Results for Health System and Governance


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.

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Data linkage & patient outcome study: Aeromedical services in Central Queensland

The development of linked data from aeromedical retrieval & health system databases will provide improved, value-added insights to patient care and outcome analysis. This first-of-its-kind study seeks to take the next step in patient-centered outcomes research and resource allocation planning by linking together existing, but independent emergency department, aeromedical, hospital and death databases. Our pilot study has linked databases, creating secure & robust infrastructure for future state-wide studies.

The aims of the study are:
a) Utilise the linked data infrastructure that we’ve created, allowing next phase state-wide replication; describe aeromedical patient outcomes (including length of stay and mortality); understand aeromedical service requirements for specific illness/ injury, those that require frequent flights, & identify steps within the patient journey.
b) Develop a better understanding of the aeromedical patient journey will help to develop appropriate health services delivery, in particular emergency departments whom most often are first point-of-service, thus ensuring better health outcomes.

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Domestic and family violence screening in the emergency department

Domestic and family violence (DFV) against women is the number one cause of hospitalisations in Australian girls and women aged 15-54 years. It is also the number one cause of death and disability in women aged 15 to 44. Although most victims of fatal DFV access health services in the 24 months prior to their deaths, many victims living with DFV go unnoticed in the community. Health care providers are well placed to identify DFV victims and refer them to appropriate services. The ED has been described as a good place to undertake identification of DFV victims in several published research papers. Yet, how to do this remains controversial, and there are no standard protocols in place in our EDs. In this project, we aim to describe the current DFV health practice culture in five Queensland EDs. Knowledge, beliefs, and attitudes, as well as what’s actually happening to detect cases of DFV, will be assessed among our front-line ED social workers, nurses, and doctors. We aim to determine how many presentations to ED are identified and referred to social worker services for DFV. Ultimately, this research will both raise awareness about the potential of the ED to detect DFV, and will help pave the way forward to a well-informed and structured ED DFV screening program for Queensland, with applicability internationally.

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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.

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Prescribing patterns and communication for oxycodone on ED discharge

There are growing public health concerns that opioid medications are being increasingly and excessively prescribed. These medications may have a serious side effect profile including sedation, tolerance, and development of addiction, and may subsequently be diverted in the community for non-medical use.

The objective of this study is to evaluate the effectiveness of an intervention for discharge oxycodone prescribing relevant to Australian Emergency Departments. The principal aims are to decrease the amount of oxycodone prescribed, improve practitioner awareness of local opioid prescribing behaviour, and improve documentation around oxycodone use on discharge.

This quality assurance evaluation study will measure the success of a multifaceted oxycodone prescribing intervention and its impact on oxycodone prescribing for patients discharged home from the Emergency Department (ED). The project is hypothesized to reduce oxycodone prescribing, improve discharge documentation, and ensure appropriate follow up plans are in place.

Pain is a common symptom in ED patients, and is often the primary reason patients seek emergency medical attention. A recent baseline audit of local prescribing records revealed oxycodone, an opioid pain medication, is prescribed in approximately 5% of patients discharged home from this ED (with an annual census of 77,500 presentations). Clinical documentation and discharge communication was either absent, incomplete, or inconsistent when discharge plans for dosing, duration of therapy, follow-up reviews and de-escalation of therapy were analysed.

To our knowledge, no published Australian data is available on oxycodone prescribing behaviours from EDs. If this project is successful, the amount of oxycodone prescribed will reduce, patients will be better informed, and the quality of medical handover to General Practitioners will improve.

With 7.4 million patient presentations to Australian EDs in 2014-15, the successful translation of an oxycodone prescribing intervention through clinical awareness and action would contribute to reducing the overall burden of opioids in the broader community

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Will a replicable ultrasound training intervention improve intravenous cannulation processes?

Most patients need intravenous access in the emergency department, but many suffer multiple attempts before the health provider is successful. This can cause patient distress and delays the time to potentially life-saving treatments.

We believe an ultrasound-guided cannulation training program will enable better recognition of patients with difficult intravenous access and increase use of ultrasound during cannulation, hence decreasing time to cannulation, increasing success rates, and reducing the number of punctures required

In this study, we are examining the current practice of inserting intravenous (IV) cannulas in the Emergency Department at the Gold Coast University Hospital. We will consider how many people get cannulas, number of attempts required, who inserts them, how successful we are, how often ultrasound is used to guide this insertion, time to successful cannulation, who uses ultrasound and how successful is ultrasound-guided placement.

We will then run a year long intervention program for doctors and nurses to improve knowledge and skills in identifying patients with difficult IV access and to learn ultrasound-guided cannulation.

Following this, the initial observational study will be repeated looking for an improvement in the number of attempts required, the time to achieve successful cannulation, and the overall success of IV cannula insertion.

We expect that our well described and professionally videotaped training module will improve cannulation processes and impact a large number of patients by reducing the number of cannulation attempts.

