Background: Overcrowding in Emergency departments adversely impacts efficiency, patient outcomes, and resource allocation. Accurate triage systems are essential for prioritizing care and optimizing resources. While traditional methods provide a foundation, they often lack precision in addressing modern healthcare complexities. Artificial intelligence (AI) and machine learning (ML) offer advanced capabilities to enhance triage accuracy, improve patient prioritization, and support clinical decision-making, addressing limitations of conventional approaches and paving the way for adaptive triage solutions. Objective: This systematic review aims to assess the use of artificial intelligence (AI) and machine learning (ML) in determining the outcomes of patients presenting in Emergency department (ED) triage. Methods: A systematic search was conducted on April 21, 2023, using electronic databases including PubMed/Medline, Cochrane Library, Ovid, and Google Scholar, without year restrictions. The main outcome of this review was to assess the use of AI and ML in the ED Triage. Articles that used different models of AI and ML to predict various outcomes of patients in the ED setting were included. Results: A total of 17 studies were included in this systematic review. Fifteen studies assessed the role of machine learning methods in emergency department triage, while two studies evaluated the role of AI and machine learning in prehospital triage. The results of our systematic review favor the use of machine learning methods and artificial intelligence in emergency triage. Machine learning models were found to be superior to conventional emergency severity score methods in determining triage, diagnosis, and early management of patients. Among the machine learning methods, the boosting model was slightly more effective. Conclusion: Our study supports the notion that AI and ML are the future of Emergency departments. They aid in predicting patient outcomes and determining appropriate management strategies more efficiently, thereby enhancing decision making in the ED.
The aim of this paper is to describe the methods and processes used to develop a theory-informed, dedicated serratus anterior plane block (SAPB) education and training program for Emergency Medicine clinicians. This program was informed by Kern's six-step approach to curriculum development. Firstly, expert consensus on education and training was developed using a modified Delphi process. Secondly, contemporary medical literature was incorporated with educational pedagogical theoretical frameworks including Bloom's taxonomy of educational objectives, backwards design, and constructive alignment, scaffolded learning, and segmented learning. Finally, these were aligned with existing national policies around regional anaesthesia in the Emergency Department. The resultant SAPB evidence-based education package is supported by the most current evidence for using the SAPB as a regional anaesthesia procedure for patients with rib fracture pain. It serves as an educational tool for clinicians already proficient in the principles of plane blocks with additional guidance on establishing local workshops for practical education as well as ongoing supervision and governance for this procedure. The development of a theory-informed, dedicated SAPB education and training program for Emergency Medicine clinicians required a balanced combination of clinical science and procedural expertise with educational theory. This provides a framework for future works when developing educational resources to introduce new clinical procedures into routine Emergency Medicine practice.
We examined whether the 116 emergency department transfers from residential aged care homes prevented by an intervention that provided on-site assessment and management following a fall led to a detectable shift in system-level emergency department utilisation. This 17-month before-and-after study was conducted at three metropolitan hospital emergency departments of a single health service in Melbourne, Australia. Monthly post-fall emergency department transfers from 108 residential aged care homes were compared before (1 May 2021 to 30 April 2022) and after (1 May 2022 to 30 September 2022) the intervention using two routinely collected administrative datasets. The primary analysis included patients eligible for the intervention. Sensitivity analyses examined patients ineligible for the intervention and a season-matched before period (1 May 2021 to 30 September 2021). Mean (SD) monthly post-fall emergency department transfers from residential aged care homes among patients eligible for the intervention were 92.2 (14.9) before and 74.2 (7.2) after implementation (mean difference [95% CI]: 18.0 [2.9, 33.1], p = 0.023; season-matched: 28.2 [10.3, 46.1], p = 0.007). Monthly post-fall emergency department transfers from residential aged care homes among patients ineligible for the intervention did not significantly differ before and after the intervention (mean difference [95% CI]: 1.8 [-3.0, 6.7], p = 0.434; season-matched: 1.8 [-5.1, 8.7], p = 0.566). We detected 78% (n ≈ 90) of the verified 116 emergency department transfers prevented. On-site assessment and management following a fall at residential aged care homes may reduce system-level emergency department utilisation. Examining sustainability and cost-effectiveness appears warranted.
