Does a Vascular Access Specialist Model in the Emergency Department (VAS-ED) improve peripheral intravenous catheter outcomes? A Randomised Controlled Trial

More than 6 million peripheral intravenous catheters (PIVCs) are inserted in patients' veins in Australian emergency departments (EDs) annually. These devices can be challenging to insert, and over half will fail before the treatment is finished. Although ED clinicians regularly insert PIVCs, most inserters are junior medical or nursing staff who often default to short PIVCs because that is what they were trained to insert. These “generalist” inserters often don’t have the skills or knowledge to select alternate vascular access devices appropriate to the patient's needs. In contrast, Vascular Access Specialists (VAS) are experts with advanced assessment and expertise in inserting and managing vascular access devices, a model that has proven successful in inpatient wards, but hasn’t yet been tested in the ED setting.

In this study, we will compare the effectiveness and cost of using VAS specialists versus generalist inserters for peripheral IV device selection and insertion. In total, 320 ED patients will be recruited and randomly allocated to receive either a VAS or generalist inserter (standard care). We will compare outcomes including first-time insertion success, device failure rates, complications, patient satisfaction, and cost between the two groups. Additionally, we will interview clinicians to better understand the barriers and facilitators to implementing and using a VAS model.

We expect that patients who have a peripheral IV device inserted by a VAS will have higher first-time insertion success, and be more satisfied with their care than patients allocated to the generalist group.

The Kids Pain Collaborative: A collaborative implementation study of acute paediatric pain care in an outer metropolitan, mixed emergency department

Although pain is the most common reason for children to come to the emergency department (ED), it is frequently under-treated and under-recognised. We know children are particularly vulnerable to inadequate pain care, relying on adults to interpret their pain and act as advocates. A recent audit of children presenting in pain at Redcliffe ED found that many children with broken arms waited for prolonged periods (48 – 174 minutes) for pain medicine. The Redcliffe ED team identified significant barriers to pain care: staff’s inability to identify pain in children, lack of parental/clinician advocacy and lack of knowledge around paediatric medicines. To address this deficit in pain care, the Kids Pain Collaborative (KPC), an interdisciplinary collaboration of experienced ED clinicians, academic nurse researchers and ED consumers, has been established to transform paediatric pain care in Redcliffe ED.

The KPC is committed to optimising ED pain care at the systems level so that no child has to wait in pain. Our aim is to co-design, implement and evaluate an innovative evidence-based model of paediatric pain care which will begin with the child and family at triage. Engaging families in pain care assessment, optimising pain care processes and facilitating a workplace culture of prioritising pain is key to the success of this project. This project aims to reduce suffering for children and their families and inform paediatric pain care practice and policy at a State level. Research design draws on recent successful implementation research undertaken at the Queensland Children’s Hospital ED (1).

Can interactive online learning using enhanced technology adequately teach trauma-based procedural skills to emergency nursing clinicians?

Injury and trauma are common presentations to Queensland Emergency Departments. Clinicians caring for trauma victims must maintain competency with trauma procedures and interventions to apply them in a time-critical context, accurately, and therefore achieve the best outcome for individual patients. Engagement with traditional educational approaches, such as face-to-face training, is challenged by workload, shift patterns, clinician location and lack of opportunity to attend dedicated training events. A previous learning needs analysis of trauma education programs has highlighted that the greatest challenges are often faced by clinicians in rural and remote locations. One solution is to include the use of online learning platforms, to connect and assess clinician knowledge, with positive feedback regarding the engagement and experience for the learner. This study aims to use high-fidelity interactive online education, using a range of technologies including 360 videos with user interaction capabilities to design and develop a scalable model for future-proofing trauma education across Queensland. The research will test the effectiveness of (1) the approach to design and development in terms of scalability and (2) the online resources and assessment procedures in terms of the impact on knowledge and skill development.

Point of care lactate testing for the earlier recognition, antimicrobial administration, and definitive management of Paediatric Sepsis in the Emergency Department

This research project will examine the impact of implementing a point of care lactate machine on the earlier administration of antibiotics in paediatric patients diagnosed with sepsis in the Emergency Department. Elevated lactate levels have been shown to be an accurate prognostic factor in predicting morbidities among patients with sepsis. Current practice requires serum lactate samples collected via intravenous cannulation, a task that is both time consuming and challenging for paediatric patients and clinicians. The point of care lactate machine is a portable, single operator handheld device, requiring finger-prick blood sample to obtain an accurate lactate result. This negates the need for intravenous cannulation to obtain objective data to aid clinical decision making. This may result in the earlier recognition of sepsis, administration of antibiotics and transfer to definitive care.

Applications of a novel neurosurgical service accessibility index to improve emergency care of people sustaining a road trauma-related traumatic brain injury in Queensland

Queensland’s dispersed population poses significant challenges to emergency trauma system design, requiring both road and aeromedical retrieval services, trauma outreach services and specialist transfer protocols for time critical injuries to maximise survival.

Road trauma is one of the main mechanisms causing traumatic brain injury (TBI). Pinpointing geographic regions with significant disadvantage for timely access to neurosurgical services is needed for targeting education, treatment and outreach services to Queensland regions most in need.

The Injury Treatment and Rehabilitation Accessibility Queensland Index (iTRAQI) is a tool being developed by this team, and piloted for TBI. iTRAQI maps aeromedical/road transport access routes and uses travel time to acute neurosurgical and rehabilitation services to rank accessibility among Queensland localities under realistic scenarios.

