The primary aim of this study is to assess the effectiveness of an intervention designed to improve the quality of blood cultures collected in a busy emergency department.
Blood cultures are tests that are frequently ordered by emergency doctors to detect and identify bacteria present in the blood of patients who are unwell. The test requires a sample of blood to be collected from the patient. Like many tests, the quality of the results is related to the quality of the sample collection process.
Several factors may influence the quality of sample collection and increase the chance of sample contamination. These include not collecting enough blood and poor sterility of the collection process. Contamination of blood cultures may result in the patient staying longer in hospital, being prescribed unnecessary antibiotics and increasing the costs of care.
This study will implement a rigorous intervention to reduce contamination rates in blood culture samples collected at the Emergency and Trauma Centre at the Royal Brisbane and Women’s Hospital. The intervention comprises: education to staff that collect blood cultures; the introduction of blood culture collection kits; and regular feedback of quality indicators to the clinicians that collect blood cultures.
If the intervention is successful then a reduction in blood culture contamination rates and single sets of cultures should be seen. The average volume of blood cultured should increase. These outcomes should lead to a reduction in patients’ lengths of stay, costs of care, and positive effects in anti-microbial stewardship and patient flow.READ MORE
Procedural sedation in emergency departments is performed on a daily basis. The current management plan arguably inflicts unnecessary pain and distress on children. This open label, multicenter, randomised control trial is investigating whether paediatric procedural sedation can be achieved with just one needle. The research team’s focus is the on determining the best outcome for the child in procedural sedation, prioritising psychological as well as medical consequences.READ MORE
In Australia, the existing model of emergency department care is struggling to cater for the needs of the older population. A large proportion of older patients arriving at emergency departments are from residential aged care facilities (RACFs). Nursing staff in RACFs often participate in decision making pertaining to transfer of residents to the emergency department, but very little research has been done on the decision making involved in this process.
The proposed mixed methods study will engage with RACF nursing staff to understand their decision to transfer a resident, their perception of communication with the emergency department, and the services that influence the decision. The project outcomes will provide a detailed understanding of existing service provision, communication between facilities, and potential gaps in education and skills.READ MORE
Introducing a novel model of care to the emergency department may provide significant reductions in key performance indicators, such as patient length of stay, or the National Emergency Access Target (NEAT).
In previous studies, researchers have found that rostering a physician to work at triage can lead to significant improvements on a range of metrics, including time to treatment, patient length of stay and rate of patients who left before receiving treatment. However, in a regional hospital where staffing numbers and budgets are under pressure this model may not be possible.
The objective of this study is to implement a novel model of care at triage in the Hervey Bay Hospital Emergency Department. For a trial period of three months, junior doctors (PHO/registrar level) will be rostered to work at triage on alternate day shifts. A range of outcome measures will be compared with day shifts when junior doctors are not rostered at triage. This model may be relevant for other regional emergency departments.READ MORE
Many people who attend hospital emergency departments (EDs) are triaged as having non-urgent concerns, which could be managed by other health services such as the GP. The way regional health services are designed can contribute to the rate of non-urgent presentations in EDs. The impact of non-urgent patients in EDs can result in crowding, ambulance diversion and access block, which are linked to poorer patient outcomes, increased morbidity and staff burnout. While some recognition of this problem exists nationally, many policies or strategies implemented to reduce the incidence of these presentations have not been evidence-based, effective or economically evaluated. We aim to develop a draft regional strategy for reducing non-urgent presentations in emergency.
