This is a multicentre, open-labelled diagnostic randomised controlled trial to comparing the use of portable ultrasound and x-ray imaging to diagnose a buckle fracture in children. The trial will determine if there are differences in functional outcomes, patient and care-giver preferences, and health system benefits.
Children frequently present to the emergency department with forearm injuries and often have an x-ray to assess if there is a fracture. Due to the soft and plastic nature of the bones in young children, injuries can cause their bones to bend, known as a buckle fracture. Bedside ultrasound is a test that emergency practitioners can use to rapidly diagnose a fracture at the time of examination, without exposing children to ionising radiation. Ultrasound in this setting is well tolerated, only requiring light touch and gentle manipulation of the forearm and has similar accuracy when compared with x-rays for diagnosing children’s forearm fractures.
This is the first trial of its kind to assess whether an x-ray is unnecessary when there is either a buckle fracture or no fracture seen on a portable ultrasound machine. This is important as they can be treated at the time of review without any further delay, which will avoid these children being exposed to ionising radiation. Children will be randomised to receive either an ultrasound or x-ray for their forearm injury. Both groups will be followed up to see whether there are any differences in their recovery and to determine any complications. We will also determine the time and cost implications of this new approach, which could enable families to go home earlier and could be more cost-effective, with less x-rays being ordered.READ MORE
The overarching aim of this study is to estimate the magnitude of the need for care at the end of life care in the emergency department, and to describe care delivery practices, processes and outcomes for older people who present to the emergency department requiring end of life care.
Australians aged 65 years and over account for 22% of emergency department presentations. Currently, this group makes up 15% of the population, but this predicted to rise to 20% by 2037.
There are two trajectories of end of life in the emergency department: ‘unexpected’ and ‘expected’ deaths. Unexpected deaths stem from acute illness or sudden, traumatic events. Expected deaths stem from deterioration of chronic illnesses.
When expected deaths occur in the emergency department, staff dissatisfaction and distress as well as frustration for patients and their families can result. In Singapore, around 50% of deaths in people aged ≥ 65 who died in one emergency department were considered ‘expected’. This highlights the need to understand if the situation is the same here in Australia and to what extent quality end of life care is provided for both trajectories of dying (i.e. expected and unexpected). Our study will identify the ‘unexpected’ and the ‘expected’ deaths among people aged ≥ 65 who die within 48 hours of emergency department presentation.
From a health perspective, a disaster overwhelms the normal operating capacity of a health service, where an outside health response is required to restore and maintain the normal day-to-day health services and standards of care for the disaster-affected community. The Australian healthcare system is tested annually with disasters of a conventional nature (e.g., floods, cyclones, bushfires), however, the Australian healthcare system has not been recently tested by non-conventional disasters such as Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) disasters. As a result, the ability to determine the healthcare system response is difficult. Further, there is no research specific to the Australian emergency department’s capacity for disaster response in CBRNe events.
This study addresses this gap. We will use a mixed methods approach to undertake two discrete, yet related studies. Study 1 involves undertaking surveys with key emergency disaster personnel from seven Queensland hospitals to describe the capacity of hospital emergency care services ability to respond following a CBRNe disaster. Study 2 includes undertaking focus groups with key clinicians and leaders from the participating sites to identify and explore enablers and barriers within emergency care services to provide CBRNe disaster response. Findings from these studies will provide an evidence base regarding the capacity for several Queensland emergency departments, located in metropolitan, regional and rural settings, to respond to disasters.READ MORE
Peripheral intravenous cannulation (PIVC) is a vital part of modern medicine, however the use of cannulas has become prolific, with many never used. The patient risks that are associated with PIVC are well documented, including pain and even infections, which can be severe and lead to death.
PIVCs which are inserted but never used (idle PIVC), have the risks and downsides, but no potential benefits. Reducing the rate of idle PIVC may reduce the overall rate of risks, side-effects and infections associated with PIVC, but it may also .lead to patients who require PIVC not receiving one.
In this study, we are looking into the reasons why clinicians decide to insert a PIVC. We aim to describe: I) the proportion of PIVCs placed that do not get used within 24 hours (idle PIVCs), II) differences between the pre-hospital setting and the emergency department and III) describe which factors are associated with clinicians’ decision making regarding PIVC insertion.READ MORE
The aim of this study is to evaluate securement devices for peripheral intravenous catheters (PIVC) in the paediatric ED to determine which method is most effective for reducing PIVC failure, associated costs, acceptability and patient distress.
Infants and children depend on PIVCs for the provision of medical therapy within the emergency department and during hospitalisation. However, PIVC insertion and management is challenging and more than 25% of devices fail. PIVC failure is costly for both the patient and healthcare organisation. Failure may require the child to undergo traumatic reinsertion procedures, delay important medical treatment and prolong length of hospital stay. One way to reduce PIVC failure is with effective PIVC dressing and securement, by ensuring correct catheter position in the vein.
