Results for Health System and Governance


Understanding why aged care residents are transferred to the ED

In Australia, the existing model of emergency department care is struggling to cater for the needs of the older population. A large proportion of older patients arriving at emergency departments are from residential aged care facilities (RACFs). Nursing staff in RACFs often participate in decision making pertaining to transfer of residents to the emergency department, but very little research has been done on the decision making involved in this process.

The proposed mixed methods study will engage with RACF nursing staff to understand their decision to transfer a resident, their perception of communication with the emergency department, and the services that influence the decision. The project outcomes will provide a detailed understanding of existing service provision, communication between facilities, and potential gaps in education and skills.

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Junior doctors at triage improve patient flow in the ED

Introducing a novel model of care to the emergency department may provide significant reductions in key performance indicators, such as patient length of stay, or the National Emergency Access Target (NEAT).

In previous studies, researchers have found that rostering a physician to work at triage can lead to significant improvements on a range of metrics, including time to treatment, patient length of stay and rate of patients who left before receiving treatment. However, in a regional hospital where staffing numbers and budgets are under pressure this model may not be possible.

The objective of this study is to implement a novel model of care at triage in the Hervey Bay Hospital Emergency Department. For a trial period of three months, junior doctors (PHO/registrar level) will be rostered to work at triage on alternate day shifts. A range of outcome measures will be compared with day shifts when junior doctors are not rostered at triage. This model may be relevant for other regional emergency departments.

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International mass gathering impact on Gold Coast Hospitals’ emergency departments

The objective of this study is to describe the impact of the 2018 Commonwealth Games held in Queensland, Australia on the emergency departments in the Gold Coast region. This research has two key aims, which align with two discrete but related studies:

Study 1 Aim: To describe and determine whether changes in patient, health service, and economic outcomes occur before, during and after the Commonwealth Games.
Study 2 Aim: To explore healthcare staff experience of planning, preparedness and lessons learnt from the Commonwealth Games.

Findings from this study will provide an evidence base regarding the impact of a large sporting mass gathering on public and private emergency departments, forming an invaluable resource for future Commonwealth Games planners, as well as response planning for other mass gatherings, sporting or otherwise.

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Data Extraction from Electronic Health Records for a Chest Pain Clinical Data Registry: The Chest Pain DECoDeR Study

Patient health records contain a significant amount of information through each episode of care provided at a healthcare facility. However, due to the unstructured nature of the clinical information in each record, the clinical data is not readily accessible for research or administrative use unless an expensive and time-consuming manual process is used. Methods of data extraction through various algorithms are available but require training and testing a dataset of annotated health records.

To address this issue, my key aim is to generate structured clinical data from previously inaccessible and unstructured electronic records. I am attempting to develop a process of automatically extracting clinical data from electronic records of patients who present with chest pain to emergency departments in Queensland. The clinical data extracted will be composed of the documented cardiac risk stratification for each patient and major adverse cardiac events.

To develop this data extraction process, an annotation scheme was designed using a widely accepted standardized reporting guideline. Using the annotation scheme, emergency clinicians annotate patient records to produce an annotated dataset for both training and testing machine learning algorithms.

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Mixed methods study of the Geriatric Emergency Department Intervention (GEDI)

As the population of Australia grows the percentage of those aged >65years is expected to double over the next 30 years. This will lead to more patients presenting to emergency of which a significantly larger portion will be frail and/or from residential care facilities (RCF). This vulnerable population is at significant risk of hospital acquired complications including acute confusion, falls, and infections if they suffer prolonged stays in the emergency department (ED) or on admission to hospital.

The GEDI program is an innovative nurse led intervention designed to improve emergency care of frail older persons who develop an acute medical problem. GEDI's are trained in geriatrics and have excellent communication skills liaising with RCF staff, families, general practitioners, ED medical officers/nurses and inpatient teams. Their role also involves patient centred geriatric risk assessment and management to minimise the negative impact of the older person’s emergency visit. The program has already been shown to led to a decrease in ED and hospital length of stay, improved patient and staff satisfaction and decrease in overall cost of care.

