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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 20-January-2012, Vol 125 No 1348

Auckland District Health Board’s new emergency care initiatives
We are pleased to read of Auckland District Health Board’s (ADHB’s) initiatives to remove the cost barriers to out-of-hours care, the diversion of ambulances to accident and medical (A&M) clinics and funding schemes that pay for some treatments and tests in the community such as ultrasound for deep vein thrombosis (DVT) and intravenous antibiotics for various infections.1
Coroner Shortland has recently made the following recommendation, which would appear to be supportive of the ADHB’s initiatives above.2
Protocol for pre-hospital parenteral antibiotics
  • That the Royal New Zealand College of General Practitioners initiate a national working group to develop a protocol for the administration of pre-hospital parenteral antibiotics.
  • That the protocol includes the signs and symptoms of suspected bacterial sepsis and indicators for the taking of blood culture samples, in patients without haemorrhagic rash.
  • That the Royal Australasian College of Physicians and the national clinical working group for the New Zealand ambulance sector be included amongst those invited to participate in this working group.
The recent article by Morris and Brandaranayake3 entitled “Pre-hospital antibiotics for meningococcal disease remains low” highlights part of the need for such a national integrated approach as recommended by Coroner Shortland. The authors’ study notes that while the early use of antibiotics remains a goal of care in the seriously ill patient, and despite the considerable publicity regarding meningococcal deaths, only 23% of patients with signs of meningococcal septicaemia, 26% of patients with signs of meningitis and 37% of patients with signs of both meningococcal septicaemia and meningitis received pre-hospital antibiotics. The authors conclude that “More focus on primary care attention to early administration of antibiotics on suspicion of meningococcal disease remains a worthwhile recommendation with such a potentially life-threatening illness.”
Coroner Shortland made further recommendations relevant to Dr Parke’s article, including:
Early warning scoring system for assessing physiological instability
  • The Royal New Zealand College of General Practitioners develop and propagate an objective for assessing physiological instability, which integrates multiple physiological markers.
  • A national clinical working group for the New Zealand ambulance sector develop and promulgate an objective for assessing physiological instability, which integrates multiple physiological markers.
We commend these national integrated Coronial recommendations to the relevant parties as a means of not only potentially improving clinical outcomes for seriously ill patients but also of better coordinating care between the emergency department (ED) and primary care in New Zealand.
Lance Gravatt
Auckland
gravatt@ihug.co.nz
References:
  1. Parke T. Diversion of emergency acute workload to primary care: an attractive private sector alternative to public hospital emergency departments? N Z Med J. 16 December 2011;124(1347):6-9. http://journal.nzma.org.nz/journal/124-1347/5002/content.pdf
  2. Coroner Shortland. Inquest into the death of ZACHARY GRAVATT. 1 November 2011; CSU-2009-AUK-000932.
  3. Morris B, Bandaranayake D. Pre-hospital antibiotics for meningococcal disease remains low. N Z Med J. 23 September 2011;124(1343):86. http://journal.nzma.org.nz/journal/124-1343/4895/content.pdf
     
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