Our trial aims to test if new advances in catheter securement, medical grade superglue (Histoacryl) and an integrated dressing securement product (SorbaView SHIELD), are effective at preventing cannula failure and complications in paediatric patients. Using a three arm, randomised controlled trial, this study will recruit 460 paediatric patients at two regional emergency departments (Logan Hospital, Ipswich Hospital). Children will be randomised to receive PIVC securement by i) standard care, ii) advanced dressing or iii) medical grade superglue and advanced dressing. The main outcome of this trial is PIVC failure, with other important questions surrounding cost effectiveness and patient comfort also to be explored.
It is important for effective, improved cannula security to be explored as this is frequently a first line device choice for treatment, being highly effective in rapid treatment situations. A result in improved treatment delivery will benefit with cost savings in not only product but clinician time spent re-inserting, and a reduction in unnecessary, painful procedures for children.READ MORE
Improving patient experiences is part of Queensland’s 2016-2020 Strategic Plan to enable safe, quality healthcare services. Yet, current emergency department(ED) patient experience measures, including the burdensome 82-item Queensland Health (QH) ED patient experience survey, fail to reflect patient preferences for care experiences, inhibiting the design and evaluation of healthcare services that reflect patient preferences, and the delivery of value-based healthcare.
The aim of this project is to develop an ED patient experience classification system and accompanying scoring algorithm that can be used to both measure and value patient experiences in Queensland EDs. It will provide a proof of concept for an Australia-wide development, valuation and knowledge transfer study.READ MORE
The objective of this study is to describe the impact of the 2018 Commonwealth Games held in Queensland, Australia on the emergency departments in the Gold Coast region. This research has two key aims, which align with two discrete but related studies:
Study 1 Aim: To describe and determine whether changes in patient, health service, and economic outcomes occur before, during and after the Commonwealth Games.
Study 2 Aim: To explore healthcare staff experience of planning, preparedness and lessons learnt from the Commonwealth Games.
Findings from this study will provide an evidence base regarding the impact of a large sporting mass gathering on public and private emergency departments, forming an invaluable resource for future Commonwealth Games planners, as well as response planning for other mass gatherings, sporting or otherwise.READ MORE
After whiplash injury, half of patients never fully recover. The human and economic cost is enormous, and current mainstay treatments are ineffective. Most recovery, if it occurs, takes place in the first two to three months. This early time period offers a ‘window of opportunity’ to pro-actively intervene and prevent the chronic pain. The Emergency Department (ED) is ideally placed to provide very early intervention. We have shown that upregulation of pain in the central nervous system occurs soon after whiplash injury and predicts poor recovery. We aim to target these central nervous system processes with pregabalin in conjunction with evidence based physiotherapy advice/exercise in the ED. The results have potential to fundamentally change the treatment of acute whiplash injury.READ MORE
“Blind Prescribing” describes the situation where a medical practitioner prescribes a medication they know little about.
Theoretically, ‘blind prescribing’ could lead to higher rates of medication error and unsafe medical practice. The project aims to determine if Blind Prescribing occurs in emergency medicine, to identify the prevalence of the practice, and propose situational and contextual factors pertinent to Emergency medicine that are thought to enable this practice.
Healthcare workers in emergency departments are at high risk of exposure to blood-borne infections from occupational exposure. The financial and human costs of these injuries are significant. The risks such health care workers face are made more difficult in recent times because of three interconnected reasons. First, emergency care workers are at high risk of occupational exposures because of the nature of their work and the environment they operate in. They work in highly volatile and high-stakes situations. Second, emergency departments face unprecedented demands for emergency medical care. With increased numbers of patients, waiting times for medical treatment inevitably increase, leading to patient dissatisfaction, aggression and violence, larger and heavier workloads, decreased patient and staff satisfaction, and higher staff turnover and burnout. Third, emergency physicians are routinely called upon to manage healthcare workers who have sustained these occupational exposure injuries. The more patients there are, the more at risk emergency physicians and others are at risk of occupational exposures.
These injuries are largely preventable. Emergency physicians have key roles to play with their prevention, but lack a rigorous reporting system and sensitive data management system with a universal regulatory framework to do so. While national guidelines exist to govern the clinical management of such injuries, there is no consistency of regulatory and legislative workplace health and safety frameworks in which emergency physicians are required to operate across the country, making their prevention, control and management by emergency physicians highly problematic. This study will provide a definitive systematic review of the legislative and regulatory workplace health and safety frameworks governing the management, control and prevention of occupational exposures across Australia. Moreover, the study will provide baseline data and pilot research for a larger study that suggests the development of a culture of patient safety within the emergency department and the wider hospital environment first requires a culture of staff safety. For the true financial and human costs of occupational exposures to be known, it is critical to gauge the extent the problem. When we consider the estimated under-reporting in the United States or Australia, where it is estimated that up to 85% of occupational exposures are not reported due to the systematic under-reporting of sharps injuries, the financial and human costs associated with occupational exposures are significant.READ MORE