Exploring Cultural and Linguistic Diversity in the Emergency Department (CALD ED) study

Providing equitable and appropriate care to populations with cultural and linguistic diversity (CALD) can be a challenge for Emergency Department (ED) providers.

This qualitative study aims to explore cultural and linguistic diversity in the ED, to inform evidence-based strategies to support patients from CALD backgrounds and guide subsequent research directions.

Researchers will consider individual patients, and their affiliation to people, organisations, their community and culture to explore barriers and facilitators to care delivery from the perspective of clinicians (doctors and nurses) and patients from CALD backgrounds.

The study involves collaboration with health and community partners, and a research team largely from CALD backgrounds whose language skill set will be utilised in a novel way (i.e. with translating information forms and supporting patient interviews).

The project is co-funded by a grant from the Gold Coast Health Collaborative Research Grant Scheme. Gold Coast Health is funding the quantitative arm of the study describing ED use by patients from CALD backgrounds.

Domestic and family violence screening in the emergency department

Domestic and family violence (DFV) against women is the number one cause of hospitalisations in Australian girls and women aged 15-54 years. It is also the number one cause of death and disability in women aged 15 to 44. Although most victims of fatal DFV access health services in the 24 months prior to their deaths, many victims living with DFV go unnoticed in the community. Health care providers are well placed to identify DFV victims and refer them to appropriate services. The ED has been described as a good place to undertake identification of DFV victims in several published research papers. Yet, how to do this remains controversial, and there are no standard protocols in place in our EDs. In this project, we aim to describe the current DFV health practice culture in five Queensland EDs. Knowledge, beliefs, and attitudes, as well as what’s actually happening to detect cases of DFV, will be assessed among our front-line ED social workers, nurses, and doctors. We aim to determine how many presentations to ED are identified and referred to social worker services for DFV. Ultimately, this research will both raise awareness about the potential of the ED to detect DFV, and will help pave the way forward to a well-informed and structured ED DFV screening program for Queensland, with applicability internationally.

Patients transfers from rural hospitals – are we getting it right?

The aim of this research was to provide preliminary data on patients transferred to Toowoomba Hospital from 18 rural hospitals within the Darling Downs Hospital and Health Service. The data was collected via a retrospective audit in order to identify transfers where quality and safety may not have been optimal.

There has been no clear indication of the magnitude of the potential problems with patient transfers and no validated method for obtaining this information.

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

Missed injuries in trauma patients are a well recognised 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. The idea of a tertiary survey has been proposed as one strategy to reduce the incidence of missed injuries in trauma patients. This involves a re-evaluation within 24 hours of admission with a complete head to toe examination, review of laboratory results and radiologic studies. This is frequently documented on a tertiary survey form that is filed in the medical record.

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

Emergency Department (ED) 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 Gold Coast region and collected data since 2006 on more than 3000 children from birth with follow-up at 1, 3 and 5 years. Based on this fundamental initial work, the researchers will develop further research that aims to improve health care access and health care quality for this vulnerable population. This will better inform health care policy and education and reconfiguration of ED models of care that will enable more appropriate and efficient use of the ED to better meet the needs of the populations they serve.

This study aims to describe health care use by children aged 0-5 years living in the Logan, Gold Coast and Tweed regions. It will link the EFHL data with routinely collected data by Queensland and NSW Health (ED, inpatient and cost data) and Medicare Australia data (includes data on GP visits, medications prescribed and vaccination status). The project will focus on describing the health care use of these young children. This will include ED visits, hospital admissions, GP visits and medication use. It will aim to describe any associations between social, demographic, geographic and economic patient characteristics and common ED presentations and diagnoses (such as fever, asthma and injuries).

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. However, there have been no relevant studies that have investigated the effects of intravenous fluids on the emergency department length of stay of moderate to severely alcohol intoxicated patients.

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 the scientific literature. Preliminary data suggests that a conservative approach to management may allow faster healing and reduce the risk of recurrence from around 25 per cent to 5 per cent in the first year. Conservative management is also likely to reduce the risks of prolonged admission due to persistent leak from approximately 30 per cent to less than 10 per cent and of other complications related to interventional management. Clinicians are, however, unlikely to change a practice entrenched for decades and re-enforced by current international guidelines without robust evidence.

This study will significantly increase our understanding of Primary spontaneous pneumothorax and its optimal management. If allowing the lung to remain collapsed initially results in improved healing of the pleural defect and lower recurrence rates then this study will contribute to improve outcomes and a reduction in the morbidity associated with current treatment.

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 fracture was picked up by the treating doctor and that the patient was appropriately treated.
The procedure for checking X-Ray reports and checking that the patient was appropriately treated is laborious and time consuming. Moreover, due to resourcing problems, it is often done days after the patient’s initial presentation to the Emergency Department. A more timely and efficient process is required.