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
In order to understand the effectiveness of health service delivery, and the impact of changes in processes and procedures, it is important to first be capable of analysing the data that documents patients’ journeys through the hospital. This project will bring together key data from multiple disjointed information systems so that analysis can be undertaken on the flow of patients through the Gold Coast Hospital (GCH); from the ambulance, through the Emergency Department, and admission to a ward, including the operating rooms, radiology, pathology, and pharmacy that they encounter up to their departure. With this holistic view of patients’ journey of care, the baseline and measure impact of initiatives will be determined to ensure that patients flow through the environments with minimal delay and improved outcomes.READ MORE
This research aimed to investigate the impact of opening a new ED within a health service district. The study involved linking ambulance, emergency department (ED) and hospital data from three EDs to better understand the patient journey and patient and health service outcomes when a new ED opens within the health service. The project aims were to:
1. Describe and compare patient and health service outcomes at three EDs before and 12 months after Robina ED opening;
2. Describe and compare outcomes for patients arriving to ED by ambulance based on whether off stretcher time is/is not delayed by >30 mins.
Injury is the leading cause of death and the second highest contributor to the burden of disease of Australians aged between 12 and 24 years. One of the contributing factors to trauma death is the inability for the injured patient to clot properly. Studies have shown that in approximately 10-50% of trauma patients the blood does not clot properly, with patients exhibiting abnormal clotting up to 4 times more likely to die from their injuries.
This study aims to estimate the proportion of injured patients with clotting problems at the time paramedics treat them. The Queensland Ambulance Service (QAS) High Acuity Response Unit (HARU) currently services the Greater Brisbane area and will commence operations on the Gold Coast Area in the latter half of 2015. The HARU provides advanced trauma interventions including blood transfusions and ultrasound scans to detect internal bleeding. In 2014 the HARU treated approximately 370 moderate to severely injured patients in the Greater Brisbane area.
In this study, HARU team members will take blood from patients during their treatment in the field. The blood will then be analysed to see if there are any clotting abnormalities. They will also perform a quick screening blood test in the field to see if this screening test corresponds to the laboratory analysis.
Identifying which patients are not clotting properly prior to hospital arrival may pave the way for life saving treatment to be started on the way to hospital, and for rapid intervention on arrival at hospital.
Increasingly, prisoners are requiring transfer to and assessment in the ED; some for illnesses that may be treated in the custodial environment with an appropriately trained health care professional. Optimising how health care is delivered in the watch house environment was the focus of this study, following recommendations in a recent (2012) Inquiry following the death of Herbert John Mitchell.
This study is underpinned by recommendations from deaths in custody, the literature and anecdotal experience. The study will provide a comprehensive outcomes evaluation of a 66 day trial of a model where emergency nurses were posted to the local watch house for an 8hr late shift and a 10hr night shift to supplement domiciliary nursing services to provide 24hr nursing presence in the watch house. This model of enabling experienced emergency nurses the opportunity to work within an 'out of hospital environment' but with the support from medical colleagues has not to our knowledge been trialed elsewhere and is therefore innovative.
The impact expected from this study is on the prisoners, health care staff and police staff working in this model. We expect the following main outcomes: less transfers of prisoners to ED from the watch house and a cost effective model.READ MORE
Queensland Health have recognised that patient flow strategies are required for emergency departments in order to i) improve the patient journey and experience; ii) reduce delays and increase access to health care services; and iii) provide best clinical practice across the state. An Emergency Department Ambulance Off-Load Nurse (EDAOLN) role was commenced on Friday 17 August 2012 at the Gold Coast Hospital. The aim of this advanced nursing role was to provide rapid triage and assessment for patients arriving to the ED by ambulance and to commence initial meaningful treatment as required (such as X-rays, pathology, analgesia) on a 24/7 basis.
A retrospective study of all ED presentations (n=21,454) made to the Hospital, during July 9, 2012 - November 2, 2012; 39 days before (T1), during (T2) and after (T3) the introduction of the trial of an EDAOLN role. The primary outcome of interest was time to be seen by a clinician.READ MORE
This study will evaluate the accuracy of prehospital ultrasound in patients when performed by the rapid emergency response team, consisting of paramedics and prehospital doctors in the Greater Brisbane, Logan and Ipswich areas (50km radius of the CBD), and will also compare the accuracy of paramedic performed scans to those performed by doctors.
Ultrasound in Emergency Department (ED) is rapidly becoming an extension of the clinical exam. Focussed Assessment with Sonogram in Trauma (FAST) has been shown to be a rapid and non invasive means of detecting the presence of intraperitoneal and intrapericardial fluid without the need to remove the patient from the ED. In unstable patients it assists in determining the cause of bleeding and prioritising interventions. Like most imaging studies, the accuracy of the FAST is operator and equipment dependent. It is hypothesised that in the pre-hospital setting, numerous environmental factors including ambient light, vehicle movement together with the lower resolution of displays, may all impact on the accuracy of the scans. Additionally, in Australia, the vast majority of pre-hospital care providers are paramedics, a profession that generally speaking are not exposed to ultrasound in day to day practice. This lack of familiarity with the imaging modality may impact on the accuracy of interpretation.READ MORE
Aeromedical retrievals and transfers are an essential component of modern Emergency Medicine. These services provide high quality emergency care to the patient and facilitate transport from the roadside or smaller hospitals to larger centres able to perform potentially life saving treatments and provide definitive care. Thus they help ensure equity of access to high quality medical care regardless of physical isolation. This is especially important in Queensland, the most decentralised Australian state.
Until recently aeromedical clinical coordination and retrieval services in Queensland were provided by a several different organizations. In 2005 a system restructure was commenced and a state-wide centralised Queensland Emergency Medical System (QEMS) Clinical Coordination Centre and dedicated medical retrieval and transfer service was established. Standardised retrieval service data has been collected centrally since February 2007 with over 18,000 patients transported each year.
The project will review in detail five years of state-wide aeromedical retrieval system activity to describe the nature and extent of services provided.READ MORE