Using an original triage and on call management tool aids identification and assessment of the acutely unwell surgical patient.

Until now, there have been no published surgical triage tools. We have developed the first such tool with a tiered escalation policy, aiming to improve identification and management of critically unwell patients. The existing sheet which is used to track new referrals and admissions to the surgical assessment unit was reviewed. The sheet was updated and a traffic light triage tool generated using National Early Warning Scores (NEWS), sepsis criteria and user discretion. A tiered escalation policy to guide urgency of assessment was introduced and education sessions for all staff undertaken, to ensure understanding and compliance. Through multiple 'plan-do-study-act' cycles, the new system and its efficiency have been analysed. Prior to intervention, documentation of NEWS did not occur and only 13% of admission observations were communicated to the surgical team. Following multiple cycles and interventions, 93% of patients were fully triaged, and 80% of 'red' and 'amber' patients' observations were communicated to the surgical team. The average time for a registrar to review a 'red' patient was 37 min and 79% of 'green' patients were reviewed within an hour of their presentation. Rapid identification of the unwell patient is crucial. Here we publish the first triage tool that enables early assessment of septic and otherwise potentially unwell surgical patients.

Using a sedimentation scanner to determine mangrove health responses to sedimentation derived from dredging. An example from northwestern Australia.

A sedimentation scanner was used to measure daily sediment height at 10 sites associated with a 14 million cubic metre dredging project in Port Hedland harbour, Western Australia, between July 2011 and May 2012. Data were collected from seven potential impact sites, where up to 35 mm of additional sedimentation was predicted via modelling to result from dredging and at three reference sites, where background variation was monitored. A variety of mangrove habitat health indices from each site (including leaf area and health, pneumatophore and faunal burrow density) were collected before, during and after dredging. Despite predictions, most impact sites received between 0 and 10 mm over the dredging period, with one site experiencing a gain of 28 mm. Reference sites received between 2 and 28 mm which was attributed to natural processes. It was concluded that the health of Avicennia marina (Forssk.) Vierh. and Rhizophora stylosa Griff., the most common mangroves, were neither affected by a net sedimentation up to 28 mm of over a period of 11 months (i.e. 30.5 mm y-1) nor rapid changes over shorter time periods such as 14 mm over two days. This technology could be deployed in any tidally influenced sedimentary environment where short-term processes were of interest.