We aimed to describe the profile of patients with low back pain who received pathology testing in emergency departments or after inpatient admission, and to describe the ordered tests. A retrospective study of electronic medical records from three emergency departments in Sydney, New South Wales, Australia, from January 2016 to October 2021, was undertaken. We included patients diagnosed with a lumbar spine condition at discharge from the emergency department and extracted their demographic and episode of care characteristics. Pathology tests were ordered in 23.8% of 15,300 episodes of care. Patients who received pathology testing were typically older, were female, had a non-English preferred language, required an interpreter, arrived by ambulance during working hours, had their condition triaged as urgent, had a diagnosis of a serious low back pain pathology, were admitted to inpatient wards, and had an increased length of stay. Full blood count, electrolytes, urea, creatinine (EUC) and liver function tests were the most ordered tests. The characteristics of patients with low back pain receiving pathology testing in emergency departments as well as those of the tests were described. The results suggest that guideline recommendations were partly followed, but an investigation into the appropriateness of pathology testing is needed to confirm this hypothesis and ensure the relevance of low back pain care in emergency departments.
Family, domestic and sexual violence (FDSV) is a global health issue affecting one in four women. Emergency departments (EDs) are often the first point of healthcare contact for people experiencing FDSV. Virtual emergency departments have been introduced in Australia to improve access to care and reduce pressure on physical EDs, but little is known about FDSV presentations in this setting. This study aimed to identify and describe FDSV presentations to the Victorian Virtual Emergency Department (VVED). A retrospective cohort study examined FDSV presentations to VVED between 1 July 2023 and 30 June 2024. Cases were identified using VVED, injury surveillance, and clinician documentation data. Records were filtered by age, sex and injury intent, followed by file review to confirm eligibility. Demographic and presentation characteristics were summarised using descriptive statistics. Twenty-one FDSV presentations were identified among 173,936 VVED presentations (0.012%). All were female, median age 37 years. Most were born in Australia (86%) and lived in socioeconomically disadvantaged areas (62%). Intimate partner violence was the most common form of FDSV (81%), and injuries above the clavicle (head, face and neck injuries) were the most frequent presentation (53%). Most patients were referred via healthcare professionals (76%). One-third were directed to physical EDs, while most were managed virtually with follow-up arranged through general practitioners or other healthcare providers. FDSV presentations were rarely identified in the virtual emergency setting, suggesting under-detection. Virtual EDs offer opportunities to support people experiencing violence, but improved clinician training, documentation and referral pathways are needed.
To synthesise evidence on opportunistic screening for asymptomatic sexually transmitted infections and bloodborne viruses (STI/BBV) in emergency departments (EDs), focusing on detection, public health outcomes and feasibility. An integrative review was conducted using Whittemore and Knafl's framework. PubMed, EBSCO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, and Embase were searched (2012-2024). Eligible sources included quantitative, qualitative, mixed-methods and policy papers. Studies were appraised with the Mixed Methods Appraisal Tool (MMAT) and synthesised thematically. A total of 20 studies were included. Thematic synthesis identified four key domains: routine or opt-out ED screening increased case detection and was cost-effective; barriers included privacy concerns, workflow constraints and low risk perception; behaviour-based eligibility better aligned screening with actual risk factors, whereas population-based approaches often misclassified exposure; and implementation was facilitated by confidentiality safeguards, streamlined workflows, self-collection and electronic prompts. Routine, opportunistic asymptomatic STI/BBV screening embedded within emergency department workflows reliably increases case detection of Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and HIV and is cost-effective. Behaviour-based eligibility better aligns screening with actual transmission risk than identity- or population-based stratification, and implementation strategies that safeguard confidentiality, support self-collection, deliver results discreetly, and integrate electronic prompts into routine workflows consistently improve acceptance and feasibility. For Australian emergency departments, the evidence supports adopting routine, opportunistic, behaviour-based screening as a feasible, high-yield public health intervention. Conclusions are bounded by the predominance of United States studies, limited longitudinal follow-up, and the use of a single reviewer.
