptions of mandatory assessments (primary examination, fellowship examination and mandatory trainee research requirement) and feedback at work. Qualitative data were analysed using grounded theory methodology – themes were identified by close examination of full text responses. In total, 622 trainees responded to the survey (response rate of 37%). Trainees report that general clinical supervision is adequate; however, direct supervision at the bedside and feedback could be significantly improved. They perceive that the primary examination is necessary, although they feel it is irrelevant to their development as emergency trainees and are keen for more clinically applied knowledge to be tested. They dislike mandatory trainee research, feel inadequately supported and distracted from other aspects of their training. The fellowship examination was overall thought to be fair; however, there were concerns with the time pressures and restrictions to the written component of the examination. Additionally, the structured clinical examination was popular, whereas short cases and long cases were very unpopular. ACEM trainees' views of training may help inform curriculum development, and might assist those providing education to improve local training programs. 相似文献
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This study sought to determine the frequency and types of violence that occurred during the previous year against health care
workers in emergency departments in Denizli, Turkey, and to discern the views of workers on the prevention of such aggressive
behavior. This study was conducted from March 1 to April 15, 2003, and included a group of 79 health care workers from the
emergency departments of 3 hospitals in Denizli, namely, the Hospital of Pamukkale University Medical Faculty, the City Hospital
of Denizli, and the Hospital of the Social Insurance Foundation. Data were collected from a self-administered questionnaire.
In all, 88.6% of participants had been subjected to or had witnessed verbal violence, and 49.4% of them had been subjected
to or had witnessed physical violence during the previous year. The most frequent reason (31.4%) for violence was abuse of
alcohol and drugs by perpetrators. The second most frequent reason (24.7%) was the long waiting times typical of emergency
departments. The most common type of violence was loud shouting; swearing, threatening, and hitting were the next most frequent
violent behaviors. In all, 36.1 % of subjects who had experienced violence reported that they developed psychological problems
after the incident. Most participants commented on the insufficiency of currently available security systems within emergency
departments and on the need for further training about violence. All health care personnel within emergency departments should
be aware of the risk of violence and should be prepared for unpredictable conditions and events; in addition, security systems
should be updated so that violence within emergency departments can be prevented. 相似文献
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Marie Frances Gerdtz Marnie Collins Matthew Chu Audas Grant Robin Tchernomoroff Cecily Pollard Judy Harris Jeff Wassertheil 《Emergency medicine Australasia : EMA》2008,20(3):250-259
Objective: The Emergency Triage Education Kit was designed to optimize consistency of triage using the Australasian Triage Scale. The present study was conducted to determine the interrater reliability of a set of scenarios for inclusion in the programme. Methods: A postal survey of 237 paper‐based triage scenarios was utilized. A quota sample of triage nurses (n = 42) rated each scenario using the Australasian Triage Scale. The scenarios were analysed for concordance and agreement. The criterion for inclusion of the scenarios in the programme was κ ≥ 0.6. Results: Data were collected during 2 April to 14 May 2007. Agreement for the set was κ = 0.412 (95% CI 0.410–0.415). Of the initial set: 92/237 (38.8%, 95% CI 32.6–45.3) showed concordance ≥70% to the modal triage category (κ = 0.632, 95% CI 0.629–0.636) and 155/237 (65.4%, 95% CI 59.3–71.5) showed concordance ≥60% to the modal triage category (κ = 0.507, 95% CI 0.504–0.510). Scenarios involving mental health and pregnancy presentations showed lower levels of agreement (κ = 0.243, 95% CI 0.237–0.249; κ = 0.319, 95% CI 0.310–0.328). Conclusion: All scenarios that showed good levels of agreement have been included in the Emergency Triage Education Kit and are recommended for testing purposes; those that showed moderate agreement have been incorporated for teaching purposes. Both scenario sets are accompanied by explanatory notes that link the decision outcome to the Australasian College for Emergency Medicine Guidelines on the Implementation of the Australasian Triage Scale. Future analysis of the scenarios is required to identify how task‐related factors influence consistency of triage. 相似文献
