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.

Link between clinical errors and emergency shift patterns

There is a well-established link between shift work, nurse exhaustion and clinical errors. However there is a lack of research focusing specifically on emergency departments (ED) and nurse rostering patterns.

ED nurses are at particular risk of fatigue due to the fast-paced and demanding nature of the work environment caring for high acuity patients, increasing the risk of clinical errors and threatening patient safety. Shift work in the ED is an around-the-clock occupation, frequently nurses are required to commence work at 07:00 on the morning following a 21:30 finish, a shift pattern termed a “late/early”. Understanding the impact that this shift pattern may have in adverse clinical events is critical for patient and staff well-being.

This novel project will collect and analyse retrospective data from the ED at Nambour General Hospital to ascertain whether late/earlies are associated with adverse patient outcomes. We will use a logistic regression model to analyse data collected from PRIME (electronic database for clinical incident reporting), TrendCare (online nurse rostering system), EDIS (Emergency Department Information System) and patient medical records. This analysis will allow us to identify any association between clinical incident severity rating, patient outcomes, time of the incident, staff roster patterns and level of nursing experience.

The results of this study will therefore provide significant insights into the relationship between ED nurse shift patterns and adverse clinical events. The outcomes of this research may be used to assist and improve rostering practices, fatigue management, staff well being, and improve patient safety outcomes.

Will a mandatory clinical debriefing program affect levels of psychological distress in Emergency Registrars.

Emergency doctors have been shown to exhibit higher levels of psychological distress and burnout than both their medical colleagues and the general population. This study will measure levels of burnout and psychological distress amongst Emergency Registrars before and after the implementation of a clinical debriefing program. It will be ascertained whether there is a difference in the before and after scores and whether the change is statistically significant.

Cost effectiveness and Clinical outcomes of B-type Natriuretic Peptide (BNP) Point of Care Testing versus BNP Laboratory testing for Adults with Dyspnoea in the Department of Emergency Medicine at Nambour General Hospital.

Patient flow and access block will be evaluated through comparing time to decision making in the Emergency Department (ED) and Emergency Department length of stay (ED LOS) between patients who have POC and Laboratory BNP testing. Cost effectiveness will be evaluated by reviewing treatment type given, admission rate, ICU admission rate, inpatient length of stay (IP LOS), Emergency Department Length of Stay and 30day readmission rate.

This study will build upon the findings of a similar concurrent study. Both studies demonstrate a poor utility in BNP testing in patients presenting with shortness of breath in reducing Emergency Department length of stay. While this limits the potential for BNP Point of care testing within the ED, the validated Abbott Point of Care BNP cartridge will have the good potential for improving patient care in rural and remote cardiac outpatient locations where current BNP testing results take several days to obtain.

The effect of consecutive night shifts on the psychomotor performance of registrars working in the emergency department.

The objective of this research was to evaluate the effect of working consecutive night shifts on sleep time, prior wakefulness, perceived levels of fatigue and psychomotor performance in a group of Australian emergency registrars. A prospective observational study with a repeated within-subjects component was conducted. Sleep time was determined using sleep diaries and activity monitors. Subjective fatigue levels and reciprocal reaction times were evaluated before and after day and night shifts.

Sedation for Acute Agitation in Emergency Department Patients: Targeting Adverse Events (SIESTA)

Acutely agitated patients are commonly seen in the emergency department (ED). As these patients may cause harm to themselves or others, a large proportion need to be managed with injectable sedative medications such as benzodiazepines (eg midazlolam) and/ or antipsychotics (e.g droperidol).

Unfortunately, these medications may precipitate life threatening events (e.g hypoventilation). Safety data related to the use of these medications for the management of acute agitation in the ED setting are scant. Acute agitation in the ED setting is usually caused by mental health issues or substance abuse, again little is known about which sedative medications are best suited for different groups of acutely agitated patients.

The aim of this study is to determine the nature and incidence of adverse events associated with parenteral sedation medication administered to acutely agitated patients in the ED and to determine the risk factors for these adverse events. It is a multicentre national observational study, aiming to recruit 2000 patients over the age of 18, over a 2 year period. It is hoped that the evidence this study generates will define the risk of AE in this population and may guide clinicians in future treatment choices in sedating this challenging group of patients, hopefully reducing future AE.

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.