Supporting adoption of the palliative approach toolkit in residential aged care: an exemplar of organisational facilitation for sustainable quality improvement.

: National guidelines and resources to support a palliative approach in residential aged care were designed to improve the provision of palliative and end-of-life care; however, implementation has been sporadic.: To support implementation of a palliative approach in aged care using a facilitation training model and existing palliative approach toolkit resources.: Organisation-wide educational intervention delivered by a specialised Palliative Approach Facilitator for 6 months.

The appropriateness of low-acuity cases referred for emergency ambulance dispatch following ambulance service secondary telephone triage: A retrospective cohort study.

Objective: Ambulance-based secondary telephone triage systems have been established in ambulance services to divert low-acuity cases away from emergency ambulance dispatch. However, some low-acuity cases still receive an emergency ambulance dispatch following secondary triage. To date, no evidence exists identifying whether these cases required an emergency ambulance.

Patient and case characteristics associated with 'no paramedic treatment' for low-acuity cases referred for emergency ambulance dispatch following a secondary telephone triage: a retrospective cohort study.

Background: Predicting case types that are unlikely to be treated by paramedics can aid in managing demand for emergency ambulances by identifying cases suitable for alternative management pathways. The aim of this study was to identify the patient characteristics and triage outcomes associated with 'no paramedic treatment' for cases referred for emergency ambulance dispatch following secondary telephone triage.

Methods: A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch following secondary telephone triage between September 2009 and June 2012.

Epidemiology of unplanned out-of-hospital births attended by paramedics.

Background: Over the previous two decades the incidence and number of unplanned out of hospital births Victoria has increased. As the only out of hospital emergency care providers in Victoria, paramedics would provide care for women having birth emergencies in the community. However, there is a lack of research about the involvement of paramedics provide for these women and their newborns.

Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study.

Objective: To investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage.

Design: A pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage.

Setting: The secondary telephone triage service, called the Referral Service, and the hospitals were located in metropolitan Melbourne, Australia and operated 24 hours a day, servicing 4.

Differences in emergency ambulance demand between older adults living in residential aged care facilities and those living in the community in Melbourne, Australia.

Objective: To describe the clinical presentation and temporal variation in ambulance service cases involving patients aged 65 years or older (older adults) from residential aged care facilities and those who are community dwelling (CD).

Methods: This study used four years of electronic case records from Ambulance Victoria in Melbourne, Australia. Trigonometric regression was used to analyse demand patterns.

Supporting a good life and death in residential aged care: an exploration of service use towards end of life.

Background: The concept of a 'good death' involves end-of-life care in an appropriate setting and in keeping with the person's preferences. Limited research has examined the circumstances and place of death for older people living in residential aged care.

Objective: This exploratory study investigated the nature of health service use and place of death of older people living in aged care to identify factors that lead to transfer of end-of-life care to other settings and poorer outcomes.

The rhetoric and reality of nursing in aged care: views from the inside.

Background: Aged care services and nursing roles are evolving in response to policy reform and increasing consumer expectations, however the nursing workforce is declining in numbers.

Aims: To examine registered nurses' perceptions and experiences of working in aged care.

Methods: Descriptive, exploratory study involving thematic analysis of individual interviews.

Utilisation of emergency medical services for severe hypoglycaemia: An unrecognised health care burden.

Aims: Diabetes is associated with several acute, life-threatening complications yet there are limited data on the utilisation of prehospital services for their management. This study aimed to examine the utilisation of emergency medical services (EMS) for prehospital hypoglycaemia, including patient characteristics and factors related to hospital transportation.

Methods: An observational study of patients requiring EMS for hypoglycaemia across Victoria, Australia over three years was conducted.

Information management in the Australian aged care setting.

Background: Information management systems and processes have an impact on quality and safety of care in any setting and particularly in the complex care setting of aged care. Few studies have comprehensively examined information management in the Australian aged care setting.

Objective: To (i) critically analyse and synthesize evidence related to information management in aged care, (ii) identify aged care data collection frameworks and (iii) identify factors impacting information management.

Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

Background: Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes.

Antenatal Emergency Care Provided by Paramedics: A One-Year Clinical Profile.

Objective: To report on clinical and socio-demographic factors of a one-year caseload of women attended by a statewide ambulance service in Australia, who presented during pregnancy, prior to the commencement of labor.

Methods: Retrospective clinical data collected via in-field electronic patient care record (VACIS®) by paramedics during clinical management was provided by Ambulance Victoria. Cases were electronically extracted from the Ambulance Victoria Clinical Data Warehouse via comprehensive filtering followed by case review.

Temporal trends in falls cases seen by EMS in Melbourne: The effect of residence on time of day and day of week patterns.

Background: Injury due to falls is a major public health problem, especially for older people. We aimed to determine the accuracy of the ambulance call taker triage algorithm relative to paramedic assessment, and characterise variation in ambulance service demand for falls cases involving older adults over time and by residence type.

Method: We obtained all ambulance case records for January 2008 to December 2011 for adults aged 65 or over in Melbourne, Australia.

