Peripheral intravenous catheters (PIVCs) are small plastic tubes placed in a patient’s vein for the delivery of intravenous fluid and medications. In the emergency department, many patients present with difficult intravenous access and require multiple insertion attempts to successfully place a PIVC. This can be time consuming for clinical staff, costly for hospitals, and painful for patients. Correct device selection is a key strategy to ensure first-time insertion success.
This study will recruit 406 adult participants at two emergency departments in order to test if novel PIVCs with a retractable guidewire (AccuCath Ace™ Intravascular Cannula, BD), compared to standard care, are effective at increasing first-time insertion success for patients with difficult vascular access.READ MORE
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.READ MORE
Cellulitis is an infection of the skin and underlying soft tissues and leads to redness, pain and sometimes fever. Once diagnosed, the emergency doctor needs to decide an appropriate type and dose of antibiotic and decide to give it orally (tables/capsules) or intravenously (via a drip).
Despite this being a common diagnosis in the ED, guidelines are not based on high-quality evidence making it difficult for doctors to make evidence-based choices and there is wide variation in how cellulitis is treated. This prospective cohort management study aims to describe the ED management and clinical outcomes of adult patients with cellulitis.READ MORE
In 2018, there were 3046 deaths by suicide in Australia. Suicide was the leading cause of death among people age 15-44 in 2016-2018. In Queensland, rates remain highest in young men, particularly in rural areas.
The emergency department (ED) can be the only option for people in a mental health crisis. Presentations with self-harm and attempted suicide are recognised high-risk events for subsequent suicide.
This data-linkage study is the first of its kind in Queensland, examining ED presentations with self-harm between 2012 and 2017, utilising data from a collaboration examining broader mental health presentations. This ED data will be ‘linked’ to inpatient admissions and death records, allowing insight into the patient journey over several years.
Aligning with national and international calls to make suicide and self-harm a priority for research and policy innovation, the study will examine the demographics, co-morbidities and characteristics of these patients, and factors predictive of hospital admission to improve care and recognition around those presenting to ED with self-harm.READ MORE
In the acute phase of police detention, health concerns can emerge for detainees, especially around drug dependence, mental health conditions, and physical injury. In addition are system complexities including crowding.
In the event of an infectious disease outbreak (such as COVID-19), crowded conditions amongst a population with greater underlying burden of disease than the general population creates significant public health and economic concern. Furthermore, access to resources and expertise to manage health concerns in this environment can be challenging, especially in rural areas.
Researchers will interview key stakeholders involved with the care delivery and decision making of detainees, to identify innovative strategies to delivering healthcare in watch-house settings. This research will consider the decision making processes and costs associated with the delivery of healthcare in police watch-houses that may reduce the need for transfer to hospital emergency departments or reduce the potential for deaths in custody.
This research addresses the World Health Organisation’s (WHO) recommendation to understand how evidence-based health services can be provided for those requiring treatment, care and illness prevention whilst in police custody. It also identifies ways in which the need for expensive hospital stays can be minimised.
The expected impact of this research is the capability to identify and inform joined-up approaches so that cost-effective, safe, quality emergency care can be provided to detainees in police watch-house settings.READ MORE
Health workers are at increased risk of exposure and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The implications of healthcare worker infection are wide-reaching and impact not only the worker, but also have implications for nosocomial spread in the pre-symptomatic phase and depletion of the skilled workforce required to manage an increased volume of presentations.
Front-line health care workers represent a unique cohort to follow for trends in SARS-CoV-2 infection, immune response and antibody production as well as monitoring for re-infection. Understanding the implications of staff infection on the potential for long-lasting immunity is of key significance to staff and leaders of EDs. Equally, understanding of asymptomatic staff infection can inform policy regarding routine screening of staff to minimise the risk of nosocomial spread to other staff and patients.READ MORE
Reports worldwide indicate there has been a change in the cohort of patients seen within hospital emergency departments (EDs) during COVID-19, with fewer presentations for non-COVID symptoms, such as chest pain.
This study will evaluate the impact of COVID-19 on Queensland EDs by reviewing the number and nature of patient presentations, and generate a comprehensive statewide evidence-base to understand and manage patients who require emergency care during a global pandemic. It is expected that results will inform future management strategies and guiding documents generated in the event of a ‘second wave’, or other large scale disaster.READ MORE
Paediatric peripheral intravenous cannula (PIVC) insertion is a frequently performed procedure in the emergency department (ED), which can result in significant distress for both the child and caregiver, particularly when there are multiple attempts. Children with difficult intravenous access (DIVA) are generally poorly recognised but several studies have developed prediction tools. Furthermore, the use of ultrasound (US) has been demonstrated to improve the success rate of paediatric DIVA patients when used as an adjunct.
This research will shine a spotlight on current practice in the largest mixed ED in Queensland, which aims to determine factors contributing to paediatric DIVA patients and attitudes towards the use of US to assist first pass success. Furthermore, this background data will lay the foundation to inform an interventional trial using US to improve PIVC practices for children in the ED. Novice researchers in this project will be well supported by a research team with a strong track record of completing projects that can impact patient careREAD MORE
This is a multicentre, open-labelled diagnostic randomised controlled trial to comparing the use of portable ultrasound and x-ray imaging to diagnose a buckle fracture in children. The trial will determine if there are differences in functional outcomes, patient and care-giver preferences, and health system benefits.
Children frequently present to the emergency department with forearm injuries and often have an x-ray to assess if there is a fracture. Due to the soft and plastic nature of the bones in young children, injuries can cause their bones to bend, known as a buckle fracture. Bedside ultrasound is a test that emergency practitioners can use to rapidly diagnose a fracture at the time of examination, without exposing children to ionising radiation. Ultrasound in this setting is well tolerated, only requiring light touch and gentle manipulation of the forearm and has similar accuracy when compared with x-rays for diagnosing children’s forearm fractures.
This is the first trial of its kind to assess whether an x-ray is unnecessary when there is either a buckle fracture or no fracture seen on a portable ultrasound machine. This is important as they can be treated at the time of review without any further delay, which will avoid these children being exposed to ionising radiation. Children will be randomised to receive either an ultrasound or x-ray for their forearm injury. Both groups will be followed up to see whether there are any differences in their recovery and to determine any complications. We will also determine the time and cost implications of this new approach, which could enable families to go home earlier and could be more cost-effective, with less x-rays being ordered.READ MORE
The overarching aim of this study is to estimate the magnitude of the need for care at the end of life care in the emergency department, and to describe care delivery practices, processes and outcomes for older people who present to the emergency department requiring end of life care.
Australians aged 65 years and over account for 22% of emergency department presentations. Currently, this group makes up 15% of the population, but this predicted to rise to 20% by 2037.
There are two trajectories of end of life in the emergency department: ‘unexpected’ and ‘expected’ deaths. Unexpected deaths stem from acute illness or sudden, traumatic events. Expected deaths stem from deterioration of chronic illnesses.
When expected deaths occur in the emergency department, staff dissatisfaction and distress as well as frustration for patients and their families can result. In Singapore, around 50% of deaths in people aged ≥ 65 who died in one emergency department were considered ‘expected’. This highlights the need to understand if the situation is the same here in Australia and to what extent quality end of life care is provided for both trajectories of dying (i.e. expected and unexpected). Our study will identify the ‘unexpected’ and the ‘expected’ deaths among people aged ≥ 65 who die within 48 hours of emergency department presentation.