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Tuesday, 6 June 2017
Autumn Edition 2017

Welcome to the Autumn 2017 Edition of the Emergency Care Institute (ECI) Newsletter. This edition includes the key ECI dates for the remainder of 2017, so pop them in your diary now.

Farewell from the ECI Clinical Director

After 6 years at the helm it is time for me to say goodbye to the ECI, so I’d like to take the opportunity to say farewell and reflect on what has happened over this time.

In 2011, I was fortunate to be offered the opportunity, freedom and funding to lead the establishment of the Emergency Care Institute, located at the NSW Agency for Clinical Innovation. From the outset, the ECI was set up to support NSW EDs to deliver better emergency care and to do this collaboratively with all stakeholders (including consumers), especially those working at the coal face in ED. All of us who worked within EDs had too often had the experience of having what seemed like a good idea to another part of the system foisted upon us to implement, when unfortunately, it was not possible or practical to do so in the very demanding ED environment. There was a perception that EDs were not being listened to (and no doubt by others that we were not listening). We were familiar with increasing demand, ad-hoc access to clinical tools and resources, limited emergency care research and translation of best practice, overcrowding and many other challenges. EDs did not have a combined voice, where the smallest level 1 and the largest level 6 department shared information and understood the others’ challenges, or engaged in common initiatives. Even more remarkably, EDs did not have a forum to embed multidisciplinary communication within their own staff at the state level, or to engage collectively with other groups.

Fast forward to June 2017, and ECI and EDs have come a long way. At the system level we’ve seen time based targets (NEAT then ETP) and despite inevitable pressure points, these have changed EDs and hospitals for the better, driving understanding of the value of senior staff in EDs and the critical role of the rest of the system in sustainable emergency care. ECI outputs have included direct and routine review of all NSW ED related incidents and RCAs and creation of a taxonomy to improve capture of relevant information to inform change; deep engagement with ED staff, professional bodies, all NSW Health pillars, other bodies and the Ministry, and other government, not for profit and private services with an impact on emergency care; the production of novel educational resources which specifically address gaps in capacity; an openly accessible, comprehensive website, linked to ED information systems, full of fantastic clinical, process, quality and administrative resources to enable a clinician to provide evidence based care, at the bedside or running the department, at any hour in any ED anywhere; and a significantly enhanced emergency care research environment, with ECI co-leading multicentre studies, providing in-kind and other support. This has translated into a major reduction in serious critical incidents occurring in NSW EDs, reduced variability and increased efficiency of care, and enthusiasm among EDs to do more, even in the face of continually increasing demand. EDs now have a voice in what affects them, including IT, new ED builds, police processes, public health, pre-hospital, transfer and transport, models of care, policy and other clinical specialty guidance, both within the hospital system and the community.

All this progress has only been possible through the efforts of many individuals across emergency care and the broader system, and I would like to thank everyone for their support, work, feedback, and collaboration over the past six years. Special thanks go to ECI committee co-chairs over this time (Anne Hawkins, Tony Joseph, Stuart Stapleton, Jacqui Irvine, Matt Bragg, Kylie Stark, Kate Curtis, Richard Paoloni, Anna Holdgate, Amith Shetty, Alan Forrester, Liz Cloughessy), Vanessa Evans, ECI Network Manager and the wonderful ECI team (Sophie Baugh, Matthew Murray, Hatem Alkhouri, Dwight Robinson, Nick Goryl, Zafirul Hussain, John Mackenzie and the ECI Advanced Trainees) and to Sarah Marmara, Principal Policy Officer, Emergency Access at NSW MOH for her unfailing partnership in the quest for a unified voice for EDs.

It's been lots of fun!

Associate Professor Sally McCarthy

New and revised clinical tools - edit

Check out these new and revised clinical tools endorsed by the Clinical Advisory Committee in December. 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.


• Local and Regional Anaesthesia (reviewed)

Facial and Dental Blocks (reviewed)

Lumbar Puncture (reviewed)

Patient Factsheets

Tick Bite Patient Factsheet (new)

Decision Support Tools and other

Tick Bite Management (new)

Eye Trauma – chemical burns (new)

Aged Care – elder abuse

Aged Care – consent (new)

Aged Care – delirium (new)

Aged Care – palliation (new)

Ear Nose and Throat



Cardiac Arrest

Atrial Fibrillation



Anti platelet medication

Aortic Dissection



Renal Colic

Contrast Induced Nephropathy



Insulin Management Guidelines

Pulmonary Thromboembolism

Adrenal Crisis - Treatment

• Abdominal Emergencies – landing page

• Abdominal Emergencies - paediatrics 

• Abdominal Emergencies – AAA

• Abdominal Emergencies – acute appendicitis

• Abdominal Emergencies – acute cholecystitis

• Abdominal Emergencies – acute pancreatitis

• Abdominal Emergencies – bowel obstruction

• Abdominal Emergencies – ischaemic gut

• Abdominal Emergencies – diverticulitis

• Abdominal Emergencies – PID


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

Hearing from users of our website

A key goal of the ECI is to provide a website with a wide range of up to date and relevant clinical resources, helping any ED staff member to provide excellent patient care wherever they may be.