A novel approach for managing the growing demand for ambulance services by low-acuity patients.

Objective The aim of the present study was to describe the Ambulance Victoria (AV) secondary telephone triage service, called the Referral Service (RS), for low-priority patients calling triple zero. This service provides alternatives to ambulance dispatch, such as doctor or nurse home visits. Methods A descriptive epidemiological review of all the cases managed between 2009 and 2012 was conducted, using data from AV case records, the Victorian Admitted Episodes Dataset and the Australian Bureau of Statistics.

Developing an Australian health and aged care research agenda: a systematic review of evidence at the subacute interface.

Objective The aim of the present study was to systematically review articles describing recent interventions that aimed to improve access and outcomes for older people at the interface between health and aged care, with a focus on subacute care programs of palliative care, rehabilitation, geriatric evaluation and management (GEM) and psychogeriatrics. Methods Australian studies published between 2008 and 2013were evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and National Health and Medical Research Council of Australia (NHMRC) guidelines. Included studies were summarised according to focus areas and results discussed in the current Australian subacute health care context.

General practice and residential aged care: A qualitative study of barriers to access to care and the role of remuneration.

Background: More than 169,000 people live in residential aged care facilities (RACFs). As people age they use health services, particularly general practitioner (GP) services, more frequently but many GPs do not attend patients in RACFs.

Aims: To examine GPs' perceptions of barriers to providing care to patients in RACFs.

Temporal trends in cardiovascular demand in EMS: Weekday versus weekend differences.

Diagnosed cardiovascular disease has well-reported temporal patterns, with demand distribution peaks in the late morning and greater case numbers on Mondays and in winter. We aimed to report temporal patterns of presumptive cardiovascular disease cases as determined after emergency medical services (EMS) assessment and to characterize the demand distribution by day of the week. We conducted a secondary analysis of all Ambulance Victoria cases in metropolitan Melbourne (Victoria, Australia) between January 2008 and December 2011.

Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia.

Background: People with the cardiac arrhythmia supraventricular tachycardia (SVT) frequently present to clinicians in the prehospital and emergency medicine settings. Restoring sinus rhythm by terminating the SVT involves increasing the refractoriness of atrioventricular nodal tissue within the myocardium by means of vagal manoeuvres, pharmacological agents, or electrical cardioversion. A commonly used first-line technique to restore the normal sinus rhythm (reversion) is the Valsalva Manoeuvre (VM).

Time of Day and Day of Week Trends in EMS Demand.

Objective: We examined temporal variations in overall Emergency Medical Services (EMS) demand, as well as medical and trauma cases separately. We analyzed cases according to time of day and day of week to determine whether population level demand demonstrates temporal patterns that will increase baseline knowledge for EMS planning.

Methods: We conducted a secondary analysis of data from the Ambulance Victoria data warehouse covering the period 2008-2011.

Victorian paramedics' encounters and management of women in labour: an epidemiological study.

Background: Although it is generally accepted that paramedics attend unexpected births, there is a paucity of literature about their management of women in labour. This study aimed to investigate the caseload of women in labour attended by a statewide ambulance service in Australia during one year and the management provided by paramedics.

Methods: Retrospective clinical data collected on-scene by paramedics via in-field electronic patient care records were provided by Ambulance Victoria.

Ethics in Evaluating a Sociotechnical Intervention With Socially Isolated Older Adults.

The purpose of this article is to consider how ethical principles can inform the effective design and implementation of technology-based interventions that aim to promote the well-being of socially isolated older adults. We evaluated a new iPad application with small groups of older adults. In this article, we reflect on the ethical issues encountered at each stage of the research process.

Measuring the effectiveness of a revised clinical practice guideline for the pre-hospital management of supraventricular tachycardia.

Objective: To evaluate the effect of changes to the pre-hospital management of patients with supraventricular tachycardia (SVT) following intervention with a revised Clinical Practice Guideline (CPG). The major CPG revisions were removal of verapamil, addition of adenosine and an emphasis on Valsalva manoeuvre.

Method: We undertook a retrospective case study using data collected by paramedics.

Prehospital management of supraventricular tachycardia in Victoria, Australia: epidemiology and effectiveness of therapies.

Objective: The present study examined patient demographics, characteristics and the effectiveness of current prehospital supraventricular tachycardia (SVT) management by ambulance paramedics in Victoria, Australia.

Method: We conducted a retrospective study of all Victorian patients attended by paramedics between 14 February 2012 and 13 February 2013, where SVT was the initial or final diagnosis. Patients were excluded if SVT was not captured on ECG, incomplete data were recorded, or SVT began after initial assessment.

Identification of the optimum vagal manoeuvre technique for maximising vagal tone.

Objectives: This study sought to determine the most effective technique for Valsalva Manoeuvre (VM) and Human Dive Reflex Manoeuvre (HDR) generation of vagal tone.

Methods: We conducted a repeated-measures trial of healthy adult volunteers from a university campus, aged 18-56 years, in sinus rhythm. Participants were randomised to VM (in supine or Trendelenberg postures) and HDR (supine or sitting postures) sequentially.