Single vs. Dual Platelet-Inhibited FIBTEM Assays in Rotational Thromboelastometry: Is a New Threshold required for Queensland Hospitals

When patients have severe bleeding, hospitals use a test called ROTEM to guide transfusions in real time. ROTEM is used in 16 hospitals in Queensland and relies on specific cut-off values to help doctors decide when to give certain blood products.

In June 2023, the manufacturer of ROTEM changed the chemical (reagent) used in one of its tests, FIBTEM, without informing doctors. FIBTEM helps guide decisions on giving fibrinogen, a protein that supports blood clotting. This change has likely lowered FIBTEM results, but hospitals are still using old thresholds that have not been validated for the new test, potentially leading to inappropriate transfusions. A study found a similar test change affected accuracy, requiring updated thresholds in the UK to avoid over-transfusion. This raise concerns that Queensland hospitals need updated thresholds. In January 2025, a safety notice alerted 16 Queensland hospitals urging all 16 hospitals to review their bleeding algorithms.

This study will analyse whether the change in the FIBTEM test has affected actual fibrinogen levels. It will compare test results before and after the change using data from 16 hospitals. If the findings show current thresholds are inaccurate, hospitals will be informed and supported in updating their bleeding guidelines. This is an urgent patient safety concern, as blood products may be given using outdated cut-offs that were not validated for the new change. This study ensures accurate transfusion decisions to improve care for critically bleeding patients.

National Emergency Department Stress, Coping and Intention to Leave Survey: DESTRESS

The emergency department (ED) is a stressful workplace. The stressful work environment has resulted in high levels of psychological distress with some using mal-adaptive coping strategies. High staff turnover is evident in some EDs. To guide the development of strategies for clinicians, health services, policy makers, and emergency colleges, this research will provide a national picture regarding the impact of stressors on health and performance.

The well-being of staff is a priority for Emergency Medicine and Nursing colleges in Australia. Research reports have emerged highlighting concerns with post-traumatic stress, sleeping problems, cardiovascular disease and increasing rates of suicide among healthcare staff. This research is critical to address such concerning trends.

This multi-disciplinary research collaborative is new, consisting of expert clinical and academic leaders from emergency nursing and medicine coming together to provide a robust approach to understand, from a national perspective, where opportunities exist to enhance clinician wellbeing and the effectiveness of local, state, or national practice or policy measures, through the longitudinal design.

This research will provide a comprehensive Queensland, as well as a national understanding of the impact of stressors on the health and performance of ED staff. When applied longitudinally, the questionnaire can be used to evaluate the outcomes of interventions and policies that seek to promote positive coping strategies for ED clinicians.

Microcirculation in shocked patients

Microcirculation refers to very small blood vessels that control oxygen and nutrient delivery and removal of waste products from our tissues and organs. Previous research has shown that a decrease in either the number of vessels, or blood flow through these vessels, can be seen in patients who are very sick as a result of infections, blood loss or heart failure. Changes in microcirculation are associated with how sick a patient is and whether or not they recover from illness. However, only small numbers have been included in other studies.

The principle hypothesis of this research is that abnormalities of the microcirculation -- identified with sidestream dark field (SDF) imaging not necessarily discernable with global measure of perfusion -- will correlate with ongoing organ dysfunction in shocked critically unwell patients.