This project will map actual pathways to definitive neurosurgical care for moderate-to-severe road trauma-related TBI and compare them to modelled iTRAQI pathways using linked prehospital, emergency, hospitalisation and compensation data.

From Big Data to the Bedside: answering big questions in emergency department pain care using artificial intelligence and patient-reported outcomes

One of the main reasons that acute pain is not well treated in the emergency department (ED) setting is that pain is difficult to measure. While patient-reported outcome measures (PROMS) are commonly used to help guide treatment of pain in settings such as chronic pain care, cancer care and migraine care, there are no similar tools available for patients with acute pain in the ED. Further hampering efforts to provide better ED pain care is poor overall understanding of the numbers and types of patients that experience pain.

Since it is a symptom rather than a diagnosis, information about pain is not systematically collected and is often obscured within free-text clinical notes. The lack of readily-available data makes it difficult to determine who exactly has experienced pain, and to design research studies to evaluate new and existing treatments.

Researchers aim to validate a PROM for pain care in the ED by administering to 400 patients who present with pain to one of two large hospital EDs. The aim is to find out the incidence and characteristics of patients who present with pain to the Royal Brisbane and Women’s Hospital ED, by using novel machine- and deep-learning techniques to process free-text information from clinical notes. This study will provide new knowledge and techniques that are essential for clinician-researchers to design and conduct studies that will ultimately improve pain care in the ED.

PaNURAMA Inter-facility Transfer Tool: a validation study of the Paediatric Non-Urgent, Risk Assessment, Management and nurse escort Assessment Tool for safe children’s inter-facility Transfer

Most paediatric inter-facility transfers within Australia are for children that do not qualify for specialist paediatric retrieval services but still require access to specialised paediatric care not offered at the local healthcare facility.

Evidence-based transfer guidance for children requiring retrieval are well established. However, for children who do not meet retrieval criteria, there is little guidance for referring and accepting clinicians on how to coordinate safe transfer. Nurse escorts are often deployed but may not be trained sufficiently to deal with arising complications during transfer. Additionally, with the availability and scope of paramedics, the deployment of nurse escorts may not be required, and unecessarily deplete valuable resources at referring facilities.

A risk stratification tool has been developed to determine which non-urgent transfers require higher level consultation and management prior to and during transfer, and nursing escort. The validation of this tool may assist to accurately identify higher-risk children, enabling application of appropriate safeguards, an appropriate level of consultation and escort, and supporting clinician decision-making surrounding transport Australia-wide.

Modelling emergency department patient flow under normal operating conditions and in a pandemic

Patient flow in emergency departments (ED) is impeded when the number of patients exceed physical and/or staffing capacity. This is often referred to as crowding, and is common problem for EDs across the country, adversely impacting patients, staff and the healthcare system.

While many strategies have been reported and trialled to mitigate the consequences of crowding and address its causes, there is no one solution that fits all EDs.

Researchers propose to develop and test a computer model to mimic the ED, simulating patient flow to provide forecasts that can inform policy makers. This is especially important in periods of anticipated high demand for emergency services such as in the current COVID-19 pandemic.

Emergency doctors will team-up with academic researchers to model patient flow in the emergency department to consider operational changes and provide knowledge to guide decision-making for improvement strategies that will lead to faster, more effective patient care, better outcomes and more effective, economical choices.

This innovative collaboration between doctors and university researchers aims to solve real-life system-level problems affecting patient care. The research will generate practical outcomes that improve clinical practice at a system level so that we can better care for our patients.

Patterns of QLD ED presentations for older adults in three time periods: pre, peri and post COVID-19

Since COVID-19 was declared a pandemic by the World Health Organization (WHO), the elderly population globally have been identified as a vulnerable group, yet there is limited literature exploring the effect of pandemics on Emergency Department (ED) presentations in this cohort.

Healthcare systems have rapidly adapted and made changes to prepare for a potential healthcare crisis that has largely targeted our frail older population. The impact of the pandemic and changes in health care delivery need to be evaluated, to ensure the measures taken did not have unforeseen negative consequences and subsequent positive consequences.

This research aims to describe the clinical profiles, patterns of presentations and factors associated with outcomes of patients, aged 60 years and over, presenting to Queensland EDs before, during and after the COVID-19 pandemic. The results of this study will assist clinicians and policymakers to better respond to the challenges of acute care provision for this complex population during future pandemics.

Providing a safe and efficient method of chest pain assessment

In this project we will evaluate a new pathway for assessing chest pain in the emergency department. The pathway is designed to reduce the costs of managing patients at low-risk of heart attack without compromising patient safety. The cost savings are estimated to be around $95 million if implemented Australia-wide, with the bulk of the cost reduction being through decreased length of stay in the emergency department.

The new pathway will be implemented at three Queensland hospitals. Data collected before and after the implementation of this pathway will be used to assess 1) whether it results in a shorter length of stay in hospital, 2) whether it is safe for identifying heart attack, and 3) whether it reduces healthcare utilisation and healthcare costs.
Over 450,000 patients present to an Australian emergency department with chest pain every year. The current approach to rule out heart attack for these patients is lengthy and costly, taking up to 26 hours at a cost of $2,127 per patient.