Reducing delayed admissions from ED to ICU, ICU discharge delay and after-hours discharge through a co-designed multi-component intervention: A stepped wedge feasibility cluster randomised trial (the REDEEM-ED-ICU trial)

Hospitals and in particular, emergency departments (ED) are often overcrowded and unable to meet ever-increasing demand. The leading cause of overcrowding is access, or ‘bed-block’. This is a serious issue as it impacts the ability of staff to provide quality care to their patients.

Hospital patient flow is a nationwide problem that has attracted attention from researchers and policymakers, yet solutions to improve it, have been ineffective. As ED and Intensive Care Units (ICU) treat the most critically ill patients, it is unsurprising that the patient’s journey through these departments is closely connected. ED patient flow can be impacted by ICU bed capacity, delayed admission into ICU, and delayed and after-hours discharge from ICU. Bed-block can have significant consequences for the patient - including increased waiting time, prolonged length of ICU and hospital stay, more hospital-acquired complications, higher mortality and increased financial burdens for the health system. It is estimated that delayed discharges from ICU alone costs Australia $40 million/year.

The proposed study aims to co-design and test a multi-component intervention to address patient flow, building on a foundation of our preliminary collaborative research looking at hospital priorities, current strategies and practice, and barriers and enablers to ICU discharge processes.

We expect the impacts of this work will include,
• Improved patient outcomes
• Improved patient flow through ICUs, including admission from ED to ICU
• Reduced cost to the Australian healthcare system.
• Informing future national competitive grant applications for national implementation of the multi-component intervention

International mass gathering impact on Gold Coast Hospitals’ emergency departments

Queensland is known for its ability to attract mass gathering events of international significance, such as the 2018 Commonwealth Games, 2023 FIFA Women’s World Cup and the 2032 Olympic Games. Such events have the potential to impact the normal operational capacity of our emergency health services.

The objective of this study is to describe the impact of the 2018 Commonwealth Games on the emergency departments in the Gold Coast region. This research has two key aims, which align with two discrete but related studies:

Study 1 Aim: To describe and determine whether changes in patient, health service, and economic outcomes occur before, during and after the Commonwealth Games.
Study 2 Aim: To explore healthcare staff experience of planning, preparedness and lessons learnt from the Commonwealth Games.