Redcliffe Hospital

To provide a 10-year update on the best available evidence evaluating the impact of nurse practitioner services on cost, waiting times, patient satisfaction, representation rates, and length of stay in emergency and urgent care settings. Systematic review. The search was completed on January 28, 2025, in Embase (Elsevier), Medline (EBSCOhost), CINAHL (EBSCOhost), Cochrane Library (Wiley), Emcare (Ovid), Web of Science Core Collection (Clarivate) and Scopus (Elsevier). The data range (2014-2024) was used to limit the search. The search was conducted with results imported into Covidence. In Covidence, two reviewers conducted screening, data extraction, and quality appraisal of articles, and findings were analysed using a narrative synthesis approach. Eligible studies examined nurse practitioner services in emergency or urgent care settings, reporting outcomes of cost, waiting times, patient satisfaction, representation rates, and length of stay. Title and abstract screening were performed on 2329 records. Of these, 236 full-text articles were reviewed, and 17 underwent critical appraisal and data extraction. Narrative analysis of outcome measures yielded mixed results, with both favourable and unfavourable findings reported regarding nurse practitioner services. Global evaluation of nurse practitioner services in emergency care remains inconsistent. Nevertheless, emerging evidence supports their positive impact, particularly in improving patient outcomes. To effectively inform policy, workforce planning and clinical integration, there is a need for professional benchmarks that provide clear frameworks for the evaluation of patient-centred outcomes and operational impacts in emergency departments. Evidence related to nurse practitioner services in emergency and urgent care clinics highlights the positive impact of nurse practitioner services on patient wait times and satisfaction; however, there is limited and variable evidence of impact on health care costs and outcomes. This paper recommends that evaluating emergency nurse practitioner services requires homogeneous research using consistent professional benchmarks and evaluation frameworks. This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. This study did not include patient or public involvement in its design, conduct, or reporting. PROSPERO 2025 CRD420250645148.

Empiric combination antibiotic therapy (ECAT) is commonly used to treat healthcare-associated bloodstream infections (HA-BSIs) and sepsis. However, the level of supporting evidence is low and clinical practice varies significantly. We conducted a post hoc analysis using the EUROBACT-2 international cohort study database, which contained data on 2406 adult patients from 328 intensive care units (ICUs) across 52 countries, collected between June 2019 and January 2021. The main outcome was the proportion of patients receiving ECAT for HA-BSIs. Patient and institutional factors influencing the use of ECAT were examined using Markov-Chain Monte Carlo estimation. Three quarters of patients (75.2%; n = 1810) received empiric antibiotic therapy, with ECAT used in approximately half of cases (52.5%; n = 950). Most patients receiving ECAT (70.4%; n = 669) were treated with two antibiotics, beta-lactams plus glycopeptides being the most common combination (40.2%; n = 382). The odds of ECAT were increased by immune deficiency (OR 1.35 [95% CrI 1.03-1.75]), SOFA scores > 11 (OR 1.77 [95% CrI 1.28-2.46]), uncommon sources of infection (OR 1.63 [95% CrI 1.02-2.59]), and admission to ICUs where > 25% of Enterobacteriaceae isolates produce carbapenemases (OR 2.46 [95% CrI 1.37-4.41). The intra-class correlation coefficients at the ICU and country levels were 23.2% and 4.4%, respectively. In conclusion, factors at the individual, institutional, and national levels may affect the use of ECAT to treat HA-BSIs. Given the impact of institutional variables on the use of ECAT and the inconclusive evidence regarding its potential risks, it is of great importance that treatment is tailored based on local antibiotic stewardship programs and the needs of the individual patient.

