Results for Staff Specialist


Can children be sedated effectively with only one needle?

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.

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Understanding why aged care residents are transferred to the ED

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.

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Junior doctors at triage improve patient flow in the ED

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.

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Developing a regional strategy for reducing non-urgent emergency department presentations

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).

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Examining the effectiveness of Brown snake antivenom

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.

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Dermatology in the Emergency Department

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.

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The impact of imaging referral guidelines on unnecessary x-ray examinations

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.

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Reducing avoidable COPD emergency presentations: An integrated cross-health service initiative

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.

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Single centre validation of the Canadian Syncope Risk Score

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)

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Medication-related emergency department presentations

In Australia, medication errors result in more than 400,000 visits to general practitioners per year, however the number of patients who present to hospital due to medication-related harm is unclear. Previous Australian and international research suggests that at least 2% of emergency department (ED) presentations are due to medication-related harm and up to one quarter of those patients require admission to hospital. Importantly, the majority of such presentations are potentially preventable, which means that interventions that target medication safety in the community and adverse events that result in ED presentations could improve patient safety and quality of life, and reduce the burden on emergency and acute health services. Before we can target strategies designed to reduce medication-related harm in the community that results in patients requiring care in the ED, we need to understand how commonly this occurs, and which patients are at higher risk of possible harm. In this study we will determine how common this problem is, the characteristics of the events and the patients in whom medication-related harm occurs, and also estimate the health service costs of medication-related ED presentations.

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research projects

Improving jellyfish sting treatment

EMF funding is improving emergency care for the elderly

Trauma: better treatment for severe bleeding

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