A randomised controlled trial with parallel groups to determine if written instructions reduce contamination of clean-catch mid-stream urine samples.

Urinalysis is commonly performed with samples examined for various chemicals, bacteria, viruses, parasites, fungi, proteins, blood and cells. A well collected mid-stream urine sample obtained to confirm or exclude urinary tract infection before the commencement of antibiotic therapy enables rapid, correct and reliable identification and antibiotic sensitivities of any infecting bacteria.

For ambulant patients the urine usually is provided through collection of a clean-catch mid-stream urine sample (MSU). Collection may be undertaken by the patient themselves or with the assistance of family, friend or health professional.
To avoid contamination by cells and bacteria, samples should be collected after discarding the first portion of the urine stream which flushes out the contaminating material. Contaminated urine may lead to false positive or uninterpretable results, inappropriate diagnosis and unnecessary or incorrect antibiotics. A known contaminated sample may necessitate a repeat test with resultant additional labour and consumable resources, potential for increased anxiety among patients and delays affecting performance targets associated with throughput of emergency department patients.

Within the Emergency Department instructions for collection of MSU are provided verbally to the patient by staff with content depending on the experience and communication skills of the individual health professional.

Diagnostic Workup for Suspected Subarachnoid Haemorrhage.

Subarachnoid haemorrhage (SAH) is a type of stroke, which affects about 10 in 100,000 Queenslanders. A patient with SAH usually complains of a sudden onset severe headache. About one in three of these patients die and another one in three survive with a disability. Early diagnosis and treatment is essential.

Diagnosis involves a Computed Tomography (CT) scan and a spinal puncture to look for blood in the spinal fluid surrounding the brain. However, these tests are not 100 per cent accurate. However, doctors and patients are concerned about complications from these tests. These include radiation from CT scans and discomfort from spinal punctures. As a result of these concerns, there is variability in what tests are ordered and why they are ordered. An understanding of this variability can assist doctors to develop guidelines and streamline the diagnosis of patients with suspected SAH.

This project consists of a series of three studies including a one month snapshot of patients presenting to the Emergency Department (ED) across Queensland complaining of a headache, a series of one-on-one interviews with a group of ED specialists at the Royal Brisbane Women’s Hospital and an examination of the accuracy of tests to look for blood in the spinal fluid obtained from a spinal puncture. The results of these studies will help plan the diagnostic workup of patients with suspected SAH.

Tissue Doppler Evaluation of Diastolic Dysfunction in Emergency Department Acute Coronary Syndromes: The TEDDy-ED pilot study.

Chest pain is a common reason for presentation to the emergency department and admission to hospital. Even when this chest pain is due to acute coronary syndrome (heart attack), it is not always clear how dangerous this might be. Australian guidelines propose a number of features that help judge severity and guide treatment. However, there is increasing evidence that impaired heart relaxation is an early sign of heart attack. This can be diagnosed using ultrasound and might be a very sensitive test to identify patients in danger.

This project aims to perform detailed ultrasound assessment of heart relaxation and filling, so we may grade the level of risk in emergency department patients admitted to hospital with suspected heart attack. Comparison will be made with common laboratory tests including troponin and b-type natriuretic peptide (BNP).

Evaluation of the Emergency Department Ambulance Offload Nurse (EDAOLN) in Queensland

Queensland Health have recognised that patient flow strategies are required for emergency departments in order to i) improve the patient journey and experience; ii) reduce delays and increase access to health care services; and iii) provide best clinical practice across the state. An Emergency Department Ambulance Off-Load Nurse (EDAOLN) role was commenced on Friday 17 August 2012 at the Gold Coast Hospital. The aim of this advanced nursing role was to provide rapid triage and assessment for patients arriving to the ED by ambulance and to commence initial meaningful treatment as required (such as X-rays, pathology, analgesia) on a 24/7 basis.

A retrospective study of all ED presentations (n=21,454) made to the Hospital, during July 9, 2012 - November 2, 2012; 39 days before (T1), during (T2) and after (T3) the introduction of the trial of an EDAOLN role. The primary outcome of interest was time to be seen by a clinician.

The Australasian Paediatric Head Injury Rules: a prospective validation of 3 international clinical decision rules for acute head injury in children presenting to emergency departments.

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.

High Flow Nasal Cannula (HFNC) Therapy in Infants with Bronchiolitis, a Randomised Controlled Trial in Regional Emergency Departments.

Bronchiolitis in infants is the leading cause of paediatric hospitalisation in Australia accounting for approximately 8000 admissions annually, of which approximately 500-600 are admitted to a paediatric intensive care unit (PICU) requiring respiratory support. None of the current treatments have successfully changed the outcome of the disease or the burden on health care systems. High flow nasal cannula (HFNC) therapy has been used over the last few years in paediatrics with reports showing a reduction in the need for non-invasive and invasive respiratory support.

HFNC reduces the work of breathing, improves the gas exchange and can be applied very early in the disease process as there is little inference with the patients comfort. There has been no “best practice” and many centres do not use the HFNC for bronchiolitis as there are opposing reports about its benefit and a lack of consensus on how to use it. This study aims to develop a multi-centre trial and to assess which patients with bronchiolitis benefit using HFNC.

In an earlier pilot study, the team found the use of HFNC therapy in PICUs significantly reduced the need for invasive ventilation and intubation, with a 40% reduced PICU admission rate, a 2.5 times reduction in intubation. They also showed the use of HFNC therapy in a paediatric ward was safe and delivered high quality care for infants with bronchiolitis. They also showed that infants <2 years of age could be safely transported on HFNC to tertiary facilities.