Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.

Objective: To estimate the proportion of ED patients in urban Queensland who are potentially suitable for general practitioner (GP) care. Methods: A retrospective analysis was conducted using ED Information System data from Metro North Hospital and Health Service in Brisbane, Australia for three consecutive financial years (2014-2015 to 2016-2017). The hospitals included two Principal Referral and two Public Acute hospitals. GP-type patients were calculated using the Australian Institute of Health and Welfare (AIHW), Australasian College for Emergency Medicine (ACEM) and the validated Sprivulis methods. Results: Of the 822 841 ED presentations, 219 567 (27%) were potentially GP-type patients by AIHW, 49 307 (6%) by ACEM and 61 836 (8%) by Sprivulis methods. The higher proportion of GP-type presentations were during 08.00 to 17.00 hours by AIHW and ACEM methods. Of the loweracuity triage categories of 4 (286 154 presentations) and 5 (5658 presentations), AIHW estimated that 62% and 80% of the patients were GP-type patients, as compared to 9% and 22% by ACEM, and 9% and 0.3% by Sprivulis method. The mean costs of adult GP-type patients is $345 by the AIHW and $406 by the ACEM method, lower than non-GP type patients ($706 and $622, respectively). Conclusions: There is considerable variation in what is considered GPtype ED presentations based on the three methods employed and this variation may have fuelled the debate surrounding what is 'avoidable' ED utilisation. Regardless, the study findings provide an interesting addition to defining and addressing appropriate utilisation of ED services.

Objective To validate the accuracy and safety of the Canadian Syncope Risk Score (CSRS) for patients presenting with syncope. Methods Single centre prospective observational study in Brisbane, Australia. Adults presenting to the ED with syncope within the last 24 h were recruited after applying exclusion criteria. Study was conducted over 1 year, from March 2018 to March 2019. Thirty‐day serious adverse events (SAE) were reported based on the original derivation study and standardised outcome reporting for syncope. Individual patient CSRS was calculated and correlated with 30‐day SAE and disposition status from ED. Results Two hundred and eighty‐three patients were recruited to the study. Average age was 55.6 years (SD 22.7 years), 37.1% being male with a 39.9% admission rate. Thirty‐day SAE occurred in seven patients (2.5%) and no recorded deaths. The CSRS performed with a sensitivity of 71.4% (95% confidence interval [CI] 30.3–94.9%), specificity 72.8% (95% CI 67.1–77.9%) for a threshold score of 1 or higher. Conclusion Syncope patients in our study were predominantly very low to low risk (72%). The prevalence of 30‐day SAE was low, majority occurring following hospital discharge. Sensitivity estimates for CSRS was lower than the derivation study but lacked robustness with wide CIs because of a small sample size and number of events observed. However, the CSRS did not miss any clinically relevant outcomes in low risk patients making it potentially useful in aiding their disposition. Larger validation studies in Australia are encouraged to further test the diagnostic accuracy of the CSRS.

NEAT has been a driver of significant improvements in access block at our institution. We see significant issues with raising the NEAT threshold to the proposed 90% in 2015, and support recent calls for re-evaluation and modification of the target.

