Me, myself, and I: A systematic review of cystic fibrosis and self-concept.

Given extensive pertinent disease factors and evolving medical treatments, this systematic review explores qualitative and quantitative cystic fibrosis (CF) research surrounding self-concept, an overarching perception of self. Research methodologies, self-concept dimensions, prominent self-concept findings and clinical recommendations are identified. Preferred Reporting Items for Systematic Review and Meta-analyses guidelines were applied. PubMed, Scopus, Medline, Psycinfo, CINAHL (ebsco), and CENTRAL Cochrane electronic databases were searched from 2012 to 2022. Methodological quality was assessed using the critical appraisal skills program. Data-based convergent synthesis was applied to analyze and report on qualitative and quantitative studies in parallel. Thirty-seven publications met the inclusion criteria, most of which employed a cross-sectional, single-center design within an adolescent and adult population. Self-efficacy, self-esteem, and self-identity studies were dimensions of self-concept identified, with studies relating to self-efficacy surrounding physical health management most prevalent. All three dimensions were positively associated with improved treatment adherence and psychosocial health. Efficacy tested intervention programs to enhance self-concept are limited; however, an extensive range of clinical recommendations are offered, highlighting the importance of clinician self-concept awareness, quality clinician-patient conversations and online CF peer-support. Self-concept is an important mechanism to optimize patient outcomes. Further CF self-concept research is required, particularly multicenter, longitudinal, and interventional studies. Early childhood, post lung transplant and the older adult CF population in particular, lack research attention. Given the potential impact of rapidly evolving CF transmembrane conductance regulator modulator drugs on many aspects of self, future self-concept research beyond the dimension of self-efficacy may be beneficial.

Impact of parental and healthcare professional concern on the diagnosis of pediatric sepsis: a diagnostic accuracy study.

Objective: The Surviving Sepsis Campaign recommends systematic screening for sepsis. Although many sepsis screening tools include parent or healthcare professional concern, there remains a lack of evidence to support this practice. We aimed to test the diagnostic accuracy of parent and healthcare professional concern in relation to illness severity, to diagnose sepsis in children. Design: This prospective multicenter study measured the level of concern for illness severity as perceived by the parent, treating nurse and doctor using a cross-sectional survey. The primary outcome was sepsis, defined as a pSOFA score >0. The unadjusted area under receiver-operating characteristic curves (AUC) and adjusted Odds Ratios (aOR) were calculated. Setting: Two specialised pediatric Emergency Departments in Queensland. Patients: Children aged 30 days to 18 years old that were evaluated for sepsis. Intervention: None. Main Results: 492 children were included in the study, of which 118 (23.9%) had sepsis. Parent concern was not associated with sepsis (AUC 0.53, 95% CI: 0.46-0.61, aOR: 1.18; 0.89-1.58) but was for PICU admission (OR: 1.88, 95% CI: 1.17-3.19) and bacterial infection (aOR: 1.47, 95% CI: 1.14-1.92). Healthcare professional concern was associated with sepsis in both unadjusted and adjusted models (nurses: AUC 0.57, 95% CI-0.50, 0.63, aOR: 1.29, 95% CI: 1.02-1.63; doctors: AUC 0.63, 95% CI: 0.55, 0.70, aOR: 1.61, 95% CI: 1.14-2.19). Conclusions: While our study does not support the broad use of parent or healthcare professional concern in isolation as a pediatric sepsis screening tool, measures of concern may be valuable as an adjunct in combination with other clinical data to support sepsis recognition. Clinical Trial Registration: ACTRN12620001340921.

Living with cystic fibrosis during the COVID-19 pandemic: a social connectedness perspective.

