Grant project

Rural and remote

> Trainee Grant Scheme

> Staff Specialist

> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Queensland

> Trainee Grant Scheme

Carotid doppler ultrasound with passive leg raise for fluid responsiveness

Fluid therapy is a valuable entity and a valuable clinical entity. However there is uncertainty regarding the fluid responsiveness of patients, particularly those with severe infections. Potential risks of fluid overload (i.e. too much fluid) exist. Excessive fluid administration is associated with increased morbidity and mortality. Carotid doppler ultrasound and passive leg raise is a way of estimating fluid responsiveness. By using this technique we believe that it will tell us if a patient will tolerate an intravenous fluid bolus of 500ml. The aim of this study is to determine if doppler ultrasound of the common carotid artery blood flow…

Principal Investigator: Dr Sangeeth Mohan
Amount Awarded: $5,150

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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…

Principal Investigator: Dr Rina Savage
Amount Awarded: $34,955
Institution:

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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…

Principal Investigator: Dr Amy Archer-Jones
Amount Awarded: $22,541
Institution:

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Effect of Buddy Taping vs Plaster in Boxer’s Fractures (5thMC) –Buddy Study.

Fractures of the metacarpal bones are the most common hand injuries. Fractures through the neck of the 5th metacarpal (little finger hand bone) account for the majority of these. They are known as Boxer’s Fractures, as they are often sustained during a punch. Boxer’s fractures are traditionally managed in plaster, but in recent years there has been some suggestion that to simply ‘tape’ the little and ring fingers together will allow similar recovery with the advantage of full mobilisation. Currently there is not enough evidence to recommend one treatment over another. Potential benefits of buddy taping include: earlier return to…

Principal Investigator: Dr Richard Pellatt
Amount Awarded: $17,425
Institution:

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Paced Electrocardiogram Requiring Fast Emergent Coronary Therapy (PERFECT) Study.

The aim of this study is to assess the performance characteristics of the modified Sgarbossa criteria for diagnosis of ACO in VPR. This is a multi-centre international trial. The number of patients presenting to our Emergency Departments with pacemakers continues to increase. Investigating whether such patients are having a heart attack is challenging. For patients without pacemakers, ECG criteria can be used to identify a subset of patients who are having a heart attack. However, for patients with pacemakers, there are no accurate electrocardiograph (ECG) criteria to diagnose heart attacks. This research has the potential to identify AMI in patients…

Principal Investigator: Dr Gary Mitchell
Amount Awarded: $16,866
Institution:

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> Staff Specialist

Propofol on trial for headaches in the Emergency Department setting

Headache is a common and frequently disabling clinical disorder that accounts for nearly 2% of all emergency department presentations. Often patients are experiencing a headache that is not responding to commonly available medications. However, there is no good evidence to support which available hospital medications consistently offer effective pain relief to individuals with these types of refractory headache. Understandably this is a challenging scenario in the emergency department setting for both the patient and physician that often leads to inadequate or unsatisfactory symptom relief. In a few small trials, there has been promising evidence that the medication propofol is potentially…

Principal Investigator: Dr Erik Wood
Amount Awarded: $7,860
Institution:

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A brief psychological intervention to promote recovery after mild traumatic brain injury

Mild traumatic brain injury (mTBI) is a common injury with potentially profound consequences. Although many patients recover within a few days to a few weeks, an estimated 15-40% develop post-concussion syndrome (PCS), which consists of an array of cognitive, emotional, and physical symptoms.(TBI symptoms that persist beyond three months often develop into a chronic, potentially life-long, health problem.) PCS is associated with problems returning to work, social difficulties, higher healthcare utilisation, and poorer quality of life. The mitigation of PCS represents a significant clinical problem. An effective evidence-based early intervention to prevent PCS is sorely needed. There is a growing…

Principal Investigator: Dr Shane Martin
Amount Awarded: $69,657
Institution:

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First aid oxygen treatment of divers with decompression sickness

Decompression sickness (DCS), commonly called the bends, involves formation of gas bubbles in the body following scuba diving. These bubbles can cause a variety of problems, ranging from minor aches and pain, to severe stroke-like symptoms. Providing pre-hospital oxygen therapy at the highest concentration possible provides needed oxygen to body tissues, reduces bubbles and can often relieve symptoms. Oxygen has been shown to reduce the number of hyperbaric treatments a diver with DCS will require so improving pre-hospital oxygen delivery will lead to decreased hospital costs. However, the ideal oxygen delivery system has not been determined. Using new techniques and…

Principal Investigator: Dr Denise Blake
Amount Awarded: $30,003
Institution:

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Evaluating rates of skin colonisation with MRSA or Group A Streptococci

Group A Streptococcal (GAS) is known to be the cause of Acute Rheumatic Fever (ARF) and Chronic Rheumatic Heart Disease (CRHD). Worldwide Community acquired (CA) Methicillin Resistant Staphylococcus Aureus (MRSA) is an increasing problem which has also been identified in Australia since the 1990s. At times, the rates in North West HHS have been as high as 30%. This has implications for both the local HHS and the health system more broadly for patients that then require transfer to other facilities. The purpose of this research is to conduct a snapshot study for the evaluation of rate of skin colonisation…

Principal Investigator: Dr Geoffrey Rofe
Amount Awarded: $68,224
Institution:

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Ketamine versus propofol in sedation of psychiatric patients requiring retrieval

The aeromedical retrieval of acute psychiatric patients is a challenging scenario for the most experienced clinician. This is due to the potential for unpredictable behaviour among these patients, coupled with the inherent dangers of the aviation environment. Chemical restraint is one of the accepted strategies in this environment to ensure patient and crew safety and to minimise patient distress. Benzodiazepines and antipsychotics have been the most commonly employed drugs for chemical restraint, although they are sometimes limited by adverse reactions and inadequate sedation endangering the safety of patient and health care providers. Consequently, there has been increasing interest in drugs…

Principal Investigator: Dr Luke Burman
Amount Awarded: $8,400
Institution:

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Is prednisolone an effective treatment for Bell’s Palsy in children?

Bell’s palsy or acute idiopathic lower motor neurone facial paralysis is characterised by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. It is the third most common neurological reason for children to present acutely to hospital. In adults, there is conclusive evidence from two major recent trials that a short course of prednisolone, a cheap, widely available and safe steroid, can significantly increase the number of Bell’s palsy patients who completely recover. While the medical problems associated with Bell’s palsy are similar, in children there is no good evidence…

Principal Investigator: Dr Shane George
Amount Awarded: $68,179
Institution:

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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…

Principal Investigator: Dr Ogilvie Thom
Amount Awarded: $19,796
Institution:

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The Value of Avoiding the Pain of IV Catheter Failure.

Peripheral intravenous catheters (PIVC) are the most common invasive device utilised in health care, yet have very high failure rates because of infection, phlebitis, occlusion or dislodgement. Previous EMF-funded research (IVL-GONE: Intravenous Lines – Glue or Not Experiment, Bugden et al., 2015) has shown that the addition of two drops of medical grade superglue in addition to standard dressings at the insertion site of PIVCs can reduce the failure rate from 27% to 17% over 48 hours. Reduction in failure rates is expected to have beneficial effects on patient comfort and outcomes, along with hospital flow and costs. Uptake of…

Principal Investigator: Dr Mark Scott
Amount Awarded: $30,550
Institution:

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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…

Principal Investigator: Dr Sheree Conroy
Amount Awarded: $5,940
Institution:

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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…

Principal Investigator: Dr Jacob Crosdale
Amount Awarded: $8,620
Institution:

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> Rural and Remote Research Program

> Research Scholarship Grant

Research Scholarship Grant Dr Jeremy Furyk

Status epilepticus (SE) occurs when seizures do not stop spontaneously and can result in long-term disabilities and occasionally death. There is a paucity of high quality evidence on SE, particularly in children and causes and outcomes are different from adults. This programme of research on SE uses mixed methods to address this gap in knowledge. The research includes establishing a national registry of status epilepticus in children, identifying consensus research priorities amongst experts, and a qualitative evaluation of alternatives to informed consent (which is a potential barrier to prospective emergency research).

Principal Investigator: Dr Jeremy Furyk
Amount Awarded: $150,000
Institution:

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> Project Grant

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…

Principal Investigator: Dr Mark Edwards
Amount Awarded: $50,000
Institution:

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Kids THRIVE

Children may present to an emergency department with life threatening conditions that require immediate treatment to support their breathing to allow enough oxygen to be supplied to the body. In these circumstances a child is given medication to put them to sleep and the airway is secured with the insertion of a tube into the windpipe. This transition from spontaneous breathing awake to controlled respiration under anaesthetic via a breathing tube is called intubation and is associated with a high risk for low oxygen levels in the body or low blood pressure. Newer methods to avoid these risks are currently…

Principal Investigator: Dr Shane George
Amount Awarded: $282,290
Institution:

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Too much of a good thing; Does fluid resuscitation worsen septic shock?

Patients with infections are a leading cause of presentations to the Emergency Department (ED), with severe sepsis and infection causing an estimated 20,000 deaths each day across the world. Treatment is aimed at eradicating the infection and supporting the patient while recovery can take place. Frequently patients develop low blood pressure as a result of immune response that can ultimately result in further organ injury (termed septic shock). Intravenous fluids are recommended by international guidelines as the first line therapy in the ED to treat low blood pressure of sepsis with the hope of preventing organ injury and death. Despite…

Principal Investigator: Prof Louise Cullen
Amount Awarded: $77,233
Institution:

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FEISTY – Fibrinogen Early In Severe Trauma study.

Over 7000 Australians are treated for severe trauma every year. Major bleeding in the setting of trauma is associated with poor outcomes and increased rates of death. Severe trauma causes a decrease in the factors within the blood that helps clots to form and stop bleeding. This loss of clotting factors is associated with worse outcomes and it is proposed that early replacement of these factors may reduce bleeding and improve outcomes. Fibrinogen is one of the key clotting factors that needs to be replaced in severe traumatic bleeding. Currently fibrinogen is replaced using cryoprecipitate; a blood product obtained from…

Principal Investigator: Dr Don Campbell
Amount Awarded: $292,937
Institution:

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> Program Grant

> Capacity Building Grant

Rural and remote

> Trainee Grant Scheme

> Staff Specialist

> Rural and Remote Research Program

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…

Principal Investigator: Prof Mark Shephard
Amount Awarded: $95,730
Institution:

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Ketamine vs Propofol in Sedation of Psychiatric/Psychotic Patients requiring Retrieval.

