Mild traumatic brain injury (mTBI) is a common injury with potentially profound consequences. Although many patients recover within a few days to a few weeks, an estimated 15-40% develop post-concussion syndrome (PCS), which consists of an array of cognitive, emotional, and physical symptoms.(TBI symptoms that persist beyond three months often develop into a chronic, potentially life-long, health problem.)
PCS is associated with problems returning to work, social difficulties, higher healthcare utilisation, and poorer quality of life. The mitigation of PCS represents a significant clinical problem. An effective evidence-based early intervention to prevent PCS is sorely needed.
There is a growing consensus that differences in patient outcomes from mTBI are due to a range of biopsychosocial factors. For example, stress, anxiety, cognitive biases, sleep disturbance, and structural brain damage are among a number of factors that influence PCS symptom report. A focus on modifiable psychosocial factors (e.g., thoughts and behaviours) offers a promising solution: Cognitive Behavioural therapy (CBT) is well suited to altering the maladaptive beliefs, misattributions, cognitive biases and coping behaviours that promote chronicity in PCS.
The purpose of this study is to examine the feasibility and effectiveness of a Cognitive-behavioural psychotherapy (CBT)-based early intervention for patients at high-risk of developing PCS after mTBI. It is a two-site non-blinded, parallel group, randomised controlled trial comparing treatment-as-usual (TAU) and TAU+CBT intervention.
Developing an effective intervention for PCS is a critical and much-needed step in advancing our approach to the clinical management of mTBI. The outcomes of this research can inform the coordination of post-discharge care and treatment pathways, and reduce readmissions and new occasions of care.READ MORE
The Royal Brisbane and Women’s Hospital (RBWH) Department of Emergency Medicine (DEM) is constantly looking for better ways to improve the care of the sick and injured. Patients are cared for by a team of professionals including doctors, nurses and other allied health professionals. Improvements in care come largely from high quality research.
Our medical specialists in Emergency work on a wide range of challenging, innovative emergency medicine research topics. Their results are reported in some of the top professional journals, including the Lancet. Research led by other team members including nurses, however, is scarce despite the fact that these clinicians play an integral part in emergency care. We believe one of the main reasons for this is the lack of senior research mentors accessible to all clinicians in our department.
We propose creation of a dedicated research position to enhance capacity, develop grants and opportunity for research among our multidisciplinary team. She/he will identify key research questions, design scientific studies, write and submit proposals for funding, supervise the collection and analysis of study data, and support the preparation of reports for presenting and publishing in medical, nursing, and other professional meetings and journals. He/she will also provide training, guidance and encouragement to all ED staff to participate in research; liaise with other investigators (external to DEM) to facilitate optimum conduct of all departmental interdisciplinary projects. Furthermore, she/he will establish collaboration and professional partnerships with academic institutions and other research bodies to attract funds, grants and research to the department.
This position will help to improve the quality of emergency medicine research outputs from the RWBH and boost multidisciplinary team focused research in the department. It will also help build the knowledge base and provide the evidence to guide interventions by all health care workers in the emergency department.
This is a national collaborative research project approved by the National Health and Medical Research Council Partnership Projects scheme. This project aims to identify how the four-hour rule is effective in reducing access block and the adverse effects of emergency department overcrowding on patients. In particular, it will assess the impact of the four-hour rule as a policy intervention in reducing emergency department length of stay (EDLOS) over time in WA and compare the outcomes against comparable hospitals in NSW, Qld and ACT.
This project hypothesises that effective intervention for reducing EDLOS will translate into improved patient outcomes, particularly in subgroups identified as associated with the most harm from overcrowding.
This research has the potential to develop and promote long-term partnerships amongst hospitals, health services, ambulance services and researchers to conduct collaborative research related to adverse patient outcomes, overcrowding and access block in emergency departments.
The current project will involve the implementation and evaluation of a pioneering protocol for the online clinical assessment of practical skills (eCAPS) for medical residents and registrars training in Emergency Medicine. It will use a variety of web-based video technologies to facilitate the learning and innovative assessment of physical examinations of the musculoskeletal system initially targeting the knee and shoulder joints. Specifically, eCAPS includes three interdependent elements with a progressive (asynchronous to synchronous) organization of online instructor and learner-generated video resources to allow formative and summative assessments of practical competencies of Emergency Medicine residents and registrars performing selected physical examinations of the musculoskeletal system. This includes:
1. an integrated series of web-based video lectures and tailored clinical demonstrations of practical skill sets (musculoskeletal examinations) by experts in the field;
2. resident/registrar (“learner”) generated video demonstrations of selected, clinically relevant practical skills recorded with portable USB cameras (asynchronous) uploaded to a secure response and feedback online repository for personal and peer-community access; and
3. real time (synchronous) video assessment of residents/registrars completing practical skill sets for physical examination of the musculoskeletal system within a simulated OSCE (Objective Structured Clinical Examination) scenario using readily accessible web-based technologies (e.g. Skype).