This study examined the distribution of emergency departments relative to remoteness and socioeconomic disadvantage and explored service availability for children in non-metropolitan Western Australia. We conducted a spatial analysis using the Australian Government datasets. Child population counts and emergency facility locations were integrated into Quantum Geographic Information System and classified by remoteness using the Modified Monash Model (MMM) and by area-level socioeconomic disadvantage using the Index of Relative Socioeconomic Disadvantage (IRSD). Buffer zones were generated around each facility to quantify the proportion of children residing within specified distance thresholds. Service availability was assessed using facility-to-child and bed-to-child ratios. Emergency department availability declined with increasing remoteness: MMM5 contained the largest share of facilities (42.6%), followed by MMM6 (31.2%) and MMM7 (26.2%). However, ratios appeared more favourable in very remote areas, with facility-to-child ratios improving from 1:848 (MMM5) to 1:741 (MMM7). Bed availability showed a similar pattern, ranging from 1:83 in MMM5 to 1:60 in MMM7. Socioeconomic analyses revealed a concentration of facilities and bed capacity in the most disadvantaged areas, with IRSD 1 hosting 57.4% of all facilities and 35.8% of total bed capacity. Geographic and socioeconomic inequities in emergency care provision persist across rural and remote Western Australia. Apparent improvements in ratios in very remote areas are driven by low population density rather than greater service investment. These findings support a shift to needs-based paediatric emergency service planning, using remoteness and IRSD-stratified proximity and capacity measures to prioritise communities with the greatest access shortfalls.
Pressure on emergency departments is increasing, perpetuating the phenomenon known as ramping or ambulance ramping, where patients are forced to wait on stretchers in corridors until they are allocated a suitable treatment space. This once temporary response to emergency department crowding has now become the norm for many emergency departments. The ramping environment impacts the patient experience well beyond the undesirability of extended waiting times. Nevertheless, there remains little research regarding how patients experience the ramping environment and what might make their wait more comfortable. Semi-structured interviews were performed with patients who had waited at least an hour on the ramp at two Australian emergency departments. An inductive thematic analysis was undertaken to explore the patient experience while ramped and aspects of the built environment and care that participants perceived could better support their health and waiting experience. Twenty-six patients participated in the study. Four major themes and 13 subthemes were developed from the data. Participants described psychological distress, physical discomfort, an unsuitable built environment, and challenges to maintain physical health. They suggested modifications to the built environment and care received that may ameliorate some of their concerns. Ramping can create additional stresses to the patient experience. Making changes to the physical aspects of the built environment may be challenging in the short term; however, other aspects of the ramp were identified that could be considered to maximise patient-centred care.
Emergency departments are seeing an increase in mental health presentations across the globe; however, there are no standard mental health assessment models of care currently being used in emergency departments. This narrative review aims to search the literature and report the mental health models of care used globally. This narrative review conducted a search of 4 medical databases, Medline Complete, CINAHL, Embase and PsychINFO; the research team screened titles and abstracts and reviewed the full text. Risk of bias and quality assessment was conducted by 2 independent researchers. A total of 2461 articles were identified for title and abstract screening; of these, 84 were reviewed in full text and subsequently, 79 articles were excluded, resulting in 5 articles to be included in this narrative review. Two articles assessed the Psychiatric Assessment and Planning Unit (PAPU) model and reported on reduced length of stay; a third article reported a similar model and improved length of stay. Two articles reported models on sub-sample cohorts of mental health: individuals experiencing suicide ideation and individuals experiencing alcohol and substance use issues. The results of this narrative review highlight the lack of literature concerning models of care and mental health assessment in emergency departments. Of the few articles reviewed, a successful model of care and/or assessment requires a dedicated physical space in the emergency department (such as a PAPU), including mental health short stay beds and dedicated mental health staff.
Cognitive aids are used to reduce practitioners' mental load during clinical emergencies. Emerging evidence suggests the utility of cognitive aids in clinical settings such as anaesthesia, but little is known about their use within emergency medicine. This scoping review describes the extent and type of evidence on how cognitive aids assist in the resuscitation of patients in the Emergency Department (ED). The search strategy aimed to locate English language studies in the peer-reviewed literature on resuscitation or resuscitative procedures performed on patients of any age in the ED. Searches were performed using Medline, Embase, Scopus and Web of Science, from 1 January 2015 to 9 January 2025. Simulation and non-simulation studies and both electronic and non-electronic aids were included. Studies for non-ED settings were excluded. We included all study designs and data were analysed descriptively. The search yielded 4873 citations which were imported into Covidence. Following abstract/title review, 3275 citations were excluded; 74 full texts were reviewed, resulting in inclusion of 45 studies. The included studies demonstrated considerable heterogeneity in design, population, and context, with low evidence quality overall. This scoping review describes the broad array of cognitive aids available to assist ED resuscitation and highlights that although supporting evidence is generally weak there appears to be little harm from cognitive aid use. The findings indicate a need for multicentre trials of cognitive aids assessing real-world effectiveness and patient-centred outcomes. Future studies should also ensure transparent detailing of cognitive aid design and implementation to facilitate reproducibility and practical uptake.