The research aim is to conduct as a randomised clinical trial comparing the use of Ketamine and Propofol in sedating acute psychiatric patients for safe aeromedical retrieval. The inherent dangers of the aviation environment combined with the potential and unpredictable behaviour of acute psychiatric patients presents a challenge to even the most experienced aeromedical retrieval clinician. An efficacious sedation drug is vital in this environment to ensure patient and crew safety and to minimise patient distress. The outcomes of this research will highlight the potential complications, the safety profile and efficacy of different sedation agent utilised in the sedation of…

Principal Investigator: Ms Jodie Mills
Amount Awarded: $50,000
Institution:

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Using a modified blood pressure cuff to prevent cell death for rural people suffering a heart attack or stroke.

Stroke and heart attacks (HA) are caused by blocked brain or heart blood vessels. The impact of stroke or HA depends in part on time taken to unblock occluded blood vessels. Rural people with stroke or HA receive treatment to unblock vessels later than city folk. The delay to re-perfusion causes damage and worse outcomes for country people experiencing stroke or HA. Late re-perfusion is associated with increased brain or heart injury. A treatment called "remote-ischaemic-conditioning" (RIC) involves a modified blood-pressure cuff that occludes limb blood flow for short periods, is known to protect against re-perfusion injury. The aims of…

Principal Investigator: Dr Simon Black
Amount Awarded: $49,978.00
Institution:

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> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Queensland

> Trainee Grant Scheme

Sedation for Acute Agitation in Emergency Department Patients: Targeting Adverse Events (SIESTA).

Acutely agitated patients are commonly seen in the emergency department (ED). As these patients may cause harm to themselves or others, a large proportion need to be managed with injectable sedative medications such as benzodiazepines (eg midazlolam) and/ or antipsychotics (e.g droperidol). Unfortunately, these medications may precipitate life threatening events (e.g hypoventilation). Safety data related to the use of these medications for the management of acute agitation in the ED setting are scant. Acute agitation in the ED setting is usually caused by mental health issues or substance abuse, again little is known about which sedative medications are best suited…

Principal Investigator: Dr Barrie Field
Amount Awarded: $17,639
Institution:

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Ladder related injuries.

Injuries and even death as a consequence of falls from ladders are increasing, especially in the home environment where elderly men are the most frequently presenting age group. There is considerable interest among health and safety professionals to develop injury prevention campaigns focusing on both ladders and their correct use. However there are large gaps in our knowledge, particularly in relation to the product choice, contribution of alcohol or medications, and compliance of safety practices at the time of the accident. This study is a collaboration bringing together expertise in emergency medicine, health economics, accident prevention and product safety. It…

Principal Investigator: Dr Gabriella Butler
Amount Awarded: $18,633
Institution:

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> Staff Specialist

Ketamine IntraNasally Delivered in the Emergency Room: KINDER

Sick and injured children in the Emergency Department (ED) often require procedures which can cause severe pain (like fracture reduction, stitching wounds, abscess drainage) or otherwise require the child to be still and cooperative (CT scans, lumbar punctures, removal of foreign bodies). Sedative drugs are given to these patients both to relieve pain/distress and to keep them still for the procedure. ED sedation of children now has a well established body of evidence. Most of the literature relates to when the drug is given intravenously or intramuscularly. Drug delivery by these routes leads to reliable effects as the drug bypasses…

Principal Investigator: Dr Luke Burman
Amount Awarded: $63,015
Institution:

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High Flow Nasal Cannula Treatment for Infants and Children with Acute Respiratory Failure – a Pilot Trial

Worldwide, the respiratory distress associated with pneumonia and other causes remains the leading cause of death in children. In Australia 39% of intensive care admissions for children are due to respiratory disease, with bronchiolitis/viral infection representing 17%, asthma 7% and pneumonia 7%. There is an emerging trend to support respiration with methods other than oxygen, particularly in the early stage of disease process aiming to prevent the progression of disease. In under resourced countries children presenting to hospitals with severe pneumonia have a mortality rate between 13-20% and most deaths occur with hypoxemia before therapeutic benefit of antimicrobials. High flow…

Principal Investigator: Dr Fiona Thomson
Amount Awarded: $70,000.00
Institution:

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REstricted Fluid REsuscitation in Sepsis-related Hypotension (REFRESH).

Sepsis is a generalised inflammatory response to infection reaching the blood (sometimes called blood poisoning) and is a major global health problem. In industrialised countries sepsis has a significant healthcare cost as well as a mortality and morbidity burden. In Australia, the incidence of sepsis appears to be increasing. Recent data from the Australian and New Zealand Intensive Care Society adult database shows that sepsis accounts for 11% of admissions to intensive care units, and a mortality of 18% within 30 days. Conventional treatment for the initial management of septic shock is the infusion of 30ml/kg of intravenous fluid, or…

Principal Investigator: A/Prof Gerben Keijzers
Amount Awarded: $54,125
Institution:

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A Prospective Observational Cohort Study of Paediatric Status Epilepticus in Emergency Departments of Australia and New Zealand. The Status Epilepticus Australasian Registry for Children (SEARCh).

Convulsive status epilepticus (CSE) occurs when seizures do not stop spontaneously. It is the most severe form of epilepsy, and can result in long-term disabilities and rarely death. It can affect both adults and children, although the causes and outcomes are different in these groups of patients. Treatments of patients with CSE are largely based on expert opinion rather than strong evidence, due to the difficult nature of conducting quality trials in patients with this relatively infrequent condition in the emergency setting. We will determine the incidence and causes of CSE in children in Australia and New Zealand and collect…

Principal Investigator: Dr Jeremy Furyk
Amount Awarded: $69,992
Institution:

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Describing the exepriences of social workers in a tertiary ED.

The Department of Emergency Medicine at the Royal Brisbane and Women’s Hospital is a large department that includes a team of social workers. This team is available on-site 24/7. RBWH is the only facility in Queensland that has a 24/7 on-site social work service, and to date, no research has been conducted to explain the evolution of this service, its implications for the social work team, and for DEM more broadly. This study involves a qualitative analysis of the experiences of this social work team, based on information provided during interviews. Presentations to ED requiring engagement of clinicians and social…

Principal Investigator: Dr Alexandra Markwell
Amount Awarded: $14,735.00
Institution:

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Development and validation of a psychometric tool to measure the risk propensity of junior emergency doctors.

This pilot project brings together experts from the fields of emergency medicine, medical education and organisational psychology. Its aim is to develop a tool which may be used to evaluate risk propensity in emergency doctors. An individual’s propensity for risk and their decision making involving risk have both positive and negative consequences. It is most often revealed when faced with scenarios that involve a trade-off amongst competing demands. Risk-related behaviour may cause harm to self, staff and patients; however it can also be used positively when the potential benefit is high, e.g. when the risk associated with a procedure is…

Principal Investigator: Dr Charley McNabb
Amount Awarded: $36,808
Institution:

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Examination of health care assessment practices and costs pre- and post- implementation of an accelerated chest pain assessment protocol.

Current guidelines for the assessment of patients with chest pain mandate that patients remain in hospital for a minimum of 6 to 12 hours, with many staying overnight. We have developed an accelerated assessment protocol for patients who present to Emergency Departments with chest pain; the Brisbane Accelerated CHest pain protocol (BACH protocol). This strategy should support the accelerated assessment of more than 70% of all ED patients presenting with possible symptoms of a heart attack. Research into the effectiveness of the BACH protocol was completed in 2014, and showed it to be safe and effective. As such, it was…

Principal Investigator: Prof Louise Cullen
Amount Awarded: $69,395
Institution:

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Queensland pre-hospital study identifying which trauma patients are at risk of bleeding to death.

Injury is the leading cause of death and the second highest contributor to the burden of disease of Australians aged between 12 and 24 years. One of the contributing factors to trauma death is the inability for the injured patient to clot properly. Studies have shown that in approximately 10-50% of trauma patients the blood does not clot properly, with patients exhibiting abnormal clotting up to 4 times more likely to die from their injuries. This study aims to estimate the proportion of injured patients with clotting problems at the time paramedics treat them. The Queensland Ambulance Service (QAS) High…

Principal Investigator: Dr Daniel Bodnar
Amount Awarded: $64,000
Institution:

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Exploring the practice of nurse-initiated medications in the emergency department

The autonomy to nurse-initiate analgesia and selected medications enhances processes in the emergency department (ED). Nurse-initiating practice enhances patient care and clinical outcomes by improving pain assessment, it provides safe pain management, and reduces time to analgesia ED. However, the practice might be underutilised due to feelings of reluctance or apparent medication knowledge deficit. The factors that may contribute to reluctance or hinder medication knowledge are unknown. A qualitative methodology is proposed to determine these factors, because it can potentially identify practice gaps, isolate flaws in the current education method utilised in the ED, and establish strategies that maintain medication…

Principal Investigator: Dr Michael Sinnott
Amount Awarded: $7,478.84
Institution:

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> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

The Cannulation Rates in ED Intervention Trial (CREDIT)

A peripherally inserted intravenous catheter (PIVC) is a small tube placed into a vein to administer medication or fluids. PIVCs are commonly used in Emergency Departments but recent literature suggests that emergency care providers may place PIVCs more often than required; up to 50% remain unused. This places the patient at unnecessary risk of catheter­-related infections and is associated with a high financial cost to the healthcare system. We will conduct a historically controlled trial where observational data will be collected before and after an intervention aimed to reduce PIVC use. Data collected before the intervention will identify 1) how…

Principal Investigator: Prof Louise Cullen
Amount Awarded: $80,000.00
Institution:

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The Breathe Easy Early Study: BEES Study.