The evaluation of the proposed implementation of the eCAPS protocol will provide important baseline information on aspects such as the flexibility, viability and generalizability of emerging online learning options for developing and assessing practical/procedural skills within an Emergency Medicine training program.
Furthermore, the current project will provide insights into the learning outcomes of the eCAPS protocol and the potential applications of this online approach for facilitating the standardization, validation and recording of clinical competence across a range of training levels and settings including rural and remote Emergency Medicine contexts.
Patients with finger injuries often require their finger to be numb to allow their injury to be assessed properly and treated.
There are several methods available to numb the finger. Our study aims to compare two methods for numbing the patient’s finger to see which one of these methods is least painful for the patient. The first method is a single injection in the palm of the hand and the second method is two injections in the back of the hand or finger. The second method is the most commonly used method in our emergency department. Our hypothesis is that the single injection into the palm is less painful than the double injection in the back of the hand or finger.
Patients who present to the emergency department with finger injuries that require their finger to be numb for treatment or assessment of their injury will be given a study information sheet and consent will be obtained for participation in the study. Participants will then be randomly assigned to receive either the single injection in the palm or the double injection in the back of the hand or finger. A medical officer will perform the injection to numb the finger and a separate medical officer will then ask the patients to rate the pain of the injection to numb their finger. Participants will also be asked to rate their pain level before and five and ten minutes after the injection. The patient’s finger injuries will be treated as per standard care for their injury. Patients will be contacted at one week following the injection to ask them if they have any pain or signs of infection such as redness or swelling.READ MORE
Intravenous lines are placed in the majority of patients admitted to hospital. Unfortunately they often fall out, become infected, cause irritation & pain or become blocked. Occasionally this can cause a life threatening illness. Blood can leak from the intravenous line onto the patient’s skin, clothing or bed linen. This causes patient distress. It can also be dangerous for hospital staff if they accidentally come into contact with the blood.
The insertion of a replacement intravenous line is generally regarded as an unpleasant experience that would be nice to avoid. The IVL-GONE research team are researching the use of common skin glue (think super-glue) to ‘stick-on’ the intravenous line. Other benefits are thought to include keeping the bugs out, improving patient comfort & helping to protect hospital staff from blood. If the skin glue works as well as preliminary studies indicate, this could be a simple solution for a worldwide problem; Queensland research leading the world.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.
Hospital occupancy rates regularly approach 100%, with resultant access block, ambulance bypass, and the last-minute cancellation of elective surgery patients. More efficient management of inpatient beds to reduce these predicaments is imperative. This project will evaluate the impact of a patient admission forecasting system - the Emergency Department Patient Admissions Predictive Tool (EDPAPT) - that has been developed from analysis of historical admissions data at the Gold Coast Hospital.
The aim of the project will determine whether a model that forecasts patient admissions can assist with the allocation of inpatient beds to alleviate one of the major problems of most Emergency Department (ED)s: overcrowding and access block. Specifically it will determine whether the number of elective surgery cancellations and ambulance bypass occurrences are impacted by using a prediction tool, and what impact there is on ED and bed management work practices. The study will also determine if bed managers will make use of prediction tools or whether there are barriers to their use of it, such as perceived inaccuracies, preferences to rely on own judgements or default to current, familiar modus operandi.
The project was a collaboration with CSIRO’s Australian eHealth Research Centre and Queensland Health, with support from Griffith University and the Queensland University of Technology.READ MORE
The Royal Brisbane and Women’s Hospital Emergency and Trauma Centre is one of the largest emergency departments in Australia. It is the only one that includes an on-site team of social worker 24/7. This research project is the first conducted to explain the evolution of this service, its implications for the social work team, and for the department more broadly. This study involves a qualitative analysis of the experiences of this social work team, based on information provided during interviews. This is the proposed first phase of research, which will inform future research including measures such as compassion fatigue and burnout among this group.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.
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