Public health in Australasian emergency departments: Attitudes, barriers and current practices

Abstract

Objective: To understand the attitudes of consultant emergency medicine physicians and advanced trainees and the perceived barriers to public health interventions in Australasian EDs. Methods:This was a voluntary crosssectional, mixed-methods online survey of consultant emergency physicians and advanced trainees of the ACEM, conducted between December 2011 and March 2012. Results: Eight hundred and fifty-six ACEM members responded to the survey -a response rate of 33%. A similar number of consultants (70%) and trainees (75%) believed public health initiatives should be provided in the ED. Barriers identified by a similar majority of consultants and trainees to the implementation of public health interventions in EDs included dedicated time available for staff to be involved; available public health resources; available funding; clinical staff skills and expertise in public health; and the availability of staff training. Conclusions: Public health and health promotion are perceived by the majority of emergency medicine physicians as important in emergency medicine; however, substantial barriers exists to their implementation. Development of an evidence-based approach to public health interventions, which are effective and feasible in the ED environment, will facilitate a more comprehensive approach to public health initiatives in emergency medicine.

Review article: Effectiveness of ultra‐brief interventions in the emergency department to reduce alcohol consumption: A systematic review

“…Studies that utilised existing ‘standard care’ were as likely to show benefit from an ultra‐BI as those with a contrived control group. It is likely that current ‘standard care’ does not routinely include provision of even a pamphlet to at‐risk drinkers . The studies that have used ED clinicians have resulted in a significant loss to follow up in addition to a high rate of refusal .…”

“…In the USA, since 2007, it has been mandatory for all level 1 Trauma Centres to offer SBIRT to all patients . A recent survey of Australasian Emergency Physicians indicates broad support for public health and health promotion in ED, impeded by significant barriers including lack of resources and time …”

“…The demand of the ED service commitment and introduction of time‐based performance targets makes lengthy interventions by the ED clinicians unfeasible. Ultra‐BIs of less than 10 min duration or using technology may offer a pragmatic approach overcoming barriers that clinicians have identified …”

“…6 A recent survey of Australasian Emergency Physicians indicates broad support for public health and health promotion in ED, impeded by significant barriers including lack of resources and time. 7 Although evidence exists for the effectiveness of brief interventions (BIs) for alcohol problems in the inpatient and primary care settings, 8 it is unclear how this translates to the ED setting. 9 commitment and introduction of timebased performance targets makes lengthy interventions by the ED clinicians unfeasible.…”

An example of public health training in emergency medicine

“…Similar expectations for public health‐related competencies are found in the American Board and the Royal College of Emergency Medicine curriculums . Moreover, a previous study showed that a majority of Australasian Emergency Physicians and trainees believe that specific public health training is necessary …”