PURPOSE: This study explores the concept of social connectedness for adults with Cystic Fibrosis (CF), generally and during the onset of the COVID-19 pandemic, to help inform contemporary CF healthcare. Social connectedness is an essential component of belonging and refers to an individual's sense of closeness with the social world. Unique disease factors make exploration of social connectedness pertinent, added to by COVID-19, with the CF population potentially facing increased risk for severe illness. METHODS: Seventeen adults with CF in Western Australia undertook interviews, with findings categorized as overarching themes. RESULTS: In a general sense, participants described social connectedness challenges caused by CF, despite which they reported meaningful connections that benefits their mental and physical health. Within a COVID-19 specific context, participants demonstrated resilience in the face of adversity, highlighted the importance of empathy in relation to the pandemic, and described how social support is both an outcome and enhancer of social connectedness. CONCLUSIONS: This study contributes to limited social connectedness literature within CF and chronic illness in general, highlighting the importance of social connectedness awareness raising, assessments and interventions in CF healthcare inside and outside the COVID-19 pandemic.

Parental and healthcare professional concern in the diagnosis of paediatric sepsis: a protocol for a prospective multicentre observational study.

INTRODUCTION: Paediatric sepsis is a major contributor to morbidity and mortality worldwide. Assessing concern from parents and healthcare professionals to determine disease severity in a child evaluated for sepsis remains a field requiring further investigation. This study aims to determine the diagnostic accuracy of parental and healthcare professional concern in the diagnosis of children evaluated for sepsis. METHODS AND ANALYSIS: This prospective multicentre observational study will be conducted over a 24-month period in the paediatric emergency department (ED) at two tertiary Australian hospitals. A cross-sectional survey design will be used to assess the level of concern in parents, nurses and doctors for children presenting to ED and undergoing assessment for sepsis. The primary outcome is a diagnosis of sepsis, defined as suspected infection plus organ dysfunction at time of survey completion. Secondary outcomes include suspected or proven infection and development of organ dysfunction, defined as a Paediatric Sequential Organ Failure Assessment Score >0, within 48 hours of presentation, paediatric intensive care unit admission, confirmed or probable bacterial infection independent of organ dysfunction, and hospital length of stay. ETHICS AND DISSEMINATION: Ethics approval was obtained from Children's Health Queensland's Human Research Ethics Committee (HREC/17/QRCH/85). Findings will be shared with relevant stakeholders and disseminated via conferences and peer-reviewed journals TRIAL REGISTRATION NUMBER: WHO Universal Trial Number, U1111-1256-4537; ANZCTR number, ACTRN1262000134092.

Illustrating a novel methodology and paradigm applied to Emergency Department research.

AIM: To provide a practical example of how a novel methodology and paradigm was applied to a mixed methods study exploring the healthcare experiences of Australian adults who frequently use emergency department services. DESIGN: Discussion Paper. DATA SOURCES: We explored published literature discussing philosophical and methodological issues related to mixed methods research. Literature searches were performed between July 2019 and February 2021. IMPLICATIONS FOR NURSING: Phenomenology is a powerful methodology to explore the lived experience of research participants, but it is not without limitations. Mixed methods phenomenology allows nurse researchers to bring further clarity to their research phenomena, however, including phenomenology in mixed methods studies may be seen to be philosophically incompatible. The philosophical metaparadigm of dialectical pluralism provides nurse researchers with a new coherent methodological and philosophical framework for combining participants' descriptions of lived experience with a variety of data collection methods. It is effective when working with transdisciplinary research teams, and stakeholders representing diverse values and disciplines. CONCLUSION: Complex healthcare environments require sophisticated, flexible research approaches. This paper presents mixed methods phenomenological research combined with the metaparadigm of dialectical pluralism providing a methodological framework that can support multifaceted nursing research. IMPACT: The combination of mixed methods phenomenology and dialectical pluralism represents a novel solution for nurse researchers to articulate a research methodology and philosophical paradigm reflecting the complexity embedded in everyday nursing practice. This methodology offers a unique approach to exploration of challenging clinical and patient scenarios with multifaceted elements, and overcomes theories of philosophical incompatibilities between divergent methods.

Adult frequent presentation to emergency departments and adverse childhood experiences: a scoping review.

