Many people who attend hospital emergency departments (EDs) are triaged as having non-urgent concerns, which could be managed by other health services such as the GP. The way regional health services are designed can contribute to the rate of non-urgent presentations in EDs. The impact of non-urgent patients in EDs can result in crowding, ambulance diversion and access block, which are linked to poorer patient outcomes, increased morbidity and staff burnout. While some recognition of this problem exists nationally, many policies or strategies implemented to reduce the incidence of these presentations have not been evidence-based, effective or economically evaluated. We aim to to develop a draft regional strategy for reducing non-urgent presentations in emergency.
Prior research on this project was funded by La Trobe University ($20,000), the Clifford Craig Medical Research Trust ($5000) and a University of Tasmania Scholarship ($5000).READ MORE
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
Elderly people often present to the emergency department short of breath. The two most common causes – heart failure and chronic lung disease- appear much the same but need very different treatments. Differentiating the two relies on taking a good history, performing an examination and doing basic investigations such as blood tests, electrocardiogram and chest x-ray (CXR). The most accurate diagnosis from the early tests is when the CXR shows a pattern called ‘alveolar interstitial syndrome’ (AIS). An experienced doctor then adds this piece of information to other parts of the history and clinical findings, to decide if the AIS is due to pulmonary oedema (heart failure). CXR has been shown to be very specific at identifying AIS, but not very sensitive. So even with these tests, the wrong diagnosis may be made and the wrong treatment commenced. This study will look at the usefulness of lung ultrasound (LUS) in demonstrating AIS, giving an alternative to CXR for differentiating heart failure from chronic lung disease. Previous studies have shown that in the hands of intensivists, it is significantly more accurate and sensitive than CXR. If we can replicate these results in Australia, in an Emergency department, we may be able to replace CXR with a safer, faster and, cheaper and more reliable alternative.READ MORE
Shortness of breath is one of the most common reasons for presentation to Australian Emergency Departments, with millions of presentations each year. A new patient, unable to speak properly because they cannot breathe present difficulties in immediate diagnosis and therefore treatment, to emergency doctors and nurses. Immediate management involves the application of oxygen via a face-mask in addition to drug therapy and investigations including x-rays and blood tests. If breathlessness gets worse, the patient may need invasive support for breathing; a process that involves more staff, expensive machines, and resultant considerable cost to the health care system. A simpler support device that provides non-invasive humidified high flow nasal cannula is one alternative to the provision of oxygen and is currently utilised safely in adult and paediatric patients. The “high flow” delivery of humidified oxygen and air provides moderate support, which reduces the work that the exhausted patient does while breathing in and to help splint the airways open. This support is a driving pressure, which is not present during simple mask oxygen therapy. If we treat patients early with high flow therapy rather than standard facemask, we may be able to relieve symptoms of breathlessness sooner and avoid worsening of breathing difficulties. Similar work has been completed on paediatric patients with positive results and we hope to mimic this in the adult population. If possible this would reduce health care costs and allow for earlier discharge from the emergency department and/or hospital by providing this early intervention of breathing support.READ MORE
Many older persons present to the Emergency Department complaining of shortness of breath (Dyspnoea). This can be an important forewarning of heart failure, but is also present in many other conditions. In most cases, several bedside tests are carried out to identify those patients with heart failure. Despite these investigations, which include blood tests, electrocardiograph and chest x-ray, heart failure is initially misdiagnosed in up to one quarter of patients in the emergency department. This project focuses on secondary prevention of the complications of the disease caused by missed diagnosis.
Some European hospitals use bedside lung ultrasound as an adjunct to the above tests, claiming it improves recognition of heart failure, and should decrease the time to appropriate treatment. The European model of ultrasound practice is significantly different from the Australian model, and there is limited evidence supporting either model provided in the literature.
This is a multi-centre study following on from a successful pilot project. A safe, simple protocol has been tested in an Australian Emergency Department, in parallel to normal diagnostic strategies. To prove the protocol actually improves patient care, it now has to be tested as part of the diagnostic workup for breathlessness compared with the conventional diagnostic procedure.READ MORE