Applying Sydney Triage to Admission Risk Tool (START) to improve patient flow in emergency departments: a multicentre randomised, implementation study.

BACKGROUND: To determine the effectiveness of applying the Sydney Triage to Admission Risk Tool (START) in conjunction with senior early assessment in different Emergency Departments (EDs). METHODS: This multicentre implementation study, conducted in two metropolitan EDs, used a convenience sample of ED patients. Patients who were admitted, after presenting to both EDs, and were assessed using the existing senior ED clinician assessment, were included in the study. Patients in the intervention group were assessed with the assistance of START, while patients in the control group were assessed without the assistance of START. Outcomes measured were ED length of stay and proportion of patients correctly identified as an in-patient admission by START. RESULTS: A total of 773 patients were evaluated using the START tool at triage across both sites (Intervention group n = 355 and control group n = 418 patients). The proportion of patients meeting the 4-hour length of stay thresholds was similar between the intervention and control groups (30.1% vs. 28.2%; p = 0.62). The intervention group was associated with a reduced ED length of stay when compared to the control group (351 min, interquartile range (IQR) 221.0-565.0 min versus 383 min, IQR 229.25-580.0 min; p = 0.85). When stratified into admitted and discharged patients, similar results were seen. CONCLUSION: In this extension of the START model of care implementation study in two metropolitan EDs, START, when used in conjunction with senior early assessment was associated with some reduced ED length of stay.

Heavy metal bioaccumulation in two passerines with differing migration strategies.

Various anthropogenic activities have resulted in concentration of heavy metals and contamination of surrounding environments. Historically, heavy metal contamination at the Savannah River Site (SRS) in South Carolina has resulted from accidental releases of stored waste generated from nuclear weapon production in the early 1950s. Songbirds inhabiting and using resources from these areas have the potential to bioaccumulate metals but there is limited information on metal concentration levels in areas suspected of contamination as well as uncontaminated sites. Nonlethal tissues samples from avian blood and feathers provide a reliable approach for determining the bioavailability of these pollutants (As, Cd, Cr, Cu, Hg, Ni, Pb, Se, and Zn). The objectives of this study were to survey terrestrial heavy metal contamination at the SRS on potentially bioavailable contaminated (PBC) sites through blood and feather samples from resident Northern Cardinals (Cardinalis cardinalis) and migratory Great Crested Flycatchers (Myiarchus crinitus) and quantify sex-specific concentrations within species. Samples were collected in April to June of 2016. Cardinals had lower blood concentrations of Hg (ß=-0.17, 85% CL=-0.26, -0.09) and Se (ß=-0.33, 85% CL=-0.50, -0.16) than flycatchers. Cr feather concentrations were less in cardinals (ß=-1.46, 85% CL=-2.44, -0.49) and all feathers of both species from reference locations had significantly less Zn (ß=-67.92, 85% CL=-128.71, -7.14). Results indicate flycatchers were exposed to differing heavy metal levels during feather formation on their wintering grounds as compared to their recent exposure (through bloods samples) on their breeding grounds. Sex of individuals did not have a significant impact on bioaccumulation in either species. Overall, metal concentration levels in both species indicate minimal risk for acute toxicity; however, there is limited research on wild passerine populations with similar concentration levels. Therefore, further research on reproductive success of these birds should be explored.