Study questionOur primary objective is to validate the utility and safety of the Canadian Syncope Risk Score (CSRS) as a clinical decision rule when assessing patients who present with syncope to Australian emergency departments (EDs). Our secondary objective is to evaluate the economic benefits of diverting patients who are at low risk of serious adverse events from admission to hospital. TimetablePhase one of the study will be conducted during March 2018 -March 2019 at the ED of Redcliffe Hospital, an outer metropolitan hospital near Brisbane, which receives 65 000 ED presentations each year. MethodsThis protocol describes phase one of a two-phase validation study. Phase one is an observational prospective validation study. Patients aged 18 or more who present to the ED with syncope, defined as a transient loss of consciousness followed by prompt recovery within the preceding 24 hours, will be recruited as participants. Patients are excluded if they have prolonged syncope (longer than 5 minutes) or persistent reduction in Glasgow Coma Scale (GCS) score, an obvious seizure, intoxication, inability to communicate in English, or major trauma requiring hospitalisation. The study is designed to not influence patient management, with the decision regarding ultimate patient disposition remaining at the discretion of the treating clinician. Demographic and clinical information required to satisfy the domains of the CSRS will be prospectively recorded by the treating clinician, and the CSRS will be calculated retrospectively. Patients will be contacted by telephone 30 days after their initial presentation to the ED for information about any subsequent adverse events.We will undertake a cost-effectiveness analysis from the health care perspective, comparing usual care and applying the CSRS to identify patients at low risk of adverse events who can be safely discharged from the ED instead of being admitted to hospital for further evaluation. Health care costs, including those associated with inpatient stay and admission-related resource use, will be collected from routine administrative databases. Statistical analysisAs phase one is an observational validation study, no formal sample size calculation is required, but we aim to recruit about 500 eligible patients over the one-year period. Data will be summarised as means with standard deviations, medians with interquartile ranges, or frequencies and percentages as appropriate. The diagnostic utility of the CSRS will be assessed by estimating its specificity, sensitivity, positive and negative predictive values, and the area under the receiver operating characteristic (ROC) curve.Parameters included in the economic model will be informed by the collected study data. The outcome of interest is the number of inpatient admissions avoided, with results being presented as costs saved per avoided admission. Health care costs will be included in the economic model and analysed with previously published methods. The results of the economic analysis will be presented as incremental ...

Objectives: Demand for ED care is increasing at a rate higher than population growth. Strategies to attenuate ED demands include diverting low-acuity general practice-type ED attendees to alternate primary healthcare settings. The present study assessed the ED attendees' receptiveness to accept triage nurse's face-to-face advice to explore alternate options for medical care and what factors influence the level of acceptance. Methods: The ED attendees of four major public hospital EDs in Brisbane were surveyed between August and October 2018, using a questionnaire informed by Health Belief Model's cues to action. Results: Of the 514 valid responses, 81% of respondents were very likely/ likely to accept the triage nurse's advice to see a general practitioner. Selfperceived urgency of presenting condition/s (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78-0.97), not having confidence in general practitioner (OR 0.37, 95% CI 0.21-0.66) and having a medical record at the hospital (OR 0.60, 95% CI 0.36-0.99) were negatively associated with the likelihood of accepting the advice. For every point increase in perceived seriousness, the odds of accepting the advice decreased by 16% (95% CI 6-25%). Conclusion: Most of the participants believed that EDs were for emergent care and they attended the ED because they perceived their presenting condition/s to be serious and/or urgent. The acceptability of face-to-face advice by triage nurse to seek help in general practice was influenced by perceived threats of the illness, and the underlying beliefs about availability, accessibility, suitability and affordability of the service.

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Objective To inform local, state and national strategies intended to reduce demand for ED care, the present study aimed to identify key factors influencing the current provision of acute care within primary healthcare (PHC) and explore the policy and system changes potentially required. Methods Semi‐structured interviews with key stakeholders were audio‐recorded, transcribed verbatim and analysed through content and thematic approaches incorporating the Walt and Gilson health policy framework. Results Eleven interviews were conducted. Five key considerations were highlighted, namely the barriers and enablers for general practitioners (GPs) in providing acute care, barriers to patient use of PHC instead of ED, suggestions for new PHC models and improvements for current ED models. Additionally, economic issues relating to clinic funding and GP remuneration, complexities of state or federal funding and management of urgent care centres (UCC) were identified. Potential policy changes included GP clinics incorporating emergency appointments, GP triage, further patient streaming and changes to the ED medical workforce model, as well as linking hospitals with PHC clinics. Suggested system changes included improving rapid access to non‐GP specialists, offering qualifications for urgent care within PHC, developing integrated information technology systems and educating patients regarding appropriate healthcare system pathways. Conclusion The present study suggested that while PHC has the potential to attenuate the demands for ED services, a whole‐of‐system approach focusing on realignment of priorities and integrated changes are needed.