The Queensland Ambulance Service (QAS) provides out-of-hospital medical services to approximately 900,000 patients annually, and as the publicly funded provider of prehospital emergency care is called to respond to persons incarcerated within correctional facilities. The primary complaint of patients attended by QAS in this setting are minor orthopaedic injuries to the upper arm and hand. In current practice, paramedics provide short-lasting analgesia and temporary limb splinting or bleeding control, before conveying the patient to an emergency department for further management. Transport of patients from correctional facilities to public hospitals is complex, presenting potential risks to staff and the public, and is time consuming and resource intensive. As these injuries are predominately uncomplicated fractures or simple lacerations, it has been postulated these patients may be more appropriately managed by enhancing the care that can be provided onsite by the QAS, with the patient subsequently managed through an outpatient clinic and thereby avoiding an unnecessary presentation to hospital. This project proposes developing a new collaborative treatment pathway involving the QAS, QLD Health and QCS for patients with minor orthopaedic injury. The aim is to reduce unnecessary, time and resource intensive transports to hospital emergency departments for this cohort of patients. Grant funding is sought to undertake an evaluation of this initiative. This model of care provision, if proven effective, could potentially be considered for implementation in other correctional facilities or austere healthcare settings where primary health care resources are stretched, and consequently additional demands are placed on emergency care settings.READ MORE
Soon after injury, some individuals develop a condition where their body doesn't clot properly, leading to increased blood transfusions and increased mortality. An important aspect of clotting is a protein called fibrinogen which forms the scaffolding on which clots are formed. Fibrinogen is the first aspect of clotting that is impaired, but it is easily replaced if it is recognised with a specific blood test. Unfortunately this blood test may not be available rapidly in rural hospitals, which may lead to a delay in recognition. A scoring system called the Fibrinogen on Admission for Trauma (FibAT) has been developed in France, but includes criteria/interventions which we don't routinely do in Australia. In this study we will evaluate the FibAT's accuracy in detecting low levels of fibrinogen using data from 3 Queensland trauma centres. We will only use criteria that is available in rural settings.
This study is expected to show that even a modified FibAT is quite good at ruling in low fibrinogen so that it can be replaced early when a patient arrives in a rural hospital.
Many patients who present to the Emergency Department with painful conditions have extensive delays to receive pain relief. This may result in unnecessary discomfort for patients and can also mean that patients have an extended length of stay. This study focusses on improving the pain relief given to patients who present to the Emergency Department with chest pain. The study has multiple aims. The first is to identify how long patients presenting to emergency department with chest pain wait to receive adequate pain relief. The second is to document how delays to pain relief impact on the patient and on the healthcare system (in terms of greater hospital admissions, longer length of stay and the types of cardiac testing that can be performed). The third aim is to see whether a novel education campaign highlighting the importance of providing pain relief as soon as possible after the patient presents to the Emergency Department can reduce the length of time before a patient is provided pain relief. This campaign will particularly focus on the nursing staff and will empower them to advocate for rapid pain relief. It is anticipated that this campaign will reduce the time taken to provide pain relief to patients. It is also hoped to reduce hospital length of stay and hospital admissions. This study is important for improving patient comfort and improving patient and health service outcomes.READ MORE
There is a need to focus on the vulnerable type 1 diabetes (T1D) population who represent a disproportionate burden on the Australian healthcare system and who require better standards of care. Building upon our previous work, the project is an important step in determining the supports available to patients with T1D around diabetic ketoacidosis (DKA) prevention and management, outside of traditional emergency department (ED) settings and regular business hours. This is in addition to perceptions around the use of a telephone or virtual service to help prevent diabetes ketoacidosis presentations. The analysis will provide baseline comparative data for later intervention studies, and in helping to provide the evidence-based solution, perhaps in the form of clinical pathways of acute and preventative healthcare services that can be tested in later projects. We expect the impacts of this project will include: a reduction in DKA presentations (which would potentially reduce morbidity and mortality), and lessened ED presentations, workload, and both hospital admissions and economic impact. Collectively, this would attract national and international interest in Queensland emergency healthcare research.READ MORE
Consumer engagement in research is a local, national and international priority and has been described as research being carried out ‘with’ or ‘by’ consumers, rather than ‘to’, ‘about’ or ‘for’ them. Our recent scoping review on patient and public involvement in international emergency care research (under review) found only two (of the 28) studies were undertaken in Australia and reported consumer engagement in Emergency department (ED) research, illustrating that the vision of integrated consumer and community engagement in research is a long way from the current reality.
