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Emergency medicine conference, Canberra - Tuesday


Emergency medicine conference, Canberra Convention Centre

Highlights for TUESDAY November 23

9.00-10.30 session

Health reform – what does it mean at the coalface?

Professor Arthur Kellerman, Senior Principal Researcher and Paul O'Neill-Alcoa Chair in Policy Analysis at RAND Corporation will speak on “Making government policy work for you – advocacy and involvement by clinicians in public policy”.

Professor Kellerman is one of America’s leading public advocates on emergency medicine issues. He is a well-known advocate on gun control, has been a leader in public policy in emergency medicine through the Institute of Medicine in USA and now through the RAND Corporation. He will speak about his involvement in public policy in USA and how clinicians can make their own contribution in this area.

Professor Michael Ardagh, Professor of Emergency Medicine, Christchurch School of Medicine and Health Sciences, University of Otago and Christchurch Hospital will speak on “Health System Reforms and EDs in New Zealand”.

Professor Ardagh is New Zealand’s first Professor of Emergency Medicine. He has been a leading adviser to the New Zealand Government on Emergency Departments, and has helped develop and guide health system reform in New Zealand focussing on emergency departments. New Zealand has developed a six-hour access target, and Professor Ardagh will speak about this and other reforms.

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Professor Jim Bishop AO, Commonwealth Chief Medical Officer, will speak on “Clinical Governance and Health Reform”.

Engagement by clinicians has been identified as an important element to the success of health system reform. Professor Bishop will discuss the importance of clinical governance in health system reform, and outline some of the measures being proposed as part of the National Health and Hospital Network reforms.

11.00-12.30 session

Indigenous health emergencies will come under the microscope in a session which offers a critique of recent federal and Northern Territory indigenous policy as well as case presentations examining the human impact of the gap in public health statistics.

During the past five years, federal and Northern Territory governments have introduced policies such as the NT Intervention and also bilingual education, dismantling of community councils, cessation of funding for homelands, new funding only of communities tagged as hub towns, and defunding of Community Development Employment Project jobs.

Dr Hilary Tyler, emergency physician at Alice Springs Hospital, will tell the conference that many of these policies are in contravention of United Nations policies which Australia has either signed or agreed to in principal.

“At the same time, massive amounts of money have been spent on duplication of health services, and implementation of the controversial Income Management scheme.”

Dr Tyler will give an overview and critique of these policies.

In the same conference session, Dr Paul Spillane, emergency physician at Coffs Harbour Base Hospital, will discuss how the mantra of "close the gap" has in recent years permeated public consciousness and the media in relation to indigenous health.

“But what does this ‘gap’ mean to the indigenous people that it refers to and to practitioners working alongside the First Australians on a day-to-day basis?”

He will present an analysis of the human impact of these statistics on individuals, communities and health practitioners working in this setting.

The 4-hour national access target – the implementation of time-based targets for emergency departments is often a source of fear and trepidation: how the experts have dealt with it:

• Professor Jonathan Benger (professor of emergency care at the University of West of England)

• Dr Andrew Singer (principal medical advisor, acute care division, Australian Government Department of Health and Ageing)

• Professor Frank Daly (acting director of clinical services, Royal Perth Hospital).

Up to 90% of eye injuries are preventable

Up to 90% of eye injuries are preventable, according to a study of penetrating eye injuries and ruptured globes.

Dr Carmel Crock, director of the emergency department at Royal Victorian Eye and Ear Hospital, will present results of the 2009 study of penetrating eye injuries and ruptured globes presenting to the Royal Victorian Eye and Ear Hospital in Melbourne.

The study found 77 cases, of whom 84% were in men.

Visual acuity on presentation was hand movement or worse in almost half of patients (49.4%).

Injuries most frequently occurred in the home (45.5%) and at work (27.3%).

In both environments, hammering, use of nails and use of wire were common causes.

Lawn mowing and gardening also caused several injuries at home.

Few were the result of sports-related injuries.

The 20- 29 year age group (22%) accounted for the greatest number of injuries.

In those aged over 65 years, a fall was the cause of injury in 43.8% of cases.

The researchers concluded that home and work were the most common places where penetrating and ruptured globe injuries occurred.

At the conference, Dr Crock will recommend increased public awareness of the need for eye protection during home handiwork, gardening and lawn mowing.

Mandating and enforcing compulsory eye protection in the workplace of high risk industries is also essential, she says.

1.30-3.00 session

Hospital in the home – from the back door to the front door

Hospital in the Home (HIH) is a confronting health system innovation that delivers hospital technologies and hospital skills to patients at home or in nursing homes.

It redefines hospital admission to include acute care outside the hospital.

This is a result of technology advances in communications, portability and miniaturisation, drug design, and improvements in domestic technologies.

HIH was established in Victoria in 1994, and has grown to such an extent that in 2008-09 it delivered over 32,000 inpatient episodes, which represents 2.5% of all Victorian inpatient episodes and 5% of all bed days.

If HIH were a standard single hospital, it would have 500 beds, reporting very high patient satisfaction.

Victorian state reimbursement policy for HIH has been critical in the development of HIH.

Despite this remarkable progress in improving access for Victorians to both HIH and traditional beds, HIH has few medical resources.

At the conference, Dr Michael Montalto, director Hospital in the Home, Royal Melbourne Hospital, will discuss direct admission from the ED to HIH, as well as barriers to, and opportunities for, improving access.

Unusual intoxications : Dr Darren Roberts, who works in clinical pharmacology and toxicology at St Vincent’s Hospital in Sydney, will tell the conference that, while patients with acute poisoning often present following exposure to a mixture of paracetamol, benzodiazepines and/or alcohol, the breadth of exposures and variation in presentations is extensive.

“Unusual intoxications are both exciting and anxiety provoking.”

He will present cases of acute poisoning encountered in Australian hospitals where the presentation or management was unusual.

3.30-5.00 session

The 4-hour target – is this the cane toad of medicine?

The 4-hour national target (patients seen in the ED within 4 hours) is to be introduced to Australia in January 2011.

Yet, this has been a political decision made without evidence that this target is good for patient care.

Dr Simon Judkins, deputy director of emergency medicine at Austin Health, will explore the evolution of the 4-hour target, its implementation in Western Australia, and its adoption as a national target.

Such targets have potentially negative impacts on both patient care and the practice of emergency medicine in Australia, he says.

Compliance with the ED 4-hour target depends on access block – the WA experience

Western Australia, so far the only Australian state with a 4-hour emergency department target in place, can provide valuable lessons to other states, according to a study of the effects of the 4-hour target implementation.

A clinical redesign process was undertaken to support compliance with the target of 98% of patients being admitted, discharged, or transferred within 4 hours from the time of triage in the ED.

Dr Yusuf Nagree, emergency physician at Fremantle Hospital, will tell the conference that the study found compliance with the 4-hour target was almost completely dependent on the number of admitted patients sent to the ward within 4 hours.

The researchers concluded that implementation strategies should concentrate not so much on discharging patients home but rather on access block in the hospital.

National access targets – back to the future?

Opening an observation unit within an emergency department is not the answer to achieving 4-hour national access targets, according to Associate Professor Drew Richardson, chair of road trauma and emergency at Australian National University Medical School.

His study compared ED performance in June 1999 with that in June 2009. During that period an observation unit was opened.

Despite reduced ward admission rates resulting from the observation unit, there was a major decrease in ED performance, with large increases in waiting time, admission delay time, and patients not waiting.

Patients who did not wait increased over 400% during the 10-year period.


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