Shortness of breath is one of the most common reasons for presentation to Australian Emergency Departments, with millions of presentations each year. A new patient, unable to speak properly because they cannot breathe present difficulties in immediate diagnosis and therefore treatment, to emergency doctors and nurses. Immediate management involves the application of oxygen via a face-mask in addition to drug therapy and investigations including x-rays and blood tests. If breathlessness gets worse, the patient may need invasive support for breathing; a process that involves more staff, expensive machines, and resultant considerable cost to the health care system. A simpler support…

Principal Investigator: Dr Kylie Baker
Amount Awarded: $159,173.44
Institution:

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Delivering emergency care in the watch house: an outcomes analysis.

Increasingly, prisoners are requiring transfer to and assessment in the ED; some for illnesses that may be treated in the custodial environment with an appropriately trained health care professional. Optimising how health care is delivered in the watch house environment was the focus of this study, following recommendations in a recent (2012) Inquiry following the death of Herbert John MITCHELL: "Medically trained staff should be posted in all of the larger watch houses to make initial assessment and to carry out on going monitoring and re-assessment... Consideration of how best to address health issues in watch houses should involve health…

Principal Investigator: Dr David Green
Amount Awarded: $116,772
Institution:

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Reducing Emergency Department demand through expanded primary healthcare practice.

Patient demand on Emergency Departments (EDs) is rising by over 3% per annum contributing to congestion. ED congestion is known to be associated with poor health outcomes and reduced efficiency; the latter is characterised by increased waiting time, length of stay and ambulance diversion. Even though the National Emergency Access Target (the four-hour rule) has reduced the level of access block, initiatives to reduce ED demands have not had significant effect to date. Previous research undertaken by the emergency health research group at QUT has described in detail the increases in demand and has identified some contributing factors. Our research…

Principal Investigator: Dr Douglas Morel
Amount Awarded: $227,682
Institution:

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> Program Grant

> Capacity Building Grant

Capacity Building Grant Prof Louise Cullen.

The Royal Brisbane and Women’s Hospital (RBWH) Department of Emergency Medicine (DEM) is constantly looking for better ways to improve the care of the sick and injured. Patients are cared for by a team of professionals including doctors, nurses and other allied health professionals. Improvements in care come largely from high quality research. Our medical specialists in Emergency work on a wide range of challenging, innovative emergency medicine research topics. Their results are reported in some of the top professional journals, including the Lancet. Research led by other team members including nurses, however, is scarce despite the fact that these…

Principal Investigator: Prof Louise Cullen
Amount Awarded: $140,000
Institution:

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Rural and remote

> Trainee Grant Scheme

> Staff Specialist

> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Queensland

> Trainee Grant Scheme

> Staff Specialist

Drugs for the treatment of nausea and vomiting in adult patients in the emergency department setting

Nausea and vomiting is a common and distressing presenting complaint in emergency departments. Nausea describes the unpleasant sensation of the imminent need to vomit, whereas vomiting refers to the forceful oral expulsion of gastric contents associated with contraction of the abdominal and chest wall musculature. The complications from nausea and vomiting can range from trivial to serious, such as dehydration and oesophageal rupture. High level evidence supports the use of antiemetics in the management of nausea and vomiting in many settings and populations, however there is little guidance or consensus in recommendations for the management of nausea and vomiting in…

Principal Investigator: Dr Jeremy Furyk
Amount Awarded: $24,959.00
Institution:

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Morale, stress and coping strategies of staff working in the emergency department: a national and international comparison.

The impact on staff morale from working in the stressful emergency department environment is relatively unknown. This study aims to describe and compare the impact of the working environment on emergency department medical and nursing staff as well as the varied coping strategies used by ED staff in a range of ED environments of varying sizes and locations in Australia and Sweden. The findings will enhance understanding of factors that may link specific stressors to the emergency department workplace environment and can assist ED staff and managers in tailoring support mechanisms, as required.

Principal Investigator: Dr Ogilvie Thom
Amount Awarded: $29,141
Institution:

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Serum catecholamine levels in Irukandji Syndrome (IS).

Irukandji Syndrome (IS) is a condition caused by the venom of jellyfish found in the tropical waters of Australia and has received significant media attention over the past decade. The syndrome most commonly presents with a variable combination of severe generalised pain, involving the torso and limbs, nausea and vomiting, sweating, headache and severely elevated blood pressure and pulse. Documented complications of IS include myocardial (heart) damage and failure, intracerebral haemorrhage (bleeding on the brain) and death. The signs and symptoms of IS are believed to be due to excessive release of endogenous catecholamines (stress hormones). A number of in-vitro…

Principal Investigator: Dr Clinton Gibbs
Amount Awarded: $9,340
Institution:

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Validating the Manchester Acute Coronary Syndromes (MACS) Clinical Decision Rule.

Diagnosis of heart attack (acute myocardial infarction) relies on troponin testing along with additional inpatient investigations. Researchers in the United Kingdom have developed a clinical decision rule (the MACS rule) for avoiding unnecessary hospitalisation for patients with chest pain. The MACS rule places individuals into four risk groups with suggested dispositions for each group, with the very low risk eligible for immediate discharge. Initial validation of the rule revealed that 31.5% of patients met the low risk criteria and so could be discharged from hospital with no further investigation. Of these patients, none had a heart attack within 30 days.…

Principal Investigator: Prof Louise Cullen
Amount Awarded: $27,806
Institution:

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Critical Evaluation of a Targeted Point of Care ROTEM and Multiplate Guided Coagulation and Haemostasis Management Programme in Severe Trauma and Critical Bleeding.

This project investigates how to assess and treat patients with clotting disorders as a result of trauma and severe bleeding. Patients with severe trauma and critical bleeding have a high risk of death from haemorrhage and the complications that may be associated with large volume blood transfusion. The ability of the patient to form a blood clot will be assessed by a technology called viscoelastometry and aggregometry using a ROTEM/multiplate device. This device gives an in-depth assessment of the patient’s clotting and allows specific treatment to be targeted at specific clotting defects. Using this technology, the investigators hope to reduce…

Principal Investigator: Dr Donald Campbell
Amount Awarded: $69,263
Institution:

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A prospective pilot validation study for clinical decision rules in paediatric cervical spine imaging – CRIC: Children’s Rules for Imaging the Cervical Spine Evaluation Study.

Children rarely break their necks but if they do, they can risk spinal injury or death. Many more children present for assessment of possible cervical spine (neck) injuries than are subsequently diagnosed with cervical spine injury. The challenge for the emergency doctor is to identify the rare cases without subjecting too many children to unnecessary tests. These tests, x-rays and scans, have risks including exposure to radiation and associated danger of long term cancer development, as well as the possible need for sedation to perform the scan in young children. Awaiting these tests is often a time of prolonged distress…

Principal Investigator: Dr Natalie Phillips
Amount Awarded: $69,930
Institution:

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Basel Syncope Evaluation Study: BASEL IX Study.

Management of patients with syncope (loss of consciousness) is a serious problem concerning 1 - 2 per cent of Emergency Department presentations. Of these, it is known that between six and 20 per cent of patients will have a problem with their heart. The rapid and accurate identification of patients with cardiac related syncope is an important clinical need which until this time has not been met. This observational study will evaluate the diagnostic value of patients’ history, clinical judgement and new blood tests (biomarkers) for cardiac syncope. The study will recruit 720 adult patients across multiple sites internationally. Eligibility…

Principal Investigator: Prof Louise Cullen
Amount Awarded: $32,100
Institution:

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> Rural and Remote Research Program

> Research Scholarship Grant

Research Scholarship: Dr Colin Page

Doctorate of Philosophy (PHD) to study the antidotes and treatments that are commonly used by medical staff when looking after patients who are affected by drug toxicity. Dr Colin Page was awarded the Noel Stevenson Fellowship, in honour of eminent Queensland emergency medicine physician, Dr Noel Stevenson. Dr Page has developed a clinical toxicology service at Princess Alexandra Hospital and Queensland through a locally run clinical toxicology unit and is the honorary medical director of the Queensland Poisons Information Centre. Clinical toxicology is the speciality that manages patients who are affected by drug toxicity either accidentally or in overdose. The…

Principal Investigator: Dr Colin Page
Amount Awarded: $450,000
Institution:

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> Project Grant

Australia, Asia and New Zealand Dyspnoea in Emergency Departments Study.

Shortness of breath (Dyspnoea) is a terrifying symptom experienced by patients and is a common reason for presentation to Emergency Departments. There are a wide range of causes including flair up due to chronic conditions such as asthma, heart failure, chronic lung disease or liver or kidney failure. Acute conditions such as a collapsed lung, chest infection (including pneumonia), trauma (including fractured ribs), airway blockage or an allergic reaction can also be the cause. There is significant knowledge about patients who are admitted to hospital with common causes, however there is little conclusive information about Dyspnoea as a symptom, the…

Principal Investigator: A/Prof Gerben Keijzers
Amount Awarded: $96,000.00
Institution:

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The HALT-IT trial: Tranexamic Acid for the Treatment of Gastrointestinal Bleeding, an International Trial.

Gastrointestinal (GI) bleeding is a common emergency with a substantial mortality rate. Bleeding from the upper gastrointestinal system is caused by ulcers, stomach inflammation and oesophageal varices and carries a fatality rate of up to 10%. Lower GI bleeding has a variety of causes and a case fatality of about 15%. Between 10% and 25% of patients will have a repeat bleed after their first episode, and these people are four times more likely to die than people without repeated bleeding. The clotting of blood helps to stem bleeding and blood clot break down may play an important role in…

Principal Investigator: Dr Luke Lawton
Amount Awarded: $185,788
Institution:

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Supplementing Pain Management in the ED – Conventional Treatment versus Intravenous Adjunctive Low Dose Ketamine (SPECIAL-K).

