The burden of mental illness on the Australian community and public health care system is substantial. (1) Every year in Queensland, approximately 300 people who present to a rural or remote ED location with acute behavioural disturbances (ABD) require aeromedical retrieval to an Authorised Mental Health Service (AMHS). ABD is “combined physical actions made by an individual which are in excess of those considered contextually appropriate and are judged to have the potential to result in significant harm to the individual themselves, other individuals or property” of rapid onset and a severe nature.(2)The transfer of people experiencing ABD is challenging due to difficulties in balancing patient rights and safety against that of the retrieval team. The aeromedical retrieval environment is restrictive, both in physical size and in relation to resource access, necessitating a heavy emphasis on risk-mitigation. Whilst research has established a safe approach to the sedation of people with ABD, other aspects of their retrieval remain lacking in evidence, and may contribute to suboptimal care and delayed access to specialist mental health services. This programme of research aims to explore those areas to ensure the management of people with ABD requiring aeromedical retrieval is optimal. Should changes in practice be required as a result, operating procedures and policies with Queensland's aeromedical network will occur.READ MORE
Older patients with minor head injury routinely get a head scan in emergency departments due to the risk of a brain bleed. Recent studies have suggested that some of these patients may not need a head scan. However, doctors do not currently have an accurate method to identify those patients who do not need a scan.
This research aims to identify a subgroup of older patients with minor head injury who do not have a brain bleed and can be safely managed without a head scan. As there are no known Australian studies in this area, this innovative project addresses a common problem in a vulnerable group of patients with several potential benefits.
The study will inform emergency doctors about the feasibility of larger Australian studies to develop a reliable and accurate method to identify older patients who do not have a brain bleed and do not need a head scan. Such a method could benefit patients by reducing transfer from rural and remote communities to bigger hospitals for a head scan, reducing waiting times in emergency departments and reducing exposure to radiation. Such a method could also have significant cost savings to the Australian healthcare system by reducing costs associated with patient transfers, head scans and prolonged emergency department wait times.READ MORE
Each year 40,000 Australians suffer a stroke, most of which arise from interruptions in the blood supply to the brain. Treatments for stroke focus on restoring the brain’s blood supply to limit the number of brain cells which die. Patients who suffer stroke due to a blockage of the arteries supplying the brain (LVO-stroke), benefit from surgical restoration of the blood supply (known as endovascular clot retrieval, ECR), but this is only effective if performed within 24 hours of stroke onset.
Rapid detection of patients with LVO-stroke is key, however many unrelated conditions can mimic stroke symptoms. Patients suspected of suffering a stroke therefore require intensive examination and brain scans to confirm diagnosis before treatment can begin. This delays care provision, particularly for patients in regional areas who must travel to access specialist equipment. Furthermore, the sensitivity of brain scans during the early stages of stroke is poor, increasing the potential for misdiagnosis.
Researchers propose developing a blood test to rapidly screen patients for stroke. Previous research identified 11 new markers in the blood of stroke patients, suggesting diagnostic potential. In this study, researchers we will screen blood samples collected from patients with LVO-stroke to discover markers specifically associated with ECR requirement. The study will also compare the diagnostic performance of identified markers to the screening tool currently used by emergency teams to assess clinical usefulness.READ MORE
Communities of practice (CoP) are widely used to strengthen and enhance healthcare, by generating and sharing knowledge and improving organisational performance. In Australia CoPs have been used in fields such as healthcare improvement, mental health and mental health literacy, and workplace health and wellbeing and more recently in response to COVID 19.
This project will assess the possible scope for a CoP, and the extent to which a CoP might find support among collaborating service organisations, to focus attention on issues surrounding emergency mental health presentations to hospital emergency departments (EDs) in north Queensland.READ MORE
Drowning has a major global impact, with approximately 300,000 deaths each year. Yet the treatment of drowning victims has received limited investigation. This lack of evidence means that guidelines for the treatment of drowning victims are largely based on case reports or on other conditions such as acute respiratory distress syndrome (ARDS), on the premise that there may be similarities between the two conditions.
We are proposing to create a comprehensive database of information on drowning patients presenting to the emergency departments at the Sunshine Coast Hospital and Health Service. We will utilise a standardised list of data (Utstein-style guidelines for Drowning) to explore the treatment and outcomes for drowning patients over an eight-year period 2015-2022 inclusive. This will allow us to answer questions on the best ways to assist the breathing of drowning patients, if the treatment and outcomes in female drowning differ from males and why (there is some evidence females have better survival outcomes after being admitted to hospital), and to determine if the classification of drowning severity in common use around the world is useful in an Australian population.READ MORE
Emergency department (ED) waiting times are a significant predictor of the patient experience.
