Diabetes Service Mapping After Hours

There is a need to focus on the vulnerable type 1 diabetes (T1D) population who represent a disproportionate burden on the Australian healthcare system and who require better standards of care. Building upon our previous work, the project is an important step in determining the supports available to patients with T1D around diabetic ketoacidosis (DKA) prevention and management, outside of traditional emergency department (ED) settings and regular business hours. This is in addition to perceptions around the use of a telephone or virtual service to help prevent diabetes ketoacidosis presentations. The analysis will provide baseline comparative data for later intervention studies, and in helping to provide the evidence-based solution, perhaps in the form of clinical pathways of acute and preventative healthcare services that can be tested in later projects. We expect the impacts of this project will include: a reduction in DKA presentations (which would potentially reduce morbidity and mortality), and lessened ED presentations, workload, and both hospital admissions and economic impact. Collectively, this would attract national and international interest in Queensland emergency healthcare research.

Vasopressor Infusion via Peripheral vs Central Access in emergency department patients with shock – The VIPCA RCT

Shock is an umbrella description for poor blood supply to vital organs, and can lead to multi-organ failure and death. Emergency department (ED) patients with shock are amongst the sickest, with 1/3 being admitted to an intensive care unit (ICU). Low blood pressure, a key feature of shock which causes the poor blood supply to vital organs, can be treated with medications called vasopressors. Vasopressors traditionally have been given through a so-called 'central line'. Central lines are invasive to insert and require skill, and the actual insertion can lead to complications. More evidence has emerged that so-called peripheral lines (aka 'drip') are safe for vasopressor infusion. Randomised controlled trials (RCT) to compare the two strategies will provide high quality data to inform clinicians as to which approach is best for patients, staff and the healthcare budget. We propose a feasibility RCT to test processes and inform a large phase-III RCT to definitively answer this question.

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.

ED diabetic ketoacidosis presentations in people with type 1 diabetes: a pilot to improve clinical and public health system outcomes

People with type 1 diabetes (T1D) require ongoing insulin administration. Insufficient administration results in hyperglycaemia and then diabetic ketoacidosis (DKA) which, if not treated urgently, can lead to death. It is vital that all people with T1D have timely access to acute care advice and service delivery.

Across Australia, DKA is the cause of a significant and increasing number of hospitalisations, especially when considering socioeconomic disadvantage. This 2-phase project first collected retrospective data from clinical record to identify which factors are associated with poor outcomes for people with T1D presenting Caboolture Hospital ED with DKA. The research team then conducted semi-structured interviews with four patients with type 1 diabetes and 18 healthcare professionals to describe current barriers and enablers; to inform intervention development.

An evaluative study of a collaborative ED mental health program

Mental health is a nationally recognised priority area and significantly contributes to the burden of illness in the Australian community, with almost 50% of people aged over 16 experiencing a mental illness at some point in their life. Coordinating treatment and support for people with mental illness is a key priority area in the Fifth National Mental Health and Suicide Prevention Plan and is a key priority indicator.

Over the last decade several models of mental health service delivery have evolved in response to the need for specialised mental health assessment and care in EDs as client numbers and acuity increases. Research has shown that these models are effective at supporting staff and increasing consumer satisfaction. However, little is known about how well the services integrate into ED service delivery and the way in which these MH services augment ED care and processes or their cost. Nor is there any research that summarises the salient features of the various models in a way that health services may integrate them to improve service delivery.

This research project is in two parts. The first phase aims to describe and explore the structures and processes required to sustain an ED physician championed. By understanding the structure and process required and through identifying its salient features, it may allow health services to implement the model or redesign, or adapt, current practice to improve the care received by patients presenting to EDs with a mental illness. The second phase will involve three quantitative studies that will examine the performance of the model.

Understanding why aged care residents are transferred to the ED

In Australia, the existing model of emergency department care is struggling to cater for the needs of the older population. A large proportion of older patients arriving at emergency departments are from residential aged care facilities (RACFs). Nursing staff in RACFs often participate in decision making pertaining to transfer of residents to the emergency department, but very little research has been done on the decision making involved in this process.

The mixed methods study will engage with RACF nursing staff to understand their decision to transfer a resident, their perception of communication with the emergency department, and the services that influence the decision.

Evaluation of the Geriatric Emergency Department Intervention (GEDI) implementation

Advances in health have led to populations living longer with more chronic disease and frailty. Frail older people presenting to emergency departments (EDs) have special needs that are often overlooked. In response, the innovative Geriatric Emergency Department Intervention (GEDI) was developed by clinicians at Nambour Hospital, Queensland.

GEDI is a unique nurse-led, physician-championed model of service delivery which facilitates advanced assessment tailored to the individual, nurse-initiated specialist referral, fast-tracking of care through the ED and appropriate safe discharge planning for persons aged 70 and over, including those from residential aged care facilities. A successful trial in one ED was awarded the 2016 Queensland Premier’s Award for Excellence. The evaluative research we conducted found that when older adults presented to ED during the times the GEDI team was working they were more likely to be discharged, if admitted they spent, on average, 24 hours less in hospital and the costs of their care were reduced by up to 30%.

The staffing for a trial of GEDI in two further Queensland EDs will be funded by the Queensland Health Improvement Unit. This EMF-funded evaluation project employs the principles of implementation science to evaluate the introduction of GEDI into these EDs to determine whether the knowledge learned from the trial can be translated to other sites and to determine the best strategies for future implementations of GEDI across Queensland and interstate. If implementation is found to be successful future roll out of GEDI will improve patient outcomes and reduce costs in Queensland and across the country.

IVL-Gone: Assessment of the effect of skin glue on the function of a peripherally inserted intravenous line.

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.

EASI – Efforts to Attenuate the Spread of Infection: A prospective, multi-centre microbiological survey of Ultrasound Equipment in Australian Emergency Departments and Intensive Care units.

One of the causes of patients getting sick in hospital is the transfer of bacteria from one patient to the other (nosocomial infection). This transfer of bacteria can lead to serious illness, even death. There are numerous precautions taken in hospital to prevent this, such as hand washing, wearing gloves, sterile gowns and gloves during procedures etc. There has been a tremendous growth in the use of point of care ultrasound to assist clinicians in the Emergency Department, Intensive Care Unit and Anaesthetic Department. We suspect that probes, which are in contact with patients’ skin are not cleaned as often or as thoroughly as they should be. This might lead to bacterial colonization.

Often the ultrasound probes are used to assist with invasive procedures such as the placement of central and peripheral venous catheters. There is a potential for the probes to be contaminated by patients’ blood during these procedures, as well as their skin bacteria. This situation would clearly pose a risk to the well being of our patients and staff, and these procedures are most commonly performed on our sickest, most at risk patients.

We aim to investigate the bacterial colonization and blood contamination on ultrasound probes in the Emergency Departments and Intensive Care Units across numerous hospitals in South East Queensland. The amount of bacteria, the type of bacteria and the amount of blood contamination will be investigated and reported. This study has the potential to demonstrate possible contamination of our sickest patients by blood and pathogenic bacteria from ultrasound probes used by the clinicians who are caring for them. The results should lead to recommendations regarding standardised work practices for the use of this equipment in the Intensive Care Unit and the Emergency Department.

Morale, stress and coping strategies of staff working in the emergency department: a national and international comparison.

Workplace stress in the emergency department (ED) is an internationally recognised issue. It is important to understand how ED staff cope with the stressors within their working environment. The overall aim of this study was to describe and compare the impact of the working environment and varied coping strategies amongst medical and nursing staff working in Emergency Departments (ED) in Australia and Sweden.