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.

Improving the care of skin infections in the Torres Straits

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.

The Australasian Paediatric Head Injury Rules: a prospective validation of 3 international clinical decision rules for acute head injury in children presenting to emergency departments.

Many children sustain head injuries and present to emergency departments for evaluation. Even a seemingly minor incident may lead to serious injury requiring neurosurgery. While head computer tomography (CT) identifies all important injuries, there is an increasing recognition that radiation from CTs can increase the risk of fatal brain cancers, especially in younger children.

Failure to identify a significant intracranial injury quickly may result in catastrophic consequences including long-term neurological disability and or death. A number of evidence-based head injury (HI) clinical decision rules (CDRs) have been developed to help physicians identify patients at risk of having a significant head injury. These CDRs provide recommendations (including CTs) based on the presence of certain features of the history or physical examination. No HI CDRs have been validated outside of their original settings.

The identification of an optimal CDR for implementation would help to minimise risks, both of missing a clinically significant intracranial injury, and of exposure to radiation from cranial CT scans. The results will likely have a major impact on head injury management in children in Australia, New Zealand and worldwide.