BACKGROUND: Extensive literature reports the influence of childhood adversity on adult health, however few studies have explored these life antecedents in people who frequently present to the emergency department. This review synthesizes literature exploring childhood adversity influences on emergency department presentations, if and how it is identified, and interventions addressing the health care needs of this group. METHODS: Eight electronic databases were searched. Arksey and O'Malley's framework guided this review, and a quality appraisal was undertaken. Searches included all published studies until August 2020. RESULTS: Twenty-one articles were included in this review. They revealed that childhood adversity is common among adults who frequently attend the emergency department. It impacts physical and psychological health into adulthood and there is no standardized approach described to documenting childhood adversity, nor any consistent intervention reported by emergency departments to address its sequelae in adulthood. CONCLUSIONS: Several studies call for screening, intervention, and education to identify and address impacts of childhood adversity for patients who frequently present to the emergency department. However, reliable high-level studies exploring these topics specific to the emergency department are uncommon. Consequently, definitive interventions to address the healthcare needs of this group is lacking and warrants further research.

Effectiveness of programs to promote cardiovascular health of Indigenous Australians: a systematic review.

BACKGROUND: Indigenous Australians carry a greater burden of cardiovascular disease than other Australians. A variety of programs has been implemented with the broad aim of improving Indigenous cardiovascular health, however, relatively few have been evaluated rigorously. In terms of effectiveness, understanding how to best manage cardiovascular disease among this population is an important priority. The review aimed to examine the evidence relating to the effectiveness of cardiovascular programs for Indigenous Australians. METHODS: PubMed, CINAHL, PsycINFO, Scopus and Web of Science databases were systematically searched for relevant studies, limited to those published in English between 2008 and 2017. All studies that used experimental designs and reported interventions or programs explicitly aimed at improving Indigenous cardiovascular health were considered for inclusion. Methodological quality of included studies was appraised using design-specific Joanna Briggs Institute critical appraisal checklists. Data were extracted using the Joanna Briggs Institute data extraction form and synthesised narratively. RESULTS: Eight studies met the inclusion criteria and were assessed to be of varying methodological quality. Common features of effectiveness of programs were integration of programs within existing services, provision of culturally appropriate delivery models with a central role for Indigenous health workers, and provision of support processes for communities such as transportation. It was noted however, that the programs modelled the interventions based on mainstream views and lacked strategies that integrated traditional knowledge and delivery of health care. CONCLUSIONS: Very few cardiovascular healthcare programs designed specifically for Indigenous Australians, which had undergone rigorous study, were identified. Whilst the majority of included articles were assessed to be of satisfactory methodological quality, the nature of interventions was diverse, and they were implemented in a variety of healthcare settings. The limited evidence available demonstrated that interventions targeted at Indigenous cardiovascular health and related risk factors can be effective. The results indicate that there are opportunities to improve cardiovascular health of Indigenous people at all stages of the disease continuum. There is a need for further research into evidence-based interventions that are sensitive to Indigenous culture and needs. TRIAL REGISTRATION: Registered with PROSPERO International: CRD2016046688.

The patients' perspective of sustaining a fall in hospital: A qualitative study.

AIMS AND OBJECTIVES: To understand the patient's perspective of falling in hospital. BACKGROUND: A fall in hospital can affect a patient physically and psychologically, increasing their hospital length of stay and potentially putting them at risk of further complications. Despite a wealth of literature on falls that focuses on risk assessment, preventive interventions and cost, very little research has focused on the experience of the patient that has fallen, particularly within the acute hospital setting. DESIGN: A qualitative phenomenological design was used to investigate the experience of falling in hospital. METHODS: Twelve hospital inpatients that had recently fallen were interviewed while in hospital using unstructured interviews. The methodology was guided by Van Manen's approach to data collection and analysis. FINDINGS: Three key themes emerged from the analysis: Feeling safe, Realising the risk and Recovering independence and identity. These themes describe a continuum whereby falling was not initially a concern to participants, who trusted staff to keep them safe, and tended to not seek assistance. As participants began to appreciate the reality of their falls risk, they felt disempowered by their loss of independence but were more receptive to receiving assistance. Finally, as participants recovered, their desire to regain independence increased. They wanted others to perceive them as physically competent, rather than as a frail older person, meaning they were more willing to take risks with mobility. CONCLUSION: The participants' perspective of falling describes a continuum of responses with participants positioned at different psychosocial standpoints: from initial denial of their risk of falling to realisation of the importance of their fall and acceptance of its repercussions. RELEVANCE TO CLINICAL PRACTICE: By understanding the patient's perspective of falling, nurses and other health professionals conducting risk assessment can tailor their discussions and interventions to the patient's perceptions and needs.