To evaluate camera-based, advanced sensor technology for contactless vital sign monitoring (versus standard monitoring) posttriage in adult emergency department patients. A single-site, prospective, observational study was conducted at Townsville University Hospital Emergency Department between May 2025 and August 2025. Adult (≥ 18 years) walk-in patients were eligible. A convenience sample of consenting participants was recruited. Two sets of vital signs-blood pressure, heart rate, respiratory rate, oxygen saturation, temperature-were obtained. The first set was measured immediately after triage using a dual-camera system comprising a thermographic camera and a second camera with proprietary software. The second set was obtained immediately posttriage using standard monitoring equipment. Reliability and acceptability were the primary and secondary outcomes respectively. Reliability (accuracy and precision) was determined through a Bland-Altman analysis to assess agreement between the two sets of vital signs. Acceptability of technology was assessed using a participant questionnaire. A total of 300 patients were recruited, of whom 288 had complete data on paired vital signs and were included in the Bland-Altman analysis. Minimal bias was observed across most vital signs, indicating limited systematic error. Respiratory rate, oxygen saturation and temperature showed the closest agreement, whereas systolic blood pressure and heart rate exhibited the widest limits of agreement. Acceptability was high, with most participants reporting comfort, ease of use and overall satisfaction. Compared with standard vital sign monitoring, camera-based technology demonstrated good accuracy but variable precision across vital signs. Further algorithm refinement is required before reliable clinical integration.
To describe the epidemiology, healthcare utilisation and outcomes of patients presenting to emergency departments (EDs) with chronic liver disease (CLD) in Queensland, Australia. This statewide data linkage study included adult patients with CLD-related diagnoses across 104 Queensland Health EDs between 1 January 2016 and 31 August 2023. Emergency, inpatient and mortality data were linked. Patients were stratified by cirrhosis status and decompensation. Outcome was 30-day mortality. Poisson regression assessed trends, and Cox regression evaluated mortality. Amongst 15,999,186 ED presentations, 23,578 (0.15%) were related to CLD, involving 11,961 patients. Presentations increased by 2% annually (IRR 1.02, 95% CI 1.02-1.03). Cirrhosis accounted for 18,735 presentations (79.5%). Overall, 20,312 presentations (86.1%) resulted in hospital admission, 918 (4.5%) were admitted to intensive care units (ICU), and 963 (4.1%) resulted in in-hospital death. Amongst patients with cirrhosis, 16,968 (90.6%) resulted in admission, 867 (5.1%) were admitted to ICU and 899 (4.8%) died in hospital. Predictors of 30-day mortality included cirrhosis (adjusted hazard ratio (aHR) 6.92, 95% CI 5.36-8.94), malignancy (aHR 3.21, 95% CI 2.90-3.55), hepatorenal syndrome (aHR 3.15, 95% CI 2.72-3.66), encephalopathy (aHR 2.03, 95% CI 1.78-2.32) and spontaneous bacterial peritonitis (aHR 1.47, 95% CI 1.20-1.80). Presentation to tertiary hospitals was associated with lower mortality (aHR 0.75, 95% CI 0.68-0.82). CLD-related ED presentations are increasing and place substantial demand on hospital services in Queensland. Decompensation events strongly predict mortality and healthcare utilisation. ED-initiated risk stratification and coordinated care models to improve outcomes for patients with cirrhosis require development and evaluation.