Prior research on this project was funded by La Trobe University ($20,000), the Clifford Craig Medical Research Trust ($5000) and a University of Tasmania Scholarship ($5000).READ MORE
The amount of Brown snake antivenom required to properly neutralise the venom delivered in a brown snake bite remains controversial. Using appropriate amounts reduces the risks and side effects of antivenom, while optimising its positive effects. One of the major clinical symptoms of Brown snake bite is massive bleeding. We aim to use a novel method for analysis of blood clotting (the ROTEM analyser) to study the effects of Brown snake venom on blood clotting and how different doses of antivenom affect this. This information may enable us to develop a simple point of care test to determine the optimal dose of antivenom to be given, reducing the amount of antivenom needed, the length of hospital stay, and therefore overall cost of snake bite management.READ MORE
Patients presenting to the Princess Alexandra Hospital Emergency Department with dermatological conditions present a significant demand on resources. It is estimated that in many Emergency Departments (ED) at least one in 25 patients present with a skin condition. Many dermatological presentations may be better managed in an alternative environment either because they are non-urgent or require more specialised and expert care. This project aims to better understand the presentation of skin conditions to a large adult Queensland ED. The research will describe the current diagnosis and management of this cohort to the ED, assess the resource implications and understand the rationale for the patients attending ED instead of a General Practice clinic. The data will provide the information for determining the need for increased GP support such a expansion of tele-dermatology services or for the creation of a local or district acute dermatology clinic.READ MORE
In this project, the research team is investigating the effect, on x-ray request justification, of educating referrers and radiology staff on the existence and use of the Government of Western Australia’s Diagnostic Imaging Pathways. The project aims to improve clinical information provided on medical imaging requests, to assist in the assessment of justification, and reduce the number of unjustified examinations being performed. The expected impact of this project is in the removal of unnecessary x-ray examinations which provide little or no benefit to the patient. This will also have a benefit of reduced radiation exposure to patients and improved access to x-ray services for patients with a genuine need for the examination as well as a financial saving due to reduced costs for the delivery of emergency healthcare.
Up to 77% of diagnostic medical imaging examinations are considered inappropriate or unnecessary, according to prior research. Inappropriate examinations contribute to an individual’s lifetime radiation exposure, unduly increase healthcare costs, and reduce the access to x-ray services due to longer waiting times. Many countries, including Australia, have introduced imaging referral guidelines which provide referrers with evidence-based decision tools to select appropriate examinations. Use of these guidelines has significantly reduced the rate of referral without affecting the detection rate of pathology.READ MORE
Almost 3% of consumers of healthcare services in the Darling Downs, West Moreton and Gold Coast (Including Robina) regions are estimated to have Chronic Obstructive Pulmonary Disease (COPD); which is somewhat higher than the state average of 2.4%. COPD is the second leading cause of avoidable hospital admissions. Anecdotal evidence indicates continued over-utilisation of frontline resources (e.g., Emergency Department [ED]), and potential gaps in outreach services (e.g. underutilised services).
This project will inform the implementation and evaluation of referral treatment initiatives (e.g., anxiety management, smoking cessation referral, and quality intra-professional care [IPC] programs), based on identified causal factors.READ MORE
Syncope is a transient loss of consciousness with full recovery, and is a common presenting problem to the emergency department (ED). Most patients presenting with syncope have a benign cause, but others may be at risk for serious adverse outcomes. The problem is that there is currently no validated tool for knowing which patients are at risk and which can be safely discharged. Several clinical prediction rules have been developed over the years, however the sensitivity and specificity of these rules vary. This has led to an over-admission of patients who could otherwise be safely discharged, based on clinician discretion. These patients are subjected to multiple tests, including cardiac telemetry for monitoring which not only has low yield, but also results in significant costs to the healthcare system.
The Canadian Syncope Risk Score (CSRS) is the latest decision tool developed in an attempt to predict serious outcomes in patients presenting with syncope to the ED, but it has not yet been validated. This study aims to validate the CSRS at a single site, providing the first step in guiding clinicians to make better risk assessments and disposition decisions for patients with syncope. Furthermore, an innovative economic model will assess the impact of this decision tool on the healthcare system. This project is the first, critical phase toward better informed decision-making by clinicians for patients with syncope. Ultimately, this tool will enable a change to clinical practice that will result in improved patient outcomes and enhanced, targeted healthcare delivery.
Pictured to the right: Members of the Syncope research team from left to right: Ms Helena Cooney, Dr Alan Yan, Dr Jason Chan, Dr Emma Ballard (QIMR), Dr Jonathan Hunter and Dr David Brain (AusHSI)READ MORE