Pain is a common feature of major traumatic injuries. Little research has been done into the utilisation of low dose Ketamine for analgesia in the ED. Ketamine has the potential to be a highly effective method of analgesic management in haemodynamically unstable trauma patients who are unsuitable for large doses of opioid drugs but it is not utilised for this purpose due to a lack of supporting evidence and clinical concern about potential side effects. The clinical impact of this trial is in the development of an evidence base to support the use of Ketamine for analgesic purposes in the…

Principal Investigator: Dr Luke Burman
Amount Awarded: $25,170
Institution:

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Magnesium in Irukandji Syndrome Trial (MIST).

Irukandji Syndrome (IS) describes distressing symptoms following exposure to a number of different jellyfish, including severe generalised pain often associated with extremely high blood pressure, fast heart rate, sweating and anxiety. This is a serious condition, occasionally resulting in death. The research team plan to evaluate the role and efficacy of magnesium in reducing pain associated with IS.

Principal Investigator: Dr Jeremy Furyk
Amount Awarded: $105,282
Institution:

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A randomised controlled trial of intravenous paracetamol and oral paracetamol to control acute pain.

Pain is a common reason for presentation to the emergency department. In 78–86% of Australian ED presentations pain is a primary component and therefore represents a major clinical care issue. However, numerous studies have shown that pain is poorly managed in the ED. This project aims to provide evidence that intravenous (IV) paracetamol produces superior analgesia than oral paracetamol in the emergency department setting and that IV paracetamol produces good patient satisfaction, few side-effects and reduced length of hospital stay. To date the majority of trials into the effectiveness of IV paracetamol have focused on specific disease states and, to…

Principal Investigator: Dr Benjamin Close
Amount Awarded: $40,870.00
Institution:

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Measuring quality of care for musculoskeletal injuries in the Emergency Department.

The increasing demand on emergency health care in Australia has seen recent emphasis on clinical redesign initiatives that are focused on time-based performance measures and activity-based funding. While congestion in emergency departments continues, and emphasis is placed on reaching these time targets, the quality of care that patients receive when presenting with non-life threatening injuries is potentially compromised. To date, there is a lack of high-level evidence surrounding the type of quality indicators (QIs) that should be used in EDs to measure quality of care. This project will develop QIs for care of patients who present to EDs with musculoskeletal…

Principal Investigator: Dr Anthony Bell
Amount Awarded: $274,969
Institution:

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High Flow Nasal Cannula treatment for viral Bronchiolitis, a randomised controlled trial.

Acute respiratory disease is the leading cause for infants and children needing hospital admission. The main focus of hospital treatment is oxygen therapy beside disease specific treatment like inhalers for asthma or antibiotics for pneumonia. 10 to 20% of these infants or children need higher level of care at some point of their illness and will be transferred to a children’s hospital intensive care unit. This is not only expensive and imposes a huge burden on health care costs but more importantly is very stressful for these children and families because they are taken out of their familiar environment. Recent…

Principal Investigator: Dr Christa Bell
Amount Awarded: $50,800
Institution:

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ConSEPT: Convulsive Status Epilepticus Paediatric Trial

Convulsive Status Epilepticus (CSE) is the most common childhood neurological emergency, sometimes resulting in death or serious disability. CSE is managed with anticonvulsant medications in a step-wise approach until seizures stop. While some management strategies for CSE are well supported by evidence (e.g. initial administration of benzodiazepines), subsequent strategies are based on expert consensus and not evidence. Phenytoin, the traditional second line agent for CSE has a high failure rate, causes adverse events and must be administered slowly. Levetiracetam, a newer anticonvulsant, has a favourable adverse events profile, can be administered quickly and has good efficacy for various seizure types.…

Principal Investigator: Dr Jeremy Furyk
Amount Awarded: $147,820
Institution:

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Multicentre randomised controlled trial incorporating bedside lung ultrasound into the diagnosis of congestive cardiac failure in breathless older patients.

Many older persons present to the Emergency Department complaining of shortness of breath (Dyspnoea). This can be an important forewarning of heart failure, but is also present in many other conditions. In most cases, several bedside tests are carried out to identify those patients with heart failure. Despite these investigations, which include blood tests, electrocardiograph and chest x-ray, heart failure is initially misdiagnosed in up to one quarter of patients in the emergency department. This project focuses on secondary prevention of the complications of the disease caused by missed diagnosis. Some European hospitals use bedside lung ultrasound as an adjunct…

Principal Investigator: Dr Kylie Baker
Amount Awarded: $195,542.00
Institution:

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> Program Grant

Envenomation, first aid and critical care of tropical jellyfish stings.

Queensland is currently recognised as the leader in the field of jellyfish envenoming treatment. Many of the treatments for jellyfish stings are not evidence based and data is emerging that suggests that some of the treatments may do more harm to jellyfish sting victims than good. This project will investigate three major areas of present contention: • Is vinegar a suitable first aid for jellyfish stings? • Can the survival rate of victims stung by big box jellyfish be increased by simply continuing CPR for extended periods? • Can readily available and used drugs be the answer to the ever-increasing…

Principal Investigator: A/Prof Mark Little
Amount Awarded: $344,340.00
Institution:

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Adrenaline Delivery through Ventilation of Aerosolised Nanoparticles in Cardiac arrEst (ADVANCE Study).

Every second counts when a patient’s heart stops and critical to this is restarting the heart and maximising blood flow to the brain. Without adequate blood flow to the brain, eventual survivors can be left with a devastating brain injury and be forced to live for their remaining years with severely reduced quality of life. The rapid delivery of adrenaline to restore cardiac function and deliver blood to the brain is critical to improving survival. Current techniques for delivering adrenaline focus on cannulating a vein. This can take many of those crucial seconds and more frequently several minutes, as the…

Principal Investigator: Dr Andrew Staib
Amount Awarded: $250,000.00
Institution:

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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. The 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. Doctors and patients are also concerned about complications from these tests. These include radiation from CT scans and…

Principal Investigator: A/Prof Kevin Chu
Amount Awarded: $268,600.00
Institution:

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> Capacity Building Grant

Rural and remote

> Trainee Grant Scheme

> Staff Specialist

> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Queensland

> Trainee Grant Scheme

> Staff Specialist

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…

Principal Investigator: Dr Michael Sinnott
Amount Awarded: $26,701
Institution:

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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. More proof is required before it can be included in clinical guidelines.

Principal Investigator: Dr Joseph Ting
Amount Awarded: $68,058
Institution:

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

Internationally, Emergency Department (ED) and hospital overcrowding is increasing and has been associated with negative patient and staff outcomes. Associated with this overcrowding, ambulance offload time (AOT) delay (i.e. extended time from ambulance arrival to ED to offload onto hospital stretcher, also called ambulance ramping) has emerged as a crucial patient safety issue, with offloaded ambulances not available to respond back to the surrounding community. Queensland Health have recognised that patient flow strategies are required 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…

Principal Investigator: Dr David Green
Amount Awarded: $40,553.00
Institution:

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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…

Principal Investigator: Dr Christa Bell
Amount Awarded: $69,924
Institution:

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> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Rural and remote

> Trainee Grant Scheme

> Staff Specialist

> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Queensland

> Trainee Grant Scheme

Single palmar injection versus double injection dorsal digital nerve block for finger injuries in the Emergency Department: A Randomised Clinical Trial.

Patients with finger injuries often require their finger to be numb to allow their injury to be assessed properly and treated. There are several methods available to numb the finger. Our study aims to compare two methods for numbing the patient’s finger to see which one of these methods is least painful for the patient. The first method is a single injection in the palm of the hand and the second method is two injections in the back of the hand or finger. The second method is the most commonly used method in our emergency department. Our hypothesis is that…

Principal Investigator: Dr Shane Martin
Amount Awarded: $8,712.00
Institution:

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> Staff Specialist

Describing health care use in a cohort of children 0-5 years in South East Queensland.

Emergency Department presentations are disproportionately greater in young children than all other age-groups. Young children are a vulnerable population and are at risk for injury and serious medical illness. In Australia, 13 per cent of all ED presentations were from children less than 5 years of age. Factors that lead to greater ED presentation rates in young children are incompletely understood and need further investigation. This project has access to unique data from another existing study, the Environments for Healthy Living study (EFHL), run by the School of Medicine, Griffith University. EFHL recruited pregnant mothers in the Logan, Tweed and…

Principal Investigator: A/Prof Gerben Keijzers
Amount Awarded: $50,000.00
Institution:

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Decimalate: Use of an on-line Smart Test and survey to determine whether comprehension of decimals is a barrier to interpretation of clinical chemistry results among Emergency Department staff.

Recognition of the extent of medication errors resulting from misinterpretation of instructions have resulted in a multitude of recommended practices to reduce the likelihood. One area which may contribute to error, but one which has received less attention, is that of accurate interpretation of clinical chemistry results. It is well recognised that numbers containing decimal places can lead to error in medications with decimals overlooked or misplaced. Anecdotal evidence from Emergency Physicians indicates difficulty in interpreting clinical chemistry results which are presented with leading decimals (e.g. 0.0095 g/l). Misconceptions about decimals have been the subject of extensive study. Half of…

Principal Investigator: Dr Michael Sinnott
Amount Awarded: $11,369.00
Institution:

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To determine what factors inhibit interns from developing and/or recording their clinical impressions (diagnoses) and management plans following patient assessment.

A hand written chart or clinical record is the most widely used method of patient care documentation in emergency departments. Research demonstrates that medical note taking responsibilities are frequently fulfilled to less than optimal standards by clinicians in many care settings including EDs (Gordon et al., 2010, Stetson et al. 2008). This has major implications for patient safety because communication between colleagues at shift change and patient handover can be compromised by poor record keeping. In addition, without accurate documentation of what has occurred in the emergency department, other professionals are unable to learn what care has been delivered. Furthermore,…

Principal Investigator: Dr Jonathon Isoardi
Amount Awarded: $48,000.00
Institution:

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IVL-Gone: Assessment of the effect of skin glue on the function of a peripherally inserted intravenous line.

