Improving domestic violence screening practices in the emergency department: an Australian perspective.

INTRODUCTION: Domestic violence (DV) is a major cause of morbidity worldwide. The ED is a location recommended for opportunistic screening. However, screening within EDs remains irregular. OBJECTIVE: To examine intrinsic and extrinsic barriers to routine screening in Australian EDs, while describing actions taken after identification of DV. METHODS: Emergency clinicians at nine public hospitals participated in an anonymous online survey. Factor analysis was performed to identify principal components around attitudes and beliefs towards screening. RESULTS: In total, 496 emergency clinicians participated. Universal screening was uncommon; less than 2% of respondents reported screening all adults or all women. Although willing, nearly half (45%) reported not knowing how to screen. High patient load and no single rooms were 'very or severely limiting' for 88% of respondents, respectively, while 24/7 social work and interpreter services, and online/written DV protocols were top enablers. Factor analysis identified four distinct intrinsic belief components: (1) screening is not futile and could be done in ED, (2) screening will not cause harm, (3) there is a duty to screen and (4) I am willing to screen. CONCLUSION: This study describes a culture of Queensland ED clinicians that believe DV screening in ED is important and interventions are effective. Most ED clinicians are willing to screen. In this setting, availability of social work and interpreter services are important mitigating resources. Clinician education focusing on duty to screen, coupled with a built-in screening tool, and e-links to a local management protocol may improve the uptake of screening and subsequently increase detection.

COVID-19 personal protective equipment protocol compliance audit.

BACKGROUND: Personal protective equipment (PPE) compliance is important to reduce the rate of transmission of virulent pathogens to health care workers. Medical officer compliance with PPE protocol for COVID-19 was audited in a regional hospital in Australia early in the pandemic response. METHODS: Compliance was assessed based on the order and technique of donning and doffing PPE, with medical officers from multiple departments and levels of seniority audited. RESULTS: Average compliance from all participants was 58.61% with donning and 68.84% with doffing. CONCLUSION: Medical Officer compliance with PPE donning and doffing was poor and additional training was required.

Identifying the site for intercostal catheter insertion in the emergency department: is clinical examination reliable?

OBJECTIVE: To determine whether ED doctors, comprising both consultants and registrars, can accurately identify the 4th or 5th intercostal space (ICS), commonly used for intercostal catheter insertion. METHODS: An observational study was designed using a sample of ED doctors applying their clinical skills to a convenience sample of patients reflecting a heterogeneous mix of ED patients. Patients already receiving a CXR in our ED were examined by a registrar or consultant who placed a radiopaque marker on the patients' chest wall over the site they determined to be the 4th or 5th ICS. Consultant radiologists reported the marker's position from postero-anterior projection CXRs, and results were analysed comparing consultants with registrars, right to left hemithoraces and male to female patients. RESULTS: ED doctors participating in the present study placed the marker over the 4th or 5th ICS 36.2% of the time, with no significant difference between consultant and registrar groups, nor right or left hemithoraces. Accuracy was improved in female patients compared with male patients. CONCLUSION: Emergency registrars and consultants sampled from a regional ED appeared unable to reliably identify the 4th or 5th ICS, as evidenced by marker position, in a heterogeneous patient population.

Clinical supervisors and cultural competence.

OBJECTIVE: To investigate how clinical supervisors of junior doctors provide feedback and assessment on cultural competence, one of several professionalism skills outlined in the Australian Curriculum Framework for Junior Doctors. METHODS: Twenty clinical supervisors were recruited to a qualitative study in a regional hospital in Queensland, Australia. Data from semi-structured interviews (June-August 2011) were thematically analysed. RESULTS: Interviews revealed that cultural competence was interpreted by the supervising clinicians as a vague concept, and that junior doctors were not assessed in this area. Additional themes related to the cultural competence of junior doctors, as reported by their supervisors, included: limited direct supervision of, and feedback to, junior doctors; variations in approaches to assessment; clinicians' communication focuses on clinical aspects of disease process; perceived lack of cultural diversity among staff and patients; acceptance of laypersons as English interpreters; language barriers with international medical graduates; and patients' low levels of health literacy. CONCLUSION: Supervisors were unable to define cultural competence in ways that enable them to apply the concept to clinical training for junior doctors. Specific training in cultural competence, and guidelines for its assessment, is therefore recommended for clinical supervisors and junior doctors to improve their approaches to patient care and health outcomes.

Laboratory investigation into optimal temperature for plaster of Paris application.

OBJECTIVE: The present study aimed to determine the relationship between heat generated and time taken to reach maximum temperature when creating plaster of Paris casts, in relation to dipping water temperature and plaster slab thickness. METHODS: The study was conducted in a laboratory setting. A standard procedure for dipping, draining, layering and covering plaster slabs was developed. A standard temperature measurement and data-recording method was applied. Variables tested were dipping water temperature (25, 30, 40, 50 degrees C) and plaster slab thickness (10-ply and 15-ply). RESULTS: Mean maximum temperature varied between 31.9 and 41.7 degrees C, and was proportional to dipping water temperature and plaster slab thickness. Mean time to maximum temperature varied between 1216 and 728 s, and was inversely proportional to dipping water temperature and directly proportional to plaster slab thickness. All means were significantly different (P = 0.01). CONCLUSION: Increasing dipping water temperature and number of layers of plaster when making plaster slabs significantly increases temperature of plaster setting. These data are important for an understanding of optimum conditions for safer cast application. The present study highlights the need for further research in this area.