The development of linked data from aeromedical retrieval & health system databases will provide improved, value-added insights to patient care and outcome analysis. This first-of-its-kind study seeks to take the next step in patient-centered outcomes research and resource allocation planning by linking together existing, but independent emergency department, aeromedical, hospital and death databases. Our pilot study has linked databases, creating secure & robust infrastructure for future state-wide studies.
The aims of the study are:
a) Utilise the linked data infrastructure that we’ve created, allowing next phase state-wide replication; describe aeromedical patient outcomes (including length of stay and mortality); understand aeromedical service requirements for specific illness/ injury, those that require frequent flights, & identify steps within the patient journey.
b) Develop a better understanding of the aeromedical patient journey will help to develop appropriate health services delivery, in particular emergency departments whom most often are first point-of-service, thus ensuring better health outcomes.
Domestic and family violence (DFV) against women is the number one cause of hospitalisations in Australian girls and women aged 15-54 years. It is also the number one cause of death and disability in women aged 15 to 44. Although most victims of fatal DFV access health services in the 24 months prior to their deaths, many victims living with DFV go unnoticed in the community. Health care providers are well placed to identify DFV victims and refer them to appropriate services. The ED has been described as a good place to undertake identification of DFV victims in several published research papers. Yet, how to do this remains controversial, and there are no standard protocols in place in our EDs. In this project, we aim to describe the current DFV health practice culture in five Queensland EDs. Knowledge, beliefs, and attitudes, as well as what’s actually happening to detect cases of DFV, will be assessed among our front-line ED social workers, nurses, and doctors. We aim to determine how many presentations to ED are identified and referred to social worker services for DFV. Ultimately, this research will both raise awareness about the potential of the ED to detect DFV, and will help pave the way forward to a well-informed and structured ED DFV screening program for Queensland, with applicability internationally.READ MORE
Diving is a common recreational activity for both Queenslanders and tourists alike. It forms the basis for whole tourism industries based on the Great Barrier Reef. Unfortunately diving does have risks which includes decompression illness (DCI). DCI involves formation of gas bubbles and can be fatal. Treatment usually involves re-pressurisation in special chambers designed to ‘squash’ the bubbles and reduce symptoms. Affected divers can only receive this treatment in certain hospitals. They may need to be transported urgently by helicopters from the reef to hospital. However, some people believe that the vibration of the helicopter may increase the number of bubbles and make symptoms worse before divers can access treatment. This study will determine if this is true – will bubbles actually be increased by the vibration associated with helicopter flight? If vibration does increase bubble formation, then in the future alternative strategies for transporting DCI patients can be implemented to reduce the risk to these patients. To ensure safety the vibration record of helicopter flight will be recorded and reproduced using a vibrating basket model. Healthy volunteers accompanying divers in the recompression chamber will be assessed with a special ultrasound to detect bubbles following the ‘dive’ and then placed in the vibrating basket. The number of bubbles present after this will be measured again. This study will help ensure safe transport of injured divers not just in Queensland but internationally. This global importance is represented in the research team, which includes members from both Canada and other Australian states, which are collaborating in a Queensland based study.READ MORE
Current guidelines for the assessment of patients with chest pain mandate that patients remain in hospital for a minimum of 6 to 12 hours, with many staying overnight. We have developed an accelerated assessment protocol for patients who present to Emergency Departments with chest pain; the Brisbane Accelerated CHest pain protocol (BACH protocol). This strategy should support the accelerated assessment of more than 70% of all ED patients presenting with possible symptoms of a heart attack.
Research into the effectiveness of the BACH protocol was completed in 2014, and showed it to be safe and effective. As such, it was immediately recommended as usual care at the Royal Brisbane and Women's Hospital (RBWH). However, a major concern for health care services is that clinical practice may not change despite quality research identifying ways to improve patient care. Studies show that it takes around 17 years from an idea to progress from the research stage to a change in clinical practice. The current proposal is to assess whether the BACH protocol has been successfully translated into clinical care. That is, has clinical practice really changed as a result of the investment in research? If we are able to show that clinicians use this safe strategy routinely, it will support efforts to more widely use this protocol in Emergency Departments across Australia, potentially saving significant health care costs.
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.READ MORE
Irukandji Syndrome (IS) is a condition caused by the venom of jellyfish found in the tropical waters of Australia and has received significant media attention over the past decade. The syndrome most commonly presents with a variable combination of severe generalised pain, involving the torso and limbs, nausea and vomiting, sweating, headache and severely elevated blood pressure and pulse. Documented complications of IS include myocardial (heart) damage and failure, intracerebral haemorrhage (bleeding on the brain) and death.
The signs and symptoms of IS are believed to be due to excessive release of endogenous catecholamines (stress hormones). A number of in-vitro and animal studies have documented elevated adrenaline and noradrenaline levels after exposure to venom from Carukia barnesi and related jellyfish. To date, no human trials have measured serum catecholamines in patients with suspected IS.
This elevation in serum catecholamines may account for the profoundly elevated blood pressure and heart rate seen with IS. However, it is unclear what association the severe generalised pain of IS has with elevation of the endogenous catecholamines, i.e. cause or effect. The research team will conduct a prospective, observational, case-control study on patients with IS at The Townsville Hospital to measure serum levels of noradrenaline and adrenaline.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
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