With that in mind the ECI Advanced Trainees set off excitedly to meet staff in four emergency departments – RPA, Maitland, Port Macquarie and Kempsey – with a view to finding out what people find useful on the website, and to see what ideas people have for how we could make it even better. We had some amazing suggestions from the staff that we met, which we will be implementing over the coming weeks.

Thank you to all involved and stay tuned to the website to see the changes! If you have any suggestions for anything you would like to see on the website, please drop us a line, or email Lucy on Lucy.HartenAsh@health.nsw.gov.au

Small ED Quality and Safety Teleconference Pilot Project

ECI is commencing a Small ED Quality and Safety Teleconference Pilot Project, which is targeted at smaller EDs (levels 1 to 3). During these teleconferences, there will be an education component  (such as case presentations) as well as time for discussion.

We aim to provide a forum that would increase communication and collaboration between small sites across NSW, in order to improve the quality of care for all ED patients. 

We propose to hold our first teleconference in June (date TBC) – if you are interested in participating, please contact Gabby Mane (ECI Advanced Trainee) via email on gabrielle.mane@health.nsw.gov.au

ACI Translational Research Grants

The ECI has partnered with a number of research and clinical groups and endorsed three grant applications for the 2017 ACI research funding scheme. The endorsed proposals which received funding over two years are:

1. Electronic tool to facilitate decision-making and advance care planning at the end of life in the emergency department

Principle Investigator: Dr Magnolia Cardona-Morrell/ University of New South Wales
$59,587 (2017) and $25,743 (2018)

2. Trial of Emergency Medicine Protocols in Simulation Training (TEMPIST)

Principle Investigator: A/Prof Charlotte Hall/ Western Sydney University
$9000 (2017) and $19,000 (2018)

3. Improving the accuracy and effectiveness of emergency nursing clinical assessment (HIRAID)

Principle Investigator: Prof Kate Curtis/ University of Sydney
$50,525 (2017) and $37,641 (2018)

Published Research Manuscripts:

In May, two research manuscripts were accepted for publication: 

1. “Emergency Airway Management in Australian and New Zealand Emergency Departments: A multicentre descriptive study of 3710 emergency intubations”
Emergency Medicine Australasia (EMA)

2. “A sequential case series of 23 intubations in a rural emergency department in New Zealand”

Australian Journal of Rural Health (AJRH)


Research Poster Award:

A poster produced by Magnolia Cardona-Morrell and Ebony Lewis from UNSW about the CriSTAL validation project conducted in collaboration with ECI and several Sydney EDs was awarded a prize at the European Association of Palliative Care Congress 2017 in Spain in the category of Communications. The poster is entitled: “Missed opportunities to introduce non-acute care pathways for hospitalized elderly patients with palliative care needs”.

Nurse Delegated Emergency Care (NDEC)

The NDEC Nurse Management Guidelines were recently published as a statewide guideline (GL2017_009). This will now sit alongside the Policy Directive for the NDEC Medication Standing Orders (PD2015_024) in the NSW Health policy landscape and further cement the NDEC model in rural emergency care.

In late May the ECI travelled to Braidwood in Southern NSW LHD to provide an NDEC education session, enabling accreditation for NDEC RNs and building capacity in the area for further education to take place. We gratefully acknowledge Bronwynne Chisolm and Bruce Corke from Milton Ulladulla who delivered the training.

Key ECI dates for 2017

The key dates for the ECI in 2017 you need to put in your diary NOW.

  • Leadership Forum - 9 June @ Amora Hotel Jamison Sydney
  • Leadership Forum - 25 August @ Amora Hotel Jamison Sydney
  • 7th Annual Emergency Care Symposium - 10 November @ Amora Hotel Jamison Sydney

Remember!! All ECI events are recorded and posted on our website. So if you can't attend in person go to the event page and stream the presentation or check out the slides from the day. These presentations may also be downloaded as podcasts so you can listen to these while you drive

In this issue
Autumn Edition 2017
Farewell from the ECI Clinical Director
New and revised clinical tools - edit
Hearing from users of our website
Small ED Quality and Safety Teleconference Pilot Project
ACI Translational Research Grants
Nurse Delegated Emergency Care (NDEC)
Key ECI dates for 2017
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