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Training programs in emergency medicine differ from country to country. This article compares the allopathic training programs of Australasia and the United States. The perceived advantages of these programs are highlighted, but no attempt is made to determine which is the better program. The Australasian program is significantly longer and places a greater emphasis on the basic clinical sciences, physical examination skills, and academic output. Australasian College for Emergency Medicine (ACEM) regulations are relatively flexible and allow trainees to design their own programs. Trainees are encouraged to arrange accredited positions in a variety of hospitals. Overseas and part-time training may be acceptable. In the United States, trainees rotate within and from one parent institution, which provides a rigid teaching structure for a "critical mass" of trainees, based on a "core" curriculum. Rotations tend to be much shorter but ensure exposure to a broader range of clinical experience. Evaluation of trainees and teaching faculty is more frequent and documentation of procedural and resuscitation skills is required. Trainees are under the close supervision of teaching faculty at all times when working in an ED. 相似文献
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Sofronis Loizides BSc MB BS Andreas Kallis MB BS Ashwini Oswal BA MB BS Panayiotis Georgiou MB BS George Kallis BSc MB BS Manolis Gavalas MB ChB FRCS FFAEM 《Journal of evaluation in clinical practice》2010,16(1):107-110
Background Medico-legal societies and the General Medical Council have been urging a greater use of chaperones during intimate examinations. However, research into the use of chaperones has been limited only to general practice. The objectives of this national survey were to find out: (1) whether formal chaperone policy exists in accident and emergency (A&E) departments; (2) the frequency of chaperone use; and (3) clinical applications.
Methods A simple questionnaire was submitted to the lead clinicians/clinical directors of 460 A&E departments in the UK. The departments were identified through the British Association of Accident and Emergency Medicine Directory. The completed questionnaires were either posted or faxed back to our department.
Results In total, 270 of 460 forms were returned (58.7%), of which only 246 were useable. Although 81.71% of A&E lead clinicians/clinical directors believe that formal policies are needed, only 3.65% of the departments have a formal policy. The highest percentage of chaperone use was observed for male doctors examining female patients (91.46%), while the lowest percentage was observed for male doctors examining male patients (7.32%). Worryingly, 25.61% reported incidents of complaints regarding inappropriate examination by doctors.
Conclusion We have demonstrated deficiencies in chaperone use and have identified specific factors that render A&E departments particularly vulnerable to allegations of inappropriate practice. We believe that policies should be designed and implemented focusing on the specific needs of A&E departments to counteract the rising numbers of medico-legal cases, thus safeguarding patient care and protecting the health providers. 相似文献
Methods A simple questionnaire was submitted to the lead clinicians/clinical directors of 460 A&E departments in the UK. The departments were identified through the British Association of Accident and Emergency Medicine Directory. The completed questionnaires were either posted or faxed back to our department.
Results In total, 270 of 460 forms were returned (58.7%), of which only 246 were useable. Although 81.71% of A&E lead clinicians/clinical directors believe that formal policies are needed, only 3.65% of the departments have a formal policy. The highest percentage of chaperone use was observed for male doctors examining female patients (91.46%), while the lowest percentage was observed for male doctors examining male patients (7.32%). Worryingly, 25.61% reported incidents of complaints regarding inappropriate examination by doctors.
Conclusion We have demonstrated deficiencies in chaperone use and have identified specific factors that render A&E departments particularly vulnerable to allegations of inappropriate practice. We believe that policies should be designed and implemented focusing on the specific needs of A&E departments to counteract the rising numbers of medico-legal cases, thus safeguarding patient care and protecting the health providers. 相似文献
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Lessons learnt from incidents involving the airway and breathing reported from Australasian emergency departments 下载免费PDF全文
Carmel Crock Kim Hansen Toby Fogg Angela Cahill Anita Deakin William B Runciman 《Emergency medicine Australasia : EMA》2018,30(1):55-60