DSpace Collection:https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/6762026-05-23T01:27:13Z2026-05-23T01:27:13ZEvaluating the Rate of Emergency Department Avoidance Achieved in a Collaboration Between an Ambulance and Virtual Care Service: A Retrospective Observational StudyLumsden, C.Maitland, L.Rossiter, R.Chung, S.https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/7092026-04-23T06:00:52Z2026-02-01T00:00:00ZTitle: Evaluating the Rate of Emergency Department Avoidance Achieved in a Collaboration Between an Ambulance and Virtual Care Service: A Retrospective Observational Study
Authors: Lumsden, C.; Maitland, L.; Rossiter, R.; Chung, S.
Abstract: Objective: To evaluate whether a collaboration between Mid-North Coast Virtual Care (MNCVC) and NSW Ambulance (NSWA) was effective in diverting ED transfers.
Methods: A retrospective observational study over 30 months examined NSWA referrals to MNCVC. Referral characteristics, 7-day and 28-day ED presentations were analysed. ED avoidance was defined as an accepted referral without an ED presentation within 28 days.
Results: Of 629 referrals, 542 (86%) were accepted for management. ED presentations occurred in 53 (9.8%) within 7-days and 130 (24.0%) within 28-days, resulting in a 76% (412 patients) ED avoidance rate over 30 months.
Conclusions: An ambulance-diversion model to a virtual-care service showed a favourable ED avoidance rate.
Keywords: ambulance diversion; emergency medicine; retrospective study; triage; virtual care.2026-02-01T00:00:00ZEmergency Department Presentations for Low Back Pain by Remoteness and Socioeconomic Status in New South Wales: A Population-Based StudyNorth, J.Michaleff, Z. A.Lee, M.Williams, C.Stephens, A. S.https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/6912026-01-28T05:34:42Z2025-08-01T00:00:00ZTitle: Emergency Department Presentations for Low Back Pain by Remoteness and Socioeconomic Status in New South Wales: A Population-Based Study
Authors: North, J.; Michaleff, Z. A.; Lee, M.; Williams, C.; Stephens, A. S.
Abstract: Objective: To explore the patterns of emergency department (ED) presentations for low back pain (LBP) by remoteness and socioeconomic status (SES) in New South Wales (NSW).
Methods: A retrospective, population-based study of deidentified data was undertaken with data sourced from the NSW Emergency Department Data Collection (EDDC). The study population comprised NSW residents who presented to an NSW public hospital ED in 2013-2019 for LBP and were registered in the NSW EDDC. Total LBP ED presentations, quasi-Poisson regression modelled annual changes in LBP ED presentations over 2013-2019, and age and sex-standardised rates of ED presentations in 2019 were assessed.
Results: Overall, between 2013 and 2019, LBP ED presentations increased in both metropolitan and rural NSW, with mean annual percentage increases of 3.5% (95% CI 2.9-4.0) and 4.7% (95% CI 3.6-5.9), respectively. Rates of LBP ED presentations increased with decreasing SES in both metropolitan and rural areas. Rates of LBP ED presentations were higher in rural areas compared to metropolitan NSW across all SES quintiles.
Conclusions: Remoteness and SES were independently associated with rates of LBP ED presentations. Further research on the underlying causal mechanisms linking rates of LBP to each of these key sociodemographic factors is warranted. Elucidating these mechanisms would provide crucial information to inform strategies to reduce the rates and impacts of LBP presentations in EDs and help counteract social determinants of health.2025-08-01T00:00:00ZPredictive Validity of Violence Screening Tools in Emergency and Psychiatric Services: A Systematic ReviewKamarova, S.Davidson, S. R. E.Williams, C. M.Leite, M.Kamper, S. J.https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/6832026-01-28T05:35:35Z2025-08-17T00:00:00ZTitle: Predictive Validity of Violence Screening Tools in Emergency and Psychiatric Services: A Systematic Review
Authors: Kamarova, S.; Davidson, S. R. E.; Williams, C. M.; Leite, M.; Kamper, S. J.