Multidisciplinary evaluation of an emergency department nurse navigator role: A mixed methods study.

AIM: To utilise multidisciplinary staff feedback to assess their perceptions of a novel emergency department nurse navigator role and to understand the impact of the role on the department. BACKGROUND: Prolonged emergency department stays impact patients, staff and quality of care, and are linked to increased morbidity and mortality. One innovative strategy to facilitate patient flow is the navigator: a nurse supporting staff in care delivery to enhance efficient, timely movement of patients through the department. However, there is a lack of rigorous research into this emerging role. DESIGN: Sequential exploratory mixed methods. METHODS: A supernumerary emergency department nurse navigator was implemented week-off-week-on, seven days a week for 20 weeks. Diaries, focus groups, and an online survey (24-item Navigator Role Evaluation tool) were used to collect and synthesise data from the perspectives of multidisciplinary departmental staff. RESULTS: Thematic content analysis of cumulative qualitative data drawn from the navigators' diaries, focus groups and survey revealed iterative processes of the navigators growing into the role and staff incorporating the role into departmental flow, manifested as: Reception of the role and relationships with staff; Defining the role; and Assimilation of the role. Statistical analysis of survey data revealed overall staff satisfaction with the role. Physicians, nurses and others assessed it similarly. However, only 44% felt the role was an overall success, less than half (44%) considered it necessary, and just over a third (38%) thought it positively impacted inter-professional relationships. Investigation of individual items revealed several areas of uncertainty about the role. Within-group differences between nursing grades were noted, junior nurses rating the role significantly higher than more senior nurses. CONCLUSION: Staff input yielded invaluable insider feedback for ensuing modification and optimal instigation of the navigator role, rendering a sense of departmental ownership. However, results indicate further work is needed to clarify and operationalise it.

The experience of men and women with cystic fibrosis who have become a parent: A qualitative study.

AIMS AND OBJECTIVES: To explore the experiences of men and women with cystic fibrosis in becoming parents. BACKGROUND: As lifespan for people with cystic fibrosis increases, and reproductive technology advances, having a child of their own becomes a possibility. DESIGN: This study used a phenomenological framework. METHODS: Seven Australian adults with cystic fibrosis were invited to describe their experiences of becoming parents in the context of a semi-structured interview. Analysis of the data involved highlighting recurrent phrases and isolating emergent themes. RESULTS: Two overarching themes characterised the participants' experience: Counting the cost, as they recalled Concentric communication and Pathways to pregnancy; and Living the dream, as they cast a retrospective view over this, their major achievement, in the light of their Reaction: a dream comes true, Coping: a question of balance, Conjecture: the future redefined and Confidence: recalibrating. CONCLUSIONS: While advances in cystic fibrosis care and reproductive technology have increased the possibility of individuals with cystic fibrosis becoming parents, the passage to becoming a parent is a complex process. RELEVANCE TO CLINICAL PRACTICE: These findings can inform health professionals to support the adaptive work necessary for families that include members with cystic fibrosis. A contemporary understanding of this phenomenon is necessary for facilitating clinically relevant communication.

Family-centred care for families living with cystic fibrosis in a rural setting: A qualitative study.