Delirium is common and serious among older adults in emergency departments (EDs) yet screening often falls short of national expectations. This study evaluated current delirium screening practices in a metropolitan ED and identified barriers and enablers to implementing screening in line with the Australian Delirium Clinical Care Standard. A mixed-methods quality assurance study was conducted in The Prince Charles Hospital ED. A retrospective audit of 238 medical records for patients aged ≥ 65 years examined the frequency of delirium screening and associated clinical or operational factors. Semi-structured interviews with nine staff members explored perceptions, experiences and decision-making processes related to screening. Deductive framework analysis guided integration of quantitative and qualitative data. Of eligible patients, 4.2% were screened, with most assessments completed by specialist teams during weekday hours. Screened patients had longer ED stays, although this finding should be interpreted as exploratory. Nurses recognised major delirium risk factors but described screening as reactive rather than routine. Reported barriers included time pressures, environmental limitations, lack of digital integration and uncertainty about role responsibilities. Awareness of the Australian Delirium Clinical Care Standard was limited, contributing to inconsistent practice. Despite baseline knowledge of delirium risk, ED screening remains inconsistent and specialist-dependent. Strengthening adherence to national standards requires embedding screening into routine nursing workflows through clearer role delineation and the integration of prompts to support systematic assessment for all older patients.
Vaccine-preventable diseases (VPDs) are re-emerging worldwide, with declining vaccination coverage since the COVID-19 pandemic resulting in outbreaks of previously rare infections in Australasia. Emergency departments are increasingly at the forefront of recognising and managing these diseases while responding to their broader public health implications. This editorial examines the factors contributing to the resurgence of VPDs and declining immunisation rates, and their implications for ACEM training and EM practice. The accompanying articles in this issue provide practical perspectives on managing diphtheria and measles in the emergency department, addressing vaccine hesitancy and preparing for VPD-related examination questions.
Models of trauma care are actively evolving across Australasia in response to changing trauma epidemiology. Emergency physicians interested in longitudinal trauma care are well-established as inpatient trauma specialists and directors of trauma services in Australia, and these roles may become available in New Zealand. This Trainee Focus editorial compares trauma service medical staffing models, noting the expansion of a multi-specialty approach. The strengths and limitations of FACEM training as preparation for inpatient trauma specialist work are discussed. Interested trainees should seek broad clinical exposure, engage with trauma quality improvement or research activities, and network across specialty boundaries.
Diphtheria has re-emerged in Australia in 2026, prompting significant public health concern and placing additional demands on healthcare services. This article examines the early phase of the outbreak, with particular focus on its impact on EDs. The outbreak has disproportionately affected Indigenous communities, highlighting the influence of social determinants of health, geographical isolation, skin infections and waning vaccine-induced immunity on disease transmission and outcomes. Emergency clinicians faced challenges in identifying suspected cases due to the overlap of diphtheria presentations with common respiratory and skin infections. The rapid development of clinical guidelines and close collaboration with infectious disease specialists were essential in supporting clinical decision-making and standardising patient management. The outbreak also revealed a broader spectrum of cutaneous diphtheria presentations than previously recognised, raising concerns regarding healthcare worker exposure. Operational pressures, contact tracing requirements and staff isolation contributed to workforce strain and psychological stress. This experience underscores the importance of preparedness, vaccination and adaptable healthcare systems in responding to the re-emergence of infectious diseases.
Australia's ageing population resulted in increasing Emergency Department (ED) presentations among older adults, particularly frail and those at risk of adverse outcomes. Delirium contributes significantly to morbidity in this cohort. The 4AT screening tool is routinely employed to identify risk. This study examined the impact of the Geriatric Emergency Department Initiative (GEDI) on clinical outcomes for older community dwelling adults presenting to ED with a completed 4AT. A retrospective, single-centre observational cohort study was conducted at an urban district ED. Patients ≥ 75 years, and First Nations peoples ≥ 55 years, with a completed 4AT presenting between January 1 and June 30, 2023 were included. Data were extracted and analysed using descriptive and comparative statistics. Of 1756 patients, 918 (52%) received GEDI input. Overall, 1135 (65%) had a 4AT score of 0 (no cognitive impairment), 410 (23%) with 4AT of 1-3 (mild cognitive impairment), and 211 (12%) with 4AT score of ≥ 4 (probable delirium). Among patients with a 4AT of 0, GEDI involvement was associated with shorter ED lengths of stay, lower admission rates, and higher discharges home (all p < 0.001). Patients with 4AT scores 1-3, GEDI involvement lowered admission rates, increased discharges home, with no difference in ED length of stay. No significant differences were observed with 4AT scores ≥ 4 when compared to standard care. GEDI involvement reduced ED length of stay and admission rates among older adults without delirium or with mild cognitive impairment, but no significant impact was observed for patients with probable delirium.
