Examining Sepsis in the Emergency Department

Infections, particularly serious infections leading to sepsis, 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.

We are conducting a ground breaking body of research to improve our understanding of infection in Australian Emergency Departments. We will conduct a group of studies focusing on early identification and treatment of infection. Specifically, four studies will be conducted across two hospitals. The first will identify the types of historical and clinical information available to doctors during the early stages of assessment that predicts whether an individual is likely to become very ill with infection. Identifying these patients at risk of progression to severe illness can be difficult, and is important because certain potentially life-saving treatments are most effective when given early. The second study will identify the types of bacteria that cause infection in our community. The third study will examine the potential beneficial effect of a commonly prescribed class of cholesterol-lowering drugs (“statins”) on patients admitted with infection. Finally, in the fourth study we will develop an antibiotic order set that covers the major bacteria causing severe infections. This will enable earlier effective treatment of seriously ill patients. These studies are the first of their kind conducted in Australia and will ultimately enable doctors to identify and treat severe infection earlier.

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 CPR performed are limited to measurements of how well students adhere to the CPR guidelines. There is a recognised need for a means of measuring blood flow to the vital organs (brain and heart) during CPR to better directly assess the quality of the treatment being delivered.

In this research program, we plan to utilize the technology available in the new breed of high-fidelity human simulators to develop a model that accurately measures the blood flow to vital organs during CPR performed on a simulated infant. This model will allow us to more accurately compare the usefulness of various CPR teaching methods and help to determine the best methods for teaching life-saving CPR skills to health professionals and members of the general public.

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

In order to understand the effectiveness of health service delivery, and the impact of changes in processes and procedures, it is important to first be capable of analysing the data that documents patients’ journeys through the hospital. This project will bring together key data from multiple disjointed information systems so that analysis can be undertaken on the flow of patients through the Gold Coast Hospital (GCH); from the ambulance, through the Emergency Department, and admission to a ward, including the operating rooms, radiology, pathology, and pharmacy that they encounter up to their departure. With this holistic view of patients’ journey of care, the baseline and measure impact of initiatives will be determined to ensure that patients flow through the environments with minimal delay and improved outcomes.

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 Irukandji Syndrome?

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 collapsed veins post cardiac arrest are extremely difficult to find and access. If the cannula is successfully inserted, the lack of blood flow within them prevents rapid delivery of adrenaline back to the heart.

This research team is developing a device with the potential for safe, rapid adrenaline delivery directly to the lungs with each breath without the need for venous cannulation. This rapid delivery of adrenaline to the lungs, and subsequent absorption to the blood and then the heart, may change the outcome from a brain injury rendering a previously fit person unable to walk, to 100% recovery.

Diagnostic Workup for Suspected Subarachnoid Haemorrhage.

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

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

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

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.

The researchers have conducted a significant program of research and developed a more rapid approach to diagnosing chest pain. This approach allows physicians to identify the risk of heart disease as early as 2 hours after arrival in the ED using clinical information, and blood tests. The purpose of this study is to demonstrate that the assessment process for patients presenting acutely to hospital EDs with possible cardiac chest pain is safe and accurate. This study will recruit 1000 patients presenting to the Royal Brisbane and Women’s Hospital with greater than 5 minutes chest pain who are assigned as intermediate risk of acute coronary syndromes (ACS) on initial clinical assessment. These individuals will be treated according to the newly developed protocol and followed-up for 45 days to determine the accuracy of the test in predicting patient outcomes.