AIMS AND OBJECTIVES: To explore experiences of family-centred care among parents of children with cystic fibrosis living far from tertiary treatment centres and to understand what such distances mean to their care. BACKGROUND: Australia is a large continent. However, many families with a child with cystic fibrosis live in regional areas, often thousands of kilometres away from the primary treatment centres located in Australia's coastal capital cities. DESIGN: A qualitative, phenomenological design using a Van Manen () approach. METHODS: Individual, semi-structured interviews were conducted with parents (n = 7) of a child with cystic fibrosis who lived in regional Australia. Thematic content data analysis was used. RESULTS: The essence of the participants' experience was their seeking certainty and continuity in the changeable realm of cystic fibrosis while negotiating a collaborative approach to their child's care. Five core themes and two subthemes were identified: "Daily care: a family affair," including the subtheme "Accessing expert care"; "Family-centred care: seeking inclusion"; "Control versus collaboration: seeking mutual trust," with the subtheme "The team who grows with you"; "Future projections"; and "The CF circle." CONCLUSION: Some concerns are not unlike those of their city counterparts, but can be intensified by their sense of distance and isolation. RELEVANCE TO CLINICAL PRACTICE: Insight into this unique milieu from the parents' perspective is requisite so that care is appropriate to such a challenging environment and incorporates the whole family.

Indigenous cardiac patients' and relatives' experiences of hospitalisation: A narrative inquiry.

AIMS AND OBJECTIVES: To explore Indigenous people's experiences of hospitalisation for acute cardiac care. BACKGROUND: Indigenous Australians suffer a higher burden of cardiovascular ill health and hospitalisation rates in comparison with other Australians, but there is little research that explores their perspectives of hospitalisation. DESIGN: Narrative inquiry. METHODS: Interviews were undertaken using storytelling to facilitate participants' descriptions of their hospital experience. Data were collected during 2014-2015. A purposive sample of Indigenous cardiac patients that were admitted to hospital and their relatives participated. FINDINGS: The narrative revealed three linked themes that characterised Indigenous people's hospitalisation experiences: The impact of the past; The reality of the present; and Anticipating the future. Hospitalisation was challenging for participants due to their sense of dislocation and disorientation, a lack of cultural and spiritual aspects to care practices, and the poor interpersonal relationships they experienced. CONCLUSIONS: Findings revealed that there were many unmet needs during hospitalisation for Indigenous people. Past experiences and future expectations were connected in a way that impacted on participants' current hospitalisation experience. Understanding this context, with incorporation of cultural and spiritual aspects of care may help nurses and other healthcare professionals to provide more positive interactions that in turn may contribute to improved cardiac care experiences of Indigenous people during hospitalisation. Healthcare professionals need to be aware and focused on person-specific and contextualised aspects of Indigenous people's experience of hospitalisation for cardiac care in order to impact outcomes. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals need to understand Indigenous people's perspectives that contribute to improved health outcomes. Stories of participants' experiences may assist in the identification of aspects which might further the development of culturally appropriate continuity models that could effectively provide support throughout Indigenous people's hospital journeys, and beyond the hospital, and help improve associated health outcomes.

Family-centred care in cystic fibrosis: a pilot study in North Queensland, Australia.

AIMS: The aims were to: (i) examine perceptions of family-centred care of parents of children with cystic fibrosis and healthcare professionals who care for them; (ii) test design and tools in a regional population. DESIGN: Quantitative pilot study of existing questionnaire. METHODS: The methods involved were comparative, cross-sectional survey of parents of children with cystic fibrosis and health staff in North Queensland, using "Perceptions of Family Centered Care - Parent" and "Perceptions of Family Centered Care - Staff" questionnaires; and descriptive study of tools. RESULTS: Eighteen staff, 14 parents (78%, 61%); using Mann-Whitney U, showed no significant differences in scores in categories: 'support' 'respect', 'collaboration'. Comments about suitability of questionnaires varied, but were largely positive.

Implementation and evaluation of a 'Navigator' role to improve emergency department throughput.

