A whole-of-health system approach to improving care of frail older persons.

The population is aging, with frailty emerging as a significant risk factor for poor outcomes for older people who become acutely ill. We describe the development and implementation of the Frail Older Persons' Collaborative Program, which aims to optimise the care of frail older adults across healthcare systems in Queensland. Priority areas were identified at a co-design workshop involving key stakeholders, including consumers, multidisciplinary clinicians, senior Queensland Health staff and representatives from community providers and residential aged care facilities.

A multimodal intervention to optimise antimicrobial use in residential aged care facilities (ENGAGEMENT): protocol for a stepped-wedge cluster randomised trial.

Background: Inappropriate antibiotic use can cause harm and promote antimicrobial resistance, which has been declared a major health challenge by the World Health Organization. In Australian residential aged care facilities (RACFs), the most common indications for antibiotic prescribing are for infections of the urinary tract, respiratory tract and skin and soft tissue. Studies indicate that a high proportion of these prescriptions are non-compliant with best prescribing guidelines.

Retrospective identification of latent subgroups of emergency department patients: A machine learning approach.

Objective: This research aims to (i) identify latent subgroups of ED presentations in Australian public EDs using a data-driven approach and (ii) compare clinical, socio-demographic and time-related characteristics of ED presentations broadly using the subgroups.

Methods: We examined presentations to four public hospital EDs in Queensland from 2009 to 2014. An unsupervised machine learning algorithm, Clustering Large Applications, was used to cluster ED presentations.

Identifying and quantifying general practice-type emergency department presentations.

Objective: This research aims to (i) identify general practice-type (GP-type) presentations to EDs in South-East Queensland, Australia and (ii) compare and quantify the clinical, socio-demographic and time-varying characteristics between GP-type and non-GP-type presentations.

Methods: Data were collected from presentations to four EDs in Queensland from 2009 to 2014. A modified version of the Australasian College for Emergency Medicine (ACEM) method for identifying GP-type ED presentations was used.

Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine.

Introduction: The global pandemic of coronavirus disease 2019 (COVID-19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID-19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations.

Forecasting daily counts of patient presentations in Australian emergency departments using statistical models with time-varying predictors.

Objective: This research aimed to (i) assess the effects of time-varying predictors (day of the week, month, year, holiday, temperature) on daily ED presentations and (ii) compare the accuracy of five methods for forecasting ED presentations, including four statistical methods and a machine learning approach.

Methods: Predictors of ED presentations were assessed using generalised additive models (GAMs), generalised linear models, multiple linear regression models, seasonal autoregressive integrated moving average models and random forest. The accuracy of short-term (14 days), mid-term (30 days) and long-term (365 days) forecasts were compared using two measures of forecasting error.

Diagnosis of urinary tract infection in older persons in the emergency department: To pee or not to pee, that is the question.

Doreen is a 79-year-old woman referred by her general practitioner to the ED for intravenous antibiotics for a urinary tract infection (UTI). She lives in a residential aged care facility (RACF) and staff report malodourous and cloudy urine. She denies dysuria or frequency.

Comparative emergency department resource utilisation across age groups.

Objectives The aim of the present study was to assess comparative emergency department (ED) resource utilisation across age groups. Methods A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess comparative ED resource utilisation across six age groups (0-14, 15-35, 36-64, 65-74, 75-84 and ≥85 years) with previously used surrogate markers of ED resource utilisation. Results Older people had significantly higher resource utilisation for their individual ED episodes of care than younger people, with the effect increasing with advancing age.

Quality indicators in the care of older persons in the emergency department: A systematic review of the literature.

Objective: A systematic review of the literature was undertaken to assess the methodological quality of existing quality indicators (QIs) for the emergency department (ED) care of older persons.

Methods: MEDLINE, CINAHL, EMBASE and grey literature were searched. Articles were included if they addressed ED care of persons aged ≥65 years and defined a QI amenable to influence by ED providers.

Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change.

Objectives The aim of the present study was to describe trends in and age and gender distributions of presentations of older people to Australian emergency departments (EDs) from July 2006 to June 2011, and to develop ED utilisation projections to 2050. Methods A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess trends in ED presentations. Three standard Australian Bureau of Statistics population growth models, with and without adjustment for current trends in ED presentation growth and effects of climate change, were examined with projections of ED presentations across three age groups (0-64, 65-84 and ≥85 years) to 2050.

Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study.

Objective: The objective of this paper is to describe the profile of older people with cognitive impairment (CI) presenting to emergency departments (EDs).

Methods: This was a multi-centre (n=8) observational study of a convenience sample of older (≥70y) ED patients (n=579). Participants were prospectively assessed for CI and surveyed for the duration of their ED stay (n=191).

CARE-PACT: a new paradigm of care for acutely unwell residents in aged care facilities.

Background: Ageing population trends create a strong imperative for healthcare systems to develop models of care that reduce dependence on hospital services. People living in residential aged care facilities (RACFs) currently have high rates of presentation to emergency departments. The care provided in these environments may not optimally satisfy the needs of frail older persons from RACFs.

Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments.

Objectives: The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED).

Methods: A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment.

Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments.

Objectives: The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs).

Methods: A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e.

A comparative analysis of risk stratification tools for emergency department patients with chest pain.

Background: Appropriate disposition of emergency department (ED) patients with chest pain is dependent on clinical evaluation of risk. A number of chest pain risk stratification tools have been proposed. The aim of this study was to compare the predictive performance for major adverse cardiac events (MACE) using risk assessment tools from the National Heart Foundation of Australia (HFA), the Goldman risk score and the Thrombolysis in Myocardial Infarction risk score (TIMI RS).