Background: The first national peripheral intravenous catheter (PIVC) guideline was launched on May 2021 by the Australian Commission on Safety and Quality in Health Care to guide PIVC care. However, clinicians’ knowledge, attitude and practice toward the guideline are unknown, especially in emergency department (ED) settings. It is timely to explore the knowledge-practice gap to inform future strategies to optimise future PIVC practice.
Aim: To assess ED clinicians’ knowledge, attitude and adherence to the PIVC guideline.
Method: An online national survey was conducted in Australia in mid-2022. The surveys were distributed to ED clinicians via multiple professional networks and social media. Snowballing sampling method was used. The survey included both 5-point Likert scales and multiple-choice questions.
Results: 433 responses were received from ED nurses and doctors. Nearly half participants stated that they were unfamiliar with the guideline and/or its recommendations. Although some participants’ attitudes were positive towards the guideline, others did not agree with some recommendations such as avoiding multiple insertion attempts and ongoing PIVC competency monitoring. Suboptimal practice such as idle catheter insertion, choice of antecubital fossa, low confidence during insertion and lacking review of ongoing PIVC needs was concerning.
Conclusion: The survey findings suggest that some recommendations of the guideline may not be practical or acceptable to ED clinicians. Modifications of some recommendations may be required.

Background/Introduction: Trail use offer physical and mental health benefits. However, incidents can occur requiring which cause acute pain for patients and require ambulance transport to hospital.

Aim/Purpose: To describe the types of analgesic medications administered to patients who were attended by ambulance on recreational trails while mountain biking or hiking and report on the reduction in pain by these agents.

Methods/Intervention/Activity a retrospective cohort study of patients attended by ambulance (2015-2021) after mountain biking or hiking, on Western Australia (WA) trails. All data were extracted from electronic patient care records created by ambulance. We compared patient and case characteristics between mountain bikers and hikers and the reduction in pain scores achieved by different analgesics.

Results/Outcome: A total of 717 patients were included. The median initial pain score was 6 (2-8) and the median final pain score was 3 (1-5). A reduction of ≥25% in their pain score was greatest in patients who received intravenous fentanyl (81%), followed by patients administered multiple analgesics (72%) and methoxyflurane (52%). Even 37% of 134 patients who received no analgesia still reported ≥25% reduction in their pain score.

Conclusion/Recommendations: Trauma was the most common reason mountain bikers and hikers called an ambulance. Further work assessing the effectiveness of safe, non-opioid analgesics is needed to ensure non-registered practitioners can offer suitable safe analgesics to these patients. Additionally, among patients given no analgesic agent, almost half still achieved a >25% reduction in their pain scores which reiterates the importance of non-pharmacological pain reduction strategies.

Introduction: Chest pain is one of the most common causes for people to seek care at Emergency Departments (ED) in Australia. Patients presenting with chest pain are triaged high priority to facilitate early assessment and management of cardiac conditions, however not all chest pain is cardiac (59%). Currently, there is a lack of guidelines in Australia to aid in distinguishing and categorising chest pain during the triage process.
Aim: To identify, examine, and synthesize existing literature of chest pain risk stratification at triage level.
Methods: This integrative review followed Whittemore & Knafl’s five-step framework. Using keywords derived from the identified problem, a systematic search of Medline, CINAHL, and Scopus was conducted for studies published in English language from 2013-2023. Relevant primary research studies were included. Articles were evaluated with suitable appraisal checklists. Themes were identified by analysing data using a constant comparison method. Descriptive statistics were used to report article characteristics.
Results: 10 articles were included in the review. Themes identified across the studies included decision-making aids, risk factors, and morbidity and mortality. Several tools were identified including EDACS, TRIGGER, AcSAP, T1MIrs, and the m-Goldman score. Risk stratification tools appeared to demonstrate high sensitivity and average specificity when applied to the triage setting.
Conclusion: Compared to triage alone, risk stratification tools appeared to improve the overall accuracy of chest pain triage. Further research is necessary to develop externally validated risk stratification tools for chest pain at triage.

Background: Emergency department (ED) triage is often patients’ first contact with a health service and a critical point for patient experience. How patients experience triage and the waiting room has not been fully described.

Aim: To understand patients’ experiences of ED triage and waiting room.

Methods: The integrative review was guided by Toronto and Remington’s (2020) six stage approach. A systematic search of Medline, CINAHL, EmCare, Scopus, ProQuest, Cochrane Library, and JBI database was conducted for literature published in English between 2000-2022. Primary research and quality improvement (QI) studies that reported patient experience of ED triage and waiting room were included. Quality was assessed using critical appraisal tools. Data were abstracted into a matrix and analysed for descriptive statistics and themes using the constant comparison method.

Results: Twenty nine articles were included that reported observational (n=17), experimental (n=3), mixed-methods (n=4), qualitative research (n=2) or QI projects (n=3). Studies were mostly conducted at a single site (n=23), examined triage context specifically (n=21), and involved patients with low-moderate acuity (n=13). Nine interventions were identified. Provisional themes of ‘waiting’, ‘the patient as a person’, ‘information’, ‘triage processes’ and ‘initiating emergency care’ emerged across the categories of patient satisfaction, experience, perceptions, understanding and expectations of triage.

Conclusion: Preliminary results reinforce that patient experience can be impacted by wait times, the provision of information and interactions with staff, and highlight the challenge of aligning patient understanding, expectations, perceptions, satisfaction, and experience of ED triage.

Introduction: In Australia, the number of cancer cases has doubled since 1991 and is the second most common cause of death. Chemotherapy a common treatment of cancer is known to cause distressing symptoms which often lead to a person presenting to an emergency department.
The aim of this study was to investigate whether a Nurse Practitioner led model of care could improve cancer service integration and reduce hospital presentations.
Method: This was an evaluation study of a new model of care that included i) telephone helpline; ii) urgent assessment clinic; iii) rapid day treatment consultation service.
Results: The utilisation rate was 337 telephone calls involving 157 patients. The most common reason for calling the helpline was for symptom management (n=173:51%), followed by education regarding treatment (n=61:18%). All of the calls that were given a orange triage code were for symptom management (n=31). As a result of calling the helpline, 49% (n=165) of callers were given advice, information or education, 22% (n=74) were referred on to other healthcare providers and 11% (38) were admitted. Of the 38 patients that were admitted, 9 were admitted directly from the urgent NP led assessment clinic bypassing the ED.
Conclusion: The implementation of the NP led model of care has made a significant difference to and for oncology patients, reduced ED presentations, optimised symptom management, and standardized telephone helpline processes for adult medical oncology patients and families.