Deficiencies in handover processes exist, especially in communication and disposition information. These affect doctors, the ED and patients adversely. Recommendations for improvement include guideline development to standardize handover processes, the greater use of information technology facilities, ongoing feedback to staff, and quality assurance and education activities.

Patients who leave the ED without being seen (LWBS) are unlikely to be satisfied with the quality of the service provided and might be at risk from conditions that have not been assessed or treated. We therefore examined the available research literature to inform the following questions: (i) In patients who attend for ED care, what factors are associated with the decision to LWBS? (ii) In patients who attend for ED care, are there adverse health outcomes associated with the decision to LWBS? (iii) Which interventions have been used to try to reduce the number of patients who attend for ED care and LWBS? From the available literature, there was insufficient evidence to draw firm conclusions; however, the literature does suggest that patients who LWBS have conditions of lower urgency and lower acuity, are more likely to be male and younger, and are likely to identify prolonged waiting times as a central concern. LWBS patients generally have very low rates of subsequent admission, and reports of serious adverse events are rare. Many LWBS patients go on to seek alternative medical attention, and they might have higher rates of ongoing symptoms at follow-up. Further research is recommended to include comprehensive cohort or well-designed case-control studies. These studies should assess a wide range of related factors, including patient, hospital and other relevant factors. They should compare outcomes for groups of LWBS patients with those who wait and should include cross-sectoral data mapping to truly detect re-attendance and admission rates.

Sedation-related events, especially airway events, are common but very rarely have an adverse outcome. Elderly patients, deeply sedated with short-acting agents, are at particular risk. The results will help tailor sedation to individual patients.

Objective: To describe the epidemiology of mammal (human and non‐human) bite injuries in Victoria. Participants, design and setting: Retrospective case series of injuries recorded in the Victorian Emergency Minimum Dataset (VEMD) (1998–2004) and deaths recorded in the National Coroners Information System (1 July 2000 – 1 June 2006). Main outcome measures: Frequency, nature and outcome of injury as a function of mammal, victim demographics and season. Results: Of 12 982 bite injuries identified in the VEMD, dogs, humans, and cats were implicated in 79.6%, 8.7%, and 7.2% of cases, respectively. Dog bite injuries were commonly sustained to the hands/wrists (31.3%) and face/head (25.4%); cat bites to the hands/wrists (67.6%) and arms (16.0%); and human bites to the hands/wrists (37.1%), arms (20.5%) and face/head (20.4%). Males comprised 73.7% and 56.3% of human and dog bite victims, respectively, while females comprised 64.1% of cat bite victims. A third of dog bite victims (33.4%) were children aged 14 years or less. Most human bite victims (79.8%) were adults aged 20–49 years, inclusive. More injuries were sustained on weekends and during the summer, 55.4% of injuries occurred in the home, and 11.6% of patients required hospital admission. Dog bites resulted in three deaths. Conclusions: Mammal bite injuries are common and often require inpatient care. Patterns of bite injuries relate to the type of mammal involved. These epidemiological data will inform prevention initiatives to decrease the incidence of mammal bites.

Aim: This study aimed to determine the epidemiology of therapeutic errors among children in the community setting. In almost all cases (474, 96.5%, 95% CI 94.4, 97.9), the caller was advised to observe the child at home, and no child experienced significant morbidity. Preventive strategies included attention to administration care and routine, communication, medication storage, administration devices, packaging and labelling issues. Conclusion: Very young children are at particular risk, especially from single, over-the-counter medication dosing errors, made at home by family members.Key words: adverse event; child; medication error; paediatrics; therapeutic error.A therapeutic error has been defined as 'an unintentional deviation from a proper therapeutic regimen that results in the wrong dose, incorrect route of administration, administration to the wrong person, or administration of the wrong substance'. 1 Such errors are a major problem in all areas of health care 2 including the community setting where most medical care of children takes place. 3,4 Despite this, little is known about the frequency and types of therapeutic errors, their clinical importance and effective strategies for error reduction. 5-7 Furthermore, a relative paucity of Australian reports have examined this problem.There is some evidence, however, of the extent of the problem. First, children are significant consumers of both prescription and non-prescription medications, with the 1995 National Health Survey indicating that 50.5% of those aged 0-14 years had used a medication in the previous 2 weeks. 8 This population is, therefore, 'at risk' of therapeutic error. Second, over an 18-week period at three hospitals, 3.3% of emergency department paediatric attendance was associated with medication-related problems. Of these, 51.3% were thought to be preventable. 9 Finally, Kaushal et al. 6 found that adverse medication events were common in the paediatric ambulatory setting, occurring in about 16% of children treated. Of these, 20% of events were thought to be preventable, and 70% of these were related to parental medication administration.This study aimed to explore the epidemiology of therapeutic errors among children in an Australian community setting. It determined the nature, causes and outcomes of those errors reported to the Victorian Poisons Information Centre (VPIC). By following up the carers, their actions taken and recommendations to prevent future errors were determined and will inform the development of prevention initiatives. Key Points