With an EMF Capacity Building grant, The Prince Charles Hospital Emergency Department has engaged in more than 20 research projects. The majority involve significant input from the Hospital's emergency clinicians, who are working in collaboration with other Queensland and interstate emergency department and/or academic institutions such as as CSIRO.
> QAS Clinical Decision Making study
> ARISTOS, sepsis study
> REFRESH, sepsis study
> Paediatric ED evaluation
> Paediatric ED discharge communication
> Pneumothorax study
> Lung ultrasound study
> PHFEW, CO2 in paediactic nasal hi-flow
> POTTY, technique for urine sample collection for pre-toilet trained children
> ED complaints
> Pathology checking
> Melatonin for paediactric ADHD
> ED alternatives study
> Whiplash study
> Interns prescribing abilities
In order to understand the effectiveness of health service delivery, and the impact of changes in processes and procedures, it is important to first be capable of analysing the data that documents patients’ journeys through the hospital. This project will bring together key data from multiple disjointed information systems so that analysis can be undertaken on the flow of patients through the Gold Coast Hospital (GCH); from the ambulance, through the Emergency Department, and admission to a ward, including the operating rooms, radiology, pathology, and pharmacy that they encounter up to their departure. With this holistic view of patients’ journey of care, the baseline and measure impact of initiatives will be determined to ensure that patients flow through the environments with minimal delay and improved outcomes.READ MORE
In the emergency department of Gold Coast Hospital, from 1 January 2008 to 31 December 2009, 0.7% of total patient population (~1512 patients) were given either a primary or secondary diagnosis of alcohol intoxication or alcohol abuse. Non admitted patients with acute alcohol intoxication or alcohol abuse had an average emergency department length of stay of 8 hours. This prolonged length of stay in the department contributes to additional resource allocation and increased morbidity through emergency department overcrowding.
Current experimental evidence suggests that intravenous (IV) fluids do not increase rate of ethanol clearance from the blood of mildly intoxicated patients. However, there have been no relevant studies that have investigated the effects of intravenous fluids on the emergency department length of stay of moderate to severely alcohol intoxicated patients.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
Many children sustain head injuries and present to emergency departments for evaluation. Even a seemingly minor incident may lead to serious injury requiring neurosurgery. While head computer tomography (CT) identifies all important injuries, there is an increasing recognition that radiation from CTs can increase the risk of fatal brain cancers, especially in younger children.
Failure to identify a significant intracranial injury quickly may result in catastrophic consequences including long-term neurological disability and or death. A number of evidence-based head injury (HI) clinical decision rules (CDRs) have been developed to help physicians identify patients at risk of having a significant head injury. These CDRs provide recommendations (including CTs) based on the presence of certain features of the history or physical examination. No HI CDRs have been validated outside of their original settings.
The identification of an optimal CDR for implementation would help to minimise risks, both of missing a clinically significant intracranial injury, and of exposure to radiation from cranial CT scans. The results will likely have a major impact on head injury management in children in Australia, New Zealand and worldwide.READ MORE
Patients experiencing pain and swelling in their limbs following an accident will often have X-Rays in the Emergency Department. The doctor will look at these X-rays for signs of a fracture and then treat the patient accordingly. The X-Ray specialist elsewhere in the hospital will also look at these X-Rays and write a report. However, this report may not be available until after the patient and doctor have both gone home. If the X-Ray specialist’s report identifies a fracture, other staff working in the Emergency Department will need to go back and double-check the patient’s records to make sure the fracture was picked up by the treating doctor and that the patient was appropriately treated.
The procedure for checking X-Ray reports and checking that the patient was appropriately treated is laborious and time consuming. Moreover, due to resourcing problems, it is often done days after the patient’s initial presentation to the Emergency Department. A more timely and efficient process is required.