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

Grant ID: EMPJ-363R25-2016

Project Summary

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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Outcomes

Linking patient data has helped to comprehensively understand the patient journey and monitor the performance of the regional referral system.

The proposed quality framework allowed benchmarking to explore areas for improvement within the system, especially around equality and equity.

The project also led to new collaborations between Central Queensland Hospital and Health Service, Retrieval Services Queensland, CSIRO Health and Biosecurity, Royal Flying Doctor Services, LifeFlight Retrieval Medicine and James Cook University.

Future analysis of state-wide linked aeromedical data, through a referral pathway lens, will help to identify service performance improvement and strengthen the regional emergency care system.

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Dissemination

Publications:

- Edwards, K.H., Khanna, S., Franklin, R., Kuhnert, P., Jones, R., Edwards, M.T., 2022. Air ambulance retrievals of patients with suspected appendicitis and acute abdominal pain: The patients’ journeys, referral pathways and appendectomy outcomes in Central Queensland, Australia. Australasian Emergency Care. https://doi.org/10.1016/j.auec.2022.07.002.

- Edwards, K.H., FitzGerald, G., Franklin, R.C. and Edwards, M.T., 2021. Measuring More than Mortality: A scoping review of air ambulance outcome measures in a combined Institutes of Medicine and Donabedian quality framework. Australasian Emergency Care, 24(2), pp.147-159.

- Franklin, R.C., King, J.C., Aitken, P.J., Elcock, M.S., Lawton, L., Robertson, A., Mazur, S.M., Edwards, K. and Leggat, P.A., 2021. Aeromedical retrievals in Queensland: A five‐year review. Emergency Medicine Australasia, 33(1), pp.34-44.

- Edwards, K. H., FitzGerald, G., Franklin, R. C., & Edwards, M. T., 2020. Air ambulance outcome measures using Institutes of Medicine and Donabedian quality frameworks: protocol for a systematic scoping review. Systematic reviews, 9, 1-8.

- Edwards, K.H., Franklin, R.C., Aitken, P., Elcock, M. and Edwards, M.T., 2019. A program profile of air medical transport in regional Central Queensland, Australia. Air medical journal, 38(6), pp.431-436.

- King, J.C., Franklin, R.C., Robertson, A., Aitken, P.J., Elcock, M.S., Gibbs, C., Lawton, L., Mazur, S.M., Edwards, K.H. and Leggat, P.A., 2019. Primary aeromedical retrievals in Australia: An interrogation and search for context. Emergency Medicine Australasia, 31(6), pp.916-929.

Presentations:

- Edwards, K. (2022). What is the value of aeromedical patient and service linked data? Presented at the Aeromedical Society of Australasia 2022: Critical care in the air – critical care anywhere, Brisbane, Queensland 30-1 September 2022.

- Edwards, K.H. (2019). Aeromedical patient outcomes in Central Queensland: A linked data study. Invited presenter: Central Queensland Hospital and Health Service Clinical Council. Rockhampton, QLD, 14 March 2019.

- Edwards, K.H. (2018). Air ambulance outcome metrics: A systematic review of quality attributes and service delivery domains. Aeromedical Society of Australasia (ASA) 2018: Aeromedicine: the next 30 years, Hobart, Tasmania, 26-28 September 2018.

- Edwards, K.H., Edwards, M.T. (2018). Aeromedical Research. University of Queensland Rural School, Rockhampton, QLD, 15 August 2018.

- Edwards, K.H. (2018). Measuring quality care in air ambulance outcomes. PhD Cohort Conference. Townsville, 19 July 2018.

- Edwards, K.H. (2017). Linking the pieces together: The aeromedical patient journey. 3MT presented at the Health Service and Policy Research (HSRAANZ) 2017: Shifting priorities: balancing acute and primary care services, Gold Coast, Queensland, 1-3 November 2017.

- Edwards, K.H., Franklin, R., Elcock, M., Aitken, P., Edwards, M. (2017). A data linkage and patient outcome study of aeromedical retrieval services in Central Queensland. Oral poster presented at the Health Service and Policy Research (HSRAANZ) 2017: Shifting priorities: balancing acute and primary care services, Gold Coast, Queensland, 1-3 November 2017.

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