Simple prediction methods, such as rolling average, are used by hospitals in Australia to predict waiting time for patients. Although this approach is inexpensive to implement, the forecasts have limited accuracy and consequently most Australian hospital EDs do not report expected waiting times to the public.
A solution that is capable of sourcing data from ED information systems and feed it into prediction models to generate waiting time forecasts would bring practical benefits for staff and patients. There is also potential to assist clinicians and nurses to estimate demand for care and calibrate workflow.
For patients, the knowledge may reduce anxiety associated with uncertainty about the waiting time and reduce the number of patients who leave before treatment.
This project aims to use advanced statistical models and machine-learning algorithms to capture dynamic fluctuations in waiting time, to implement and validate the prediction performance of these models. The project will also build ED research capacity by educating staff on forecast modelling and data management techniques.READ MORE
Queenslanders living in regional, rural and remote areas have a higher incidence of traumatic injury and poorer access to health services than their urban counterparts.
Researchers propose to undertake a first-of-its-kind study to classify and characterise trauma patients from these areas serviced by Townsville, Cairns, Mt Isa, and Mackay Hospitals over the three-year period 2016-2018. Using patient records, researchers will examine the clinical therapies and interventions used and patient outcomes from point-of-injury through to hospital discharge.
The study will capture, collate and compare patient data from Queensland Health, Retrieval Services Queensland (RSQ), LifeFlight Retrieval Medicine (LRM) and the Royal Flying Doctor Service (RFDS) to assess the current state of emergency trauma care in the Queensland Tropics, and any potential gaps in aeromedical healthcare delivery. The results will also provide a springboard for a wider system and processes assessment of emergency trauma care for the benefit of patients in North Queensland.READ MORE
Hip fractures are extremely painful yet medications which are usually used to manage the pain can have significant complications, particularly in frail individuals. Numbing medications injected into the groin on the side of the hip fracture have been shown to decrease pain, confusion and chest infections in patients with hip fracture awaiting an operation.
It is usual for most patients presenting to emergency departments with a hip fracture to get a single injection of numbing medication. What isn’t known is whether multiple regular doses of numbing medications injected regularly via a plastic tube in the groin are more effective than a single injection in managing the pain of hip fractures.
The purpose of this study is to show multiple regular doses of numbing medications are better than a single injection. This will be achieved by examining the difference in the amount of pain, the quantity of pain medications, and the degree of confusion between the patients getting multiple doses and those getting a single injection.
This study will be the first of its kind to be done in an emergency department and is also unique in that it will involve patients with dementia who make up more than a third of patients with hip fracture and are usually excluded from studies. The study is expected to help manage the pain of the 1.6 million hip fracture patients worldwide and give emergency doctors an additional option of managing hip fracture pain.READ MORE
Emergency Departments (EDs) receive persons suffering major disturbances in their mental capacities, detained and transported by police or ambulance. The Public Health Act 2005 (Qld) (‘PHA’) – amended and in force 5 March 2017 – requires police and ambulance officers to make out an Emergency Examination Authority (EEA) at handover.1 Previously, Emergency Examination Orders (EEOs) were made out under Queensland’s Mental Health Act 2000 (‘MHA’). At handover, police and ambulance officers must make out an EEA. From handover at the ED, the PHA prescribes specific responsibilities, e.g. a doctor or health practitioner must explain to the person that they may be detained for 6-12 hours, the ED Director can order their forced return if they abscond and must take reasonable steps to return patients to a place requested.
Using qualitative and quantitative information the study focuses on the time and personnel resources required to investigate how EDs in north Queensland have responded.
No study has assessed the impacts on Queensland EDs of increasing numbers of mental health related presentations in light of legislative changes governing emergency assessmentREAD MORE
This research project is looking at cellulitis in the Torres Straits. Cellulitis is a bacterial infection of the skin that requires antibiotics. People with cellulitis usually have an area of red and hot skin and sometimes can have fevers and become really unwell. Germs called Staphylococus aureus and Streptococcus pyogenes typically cause cellulitis. It potentially can cause serious infections and are a common presentation to emergency departments and admission to hospital.
In a tropical environment such as the Torres Strait cellulitis is extremely common and contributes to a significant burden on the healthcare system. Often patients present to health care facilities in the Torres Strait with cellulitis and are transported into Thursday Island Hospital for intravenous antibiotics. This is associated with significant retrieval, emergency and hospital costs. However the treatment of cellulitis in the community has been found to be practical, safe, and cost effective. We want to find out if cellulitis can be treated at home instead of in the hospital here in the Torres Straits.
The aim of this study is to validate outpatient intravenous antibiotic management of cellulitis in the Torres Straits. We anticipate that results from this study will improve preventable emergency and hospital admissions thus having significant health economic savings here in the Torres Straits.READ MORE