Intravenous lines are placed in the majority of patients admitted to hospital. Unfortunately they often fall out, become infected, cause irritation & pain or become blocked. Occasionally this can cause a life threatening illness. Blood can leak from the intravenous line onto the patient’s skin, clothing or bed linen. This causes patient distress. It can also be dangerous for hospital staff if they accidentally come into contact with the blood. The insertion of a replacement intravenous line is generally regarded as an unpleasant experience that would be nice to avoid. The IVL-GONE research team are researching the use of common…

Principal Investigator: Dr Simon Bugden
Amount Awarded: $50,000.00
Institution:

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A randomised controlled trial of interventional versus conservative treatment of primary spontaneous pneumothorax.

Primary spontaneous pneumothorax (PSP) is defined as a collapsed lung with air in the pleural cavity that occurs in the absence of clinically apparent underlying lung disease. PSP is a significant global health problem affecting adolescents and young adults. Throughout the 20th century the treatment of PSP was predominantly bed rest, with invasive treatment reserved for severely symptomatic episodes. A study in 1966 suggested that managing large and small PSP in the community was safe. Despite this, rates of intervention have steadily increased over the decades. The reasons for this are unclear and this approach has recently been questioned in…

Principal Investigator: Dr Frances Kinnear
Amount Awarded: $50,086.00
Institution:

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> Rural and Remote Research Program

> Research Scholarship Grant

Research Scholarship Grant Prof Louise Cullen

This study is important because it will more rapidly move patients out of acute beds. It will do this by diagnosing patients with heart attacks up to four hours earlier and allowing earlier testing of patients without a heart attack but with potential heart disease, thus preventing overnight admissions. Approximately 80 per cent of patients who present to our ED each year with chest pain do not have a heart problem. Therefore, early discharge or admission of these patients would free up significant hospital resources, improve hospital flows and reduce the economic burden on the health care system. It may…

Principal Investigator: Prof Louise Cullen
Amount Awarded: $225,000
Institution:

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> Project Grant

Adding “insult to Injury” – The Effect of fresh and aged blood to oxygenation metabolisms and organ function in a clinically relevant trauma/sepsis model.

The World Health Organization reports that trauma will be the major contributor to the 49.7 million annual deaths globally from non–communicable disease in 2020. Trauma and sepsis are the two leading causes of death worldwide. This project aims to examine the effects of trauma and severe infection on oxygen supply to various tissues and organs. We will study what infection does to metabolism and the degree of inflammation in these tissues. The effects of resuscitation on these tissue parameters while using stored and fresh blood will also be studied. This study is highly relevant as blood transfusion is being increasingly…

Principal Investigator: Dr Andrew Staib
Amount Awarded: $204,402.00
Institution:

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Linking best practice workforce models to Emergency Department (ED) funding through SWAMPED: State-wide Workforce and Activity-Based Funding (ABF) Modelling for Queensland Emergency Departments.

The funding model for Emergency Departments under ABF is evolving. The challenge for ED leaders (both Medical and Nursing) will be to transition from a historical funding model to an ABF funding model. Under ABF, which is modified by jurisdiction specific purchasing initiatives, future resourcing (mainly human capital) will inevitably be linked to activity, performance, and safety and quality indicators.

Principal Investigator: Dr Anthony Bell
Amount Awarded: $190,172
Institution:

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The Australasian Paediatric Health 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…

Principal Investigator: A/Prof Jason Acworth
Amount Awarded: $298,028
Institution:

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> Program Grant

> Capacity Building Grant

Rural and remote

> Trainee Grant Scheme

> Staff Specialist

> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Queensland

> Trainee Grant Scheme

Effect of IV Fluid Therapy in Patients with Uncomplicated Acute Alcoholic Intoxication presenting to the Emergency Department, a randomised trial.

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.…

Principal Investigator: A/Prof Gerben Keijzers
Amount Awarded: $40,000.00
Institution:

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> Staff Specialist

The Utility of Ultrasound for distinguishing heart failure from other causes of dyspnoea in older persons.

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…

Principal Investigator: Dr Kylie Baker
Amount Awarded: $46,000.00
Institution:

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> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

Checking radiology reports and reviewing patient records: an IT solution for preventing missed limb fractures.

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…

Principal Investigator: A/Prof Kevin Chu
Amount Awarded: $139,001
Institution:

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> Program Grant

Quality linking of health data to evaluate patient and health service outcomes and key performance indicators following the implementation of patient flow strategies.

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.

Principal Investigator: Dr Gerben Keijzers
Amount Awarded: $104,833
Institution:

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> Capacity Building Grant

Capacity Building Grant Dr Frances Kinnear.

Principal Investigator: Dr Frances Kinnear
Amount Awarded: $190,000
Institution:

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Rural and remote

> Trainee Grant Scheme

> Staff Specialist

> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Queensland

> Trainee Grant Scheme

Evaluation of therapeutic subclavian atrial compression (TSAC): A novel technique for peripheral vascular stasis.

Two-thirds of people who sustain trauma to the upper limb proximal artery die from traumatic blood loss before reaching hospital. Timely stabilization of the injury, control of bleeding, and rapid transportation to an emergency department could dramatically improve the rate of survival. We know from research that these measures dramatically approval the rate of survival for traumatic injuries of other parts of the body. In this study, we will test the safety and efficacy of a particular procedure that we predict will improve the management of these injuries in the pre-hospital setting. We predict that the use of this procedure…

Principal Investigator: Darren Powrie
Amount Awarded: $15,652
Institution:

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Comparing intern’s assessments using mini-Clinical Evaluation Exercise (mini-CEX) with existing workplace based assessments in emergency medicine term.

With increasing numbers of Australian medical graduates, there has been a significant increase in the intern teaching and supervision workload in emergency departments (EDs). As a result, there is the potential for dilution of supervision, making assessment of intern performance more challenging. The current process for evaluating interns has no formal requirement for direct observation of an intern’s history taking or clinical examination skills. Rather the assessment of their abilities is largely derived from the quality of presentation of their clinical findings to the senior doctors supervising them. In most EDs end of term assessments are based on facilitated discussion…

Principal Investigator: Dr Victoria Brazil
Amount Awarded: $8,774.87
Institution:

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EASI – Efforts to Attenuate the Spread of Infection: A prospective, multi-centre microbiological survey of Ultrasound Equipment in Australian Emergency Departments and Intensive Care units.

One of the causes of patients getting sick in hospital is the transfer of bacteria from one patient to the other (nosocomial infection). This transfer of bacteria can lead to serious illness, even death. There are numerous precautions taken in hospital to prevent this, such as hand washing, wearing gloves, sterile gowns and gloves during procedures etc. There has been a tremendous growth in the use of point of care ultrasound to assist clinicians in the Emergency Department, Intensive Care Unit and Anaesthetic Department. We suspect that probes, which are in contact with patients’ skin are not cleaned as often…

Principal Investigator: Dr Ogilvie Thom
Amount Awarded: $9,625.75
Institution:

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A comparison between compressed air and Nitrox gas for recreational scuba divers to 18 msw.

The Emergency department at the Townsville Hospital sees the largest no of emergency patients with decompression illness due both tertiary referral and the proximity of the great barrier reef. Decompression illness is the commonest form of diving related emergency requiring emergency management. It is thought that nitrogen bubbles become trapped in the body as the gas expands upon ascent of the diver to the surface. Divers breathe from a scuba tank for the duration of the dive. Normally they would breathe compressed air for the shallower recreational dives (up to 30 metres of sea water (msw)). Divers have found that…

Principal Investigator: Dr Denise Blake
Amount Awarded: $19,382
Institution:

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> Staff Specialist

Is Helicopter Transport Safe for Divers with Decompression Illness? A Prospective Simulation Study Evaluating Intravascular Bubble Formation in Healthy Volunteers Exposed to Vibration versus Stillness following a Table 14 (241.3 kPa) Hyperbaric Treatment.

Diving is a common recreational activity for both Queenslanders and tourists alike. It forms the basis for whole tourism industries based on the Great Barrier Reef. Unfortunately diving does have risks which includes decompression illness (DCI). DCI involves formation of gas bubbles and can be fatal. Treatment usually involves re-pressurisation in special chambers designed to ‘squash’ the bubbles and reduce symptoms. Affected divers can only receive this treatment in certain hospitals. They may need to be transported urgently by helicopters from the reef to hospital. However, some people believe that the vibration of the helicopter may increase the number of…

Principal Investigator: Dr Denise Blake
Amount Awarded: $46,310.62
Institution:

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Prospective evaluation of an innovative system for online clinical assessment of practical skills (eCAPS) for Emergency Medicine residents and registrars.

The current project will involve the implementation and evaluation of a pioneering protocol for the online clinical assessment of practical skills (eCAPS) for medical residents and registrars training in Emergency Medicine. It will use a variety of web-based video technologies to facilitate the learning and innovative assessment of physical examinations of the musculoskeletal system initially targeting the knee and shoulder joints. Specifically, eCAPS includes three interdependent elements with a progressive (asynchronous to synchronous) organization of online instructor and learner-generated video resources to allow formative and summative assessments of practical competencies of Emergency Medicine residents and registrars performing selected physical examinations…

Principal Investigator: Dr Colin Meyers
Amount Awarded: $34,582.07
Institution:

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A prospective blinded evaluation of the sensitivity and specificity of pre-hospital Focussed Abdominal Sonogram for Trauma (FAST).

Emergency department use of ultrasound to detect internal bleeding has been shown to be accurate and change patient outcomes. Although previous studies have shown that it is feasible to perform ultrasound examination in the pre-hospital environment, there is a paucity of information about the accuracy of these scans. Given that prehospital ultrasound is often performed in suboptimal conditions (i.e. in the open during daylight or in the cramped confines of an ambulance), with machines less advanced than those utilised by Emergency Department staff, the accuracy and utility of pre-hospital ultrasound scans needs to be evaluated. This study will evaluate the…

Principal Investigator: Dr Stephen Rashford
Amount Awarded: $32,075
Institution:

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> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

Validation and Impact of the Four-Hour Rule in the Emergency Department: A Large Data Linkage Study.

