Results for Gold Coast Hospital and Health Service


Effect of IV Fluid Therapy in Patients with Uncomplicated Acute Alcoholic Intoxication presenting to the Emergency Department, a randomised trial.

In the emergency department of Gold Coast Hospital, from 1 January 2008 to 31 December 2009, 0.7% of total patient population (~1512 patients) were given either a primary or secondary diagnosis of alcohol intoxication or alcohol abuse. Non admitted patients with acute alcohol intoxication or alcohol abuse had an average emergency department length of stay of 8 hours. This prolonged length of stay in the department contributes to additional resource allocation and increased morbidity through emergency department overcrowding.

Current experimental evidence suggests that intravenous (IV) fluids do not increase rate of ethanol clearance from the blood of mildly intoxicated patients. However, there have been no relevant studies that have investigated the effects of intravenous fluids on the emergency department length of stay of moderate to severely alcohol intoxicated patients.

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The impact of a new emergency department on patient presentations and ambulance service delivery in health service districts in Australia.

This study involves tracking the ambulance, emergency department (ED) and hospital process for the Robina, Southport, and Logan hospitals.

Project Aims:
1. Validate ambulance ramping time;
2. Compare patient outcomes for 'ramped' vs 'non-ramped' patients who arrive to ED via ambulance;
3. Pilot merging of three health information systems (ambulance, ED, and hospital) at one site (Southport hospital);
4. Describe the characteristics of patients presenting to Southport, and Logan EDs in 12 months before Robina ED opening;
5. Describe the characteristics of patients presenting to Southport, Logan and Robina EDs in 12 months after Robina ED opening;
6. Compare ED presentations at Southport and Logan EDs before and after Robina ED opening (accounting for population growth and other possible systemic factors);
7. Compare patient outcomes at Southport, Logan and Robina EDs before and 12 months after Robina ED opening;
8. Describe and compare ambulance 'ramping time' at Southport, Logan and Robina EDs before and 12 months after Robina ED opening.

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Impact of the Emergency Department Patient Admissions Predictive Tool (EDPAPT)

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.

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REstricted Fluid REsuscitation in Sepsis-related Hypotension (REFRESH)

The REFRESH study is a multicentre, open-label, randomised, phase II clinical feasibility trial. This is the first randomised trial examining fluid volume for initial resuscitation in septic shock in an industrialised country. A pragmatic, open-label design will establish the feasibility of undertaking a large, international, multicentre trial with sufficient power to assess clinical outcomes. The embedded biomarker study aims to provide mechanistic plausibility for a larger trial by defining the effects of fluid volume on markers of systemic inflammation and the vascular endothelium.

Participants will be patients presenting to the emergency departments of Australian metropolitan hospitals with suspected sepsis and a systolic blood pressure of < 100 mmHg, persisting after a 1000-ml fluid bolus with isotonic crystalloid. Participants will be randomised to either a second 1000-ml fluid bolus (standard care) or maintenance rate fluid only, with the early commencement of a vasopressor infusion to maintain a mean arterial pressure of > 65 mmHg, if required (restricted fluid). All will receive further protocolised fluid boluses (500 ml or 250 ml, respectively), if required during the 6-h study period. The primary outcome measure is total volume administered in the first 6 h. Secondary outcomes include fluid volume at 24 h, organ support 'free days' to day 28, 90-day mortality, and a range of feasibility and process-of-care measures. Participants will also undergo serial measurement, over the first 24 h, of biomarkers of inflammation, endothelial cell activation and glycocalyx degradation for comparison between the groups.

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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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High Flow Nasal Cannula (HFNC) Therapy in Infants with Bronchiolitis, a Randomised Controlled Trial in Regional Emergency Departments.

Bronchiolitis in infants is the leading cause of paediatric hospitalisation in Australia accounting for approximately 8000 admissions annually, of which approximately 500-600 are admitted to a paediatric intensive care unit (PICU) requiring respiratory support. None of the current treatments have successfully changed the outcome of the disease or the burden on health care systems. High flow nasal cannula (HFNC) therapy has been used over the last few years in paediatrics with reports showing a reduction in the need for non-invasive and invasive respiratory support.

HFNC reduces the work of breathing, improves the gas exchange and can be applied very early in the disease process as there is little inference with the patients comfort. There has been no “best practice” and many centres do not use the HFNC for bronchiolitis as there are opposing reports about its benefit and a lack of consensus on how to use it. This study aims to develop a multi-centre trial and to assess which patients with bronchiolitis benefit using HFNC.

In an earlier pilot study, the team found the use of HFNC therapy in PICUs significantly reduced the need for invasive ventilation and intubation, with a 40% reduced PICU admission rate, a 2.5 times reduction in intubation. They also showed the use of HFNC therapy in a paediatric ward was safe and delivered high quality care for infants with bronchiolitis. They also showed that infants <2 years of age could be safely transported on HFNC to tertiary facilities.

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