Perceived incivility during emergency department phone consultations.

OBJECTIVE: Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations. METHODS: We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were classified based on the aim of consultation and deemed as 'positive', 'neutral' or 'negative' based on the perceptions of the consulting doctor. Training levels, time bands and specialty data were collected for both consulting and consulted parties. RESULTS: Fifty-seven of 714 included consultations (7.98%, 95% CI 6.2-10.2%) were reported as negative by ED medical staff. Factors associated with significant incidence of negative grading of consultation involved requests for investigations (19.3% vs 5.3%, P < 0.01), consultations with specialist trainees postgraduate year > 4 (9.1% vs 3.8%, P < 0.01) and those involving radiology specialty (18% vs 5.32%, P < 0.01). The risk was lower when the consulted professional was a specialist medical practitioner as compared to specialist trainee (4.1% vs 9.4%, P = 0.02). Multiple logistical modelling suggests that female (adjusted OR 2.4, 95% CI 1.1-5.2) medical staff are more likely to report perceived incivility during ED phone consultations. CONCLUSIONS: Perceived incivility occurs infrequently during ED phone consultations. ED female medical staff are at an increased risk of perceived incivility during phone consultations with non-ED medical professionals. Health organisations should actively pursue programmes to investigate the occurrence of incivility during healthcare consultations and implement programmes to mitigate the risk of developing a negative workplace culture.

Prospective evaluation of selected clinical criteria for cranial computed tomography in non-trauma adult patients.

OBJECTIVE: To evaluate the usefulness of previously published criteria by Rothrock et al. and Harris et al. for urgent, cranial CT in non-trauma presentations. METHODS: A prospective, observational study of consecutive adult patients with non-trauma presentations to Westmead Emergency Department, undergoing urgent cranial CT over a period of 2 years and 10 months. Clinical data were assessed to determine the presence of the proposed Rothrock and Harris criteria. Clinically significant findings defined by CT were intracerebral haemorrhage, acute infarction, intracranial infection, acute hydrocephalus, cerebral oedema and malignancy. RESULTS: A total of 1911 patients were studied. Among them, 21.7% (414/1911) of patients had clinically significant findings on CT. Application of the Harris criteria demonstrated a sensitivity of 93.5% (387/414, 95% CI 90.7-95.7) and a false negative rate of 6.5% (27/414, 95% CI 4.3-9.3) with a potential reduction in number of scans by 27.8%. With application of the Rothrock criteria, the possible scan reduction rate was 15% with a sensitivity of 98.8% (409/414, 95% CI 97.2-99.6) and a false negative rate of 1.2% (5/414, 95% CI 0.4-2.8). CONCLUSION: The Harris criteria were not validated by our study. The Rothrock criteria are also not confidently validated, but can be a useful guide for emergency physicians to help prioritize high-risk patients who might have clinically significant cranial CT findings. We have not replicated their very high sensitivity and very low false negative rates.