The study also aims to develop the materials (visual and written) needed such that the USS training program can be replicated at other Australian sites.

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A data linkage and patient outcome study of Aeromedical Retrieval Services in Central Queensland.

Aeromedical services link patients to vital health care. Currently, there is limited understanding of the aeromedical patient journey and outcomes in Queensland. This first-of-its-kind study seeks to take the next step in patient-centered outcomes research and resource allocation planning by linking together existing, but independent emergency department, aeromedical, hospital and deaths databases.

A review of the Queensland aeromedical system, (2010-2014) found there is increasing aeromedical use, with an average of 51 flights/ day (102,892 flights) tasked throughout Queensland; with cardiology cases (20%) most common. Yet, there were limitations. First, aggregated data did not clearly differentiate between inter-hospital transfer, back-transfer, multiple-step or single-step flights. Secondly, identification of frequent flyers was not possible. Finally, illness and injury categories did not include specific ICD coding; prohibiting the development of appropriate Emergency Department services.

This pilot study will link together data sets from EDIS, Death Registrar, QHAPC, and Retrieval Services Queensland. The aims of the study for Central Queensland are to develop linked data infrastructure; create future state-wide study replication; describe aeromedical patient outcomes (including length of stay and mortality); understand aeromedical service requirements for specific illness/ injury, those that require frequent flights, and identify steps within the patient journey.

Linking these databases can enable epidemiological monitoring, surveillance, analytical assessment & prospective modelling of aeromedical populations (Brook 2008), thereby improving patient care coordination. It is expected linking data will create a comprehensive picture of the patient journey, patient outcomes & of the service provided at each step; furthering capacity in understanding the patient experience. Linking aeroretrieval databases will also create a secure and robust infrastructure for future state-wide studies.

A better understanding of the aeromedical patient journey will help to develop appropriate regional health services delivery, in particular emergency departments whom most often the first point-of-service, thus ensuring better health outcomes.

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Patients transfers from rural hospitals – are we getting it right?

This research is a retrospective audit to identify the number and type of rural transfers from 18 rural hospitals to Toowoomba Hospital as the regional centre. It will aim to identify whether these referrals were appropriate by a retrospective chart review considering the medical management involved, the type of escort, hospital service required, and the timing and mode of transport. There is currently no clear indication of the magnitude of the potential problem with patient transfers and no validated method for obtaining this information. This research project will develop a method for using hospital data systems to quantify the number and nature of potential patient transfer problems. It will also provide a baseline measure of those potential problems.

This research will be phase one of a much broader body of work which will involve education & training of clinicians and nurses to improve appropriate transfers and the clinical quality and patient safety of those rural transfers that are required. This will have patient benefits in improving patient care during necessary transfers and also potentially keep patients closer to family where appropriate. Improving the quality of care in transfers and appropriateness of transfers will have economic benefits for the whole Hospital and Health Service as well as enhancing the knowledge of rural staff. These practices would then have the potential to be adopted nationally across all rural campuses.

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Outcomes in Transfers of Head and Neck Trauma Patients for Neuroimaging to Toowoomba Base Hospital Emergency Department.

Patients from Dalby and Kingaroy Hospitals are transferred to Toowoomba Hospital, for CT Scanning and advanced Radiology, when CT and Advanced Radiology services are not available locally. Dalby and Kingaroy Hospitals only have these services during business hours, Monday to Friday, and advanced Radiology when the trained Radiologist is working. This means on weekends and after-hours, patients need to be transferred to Toowoomba for these services.

It is hypothesised that a percentage of transfers from rural hospitals for head and neck imaging following minor trauma do not meet ACEM guidelines. Our aim is to investigate the reasons for transfer for CT Head and Neck scanning or advanced radiology, to see if any identifiable patterns or concerns emerge around decision making which led to the transfer. The secondary aim is to evaluate adherence to evidence based clinical practice guidelines on diagnostic imaging by ACEM.

Results of this research will include identification of transfers that were not made according to current guidelines. These results would allow education opportunities to better facilitate evidence-based decision making in transferring head or neck trauma patients for diagnostic imaging when services are not available.

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Point-of-care testing for better management of acutely ill remote patients.

Australians living in rural and remote areas experience a significantly higher burden of acute care episodes compared to those living in metropolitan and urban areas. A contributing factor is the effect of geographical isolation and its impact on access to health services including pathology testing. We aim to assess the benefits of using point-of-care testing at remotely located health centres of the Northern Territory. Point-of-care testing enables pathology testing to be performed on-site, with results available during the patient consultation. We will investigate the clinical benefits of using point-of-care testing to either rule-out a potential acute medical problem, stabilise an acutely ill patient, and/or to confirm an emergency medical evacuation is required for patient care. The project will also determine the cost savings associated with point-of-care testing preventing unnecessary emergency medical retrievals, which come at a high cost to the Northern Territory Government.

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