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Background: Oxygen "wafting" provides a non-contact oxygen alternative for uncooperative paediatric patients in the emergency department (ED). The aim of this study was to identify the combination of oxygen delivery device, flow rate and device positioning that delivers the highest concentration of wafted oxygen., Methods: ED nursing staff were surveyed to determine current oxygen wafting practice. A simulated patient and oxygen sensor were used to compare wafted oxygen concentrations for six delivery devices in various positions and oxygen flow rates., Results: Only oxygen tubing and the paediatric non-rebreather mask consistently delivered wafted oxygen concentrations above 30%. The paediatric non-rebreather held below the face produced concentrations ranging from 26.1% (10 cm) to 39.8% (5 cm). At 15 L/min, tubing held in front of the face produced concentrations ranging from 31.2% (15 cm) to 56.7% (5 cm); reducing the flow rate to 6-8 L/min had no meaningful effect on the delivered oxygen concentration. When tubing was used below the face, flow rates between 6 and 8 L/min produced somewhat higher concentrations than 15 L/min (5 cm: 36.3% vs. 30.9%)., Conclusions: When delivering oxygen by wafting, the highest oxygen concentrations are achieved when positioning tubing 5-15 cm in front of the face or positioning tubing or a paediatric non-rebreather mask 5-10 cm below the face at 10-15 L/min flow. This should be considered when using oxygen wafting in the ED., (Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: Describe the characteristics, reasons for leaving and outcomes of patients who did not wait (DNW) to be seen by a health practitioner in a regional Australian ED., Methods: Prospective observational study of a convenience sample of ED DNW patients presenting to The Townsville Hospital between June 2011 and July 2012. Seven days from each month were selected, and DNW patients presenting on those days were enrolled. An investigator attempted to contact every DNW patient by telephone in the following week to elicit reasons for leaving, subsequent health contacts, outcomes and suggestions for system improvements. Additional outcome information was obtained from hospital electronic medical records., Results: Nearly 15 000 patients presented on the study days, with 648 (4.3%) DNWs: 415 (64.0%) adults, 193 (29.8%) children (1-16 years old) and 40 (6.2%) infants. Thirty-eight (5.9%) patients who DNW were Australasian Triage Scale (ATS) category 3, 546 (84.3%) were ATS category 4 and 64 (9.9%) were ATS category 5. Most DNW patients presented on Sundays and between 1600 and 2359. Just over half of the patients who DNW (52.9%) sought additional medical treatment, with 4.9% requiring subsequent hospital admission. Three psychiatric patients who DNW required urgent mental health interventions organised by the investigators. Frustration with perceived waiting times was the most common reason for leaving without being seen., Conclusions: Regional Australia ED patients who DNW often still require medical care, with approximately 1 in 20 requiring subsequent hospital admission. Patients with psychiatric conditions who DNW might be at particular risk., (© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)