Educational interventions targeting Management of Benign paroxysmal positional vertigo in the Emergency Department

This study is an observational study. These exposures were rolled out regardless of this study. This study is a retrospective chart review not providing an intervention. 1. Three hour dizziness workshop This workshop was delivered from 10:00am to 1:00pm on Thursday 11th May during ED Registrar teaching in meeting room 2H/I in the Emergency Department at Royal North Shore Hospital (RNSH). The workshop was made up of two separate components, a 2-hr didactic and 1-hr practical section presented by the Emergency Department, Physiotherapy and Neurology staff members who were involved with EMBED. The 2-hr didactic component was made up of a PowerPoint presentation titled “Acute dizziness in the ED”. This presentation delivered a comprehensive approach to acute dizziness and introduces the EMBED Study clinical decision tool. During this presentation ED Trainees and FACEMs learned about dizziness syndromes, how to recognise and differentiate between posterior strokes, vestibular neuritis and BPPV. To facilitate knowledge acquisition and retention, a pre-education case-based quiz was conducted followed by discussion of the same cases during the presentation. 2. Clinical decision support tool, EMBED study flowchart The clinical decision support tool was made available for ED doctors to use when seeing a patient with dizziness. It has been made available on the ED Intranet and NSLHD Intranet Neurology sub-section. Flowchart development was iterative with feedback from both the Emergency Department and the Neurology Department. Use of this tool/flowchart was introduced during the dizziness workshop delivered on 11th May. The case-based discussions during the presentation served as an opportunity to utilise the flowchart with practical examples. 3. Auto Text (Template) on FirstNet Auto Text is a function available on FirstNet (electronic medical record solution used by NSW Health) to assist with medical documentation. The EMBED investigators formulated a template to be used by ED doctors to assist them with documentation of their vestibular assessment. This template was also introduced during the dizziness workshop delivered on 11th May. 4. Dizziness local champions & super-users An expression of interest was gathered from the senior registrar group on the 10th of March 2023 with the aim of training a group of super-users to become local champions for dizziness education. Over a 6-week period, ten senior registrars were provided further training and assessed by the vestibular physiotherapists in the performance and interpretation of provocative manoeuvres for BPPV. Each super-user attended two sessions as part of this training. The first session involved a competency assessment of the ability to perform BPPV manoeuvres The second session involved interpretation of examination findings to identify the different causes of dizziness such as posterior stroke, vestibular neuritis and BPPV. This session utilised audio-visual resources demonstrating the different pathologies and comprised of case-based discussions surrounding each case. The purpose of the senior ED registrar vertigo superuser group is to develop a core group of ED doctors who are passionate about assessment of acute dizziness and to sustain the educational innovation. The superuser group is encouraged to provide ongoing teaching to junior ED doctors and disseminate their knowledge at the bedside in the appropriate clinical context.