Abstract: Violence against healthcare staff, including a threat or an act of violence toward people during their work, poses a physical and psychological risk to workers internationally. Screening is an important strategy in preventing violence against healthcare professionals. The aim of this systematic review was to synthesize evidence on the predictive validity of risk assessment tools used to screen for violence and aggression risk toward healthcare workers in emergency and psychiatric departments (PD). Primary studies that examined the predictive validity of risk assessment tools for workplace violence were identified via a systematic search of Medline, PsycINFO, Embase, and the Cochrane databases. There were 62 eligible studies, ten of which had a lower risk of bias (RoB). Those studies with high RoB were primarily due to a failure to present calibration measures as part of the analysis. All included studies adopted a longitudinal design and were conducted in PDs. The ten highest-quality studies reported on eight different instruments, four of which showed acceptable to outstanding predictive performance. The Dynamic Appraisal of Situational Aggression and the Brøset Violence Checklist showed the best predictive performance; they were also validated in emergency departments and are best suited for short-term risk prediction. We recommend that the selection of a risk assessment tool should consider the following: (a) the target population, (b) the violence operationalization, and (c) the purpose of the monitoring. We note that the use of a screening tool should be a part of a multicomponent strategy to ensure staff safety.2025-08-17T00:00:00ZImpact of strategies to improve flow and lower hospital admissions for low back pain in the emergency department: an interrupted time-series analysisDavidson, S. R. E.Kamper, S.Haskins, R.Petkovic, D.Feenan, N.Smith, D.O'Flynn, M.Pallas, J. D.Donald, B.Smiles, J. P.Machado, G.Oldmeadow, C.Williams, C. M.https://mnclhd.intersearch.com.au/mnclhdjspui/handle/123456789/6772026-01-28T05:35:25Z2025-10-01T00:00:00ZTitle: Impact of strategies to improve flow and lower hospital admissions for low back pain in the emergency department: an interrupted time-series analysis
Authors: Davidson, S. R. E.; Kamper, S.; Haskins, R.; Petkovic, D.; Feenan, N.; Smith, D.; O'Flynn, M.; Pallas, J. D.; Donald, B.; Smiles, J. P.; Machado, G.; Oldmeadow, C.; Williams, C. M.
Abstract: Background: Low back pain (LBP) is a common, disabling condition that often results in presentation to the emergency department (ED). There is currently a paucity of research examining how to optimise care for this patient group and concurrently improve service efficiency. We assessed the impact of a suite of co-designed strategies to improve the flow and reduce admission rate of people with LBP presenting to the ED.
Methods: A quasi-experimental implementation science study in a 30-bed ED at an Australian tertiary referral hospital. We implemented four improvement strategies: (1) co-design and development of a local ED guideline, (2) patient handout, (3) clinician education programme and (4) rapid-access physiotherapy follow-up clinic. We included all ED presentations from patients ≥16 years old, with a final diagnosis of LBP. Using an interrupted time series analysis, we compared a pre-implementation phase (July 2014-December 2019), a transition phase (July 2020-February 2021) and a post implementation phase (March 2021-November 2021). Our primary outcome was the proportion of patients admitted to hospital, in each phase. Secondary outcomes included ED length of stay (LOS), ED presentation cost, re-presentations within five days, admission LOS and outcome measures for those patients who attended the rapid-access physiotherapy clinic.
Results: There were 5301 LBP presentations pre-implementation, 752 during transition and 732 post implementation. The mean age of patients was 50.3 (20.1) years, 53% were female and 6.5% identified as Aboriginal and/or Torres Strait Islander. We observed a small reduction (2%) in the proportion of admissions per month (post implementation vs pre-implementation slope difference 0.98 ((95% CI 0.928 to 1.035), p=0.467) and a monthly decrease of 1.5 min in the average ED LOS for these patients (post implementation vs pre-implementation slope difference -1.5 ((95% CI -8.1 to 5.1), p=0.653) which was not statistically significant. 121 patients were referred to the follow-up physiotherapy clinic, and 41% attended an appointment.
Conclusion: The improvement strategies did not significantly reduce admissions or LOS for people with LBP presenting to the ED, and based on the CIs, we cannot exclude that these increased.2025-10-01T00:00:00Z