Results for Queensland Ambulance Service


Quality linking of health data to evaluate patient and health service outcomes and key performance indicators following the implementation of patient flow strategies.

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.

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The impact of a new emergency department on patient presentations and ambulance service delivery

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.

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Queensland pre-hospital study identifying which trauma patients are at risk of bleeding to death.

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.

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Delivering emergency care in the watch house: an outcomes analysis.

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.

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Evaluation of the Emergency Department Ambulance Offload Nurse (EDAOLN) in Queensland

Internationally, Emergency Department (ED) and hospital overcrowding is increasing and has been associated with negative patient and staff outcomes. Associated with this overcrowding, ambulance offload time (AOT) delay (i.e. extended time from ambulance arrival to ED to offload onto hospital stretcher, also called ambulance ramping) has emerged as a crucial patient safety issue, with offloaded ambulances not available to respond back to the surrounding community.

Queensland Health have recognised that patient flow strategies are required 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.

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A prospective blinded evaluation of the sensitivity and specificity of pre-hospital Focussed Abdominal Sonogram for Trauma (FAST).

Emergency department use of ultrasound to detect internal bleeding has been shown to be accurate and change patient outcomes. Although previous studies have shown that it is feasible to perform ultrasound examination in the pre-hospital environment, there is a paucity of information about the accuracy of these scans. Given that prehospital ultrasound is often performed in suboptimal conditions (i.e. in the open during daylight or in the cramped confines of an ambulance), with machines less advanced than those utilised by Emergency Department staff, the accuracy and utility of pre-hospital ultrasound scans needs to be evaluated. This study will evaluate the accuracy of pre-hospital ultrasound in patients when performed by the rapid emergency response team, consisting of paramedics and pre-hospital doctors in the Greater Brisbane, Logan and Ipswich areas (50km radius of the CBD). The study will also compare the accuracy of paramedic performed scans to those performed by doctors. The accuracy of the scans will be assessed against surgical findings and hospital CT scans. Another variable to be quantified is the time taken to perform the scans, including the acquisition in a moving ambulance, given prolonged scene times may adversely affect patient outcomes. If the results of this study find that the accuracy of pre-hospital scans are high, then this will enable future studies to be conducted evaluating if pre-hospital scans affect hospital management and patient outcomes.

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The Queensland Aeromedical Retrieval System: A Review of Current Status and the Impact of State-wide System Developments.

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.

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