This is a national collaborative research project approved by the National Health and Medical Research Council Partnership Projects scheme. This project aims to identify how the four-hour rule is effective in reducing access block and the adverse effects of emergency department overcrowding on patients. In particular, it will assess the impact of the four-hour rule as a policy intervention in reducing emergency department length of stay (EDLOS) over time in WA and compare the outcomes against comparable hospitals in NSW, Qld and ACT. This project hypothesises that effective intervention for reducing EDLOS will translate into improved patient outcomes, particularly in…

Principal Investigator: Dr John Burke
Amount Awarded: $50,000
Institution:

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Developing a quality framework for the care of older patients in the Emergency Department.

Over the next 20 years there is expected to be a burgeoning in the number of people aged ≥ 70 years in Australia. This rapid aging of our population is expected to result in a marked increase in elderly patient presentations to Emergency Departments. Elderly patients have complex care needs that are highly time- and resource-intensive. In addition, the elderly more commonly have poor outcomes after discharge from emergency, with higher rates of missed diagnoses and medication errors. However, survival and health outcomes of elderly have been shown to improve with high quality care. Quality indicators (QIs) are tools that…

Principal Investigator: Dr Ellen Burkett
Amount Awarded: $280,539
Institution:

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Prevalence and risk factors associated with CA-MRSA in a Queensland Urban Emergency Department: A prospective study.

Skin infections are a common reason why people seek medical attention from an emergency department (ED). When (ED) physicians are deciding which antibiotic to use to treat a skin infection, several factors must be considered. The most important factor is the bacteria causing the infection. However, it often takes several days for laboratory results identifying bacteria to be available. Therefore, ED physicians typically prescribe flucloxacillin; an antibiotic that covers the bacteria seen in approximately 80% of skin infections. However, in some cases, bacteria known as Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) is responsible for infection. If a patient has…

Principal Investigator: Dr Julian Williams
Amount Awarded: $94,100
Institution:

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Propofol or Ketofol for Emergency Medicine Procedural Sedation- A Randomized Controlled Trial: The POKEM Study.

This project aims to determine if the drug combination called ketafol offers an improved safety profile while maintaining the same procedural success rates and patient satisfaction. This study will still treat any pain before the procedure starts or the sedative drugs are administered for the procedure itself. Patients who agree to take part will receive one or other of the alternatives in predetermined amounts. All patients receive full monitoring and standard sedation care. The second aspect to this study relates to the way in which the data will be viewed and analyzed. This study will be using a special database…

Principal Investigator: Dr Anthony Bell
Amount Awarded: $115,075.00
Institution:

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A Comprehensive Evaluation of a Hospital In Nursing Home (HINH) Program in Three Queensland Hospitals.

Increasing demand for hospital Emergency Departments (EDs) has resulted in long ED waiting times attracting media commentary and political attention. There are many factors contributing to the increasing demand in EDs, among which are increasing numbers of elderly patients in an aging population. Further more, a significant proportion of elderly patients attending EDs are from nursing homes where medical support is limited. To actively address this challenge, EDs in Queensland hospitals have been implementing a Hospital In the Nursing Homes (HINH) program, which involves sending clinical staff to nursing home facilities to provide acute medical care for residents, to provide…

Principal Investigator: Dr Bill Lukin
Amount Awarded: $297,846.00
Institution:

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The Queensland Aeromedical Retrieval System: A Review of Current Status and the Impact of State-wide System Developments.

Aeromedical retrievals and transfers are an essential component of modern Emergency Medicine. These services provide high quality emergency care to the patient and facilitate transport from the roadside or smaller hospitals to larger centres able to perform potentially life saving treatments and provide definitive care. Thus they help ensure equity of access to high quality medical care regardless of physical isolation. This is especially important in Queensland, the most decentralised Australian state. Until recently aeromedical clinical coordination and retrieval services in Queensland were provided by a several different organizations. In 2005 a system restructure was commenced and a state-wide centralised…

Principal Investigator: A/Prof Peter Aitken
Amount Awarded: $75,370
Institution:

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> Program Grant

Program of research incorporating six studies to improve the assessment and diagnosis of chest pain.

Chest pain is one of the most common Emergency Department (ED) presentations, but establishing a diagnosis of heart-related conditions is challenging and resource-intensive. Difficulties occur for a number of reasons. First, there are no tests available to rapidly identify all individuals who have heart conditions. Second, the symptoms of heart disease are varied and are common across a number of different illnesses. Thus, physicians who are treating patients with potential heart disease have to use a number of signs, symptoms, and tests to determine the likelihood that someone has heart disease. This process can take between 12 and 24 hours.…

Principal Investigator: Prof Louise Cullen
Amount Awarded: $622,939
Institution:

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> Capacity Building Grant

Cairns Base Hospital capacity building grant

Cairns Base Hospital Emergency Department is committed to attracting the best emergency physicians and trainees. Our research commitment over the years, particularly the ability to provide 4.10.70 direction and opportunities, has been recognised by our peers as significant, particularly in an environment of heavy clinical \workloads and limited funding opportunities. In the past two years the CBH executive has worked to balance this by increasing staff numbers and allowing more academic opportunities for Emergency Physician and trainees alike. This Capacity building grant allows the Hospital to appoint, for three years, Associate Professor Jamie Seymour from the James Cook University, School…

Principal Investigator: A/Prof Peter Pereira
Amount Awarded: $210,000
Institution:

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Capacity Building Grant Dr Jeremy Furyk

Principal Investigator: Dr Jeremy Furyk
Amount Awarded: $210,000
Institution:

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Capacity Building Grant Dr Gerben Keijzers

Principal Investigator: Dr Gerben Keijzers
Amount Awarded: $210,000
Institution:

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Capacity Building Grant Dr Michael Sinnott.

The Princess Alexandra Hospital (PAH) Emergency Department is a designated Level 6 Trauma Centre. In 2012, in excess of 50,000 patients presented to the PAH ED, of which more than 35 per cent were admitted. Clinical expertise within the PAH ED is wide, with specific disease emphasis in toxicology, chronic disease, multi-system disease associated with the elderly population, cardiovascular disease, sepsis and septic shock, infectious diseases and critical care. The PAH ED is a tertiary referral hospital for trainees of the Australasian College for Emergency Medicine and excels in service delivery and education; areas in which it has a national…

Principal Investigator: Dr Michael Sinnott
Amount Awarded: $210,000
Institution:

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Rural and remote

> Trainee Grant Scheme

> Staff Specialist

> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Queensland

> Trainee Grant Scheme

Blind Prescribing and the prescribing preparedness of doctors in Emergency Departments.

“Blind Prescribing” describes the situation where a medical practitioner prescribes a medication they know little about. Theoretically, ‘blind prescribing’ could lead to higher rates of medication error and unsafe medical practice. The project aims to determine if Blind Prescribing occurs in emergency medicine, to identify the prevalence of the practice, and propose situational and contextual factors pertinent to Emergency medicine that are thought to enable this practice.

Principal Investigator: Dr Michael Sinnott
Amount Awarded: $15,200
Institution:

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Placement of antiseptic solution and hand lotion as a factor influencing hand hygiene compliance in the emergency department.

Effective hand washing and hand hygiene are universally recognized as the simplest ways to prevent the spread of infection. As well as limiting the spread of disease, hand washing is one of the few effective ways to reduce the development of antibiotic resistant infections. Despite this, many studies have shown that hand hygiene and compliance best-practice standards is universally poor amongst doctors and nurses working in hospitals. Previous studies have identified many factors reported to affect hand washing compliance. The time to undertake hand hygiene, the individual’s knowledge of hand hygiene techniques, their attitudes towards its importance, workloads, and the…

Principal Investigator: Dr Michael Sinnott
Amount Awarded: $16,800
Institution:

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Will a mandatory clinical debriefing program affect levels of psychological distress in Emergency Registrars.

Emergency doctors have been shown to exhibit higher levels of psychological distress and burnout than both their medical colleagues and the general population. This study will measure levels of burnout and psychological distress amongst Emergency Registrars before and after the implementation of a clinical debriefing program. It will be ascertained whether there is a difference in the before and after scores and whether the change is statistically significant.

Principal Investigator: Dr David Ward
Amount Awarded: $9,050
Institution:

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Pilot project to assess measures of psychological impact of providing CPR on a related victim of cardiac arrest.

Cardiopulmonary resuscitation (CPR) provision by bystanders has a well recognized link to improved outcome in cardiac arrest sufferers. However, a victim of cardiac arrest is more likely to receive CPR from a non-related bystander than from a related witness. It is thought that there are psychological barriers to the provision of CPR by related persons. The overall aim of the proposed study is to examine the effects of CPR provision on persons who are related bystanders of a victim of cardiac arrest. To do this a large study is planned which will measure the psychological impact of having a relative…

Principal Investigator: Dr Iain McNeil
Amount Awarded: $14,650
Institution:

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> Staff Specialist

Development of a human cardiac myocyte assay for the production of lethal dose response curves for box jellyfish venoms: Can heat and intralipids be used as a treatment for cubozoan envenomings.

The problem of box jellyfish stings is an issue of medical and commercial importance to tropical Australia, notably in Queensland, Northern Territory and Western Australian coastal communities, threatening the perception of Australia as a safe destination. For example, approximately 160 people from Queensland resorts, including many international visitors, were hospitalized following envenoming during the summer of 2001-02 closing much of the frequented north Queensland coastline. Fatalities from Irukandji and Chironex box jellyfish stings and the loss of tourism to affected areas present both a medical and economic challenge. Although cubozoan envenoming in Australia may be seen as a minor "medical"…

Principal Investigator: Dr Peter Pereira
Amount Awarded: $41,672.83
Institution:

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A randomised, un-blinded trial of continuous infusion versus bolus dosing of flucloxacilin in the management of uncomplicated cellulitis in an Emergency Department Short Stay Ward.

Skin infections are common in the Emergency Department. Currently, such infections are treated by admitting the patient to hospital for 24 hours and giving them four injections of an antibiotic called flucloxacillin. However, an alternative way to administer antibiotics is to attach a device to the patient’s arm which infuses the flucloxacillin over a 24 hour period. We anticipate that this device will reduce the time that nurses spend giving injections and also reduce the cost to the hospital associated with giving patients multiple injections. The overall aim of this study is to trial the antibiotic device to determine whether…

Principal Investigator: Dr Peter Logan
Amount Awarded: $41,647
Institution:

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Ketamine alone versus propofol added to ketamine versus ketamine mixed in propofol for pediatric procedural sedation in emergency departments.

