Retrospect matched-cohort study of the clinical outcomes of emergency department patients streamed to acute overflow

Overcrowding and access block is a common problem across many Australian Emergency Departments (ED) resulting in poor patient outcomes (Morley et al., 2018). Consequently, patients streamed through the acute part of the ED who ideally require an acute bed are instead moved to temporary triage rooms or wait in the waiting room as Acute Overflow (AO). Monitoring for deterioration for the AO patient is therefore restricted due to lack of appropriate monitoring, staff availability, overcrowding in these areas, and bed capacity potentially resulting in poor patient outcomes. However, there is no study that has examined the impact of acute patients streamed to AO. Here, we aim to conduct a retrospective matched-cohort study, across a six-month period, to examine the clinical sequelae including any adverse events of acute ED patients streamed to AO. The findings from this study will provide insight into the potential impact of streaming patients to the AO, and may provide underlying evidence to advocate for improved monitoring and staffing of this potentially vulnerable and yet often forgotten area of the ED.

The feasibility of point-of-care ultrasound conducted by physiotherapists for the diagnosis of ankle syndesmosis injuries in the Emergency Department: A diagnostic study

Syndesmosis injuries, also known as a high ankle sprain, due to ligamentous injury are relatively uncommon but can have devastating outcomes when missed. This includes chronic pain, instability and osteoarthritis. Early surgical fixation of these injuries is recommended in some cases. Magnetic Resonance Imaging (MRI) is the most accurate way to diagnose these, but not ordered in the emergency department (ED) due to its cost and poor availability. Although clinical tests can help to narrow down who needs an MRI, they are often inaccurate in the acute phase. Ultrasound performed by sonographers can visualise ligament to components of the syndesmosis complex to streamline MRI referrals but is under demand during the day and not available afterhours. Point of Care Ultrasound (POCUS) performed by clinicians is an alternative option for imaging.

Emergency physiotherapy practitioners (EPP) typically manage patients with musculoskeletal injuries in the ED and are well placed to perform musculoskeletal POCUS. This study will evaluate the feasibility and accuracy of ED physiotherapist-performed POCUS for the diagnosis of ligament injury in the ED, indicative of a syndesmosis injury, against radiology-performed ultrasound. This could guide MRI patient selection to allow for earlier detection of unstable ankle injuries and expedite outpatient orthopaedic expert review and management. If POCUS by ED physiotherapists is demonstrated to be feasible and accurate for these syndesmosis injuries, the results of this study could inform the development of a diagnostic pathway that could be implemented in EDs locally and throughout Australia.

How are hypertensive urgencies managed in emergency departments in Queensland?

Hypertension is a highly prevalent, chronic cardiovascular disease with considerable impacts to population health. Although hypertensive urgencies are common encounters in emergency departments (ED), there is a lack of clear guidance for their clinical management. A poorly managed hypertensive urgency can leave the patient with continuing severe hypertension and at increased risk of end-organ damage. The objective of this study is to determine the current management strategies for hypertensive urgencies in Queensland EDs, and to better understand the reasons for their use. We will survey Queensland ED physicians about their use of and opinions about current management strategies for hypertensive urgencies. We will also conduct a pilot single-site observational study of management strategies for hypertensive urgencies. The findings of this study will inform the design of future research to improve management of hypertensive urgencies in EDs.

Retrospective analysis of GEDI impact on older adult patients presenting to the emergency department with a positive delirium screen (4AT)

Delirium in the older adult population is a common hospital complication linked to multiple adverse outcomes including longer lengths of stay, increased morbidity and mortality, greater cognitive and functional decline, and increased risk of re-presentation to the emergency department (ED). Patients with delirium can increase healthcare expenses by up to $30,000 extra per patient. This places a significant burden on the patient and the health system. The Geriatric Emergency Department Initiative (GEDI) has shown benefits in the ED management of older patients including reduction of re-presentations to the ED. However, the effectiveness of GEDI for older patients with delirium remains unclear. The aim of this research project is to compare clinical outcomes of older patients presenting to the ED with positive 4AT scores who received GEDI input versus those who did not, across a six-months period. The outcome measures will include ED length of stay and time to geriatric review.

Ultrasound-guided supraclavicular block versus Bier block for closed reduction of upper extremity injuries in the emergency department: an open-label, non-inferiority, randomised control trial

Upper limb injuries including bony fractures/dislocations, are sometimes deformed and require realignment in the emergency department (ED). Numerous techniques are available to allow this procedure to be painless. Bier block (BB) involves placing a band on the upper part of the affected arm to constrict blood flow, with injection of numbing agent into a hand vein on the same side to make the entire arm numb. An alternative technique is ultrasound guided supraclavicular blocks (UGSCB), which involves introducing a needle under ultrasound guidance to nerves situated just above the collar bone and injecting numbing agent around these nerves to make the arm go numb. However, the effectiveness of UGSCB when performed by ED doctors is unknown and patients might recover more quickly. We aim to conduct a randomised trial to compare UGSCB versus BB for re-aligning fractures/dislocations of the upper limb in the ED.