Evidence suggests that curative treatment for low-risk prostate cancer (LRPC) has no survival benefits over active surveillance (AS); thus, treatment choice becomes a value-sensitive decision. Decision aids (DAs) have the potential to facilitate this process, yet no DA has been tailored to the Australian health care system or population. This study aims to evaluate the impact of an online DA (Navigate) on the uptake of AS, quality of life, and decision-making in Australia. This parallel-group, prospective, randomised controlled trial recruited men (from May 2017 to May 2021) from participating cancer centres, via self-referral, or via clinician referral. The inclusion criteria were the following: a recent LRPC diagnosis, no decision on treatment, and clinical suitability for AS. Partners could also enrol. Assessments were undertaken at baseline (before decision) and after baseline (1, 2, and 6 mo). Participants were randomised 1:1 to Navigate (online DA, intervention) or a national prostate cancer website (usual care), stratified by the site/recruitment method. Partners were allocated to the group matching their respective partners. The primary outcome was self-reported uptake of AS for first-line treatment at 1 mo. The secondary outcomes included decision-making preparedness; decisional conflict, regret, and satisfaction; illness communication; and prostate cancer-specific quality of life. Intention-to-treat analyses were conducted. Of the 619 patients referred, those eligible (n=302) were randomised to either Navigate (n=153) or usual care (n=149), with no significant between-group differences at baseline. The proportion of men self-reporting AS versus another treatment was 90.6% (Navigate) versus 79.0% (usual care; p=0.008). Navigate participants also reported greater decision-making preparedness (p<0.001). Partners were allocated to Navigate (n=70) or usual care (n=49); no significant between-group differences were found. Longer-term outcomes were not measured. Providing men with an online DA resulted in higher uptake of AS for LRPC than standard resources and in increased decision-making preparedness. By increasing the uptake of AS, DAs may help reduce treatment-related morbidity. Implementation research assessing the possibility of integrating Navigate into standard care is needed.

PurposeSodium bicarbonate is commonly administered to treat metabolic acidosis in intensive care units (ICUs). There is limited evidence from randomized trials to support this practice, and observational studies show conflicting results. Our aim was to perform a target trial emulation evaluating the effect of bicarbonate therapy on mortality.MethodsRetrospective cohort study using data from 12 Australian ICUs. Inclusion criteria were adults with pH < 7.3 and PCO2 ≤ 45 mmHg within the first three days. We excluded repeat admissions, toxicology, diabetic ketoacidosis, and pre-existing end-stage renal failure. The treatment intervention was sodium-bicarbonate administration, and the primary outcome was 30-day ICU mortality with ICU discharge as a competing event. We evaluated multiple subgroups, including patients with acute kidney injury, requirement for vasoactive therapy, and pH < 7.2. The primary model utilized a parametric g-computation and rolling entry matching was performed as a sensitivity analysis.ResultsWe identified 6157 eligible admissions, of which 1764 (29%) received sodium bicarbonate. Bicarbonate therapy was associated with a 1.9% absolute mortality reduction for the primary analysis [risk ratio 0.86, 95% confidence interval (CI) 0.80 to 0.91], and significant benefits were seen across all subgroups evaluated. A similar point estimate of 2.1% was observed in the sensitivity analysis, with a sustained mortality reduction seen at 30 days.ConclusionIn this target trial emulation, bicarbonate administration was associated with a small but statistically significant reduction in mortality for patients with metabolic acidosis. Large sample sizes would be required to demonstrate this effect in a randomized trial.

Emergency Departments (ED) are critical components of the healthcare system, providing immediate care for acute conditions, injuries and trauma. Individuals who experience domestic violence (DV) face barriers accessing care in traditional EDs. These include fear of retaliation from an abuser, shame, isolation, logistical challenges. Virtual Emergency Departments (VED) have emerged as potential solutions to these challenges. Providing emergency care through telehealth offers an innovative way to meet the needs of patients who may otherwise hesitate or be unable to seek help. This article explores the intersection of VEDs and DV, examining the potential benefits and challenges of using telemedicine to support DV victim-survivors, as well as the ethical, legal and clinical considerations. By focusing on this emerging field, this opinion piece seeks to highlight how VEDs could enhance the way DV victim-survivors access care and the broader implications for healthcare delivery.