Children present to emergency departments (EDs) with injuries that require painful procedures such as straightening broken bones and suturing cuts. Medicines used for these procedures include midazolam (a sleeping medicine), nitrous oxide (laughing gas), and morphine (pain killer) as well as many others. Ketamine is one medicine that combines pain relief and sedation. Ketamine is very safe and has been used in millions of procedures around the world. Children when they wake up after ketamine may be agitated or feel like vomiting. Ketamine can raise blood pressure and some situations it should not be used. Ketamine is Australia’s preferred sedative…

Principal Investigator: Dr David Herd
Amount Awarded: $49,543
Institution:

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Pharmacokinetic Pharmacodynamics Understanding for Fentanyl Intra-Nasal for children in pain or during painful procedures: pilot study.

Fentanyl is a powerful morphine-like pain reliever. It may be given to children using a puffer (mucosal atomiser) device into the nose. This needle-free method of strong pain relief is gaining popularity in emergency departments. Intranasal fentanyl could also be used for painful procedures that currently receive very little pain relief. Examples include a meningitis test (lumbar puncture), urinary catheter for urine infections (urinary catheter), or placing a tube from nose to the stomach (nasogastric). Randomized controlled trials are required to confirm and quantify the benefit. These trials will also facilitate cost effectiveness analyses and add to safety data. Published…

Principal Investigator: Dr David Herd
Amount Awarded: $44,241
Institution:

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End of Life Issues – Withdrawal of treatment/Decision to not treat in the Emergency Department: A prospective multi-centre study.

Not infrequently, doctors working in the Emergency Department (ED) have to decide on how they are to provide treatment to dying patients. Specifically, they have to decide whether to actively treat or whether they should limit or withdraw treatment on patients who are not anticipated to live. Such decisions should be governed by legislature as well as standards set by the Australian Council on Health Care Standards (ACHCS). However, research conducted in our hospital has indicated that doctors consider a wide variety of factors including patient’s and family’s wishes when making such end-of-life decisions. We therefore raise the following questions.…

Principal Investigator: Dr Philip Richardson
Amount Awarded: $50,000
Institution:

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A diagnostic accuracy study for predicting who should have an Advance Health Directive (AHD).

Advanced health directives are legal documents that outline patients’ desires for end-of- life care. For individual’s nearing the end of their lives, advanced health directives are an important part of their treatment plan. This is because they tell health care providers about the patient’s wishes regarding treatment near the time of death. However, very few patients hold these documents. This study looks to see whether we can easily identify individuals who are nearing the end of their lives, and therefore, should have an advanced health directive. The research is an initial step in increasing the number of individuals who hold…

Principal Investigator: Dr Philip Richardson
Amount Awarded: $47,003
Institution:

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CT coronary angiography assessment of emergency patients presenting with undifferentiated chest pain and intermediate risk of coronary artery disease.

Patients presenting to the emergency department (ED) with chest pain who are assessed as having an intermediate risk of coronary artery disease (CAD) pose a diagnostic and management problem. An unstructured approach to patient management may lead to either inappropriate discharge and a missed myocardial infarction (in 1%–5% patients) or unnecessary, prolonged admissions. This has resulted in the development of a Chest Pain Assessment Service (CPAS) at The Prince Charles Hospital (TPCH). Patients admitted to CPAS undergo an exercise stress test (EST) in order to further risk stratify them into either high or low risk groups. With their result from…

Principal Investigator: Dr Allison Fifoot
Amount Awarded: $50,000
Institution:

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Prospective cohort study of cardiac risk profile of Emergency Department patients with chest pain: a comparative analysis of risk stratification tools.

Cardiac Risk profile in Emergency Departments in Australian Tertiary referral hospital (CREDIT study). Chest pain remains one of the most common complaints in patients presenting to Australian emergency departments. The personal and financial costs associated with these patients cause a significant burden to the Australian health system. Use of specifically designed methods to predict risk in patients presenting to the emergency department with chest pain have been shown to improve clinical decision making, reduce cost, prevent unnecessary admissions to coronary care beds and allows patients to be better informed of their outlook.

Principal Investigator: Dr Ellen Burkett
Amount Awarded: $50,000
Institution:

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> Rural and Remote Research Program

> Research Scholarship Grant

Research Scholarship Grant Dr Jeremy Furyk

The importance of good quality clinical trials in health care is being increasingly recognized worldwide. The London School of Hygiene & Tropical Medicine (LSHTM) is the leading postgraduate medical institution in Europe in the subjects of public health and tropical medicine. The Master of Science in Clinical Trials, conducted online, aims to provide those with some experience in the area of clinical trials to broaden their role in design, management, analysis and reporting of clinical trials. The first year of the course covers the core topics of; fundamentals of clinical trials, basic statistics for clinical trials, clinical trials in practice…

Principal Investigator: Dr Jeremy Furyk
Amount Awarded: $225,000
Institution:

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> Project Grant

Optimisation of cardiac output in emergency patients through non invasive cardiac output monitoring in the acute resuscitation phase. What does it add?

Giving intravenous fluids is one of the most common treatments used for critically ill patients in the Emergency Department; however it is difficult to know exactly how much fluid to give; too much or too little can worsen survival. Doppler ultrasound is a test that can tell us how well the heart is working, and how it is responding to treatment. Ultrasound has been used in intensive care and in the operating theatre but there is not enough research available to know whether it is practical and useful in the emergency room and whether or not using it can improve…

Principal Investigator: Dr Neil Grant
Amount Awarded: $300,000
Institution:

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C.R.A.S.H. study: A randomised study of tissue oxygenation in an ovine model of haemorrhagic shock comparing the effect of colloid, fresh red cells, aged red cells and saline.

Blood loss is a major cause of early deaths after trauma, accounting for 51% of the deaths occurring during the initial 48 hours after hospital admission. Decisions made in the early treatment of severe blood loss have important consequences for patient survival and length of time in the Intensive Care Unit. Red blood cell (RBC) transfusion is a key component of the management in acute haemorrhagic shock, based on the assumption that transfused RBCs improve delivery of oxygen to the tissues. However existing evidence suggests this may not be the case. Recent studies (NEJM358(12):1229-39) suggest however that transfusion of older…

Principal Investigator: Dr Andrew Staib
Amount Awarded: $106,375
Institution:

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The impact of a new emergency department on patient presentations and ambulance service delivery in health service districts in Australia.

This study involves tracking the ambulance, emergency department (ED) and hospital process for the Robina, Southport, and Logan hospitals. Project Aims: 1. Validate ambulance ramping time; 2. Compare patient outcomes for 'ramped' vs 'non-ramped' patients who arrive to ED via ambulance; 3. Pilot merging of three health information systems (ambulance, ED, and hospital) at one site (Southport hospital); 4.Describe the characteristics of patients presenting to Southport, and Logan EDs in 12 months before Robina ED opening; 5.Describe the characteristics of patients presenting to Southport, Logan and Robina EDs in 12 months after Robina ED opening; 6.Compare ED presentations at Southport…

Principal Investigator: Dr James Lind
Amount Awarded: $60,000.00
Institution:

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Accelerated pathway in the assessment of suspected acute coronary syndrome in the Emergency Department: a diagnostic accuracy study.

Chest pain is one of the most common conditions treated in the Emergency Department (ED), but making a diagnosis remains challenging and resource-intensive. Not all causes of chest pain are due to heart disease. Currently, doctors do a blood test to look for the presence of a cardiac chemical called Troponin I to assist them in making a diagnosis of heart disease. This chemical is released from heart muscles when they are damaged and is, therefore, a good indicator of heart attack. However, because Troponin I is released slowly, doctors have to wait for up to six hours to determine…

Principal Investigator: Prof Louise Cullen
Amount Awarded: $200,000.00
Institution:

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A study of small blood vessel circulation in critically unwell patients.

Microcirculation refers to very small blood vessels that control oxygen and nutrient delivery and removal of waste products from our tissues and organs. Previous research has shown that a decrease in either the number of vessels, or blood flow through these vessels, can be seen in patients who are very sick as a result of infections, blood loss or heart failure. Changes in microcirculation are associated with how sick a patient is and whether or not they recover from illness. However, only small numbers have been included in other studies. Therefore, we wish to investigate if; a) these changes are…

Principal Investigator: Dr Bill Lukin
Amount Awarded: $85,378.00
Institution:

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Tamsulosin for the treatment of Distal Ureteric Calculi: A Double Blinded, Placebo-Controlled, Randomized, Multi-Centre trial

Ureteric colic (or Kidney stones) is a significant public health concern within Australia, affecting as many as 5-15% of adults. As a result, a significant number of Australians experience significant pain, hospital and outpatient visits, and the potential for more significant complications such as infection, kidney damage and the need for surgical treatments. Although several methods of medical treatments to improve care of such patients have been studied overseas, some of which appear promising, the practice of “medical expulsive therapy” for ureteric colic is not widely practiced in Australia. One such medication is Tamsulosin, which seems to have an effect…

Principal Investigator: Dr Jeremy Furyk
Amount Awarded: $278,782.93
Institution:

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Medication and Fluid orders in the Emergency Department: Examining the incidence of error and adverse events.

Errors in prescribing and administering medications and fluids occur often in the hospital setting. However, limited information is known about the number or type of medication errors that occur in the Emergency Department. Moreover, little is known about the factors that cause errors in the Emergency Department. The study will involve looking at the charts of all patients who presented to the Royal Brisbane and Women’s Hospital Emergency Department over a one month period. A nurse and a pharmacist will go through the charts to identify any errors and will categorize them according to the type of error they represent.…

Principal Investigator: Dr Philip Richardson
Amount Awarded: $88,064.74
Institution:

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> Program Grant

Comparison of the Implementation of Interventions for Controlling Laboratory Blood Tests Ordering in Four Queensland Teaching Hospital Emergency Departments.

