Deadly Steps in the Emergency Department with Aboriginal and Torres Strait Islander Consumers: an evaluation of a co-design cultural safety improvement and awareness tool

Aboriginal and Torres Strait Islander (A&TSI) people presenting emergency departments are more likely to experience difficulty in communicating with healthcare providers, feel isolated, and experience shame and distress. These feelings lead to them leaving before they have been seen, or leaving before their treatment is completed, and they experience poorer health outcomes. Cultural safety is the ability of an organisation to meet the cultural needs of a group of people, and improved emergency department cultural safety has been shown to reduce rate of Aboriginal and Torres Strait Islander people leaving without being treated or before their treatment is completed. The 15 Steps Challenge Toolkit was developed in the NHS and is effective in assisting healthcare providers to see a clinical space “through the eyes of consumers”. This project aims to adapt the NHS 15 Steps Challenge toolkit to make it relevant to the experience of Aboriginal and Torres Strait Islander peoples using co-design methodology based on the “Yerin Dilly” model, which outlines values and processes to make research culturally safe. The project will be conducted in three phases to develop, trial and evaluate the Deadly Steps process. It will use both qualitative and quantitative methodologies to evaluate the process. The impacts of this project will be an improved process for evaluating and identifying opportunities to improve cultural safety, new cultural safety educational materials for healthcare providers, and improved experiences for Aboriginal and Torres Strait Islander people attending emergency departments in the Redcliffe, Caboolture, Sunshine Coast University, and Nambour hospitals.

Reducing Emergency Department demand through expanded primary healthcare practice.

Patient demand on Emergency Departments (EDs) is rising by over 3% per annum contributing to congestion. ED congestion is known to be associated with poor health outcomes and reduced efficiency; the latter is characterised by increased waiting time, length of stay and ambulance diversion. Even though the National Emergency Access Target (the four-hour rule) has reduced the level of access block, initiatives to reduce ED demands have not had significant effect to date.
Previous research undertaken by the emergency health research group at QUT has described in detail the increases in demand and has identified some contributing factors. Our research highlighted reduced access to primary healthcare is one important factor associated with increased ED demand.

The aim of this project is built on our earlier work investigating factors that influence the choice made by patients between ED and primary healthcare for acute illness, and to thus identify viable primary healthcare alternatives for diverting ED patients so as to reduce ED demand. This project will provide the necessary evidence base to subsequently develop a NHMRC grant application to trial a national model of expanded primary healthcare practice to reduce ED demand. Importantly, this project will facilitate better integration and knowledge exchange between existing primary and secondary health sectors in Queensland through the stakeholder involvement.

High Flow Nasal Cannula treatment for viral Bronchiolitis, a randomised controlled trial

Acute respiratory disease is the leading cause for infants and children needing hospital admission. The main focus of hospital treatment is oxygen therapy beside disease specific treatment like inhalers for asthma or antibiotics for pneumonia. 10 to 20% of these infants or children need higher level of care at some point of their illness and will be transferred to a children’s hospital intensive care unit. This is not only expensive and imposes a huge burden on health care costs but more importantly is very stressful for these children and families because they are taken out of their familiar environment. Recent research suggests that with early optimal respiratory support the need for transfer can be significantly reduced and many of these patients could be cared in their regional hospital allowing the family to be the main support group. This concept of “keeping the patients in their regional centre” is not only from a psychosocial aspect of advantage but will have as well a great impact on health care costs. Our research group has recently investigated the role of high flow therapy in infants with bronchiolitis and we were able to demonstrate a 40% reduction in intensive care admission. Early respiratory intervention is a fundamentally new approach, which has the potential to prevent progression and deterioration of respiratory illness. The aim of this study is to investigate the role of high flow therapy in infants with bronchiolitis, but future research and trials will also include other conditions such as asthma and pneumonia.

SWAMPED: Linking best practice workforce models to Emergency Department funding

The aims of this research are to link best practice ED workforce models to available ED funding under an activity-based funding (ABF), while contributing to the development of an improved national activity and outcome-based ED funding model. This research will identify the current status of funding of EDs, identify and critically appraise models for funding of EDs and identify the workforce implications of those funding models and propose a State-wide ED clinical workforce framework.