Blood cultures (BCs) are used in emergency departments (EDs) to investigate and manage suspected sepsis; however, their inappropriate use contributes to low-value care, providing limited clinical benefit while causing avoidable harm. Despite recommendations for more selective testing, low-value blood culture (LVBC) use persists, and there remains uncertainty on the definition, drivers, and impact of LVBCs. To map the existing literature on LVBCs in adult ED patients, including definitions of LVBCs, associated clinical contexts, contributing factors, consequences and related gaps in knowledge. Six databases were searched from inception to June 30, 2025. Studies involving adult populations and addressing LVBC use in EDs were included. Data were charted independently by two reviewers. Risk of bias was assessed using JBI critical appraisal tools. Of 1453 records screened, 18 studies were included in this scoping review. None defined LVBCs, although five themes characterising LVBCs emerged: limited impact on patient management, non-adherence to guidelines, failure to meet predictive tool thresholds, protocol-driven ordering, and BCs deemed unnecessary by clinicians. Reported prevalence of LVBCs ranged from 19% to 69%. The most referenced LVBC driver was pressure to comply with quality measures. Reported consequences of LVBCs included unnecessary treatment, investigation and prolonged stay due to false positive results. Patient-centred outcomes were rarely reported, and formal economic evaluations were lacking. LVBCs are prevalent among adult ED patients yet inconsistently defined. Addressing the issue will require standardised criteria, interventions targeting root causes, and research focused on patient-centred and economic consequences to optimise BC ordering practices.
Townsville, North Queensland, experienced record rainfall in the 2024-2025 wet season with an associated surge in the number of patients with melioidosis. A large proportion presented to the Townsville University Hospital (TUH) emergency department (ED), presenting an opportunity to assess the surge from an ED perspective. This was a retrospective case series of all patients with melioidosis that presented to TUH ED between 1 November 2024 and 30 April 2025. Cases for the entire region were sourced from the Statewide Reference Laboratory, and then individually assessed to ascertain whether they first presented to the TUH-ED. There were 57 patients with confirmed melioidosis that presented to the TUH ED in the 2024-2025 wet season, 40 males and 17 females. Risk factors for melioidosis were present in 51 (88%), with diabetes being the most common (47%). ED blood cultures were taken in 54 patients and were positive in 36 (67%). All patients were admitted, with a median length of stay of 11 days; 12 (21%) patients had an intensive care admission, and hospital mortality was eight (14%). Pulmonary involvement was evident in 79% and prostatic involvement in 30% of males. Meropenem was administered in ED to 53% overall, and 80% of those with severe illness. The surge of patients with melioidosis demonstrated a wide spectrum of infection foci and severity of illness. In melioidosis endemic regions following significant rainfall, we recommend to culture widely, administer meropenem for severe infections and consider melioidosis as a cause for unusual presentations.
To evaluate the safety and effectiveness of the pregnancy-adapted YEARS guideline at a major referral emergency department. This was a single-centre, retrospective cohort study of the impact of pregnancy-adapted YEARS guideline at Townsville University Hospital Emergency Department. Pregnant women who presented between July 2018 and June 2025 (2 years before to 5 years after) and were investigated for possible pulmonary embolism (PE) were eligible. Safety was defined as the rate of venous thromboembolism (VTE) at 90 days, and effectiveness as the proportion of women who did not undergo imaging. A total of 532 pregnant women were identified, 76 in the 2 years pre-guideline and 456 in the 5 years post-guideline. Pre-guideline, 24 out of 76 (32%) had D-dimers with no imaging, 36 (47%) had both D-dimers and imaging, 16 (21%) had imaging without D-dimers and there was 1 diagnosed with PE (1.3%). Of the 456 women who presented after guideline introduction, 168 (37%) were evaluated with D-dimers alone, 276 (61%) had D-dimers and imaging, 12 (3%) had imaging without D-dimers and 4 (0.9%) were diagnosed with PE. Of the 168 women post-guideline assessed with D-dimers only, outcome data were available for 150 (89%), none of whom had VTE. The introduction of the pregnancy-adapted YEARS guideline was associated with increased investigation for PE. Over 5 years, there were no known cases of missed PE.