In this research project, we will evaluate the structures, processes and outcomes of the GEDI intervention relevant to the RCF cohort. This study will look specifically at the RCF dwelling cohort as they have often been excluded from previous studies. We hope to use the outcomes of this research to gain a greater understanding of the problems faced by our frail ED RCF population and with this knowledge develop innovative evidenced based healthcare solutions.

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Developing a regional strategy for reducing non-urgent emergency department presentations

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 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).

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Dermatology in the Emergency Department

Patients presenting to the Princess Alexandra Hospital Emergency Department with dermatological conditions present a significant demand on resources. It is estimated that in many Emergency Departments (ED) at least one in 25 patients present with a skin condition. Many dermatological presentations may be better managed in an alternative environment either because they are non-urgent or require more specialised and expert care. This project aims to better understand the presentation of skin conditions to a large adult Queensland ED. The research will describe the current diagnosis and management of this cohort to the ED, assess the resource implications and understand the rationale for the patients attending ED instead of a General Practice clinic. The data will provide the information for determining the need for increased GP support such a expansion of tele-dermatology services or for the creation of a local or district acute dermatology clinic.

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The impact of imaging referral guidelines on unnecessary x-ray examinations

In this project, the research team is investigating the effect, on x-ray request justification, of educating referrers and radiology staff on the existence and use of the Government of Western Australia’s Diagnostic Imaging Pathways. The project aims to improve clinical information provided on medical imaging requests, to assist in the assessment of justification, and reduce the number of unjustified examinations being performed. The expected impact of this project is in the removal of unnecessary x-ray examinations which provide little or no benefit to the patient. This will also have a benefit of reduced radiation exposure to patients and improved access to x-ray services for patients with a genuine need for the examination as well as a financial saving due to reduced costs for the delivery of emergency healthcare.

Up to 77% of diagnostic medical imaging examinations are considered inappropriate or unnecessary, according to prior research. Inappropriate examinations contribute to an individual’s lifetime radiation exposure, unduly increase healthcare costs, and reduce the access to x-ray services due to longer waiting times. Many countries, including Australia, have introduced imaging referral guidelines which provide referrers with evidence-based decision tools to select appropriate examinations. Use of these guidelines has significantly reduced the rate of referral without affecting the detection rate of pathology.

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Reducing avoidable COPD emergency presentations: An integrated cross-health service initiative

Almost 3% of consumers of healthcare services in the Darling Downs, West Moreton and Gold Coast (Including Robina) regions are estimated to have Chronic Obstructive Pulmonary Disease (COPD); which is somewhat higher than the state average of 2.4%. COPD is the second leading cause of avoidable hospital admissions. Anecdotal evidence indicates continued over-utilisation of frontline resources (e.g., Emergency Department [ED]), and potential gaps in outreach services (e.g. underutilised services).

This project will inform the implementation and evaluation of referral treatment initiatives (e.g., anxiety management, smoking cessation referral, and quality intra-professional care [IPC] programs), based on identified causal factors.

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Medication-related emergency department presentations

In Australia, medication errors result in more than 400,000 visits to general practitioners per year, however the number of patients who present to hospital due to medication-related harm is unclear. Previous Australian and international research suggests that at least 2% of emergency department (ED) presentations are due to medication-related harm and up to one quarter of those patients require admission to hospital. Importantly, the majority of such presentations are potentially preventable, which means that interventions that target medication safety in the community and adverse events that result in ED presentations could improve patient safety and quality of life, and reduce the burden on emergency and acute health services. Before we can target strategies designed to reduce medication-related harm in the community that results in patients requiring care in the ED, we need to understand how commonly this occurs, and which patients are at higher risk of possible harm. In this study we will determine how common this problem is, the characteristics of the events and the patients in whom medication-related harm occurs, and also estimate the health service costs of medication-related ED presentations.

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research projects

Improving jellyfish sting treatment

EMF funding is improving emergency care for the elderly

Trauma: better treatment for severe bleeding

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