Consumer engagement can improve the quality and relevance of research, identify unmet needs, reduce wasted research efforts, and improve ED services and patient experiences, particularly for vulnerable and high-risk patient groups. Whilst there has been an increase in consumer engagement in international research, opportunities for consumers to contribute to emergency care research in Australia are scarce and there are very few documented studies of consumer engagement in ED research.
This project aims to understand the current challenges and barriers to consumer engagement being undertaken in ED research, both in Queensland and nationally in Australia. The project will also identify readiness for consumer engagement, exploring the factors which influence, drive and support researchers to engage consumers in ED research. In addition, it will also scope the potential for a statewide / National Emergency collaborative network for Consumer Engagement and assess support among key stakeholders in emergency care in Queensland and nationally.READ MORE
Shock is an umbrella description for poor blood supply to vital organs, and can lead to multi-organ failure and death. Emergency department (ED) patients with shock are amongst the sickest, with 1/3 being admitted to an intensive care unit (ICU). Low blood pressure, a key feature of shock which causes the poor blood supply to vital organs, can be treated with medications called vasopressors. Vasopressors traditionally have been given through a so-called 'central line'. Central lines are invasive to insert and require skill, and the actual insertion can lead to complications. More evidence has emerged that so-called peripheral lines (aka 'drip') are safe for vasopressor infusion. Randomised controlled trials (RCT) to compare the two strategies will provide high quality data to inform clinicians as to which approach is best for patients, staff and the healthcare budget. We propose a feasibility RCT to test processes and inform a large phase-III RCT to definitively answer this question.READ MORE
Communities of practice (CoP) are widely used to strengthen and enhance healthcare, by generating and sharing knowledge and improving organisational performance. In Australia CoPs have been used in fields such as healthcare improvement, mental health and mental health literacy, and workplace health and wellbeing and more recently in response to COVID 19.
This project will assess the possible scope for a CoP, and the extent to which a CoP might find support among collaborating service organisations, to focus attention on issues surrounding emergency mental health presentations to hospital emergency departments (EDs) in north Queensland.READ MORE
The “Buddy Study” funded in the EMF grant round 25 showed a common type of hand fracture can be treated without a plaster – a finding that if applied broadly could result in patients returning to work faster and significant healthcare savings. However, since the study was published in 2019 it is unclear to what degree there has been a change in how clinicians actually treat this fracture.
This follow up study will explore factors related to research reach, adoption, and implementation at two hospitals in Queensland to 1) inform a strategy to implement knowledge related to hand fractures and to 2) explore how participation in research affects implementation.READ MORE
Cellulitis is an infection of the skin and underlying soft tissues and leads to redness, pain and sometimes fever. Once diagnosed, the emergency doctor needs to decide an appropriate type and dose of antibiotic and decide to give it orally (tables/capsules) or intravenously (via a drip).
Despite this being a common diagnosis in the ED, guidelines are not based on high-quality evidence making it difficult for doctors to make evidence-based choices and there is wide variation in how cellulitis is treated. This prospective cohort management study aims to describe the ED management and clinical outcomes of adult patients with cellulitis.READ MORE
Blood cultures are tests performed to identify whether patients have pathogens in their blood, such as bacteria and fungi. Emergency clinicians frequently order blood cultures to prescribe appropriate antibiotics for patients. Blood cultures are particularly important to rapidly identify and treat severe infection.
For test accuracy, the best time to collect blood cultures is before a patient has received an antibiotic. However, patients with severe infections may have multiple sets of blood cultures taken over several days. It is unknown whether taking multiple blood cultures improves patient care.
This study will investigate how many patients have repeat blood cultures and whether subsequent blood cultures yield the same result. If found to be redundant, it may be possible to avoid unnecessary blood tests, improve patient comfort, decrease costs to the health service, and reduce practitioner workloads.READ MORE