Welcome to the Spring 2017 Edition of the Emergency Care Institute (ECI) Newsletter. This edition includes updates to the NDEC program; ECI visits and a new phase for the airway registry. 

Check out these new and revised clinical tools endorsed by the Clinical Advisory Committee in September 2017. These credible, robust, peer-reviewed tools have been developed and endorsed by the ECI and made available for you to use at the point of care.

Obstetrics and Gynaecology 

• Hyperemesis gravidarum
• Trauma in pregnancy

Anaphylaxis

Thyroid Storm

End of Life Care - Cultural Awareness

Pneumonia

• Aetiology CAP
• Pneumonia Scores
• Diagnostic Evaluation
• Management
• Further References and Resources

Patient Factsheets

• Appendicitis 
• Paediatric Factsheets

Procedures

• Dental Emergencies
• EZ IO
• Pericardiocentesis

Emergency Treatment Performance

Red Flag Modules

• A missed opportunity
• Going down the tube 
• Tied in a knot 

​If you can't find it - let us know here.

Spring is here – vibrant, energetic and full of potential: just like the latest educational collaboration to be brought to you by the ECI!

Following on from the success of three pilot meetings earlier this year, September saw the launch of the first regular, open invitation ‘E-QuEST’ teleconference. E-QuEST (ED Quality, Education and Safety Teleconference) is a monthly morbidity and mortality style meeting, aimed at supporting smaller (level 1-3) EDs.

Quality improvement initiatives are an essential part of Emergency Department activity, but we recognise that it can be difficult for smaller departments to run regular M+M meetings, or to generate regular, dispassionate and annonymised educational forums.

E-QuEST offers clinical and managerial staff the opportunity to partake in an educational M+M style discussion using real, de-identified scenarios.  Each meeting is structured around a different topic of interest and uses two or three case-based discussions to highlight potential high risk situations, to provide education around approved clinical guidelines or pathways, and to facilitate the exchange of ideas between clinicians.

Many of the participating clinicians are practicing in similar environments and will face comparable resource, system or geographical challenges – this teleconference offers a platform where they may learn from and support each other.

The October and November E-QuESTs saw a massive turnout with participants dialling in from all over New South Wales – from Tibooburra to Tumut, Delegate to Goodooga! We’d like to thank all of you who have engaged so far, and hope to have even more of you join us for our next,December meeting.

All of the slides from our previous meetings are available on our website under ‘ED Administration > E-QuEST’. If you have cases or ideas that you would like to share, present or discuss please email

• Anne.Walton or
• Joseph.Marwood

We hope to speak with you very soon.

The NSW Emergency Care Institute is currently conducting a multi-centre observational study which forms the “Airway Registry”.

Phase II of the project which has been running since 2013 collected airway management data from more than 5000 patients across a range of rural, regional and metropolitan EDs in NSW and more widely in Australia and New Zealand. The data was used to describe the practice of airway management in the ED and provide a dashboard feedback to each participating site. 

The ANZEDAR team has developed an online electronic data collection form using REDCap™ which is currently being piloted at three emergency department in NSW. Some of the metrics that it includes are non-identifying patient demographics, indication for intubation, the rate of first pass success and the rate of complications. This new design will allow each site to monitor their own practice with the aim of continual development and quality improvement. 

Recruitment in Phase III of the study will start in March 2018. If you are interested in joining the airway registry or wish to know more information please contact Hatem Alkhouri.

Following nearly four years of program development, enhancement and statewide implementation, the NDEC model has reached a state of sustainability.

The ECI adapted the NDEC model from one developed and implemented in Walcha in Hunter New England LHD. We began supporting implementation of the adapted model in rural EDs in NSW in 2013.

There are now 21 NDEC sites across the state; 10 of which are ‘live’. To date 132 people have completed the online NDEC education modules.

NDEC is supported by comprehensive web-based resources to assist with the clinical, education and project management aspects of implementation. The model is further validated and supported with the publication of two key documents on the NSW Health policy distribution system:

• PD2015_024 - Standing Orders for the Supply or Administration of Medication under the NDEC Model
• GL2017_009 - Nurse Delegated Emergency Care Nurse Management Guidelines

This year the ECI facilitated three NDEC outreach education sessions, targeting RNs and nurse educators to build capacity to deliver further NDEC education locally (pictured is the session held in Dorrigo in October).

The substantial experience and knowledge in the system, along with the activities mentioned above have fostered self-sufficiency within LHDs to operate NDEC. As a result, from 2018 the ECI be scaling back its day to day involvement in order to focus on other priorities across emergency care.

The ECI will maintain responsibility for all the NDEC resources. We will also maintain a process for reviewing applications from new sites seeking to implement, and be available to respond to queries.

Should you wish to know more please contact Nick Goryl.

On 17 and 18 October the ECI team took a trip to the northern sector of Mid North Coast Local Health District. The first day was a whirlwind tour of the EDs at Coffs Harbour, Bellingen and Macksville. It was great to learn about some model of care and staffing enhancements that have been implemented since out last visit up there.

On day two we trekked up to the plateau to visit Dorrigo ED and facilitate an education session for RNs and Nurse Educators on the Nurse Delegated Emergency Care (NDEC) model. Once again a big thanks to Helen Stevens, Paediatric CNC from Hunter New England LHD for coming to Dorrigo to run the session. Thanks also to Antony Altea, A/CNC at MNCLHD for coordinating the NDEC session, to Lynn Forsyth at Dorrigo for kindly providing catering and to all the enthusiastic participants at the education session.

As always it was excellent to visit with some familiar ED staff and to make some new connections as well. Thanks to all for having us.

In late November we visited Blacktown and St George Emergency Departments to promote awareness of our web-based clinical resources. We’re hoping to get around to a few other EDs before the end of the year. If you’re interested in having some ECI staff come and do a presentation on our website, please get in touch with us here.

Dr Anne Walton and Mr Antony Altea demonstrating an eye assessment. Photo taken by Nick Goryl

Dr Anne Walton demonstrating the use of an ophthalmoscope Photo taken by Nick Goryl

Keep your eyes peeled for another big year in 2018. The ECI will be adding the 2018 event calendar to the website shorly.