Doctors frequently need to order blood tests in the Emergency Department when patients come to hospital with a medical or surgical emergency. In all but the most trivial cases, laboratory blood tests are requested as part of the diagnostic workup. Doctors and even the patient are often concerned about missing a diagnosis if enough blood tests are not done. However, medical research worldwide has revealed that test ordering is excessive and often unnecessary. The growth in test ordering places an enormous financial strain on our health care system, and includes unnecessary investigations or treatment. Thus, reducing the number of unnecessary…

Principal Investigator: A/Prof Kevin Chu
Amount Awarded: $130,723
Institution:

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Examining Sepsis in the Emergency Department: A prospective program of research designed to characterize and facilitate improved outcome for admitted patients with community-acquired infection.

Infections, particularly serious infections, cost the Australian healthcare system millions of dollars every year and impose a significant burden of illness on the Australian community. Serious infections also have the capacity to cause tragedy at a much more personal level, with lethal outcomes possible even in young healthy individuals. Despite the significant consequences of these illnesses, we have very limited information about the best way to identify and treat infection in Emergency Departments. Therefore, research that provides more information is vital. For this reason, we are conducting a ground breaking body of research to improve our understanding of infection in…

Principal Investigator: Dr Julian Williams
Amount Awarded: $90,056.17
Institution:

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The “Skills Training Options for Resuscitation in Kids” (STORK) Program.

A cardiac arrest in a child has a devastating effect on the child, their family and their healthcare workers. Fortunately, paediatric cardiac arrest is uncommon but if not treated promptly and adequately it results in death or severe brain damage. Providing quality cardiopulmonary resuscitation (CPR) is one of the most important factors in improving outcome after cardiac arrest in children. High quality CPR improves the amount of blood flowing to the brain and heart during cardiac arrest. There is a direct link between increased blood flow and increased survival after cardiac arrest. Unfortunately, current methods for assessing the quality of…

Principal Investigator: Dr Jason Acworth
Amount Awarded: $220,320
Institution:

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> Capacity Building Grant

Rural and remote

> Trainee Grant Scheme

> Staff Specialist

> Rural and Remote Research Program

> Research Scholarship Grant

> Project Grant

> Program Grant

> Capacity Building Grant

Queensland

> Trainee Grant Scheme

Cost effectiveness and Clinical outcomes of B-type Natriuretic Peptide (BNP) Point of Care Testing versus BNP Laboratory testing for Adults with Dyspnoea in the Department of Emergency Medicine at Nambour General Hospital.

Patient flow and access block will be evaluated through comparing time to decision making in the Emergency Department (ED) and Emergency Department length of stay (ED LOS) between patients who have POC and Laboratory BNP testing. Cost effectiveness will be evaluated by reviewing treatment type given, admission rate, ICU admission rate, inpatient length of stay (IP LOS), Emergency Department Length of Stay and 30day readmission rate. Clinical significance will be explored through reviewing probable diagnosis and severity of Congestive Heart Failure (CHF) in relation to BNP levels. Probability of diagnosis of CHF is to be recorded by the treating doctor…

Principal Investigator: Dr David Ward
Amount Awarded: $13,050
Institution:

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The effect of consecutive night shifts on the psychomotor performance of registrars working in the emergency department.

All registrars working night shifts in the Nambour Emergency Department will be informed about the study and invited to participate on a voluntary basis. The registrars will be asked to complete a brief questionnaire to gather basic demographic information. Each registrar will be asked to fill out a sleep diary for the 24 hours prior to each shift tested. They will be asked to note the periods during the last 24 hours that they slept, the quality of sleep, when they ate, when they consumed caffeine, how fatigued they feel and how well they think they will perform on the…

Principal Investigator: James Tilleard
Amount Awarded: $16,850
Institution:

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> Staff Specialist

ABC (Arm-banding, Barcoding, Compliance) of Patient Safety – Arm-banding the Emergency Patient – Does technology reduce patient misidentification of pathology specimens.

Accurate identification of patients is critical to their safety and to the efficient management of health services. Without accurate identification incorrect procedures may be performed, patients may have unnecessary tests performed on them or there may be delays in their care as pathology or other tests must be repeated. We plan to study the process of patient identification during blood collection in the Emergency Department. This is the most common procedure performed in the Emergency Department. Mislabeling of pathology specimens can lead to fatal adverse events, such as incompatible blood transfusions. Results attributed to the wrong patient can lead to…

Principal Investigator: Dr David Spain
Amount Awarded: $42,400
Institution:

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Procedural sedation in the Emergency Department; A comprehensive analysis of a prospective registry of consecutive procedural sedations and telephone follow-up.

Patients frequently present to the Emergency Department (ED) requiring brief by painful procedures as part of their medical treatment. Completion of these procedures in a safe and timely manner should be a core competency of an Emergency Physician. Insufficient data currently exists to guide the Emergency Physicians in the conduct of these procedures. A specific and highly comprehensive registry of patient related parameters, patient and physician satisfaction with the sedative episode is required.

Principal Investigator: Dr Greg Treston
Amount Awarded: $50,000
Institution:

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Regulatory systems for occupational exposures in emergency care: Contemporary challenges for the emergency physician in prevention, control and management.

Healthcare workers in emergency departments are at high risk of exposure to blood-borne infections from occupational exposure. The financial and human costs of these injuries are significant. The risks such health care workers face are made more difficult in recent times because of three interconnected reasons. First, emergency care workers are at high risk of occupational exposures because of the nature of their work and the environment they operate in. They work in highly volatile and high-stakes situations. Second, emergency departments face unprecedented demands for emergency medical care. With increased numbers of patients, waiting times for medical treatment inevitably increase,…

Principal Investigator: Dr Michael Sinnott
Amount Awarded: $50,000
Institution:

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The effects of implementation of a tertiary survey tool for multi-trauma patients.

Missed injuries in trauma patients are a well recognized phenomenon. Currently at Gold Coast Hospital there is no formalized process for review of multi-trauma patients who are admitted to the general ward. Anecdotal evidence from the emergency department’s monthly trauma review meeting suggests that there are multiple factors that contribute to missed injuries. Commonly patients with an altered level of consciousness, those that are intoxicated or those that are unstable and require immediate operation, have injuries that may not be recognized in the ED. Also at risk are patients transferred from other facilities that have been assessed and managed elsewhere.…

Principal Investigator: Dr Gerben Keijzers
Amount Awarded: $46,552
Institution:

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A randomized controlled trial comparing patient controlled versus physician controlled sedation in the Emergency Department.

Emergency Department patients are often sedated before undergoing painful procedures such as manipulation of fractures and dislocations. Propofol is a sedative drug commonly used for this purpose. Presently, the drug is always given by the doctor. However, there is evidence to suggest that the drug can be safely administered by the patient to him or herself. The patient does this by pressing a button on a pump which delivers the drug on demand in a controlled manner. This is called patient controlled sedation. There are potential benefits when the patient gives the sedative drug to him or herself including getting…

Principal Investigator: A/Prof Anthony Bell
Amount Awarded: $25,247
Institution:

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Comparison of the quality and completeness of the medical record and the proportion of appropriate referrals for suspected abusive injury of young children.

This study examines the data gathered and documented in patient charts with respect to the possibility of abusive injury in presentations by injured children under 3 years of age, as well as conclusions made by the treating doctor with respect to the possibility of abusive injury, and whether or not a consultation with an emergency or child protection specialist was made in reference to this issue. These data are compared: 1/ Between two sample periods at the Mater Children’s Hospital before and after the introduction of an electronically generated proforma to prompt such data collection 2/ Between these samples and…

Principal Investigator: Dr Ronald Clark
Amount Awarded: $24,898
Institution:

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> Rural and Remote Research Program

> Research Scholarship Grant

Research Scholarship Grant Dr Joseph Ting

Principal Investigator: Dr Jospeh Ting
Amount Awarded: $150,000
Institution:

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Noel Stevenson Research Scholarship – A/Prof Peter Aitken

Disasters have caused the loss of more than 12 million lives and affected more than 50 million people in the past 50 years alone. Disasters involve not just more patients, but a different type of patient in a system under extreme stress. Emergency Departments (ED), as the ‘front door’ to the health system are a key part of the disaster response and a well prepared ED is essential to save lives. Being prepared involves education and training however disaster health education is not well developed in Australia. The research program aim is the development of a disaster education framework for…

Principal Investigator: A/Prof Peter Aitken
Amount Awarded: $150,000
Institution:

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> Project Grant

The sepsis registry: A prospective database to characterise and facilitate improved outcome for admitted patients with community-acquired infection.

Infections, particularly serious infections, cost the Australian healthcare system millions of dollars every year and impose a significant burden of illness on the Australian community. Serious infections also have the capacity to cause tragedy at a much more personal level, with lethal outcomes possible even in young previously healthy individuals. Despite the significant consequences of these illnesses, we have very limited information about the best way to identify and treat infection in Australian Emergency Departments. Therefore, research that provides more information on infection is vital. This study aims to improve our understanding of infection in Australian Emergency Departments. We will…

Principal Investigator: Dr Julian Williams
Amount Awarded: $200,000
Institution:

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Impact of the Emergency Department Patient Admissions Predictive Tool (EDPAPT)

Hospital occupancy rates regularly approach 100%, with resultant access block, ambulance bypass, and the last-minute cancellation of elective surgery patients. More efficient management of inpatient beds to reduce these predicaments is imperative. This project will evaluate the impact of a patient admission forecasting system - the Emergency Department Patient Admissions Predictive Tool (EDPAPT) - that has been developed from analysis of historical admissions data at the Gold Coast Hospital. The aim of the project will determine whether a model that forecasts patient admissions can assist with the allocation of inpatient beds to alleviate one of the major problems of most…

Principal Investigator: Dr David Green
Amount Awarded: $100,000.00
Institution:

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> Program Grant

> Capacity Building Grant

CONTACT US +61 7 3720 5700 info@emfoundation.org.au 2/15 Lang Parade Milton Qld 4064