Evaluating mild traumatic brain injury management at a regional emergency department
- Authors: Brown, Ashlee , Twomey, Dara , Shee, Anna
- Date: 2018
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 24, no. 5 (2018), p. 390-394
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- Description: background: Emergency departments (EDs) are usually the first point of contact, and often the only medical service available, for patients with mild traumatic brain injury (mTBI) in rural and regional areas. Clinical practice guidelines (CPGs) have been created to ensure best practice management of mTBI in EDs. Adherence to mTBI CPGs has rarely been evaluated in rural and regional areas. Aim: The aim of this paper was to assess a regional health service's adherence to their mTBI CPG. Methods: This was a 12-month retrospective audit of 1280 ED records of patients ≥16 years presenting with mTBI to a regional Australian ED. Case selection used the Victorian Admitted Episodes Dataset codes for suspected head injury: principal diagnosis codes (S00-T98), concussive injury recorded in diagnosis codes (S06.00-S06.05) and unintentional external cause code (V00-X59). The data were collected to determine 4-hour observation rates, CT scan rates, safe discharge and appropriate referral documentation. Results: Fewer people received a CT scan than qualified (n=245, 65.3%), only 45% had 4-hour observations recorded, safe discharge was documented in 74.1% of cases and 33% received educational resources. Discussion/conclusion: Several key elements for the management of mTBI were under-recorded, particularly 4-hour observations, safe discharge and education. Acquired brain injury clinic referrals were received in overwhelmingly fewer cases than had a CT scan (n=19, 6.3%). Overall, this study suggests that the regional health service does not currently fully adhere to the CPG and that the referral services are potentially underutilised.
Implementing an intervention to promote normal labour and birth : A study of clinicians' perceptions
- Authors: Shee, Anna , Nagle, Cate , Corboy, Denise , Versace, Vincent , Robertson, Carolyn , Frawley, Natasha , McKenzie, AnneMarie , Lodge, Julie
- Date: 2019
- Type: Text , Journal article
- Relation: Midwifery Vol. 70, no. (2019), p. 46-53
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- Description: Objective: Prior to implementation of a Normal Labour and Birth Bundle (NLBB) at a regional maternity service in Victoria, Australia, this study aimed to understand clinician factors that may influence the uptake, acceptance and use of the NLBB. Design: This was a mixed methods study in which The Theory of Planned Behaviour (TPB) provided the framework for the conduct and analysis of the staff survey and focus groups. Descriptive and multiple regression were used to analyse the survey data and thematic analysis was used for the focus group data. Participants: Participants for the survey and focus groups included clinicians providing publicly funded care and management of labour for women birthing at the health service. Maternity care clinicians were invited to participate in both the survey and the focus groups. Findings: Seventy-six clinicians (88.8%) responded to the survey. Mean scores for TPB constructs were well above the mid-scale score of 4, indicating strong positive attitudes, high levels of self-efficacy and positive social pressure to use the NLBB and strong intentions to use it in the future. Self-efficacy was the strongest independent predictor (beta=0.45, p < 0.001) of intention to use the NLBB (overall model R2 = 0.38). A valued consequence of implementing standardised and objective guidelines, highlighted in the focus groups, was the positive impact on clinicians' confidence in their decision-making. Key conclusions: This study found that midwives and obstetricians were in favour of using a normal labour and birth care bundle and perceived the bundle to align with the expectations of work colleagues and the women they care for. The findings of this study show that clinicians at the health service had strong intentions to use the normal labour and birth care bundle in the future. Implications for practice: Implementation science is important in embedding and sustaining practice change. Understanding staff perceptions is an essential first step of this process. (c) 2018 Elsevier Ltd. All rights reserved.