BACKGROUND: Emergency department overcrowding impacts patients, staff, and quality of care, and there is government pressure to optimize throughput and reduce waiting times. One solution for improving patient flow is the emerging 'navigator' role: a nurse that supports staff in care delivery; facilitating efficient and timely patient movement through the emergency department. METHODS: A 20-week project was implemented to evaluate an emergency department nurse navigator role. A controlled trial was used. The navigator worked on a week-on-week-off basis, eight hours per day, seven days per week. Time-based and cost-associated outcomes were compared. RESULTS: Data from nearly 20,000 presentations during the trial period were analysed. All outcomes were improved during the ten weeks the Navigator was working. A slight improvement in National Emergency Access Target compliance was shown, with an average of 4.5min per presentation saved. The labour cost associated with the time saved was estimated to be $170,000. CONCLUSIONS: The results from this study indicate that for a relatively small investment, complementary nursing roles such as the navigator can impact emergency department patient flow. However, further studies are required to determine optimisation of the role. RELEVANCE TO PRACTICE: This study provides rigorous evidence of the effects of a nurse navigator role on emergency department throughput. Whilst positive outcomes were demonstrated, suggesting a whole-of-system benefit, the magnitude of effect on a per-presentation basis was relatively small. Further studies are required to demonstrate the clinical relevance of such roles.

Indigenous peoples' experiences and perceptions of hospitalisation for acute care: A metasynthesis of qualitative studies.

OBJECTIVE: The objective of this study was to explore Indigenous people's experiences and perceptions of hospitalisation and acute care. METHODS: Systematic procedures were used for the literature search covering the period from 2000 to 2016. Final search was conducted in early September 2016. Quality of the selected studies was assessed using the Critical Appraisal Skills Program. Data extraction was conducted using the data extraction tool from the Joanna Briggs Institute. A thematic approach to synthesis was taken. Statements were assembled to produce aggregated data of the findings, which were then categorised based on similarity of meaning, and the categories were used to produce comprehensive synthesised findings. DATA SOURCES: The literature search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature, Google scholar, Medline, Psychology and Behavioural Sciences, and PsycINFO. Manual searches of the International Journal of Indigenous Health, Menzies website and references of reviewed papers were also conducted. Inclusion criteria were qualitative articles, published in English from across the world, in peer-reviewed journals, that investigated acute health care experiences of Indigenous people. REVIEW METHODS: A metasynthesis of qualitative research studies was conducted following Joanna Briggs Institute guidelines. FINDINGS: A total of 21 primary studies met the inclusion criteria. Three themes emerged from the metasynthesis: Strangers in a strange land; Encountering dysfunctional interactions; and Suffering stereotyping and assumptions. These themes emphasised the importance of meaningful relationships for Indigenous people and highlighted their cultural marginalisation in hospital settings. CONCLUSION: The findings indicate that healthcare experiences of Indigenous patients and their relatives in acute settings can fall well short of their expectations and needs. It behoves healthcare professionals to firstly be aware of such discrepancies, and secondly to implement strategies that enable inclusive and individualised care.

Parental Experience of Information and Education Processes Following Diagnosis of Their Infant With Cystic Fibrosis Via Newborn Screening.

UNLABELLED: Following diagnosis with cystic fibrosis (CF), initial education powerfully influences parental adjustment and engagement with care teams. This study explored the education needs of ten parents following their infant's diagnosis with CF via newborn screening. DESIGN AND METHODS: Phenomenological study using van Manen's approach, with ten participant parents of children 1-8 years with CF. RESULTS: Parents recounted varying degrees of coping with information they acknowledged as overwhelming and difficult. For some it was too much too soon, while others sought such clarity to put CF into context. CONCLUSIONS: Participants delivered insight into their engagement with their education about CF. Their recommendations for appropriate context, content, format and timing of delivery enable development of education that is accurate and relevant.

Users' experiences of an emergency department patient admission predictive tool: A qualitative evaluation.

