Emergency Medicine in Australia☆,☆☆,★
Section snippets
HEALTH CARE BACKGROUND
Australia is a highly developed country that ranks among the best in terms of health status. Compared with the United States, Australia enjoys lower rates of infant mortality, under-5-year mortality, and standardized mortality rates, as well as a longer life expectancy at birth and better immunization coverage.1 Australia achieves these indicators despite lower per capita health expenditures than the United States. Table 1 presents selected health indicators for the two countries.
National
SPECIALTY RECOGNITION
As a British Commonwealth country, specialties in allopathic medicine evolved on the British model. Primary health care was traditionally provided by the general practitioner (GP), who was office based and lacked major public hospital admission rights. Referral care was provided by the specialist, who was office based and maintained hospital admitting rights. Emergency care was commonly provided by GPs at rural hospitals or by junior medical staff at urban teaching hospitals.
In 1967, the first
EMERGENCY MEDICINE TRAINING
Medical school training in Australia traditionally lasts 5 or 6 years. Undergraduate emergency medicine education is still seen as being in the domain of older, established specialties. Universities may have dedicated emergency medicine curricula, yet there are no autonomous university medical school departments of emergency medicine in Australia. However, it is expected that the first chair in emergency medicine will be established shortly.
Postgraduate emergency medicine training lasts 7
EMERGENCY MEDICINE PRACTICE
Approximately 700 to 800 hospitals in Australia receive acute care patients, and most of these have emergency reception areas. Hospital-based emergency medicine is practiced mainly in the 67 major institutions accredited for emergency medicine training. These institutions receive the vast majority of seriously ill or injured emergency patients. A statistical profile for the United States and Australia is presented in Table 3.
Physician staffing at most major urban EDs comprises two to seven
EMERGENCY MEDICINE ADMINISTRATION AND RESEARCH
Clinical care is the fundamental activity of emergency medicine specialists in Australia. Even at academic medical centers, where the usual working week is in 45 to 65 hours, the main activity is clinical in nature. Administrative time spent by department directors may eclipse clinical time. Formal classroom teaching is a relatively minor activity occupying less than 5 hours per week. Emergency medicine research is also relatively embryonic. Work to date has focused on health systems,
References (15)
The State of the World's Children 1995
Pathways to Better Health: Issues Paper No. 7
President's message
Emerg Med
(1994)President's message
Emerg Med
(1994)The examination process in emergency medicine
Emerg Med
(1991)Australian College for Emergency Medicine: Fellowship Examination 1986 to 1992
Emerg Med
(1993)The Development of Emergency Medicine in Australia: Workforce Implications
(1990)
Cited by (26)
Existing infrastructure for the delivery of emergency care in post-conflict Rwanda: An initial descriptive study
2011, African Journal of Emergency MedicineTriage
2008, Pediatric Emergency MedicineIdentifying high-risk patients for triage and resource allocation in the ED
2007, American Journal of Emergency MedicineCitation Excerpt :Most hospitals use either a 3-level system (emergent, urgent, and nonurgent) [6] or a 5-level system (resuscitation, emergent, urgent, less urgent, and nonurgent) [6,7]. Previous studies found the 5-level system to be more reliable than the 3-level system [6,8-11] and better at predicting resource consumption, admission rates, length of stay, and mortality [12,13]. The Canadian Emergency Department Triage and Acuity Scale (CTAS) is a 5-scale system ranging from resuscitation (level I) to nonurgent (level V).
Triage
2007, Pediatric Emergency MedicineFive-level triage system more effective than three-level in tertiary emergency department
2002, Journal of Emergency NursingCitation Excerpt :However, hospitalization rates may vary due to factors other than patient acuity and, given the lack of reliability of the 3L systems, validity cannot be established with current 3L triage models. Australian researchers have reported that the 5L National Triage Scale is valid through strong correlations with resource consumption, admission rates, ED length of stay, and mortality.17,27,28 Validity of the 5L ESI has been demonstrated in pilot studies, which indicate strong correlations of triage levels with ED resource consumption, admission rates, and mortality.11,29,30
The case for a universal, valid, reliable 5-tier triage acuity scale for US emergency departments
2001, Journal of Emergency NursingCitation Excerpt :The National Triage Scale (NTS), the first standardized 5-level acuity system, originated in 1993 in Ipswich, Australia. It has shown good reliability with similar degrees of agreement when analyzed by site and years of nurse experience.10,16-19 One study found that with the NTS, more than 50% of 110 Australian nurses had exact agreement on 100 written patient profiles.20
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From the Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia*; and the Department of Emergency Medicine, Royal Brisbane Hospital, Brisbane, Australia.‡
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Address for reprints: Dr Peter Cameron, Department of Emergency Medicine, Royal Melbourne Hospital, Royal Parade, Parkville 3050, Melbourne, Australia
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Reprint no. 47/1/75956