improving the structure and function of clinical handover

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orted by emergency department (ED) staff, as a strategyo enhance the health response capacity.

This study was undertaken retrospectively to profileatients presenting to the IAC and ED with influenza-likeymptoms (ILS), and test the relationships that influencedhis collaboration. This study was descriptive in naturesing an existing patient information system as a means ofata collection. The patient sample for this study includedresentations with ILS to the IAC or ED during the IAC oper-tional period; 3 June 2009—3 July 2009.

A total of 1106 patients presented with ILS duringhe study period, 967 (87.4%) during the IAC opera-ional times (0900—1700). Patients who presented to theD were younger than those who presented to the IACp = 0.001). A higher proportion of patients presented inhe morning period (0900—1300) (p < 0.0005). There were aigher proportion of discharges from the ED than expectedp < 0.0005).

With most patients presenting in the morning period,his has staffing and resource implications. Triage processesnd guidelines should be enhanced to stream patientsccording to their likely disposition. A sustainable IACike model should be implemented to support situationshere increased ED patient presentations are experiencedr expected. The results of this study have staffing andesource implications, in order to enhance the ED responseapacity.

eywords: H1N1; Influenza; Emergency; Patient presenta-ion; Response; Influenza assessment clinic; Fever clinic

oi:10.1016/j.aenj.2010.08.320

-VITALafety and Quality 5C

mproving the structure and function of clinical handover

on Wilson

Sydney South West Area Health Service, C/- Emergencyepartment Campbelltown Hospital, Therry Rd., Campbell-own, NSW 2560, Australia

-mail address: ron.wilson@sswahs.nsw.gov.au.

Issues were identified whereby the clinical handover pro-ess either contributed to or failed to identify or screen forlinical risk (missed, duplicated, incorrect medication; lackf recognition of an unwell patient; lack of reference toesults and complaints initiated a change in handover tech-ique) A systematic process was developed to assist staffith information transfer and risk reduction. The clinicalandover was moved to the bedside with patient sightingnd staff introduction. Confirmation occurs with the clinicallan and covers the presentation, observations, medica-ions, treatments, plan and documentation. The aim was toevelop a reliable, safe and systematic process for clinicalandover that was easy to use, transportable and measur-

The implementation of the P-VITAL process together withbedside handover would be established within the ED and

upported by education, policy, audit and evaluation.

sAsrs

Conference Abstracts

The clinical file was to be used during handover, andisualisation with confirmation would occur with handover.he patient would be orientated to the oncoming shift ande informed that a hand over process was in progress. Therocess was audited.

All handovers occurred at the bedside with the clinicalle addressing elements of P-VITAL. The handover eval-ation discovered potential for or actual error. The newandover process may have contributed to a reduction inlinical errors and patient complaints.

A patient survey was implemented. This assisted withonfirmation that the new handover process was both estab-ished into the department and was well accepted byatients and their families.

eywords: Clinical handover; P-VITAL; Patient satisfaction

oi:10.1016/j.aenj.2010.08.321

utcome of emergency department patients with non-raumatic hypotension

eter Chenga, DeVilliers Smita, Julie Considine, Graemeukec

Emergency Department, The Northern Hospital, Northernealth, 185 Cooper St., Epping, Victoria, AustraliaDeakin University-Northern Health Clinical Partnership,/- School of Nursing, Deakin University, 221 Burwood Hwy,urwood, Victoria 3125, AustraliaCritical Care Department, The Northern Hospital, North-rn Health. 185 Cooper St., Epping, Victoria, Australia

-mail addresses: peter.cheng@nh.org.au (P. Cheng),evilliers.smit@nh.org.au (D. Smit),ulie.considine@deakin.edu.au, julie.considine@nh.org.auJ. Considine), graeme.duke@nh.org.au (G. Duke).

Hypotension is a known predictor of mortality and mor-idity in Emergency Department (ED) patients. The aimf this study is to determine the mortality, length of staynd outcomes in a cohort of emergency department (ED)atients with non-traumatic hypotension. A prospectivebservational design was used. The study was conductedt The Northern Hospital, a 325-bed urban district teach-ng hospital with 45,000 adult ED presentations a year.atients over 18 years old with non-traumatic hypoten-ion defined as systolic blood pressure below 100 mm Hgere recruited based on observations collected during their

tay in emergency department by a dedicated researchssistant. Patients with a history of trauma relating tohe presenting complaint were excluded. The main out-ome measures were 28-day mortality rates, ICU admissions,ength of stay, rates of representation and Medical Emer-ency Team (MET) calls. A total of 91 ED patients withocumented hypotension were enrolled: 70.4% were admit-ed to hospital. Hypotension was categorised by durations: (i) single, (ii) recurrent, (iii) sustained or (iv) sustainedrolonged hypotension. All patients survived beyond ED