Emergency department overcrowding is an increasing issue impacting patients, staff and quality of care, resulting in poor patient and system outcomes. In order to facilitate better management of emergency department resources, a patient admission predictive tool was developed and implemented. Evaluation of the tool's accuracy and efficacy was complemented with a qualitative component that explicated the experiences of users and its impact upon their management strategies, and is the focus of this article. Semi-structured interviews were conducted with 15 pertinent users, including bed managers, after-hours managers, specialty department heads, nurse unit managers and hospital executives. Analysis realised dynamics of accuracy, facilitating communication and enabling group decision-making Users generally welcomed the enhanced potential to predict and plan following the incorporation of the patient admission predictive tool into their daily and weekly decision-making processes. They offered astute feedback with regard to their responses when faced with issues of capacity and communication. Participants reported an growing confidence in making informed decisions in a cultural context that is continually moving from reactive to proactive. This information will inform further patient admission predictive tool development specifically and implementation processes generally.

EN2RN - transitioning to a new scope of practice.

BACKGROUND: In Australia, newly graduated registered nurses enter the workforce and a number of these have previous experience as enrolled nurses. For all newly graduated registered nurses, transitioning to the new role can be challenging. AIM: The aim of this study was to explore the experiences of enrolled nurses transitioning to the role of registered nurses to support the development of effective transition programs. DESIGN: An exploratory qualitative design. METHODS: In-depth interviews with a purposive sample from one health service in South East Queensland, Australia. Data were analysed thematically. FINDINGS: The three main themes emerging from analysis: a new scope of practice, perceptions of capability, building on experience and knowledge. CONCLUSIONS: We recommend assessment of individual learning needs and support during the transition period which acknowledges previous experience and recognises learning required to effectively transition to the role of a registered nurse.

The Implementation and Evaluation of the Patient Admission Prediction Tool: Assessing Its Impact on Decision-Making Strategies and Patient Flow Outcomes in 2 Australian Hospitals.

STUDY OBJECTIVES: To evaluate the implementation of a Patient Admission Prediction Tool (PAPT) in terms of patient flow outcomes and decision-making strategies. SETTING: The PAPT was implemented in 2 Australian public teaching hospitals during October-December 2010 (hospital A) and October-December 2011 (hospital B). DESIGN: A multisite prospective, comparative (before and after) design was used. Patient flow outcomes measured included access block and hospital occupancy. Daily and weekly data were collected from patient flow reports and routinely collected emergency department information by the site champion and researchers. RESULTS: Daily decision-making strategies ranged from business as usual to use of overcensus beds. Weekly strategies included advanced approval to use of overcensus beds and prebooking nursing staff. These strategies resulted in improved weekend discharges to manage incoming demand for the following week. Following the introduction of the PAPT and workflow guidelines, patient access and hospital occupancy levels could be maintained despite increases in patient presentations (hospital A). CONCLUSIONS: The use of a PAPT, embedded in patient flow management processes and championed by a manager, can benefit bed and staff management. Further research that incorporates wider evaluation of the use of the tool at other sites is warranted.

Paediatric pain assessment and management in the emergency setting: the impact of a paediatric pain bundle.

OBJECTIVES: To evaluate the impact of a paediatric pain bundle on pain assessment and management of children with fractured forearms who presented to an Emergency Department (ED). METHODS: A descriptive, comparative pilot study was conducted at a large regional hospital ED to describe differences in pain assessment, management and documentation in the 4months before and after the implementation of a paediatric pain bundle. RESULTS: A total of 242 children with fractured forearms visited the ED over two separate 4-month periods during 2009. Compared to the pre time period, children in the post time period did not differ significantly regarding pain assessment score documentation (13.5% vs. 20.7%, p=0.14), administration rate of analgesia (58.7% vs. 65.5%, p=0.28) or time to analgesia (28min vs. 35min, p=0.22). CONCLUSIONS: In this pilot study, findings indicated clinical significance but not statistical significance. The assessment and management of pain in the ED paediatric population is challenging due to difficulties interpreting responsiveness and to organisational and system imperatives that delay time critical aspects such as time to analgesia. Further focus on documentation, assessment and management practices is required in larger populations across a number of sites.