Emergency department (ED) waiting times are a significant predictor of the patient experience.
Simple prediction methods, such as rolling average, are used by hospitals in Australia to predict waiting time for patients. Although this approach is inexpensive to implement, the forecasts have limited accuracy and consequently most Australian hospital EDs do not report expected waiting times to the public.
A solution that is capable of sourcing data from ED information systems and feed it into prediction models to generate waiting time forecasts would bring practical benefits for staff and patients. There is also potential to assist clinicians and nurses to estimate demand for care and calibrate workflow.
For patients, the knowledge may reduce anxiety associated with uncertainty about the waiting time and reduce the number of patients who leave before treatment.
This project aims to use advanced statistical models and machine-learning algorithms to capture dynamic fluctuations in waiting time, to implement and validate the prediction performance of these models. The project will also build ED research capacity by educating staff on forecast modelling and data management techniques.READ MORE
Queenslanders living in regional, rural and remote areas have a higher incidence of traumatic injury and poorer access to health services than their urban counterparts.
Researchers propose to undertake a first-of-its-kind study to classify and characterise trauma patients from these areas serviced by Townsville, Cairns, Mt Isa, and Mackay Hospitals over the three-year period 2016-2018. Using patient records, researchers will examine the clinical therapies and interventions used and patient outcomes from point-of-injury through to hospital discharge.
The study will capture, collate and compare patient data from Queensland Health, Retrieval Services Queensland (RSQ), LifeFlight Retrieval Medicine (LRM) and the Royal Flying Doctor Service (RFDS) to assess the current state of emergency trauma care in the Queensland Tropics, and any potential gaps in aeromedical healthcare delivery. The results will also provide a springboard for a wider system and processes assessment of emergency trauma care for the benefit of patients in North Queensland.READ MORE
Hip fractures are extremely painful yet medications which are usually used to manage the pain can have significant complications, particularly in frail individuals. Numbing medications injected into the groin on the side of the hip fracture have been shown to decrease pain, confusion and chest infections in patients with hip fracture awaiting an operation.
It is usual for most patients presenting to emergency departments with a hip fracture to get a single injection of numbing medication. What isn’t known is whether multiple regular doses of numbing medications injected regularly via a plastic tube in the groin are more effective than a single injection in managing the pain of hip fractures.
The purpose of this study is to show multiple regular doses of numbing medications are better than a single injection. This will be achieved by examining the difference in the amount of pain, the quantity of pain medications, and the degree of confusion between the patients getting multiple doses and those getting a single injection.
This study will be the first of its kind to be done in an emergency department and is also unique in that it will involve patients with dementia who make up more than a third of patients with hip fracture and are usually excluded from studies. The study is expected to help manage the pain of the 1.6 million hip fracture patients worldwide and give emergency doctors an additional option of managing hip fracture pain.READ MORE
Emergency Departments (EDs) receive persons suffering major disturbances in their mental capacities, detained and transported by police or ambulance. The Public Health Act 2005 (Qld) (‘PHA’) – amended and in force 5 March 2017 – requires police and ambulance officers to make out an Emergency Examination Authority (EEA) at handover.1 Previously, Emergency Examination Orders (EEOs) were made out under Queensland’s Mental Health Act 2000 (‘MHA’). At handover, police and ambulance officers must make out an EEA. From handover at the ED, the PHA prescribes specific responsibilities, e.g. a doctor or health practitioner must explain to the person that they may be detained for 6-12 hours, the ED Director can order their forced return if they abscond and must take reasonable steps to return patients to a place requested.
Using qualitative and quantitative information the study focuses on the time and personnel resources required to investigate how EDs in north Queensland have responded.
No study has assessed the impacts on Queensland EDs of increasing numbers of mental health related presentations in light of legislative changes governing emergency assessmentREAD MORE
This research project is looking at cellulitis in the Torres Straits. Cellulitis is a bacterial infection of the skin that requires antibiotics. People with cellulitis usually have an area of red and hot skin and sometimes can have fevers and become really unwell. Germs called Staphylococus aureus and Streptococcus pyogenes typically cause cellulitis. It potentially can cause serious infections and are a common presentation to emergency departments and admission to hospital.
In a tropical environment such as the Torres Strait cellulitis is extremely common and contributes to a significant burden on the healthcare system. Often patients present to health care facilities in the Torres Strait with cellulitis and are transported into Thursday Island Hospital for intravenous antibiotics. This is associated with significant retrieval, emergency and hospital costs. However the treatment of cellulitis in the community has been found to be practical, safe, and cost effective. We want to find out if cellulitis can be treated at home instead of in the hospital here in the Torres Straits.
The aim of this study is to validate outpatient intravenous antibiotic management of cellulitis in the Torres Straits. We anticipate that results from this study will improve preventable emergency and hospital admissions thus having significant health economic savings here in the Torres Straits.READ MORE
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.READ MORE
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.READ MORE
The development of linked data from aeromedical retrieval & health system databases will provide improved, value-added insights to patient care and outcome analysis. This first-of-its-kind study seeks to take the next step in patient-centered outcomes research and resource allocation planning by linking together existing, but independent emergency department, aeromedical, hospital and death databases. Our pilot study has linked databases, creating secure & robust infrastructure for future state-wide studies.
The aims of the study are:
a) Utilise the linked data infrastructure that we’ve created, allowing next phase state-wide replication; describe aeromedical patient outcomes (including length of stay and mortality); understand aeromedical service requirements for specific illness/ injury, those that require frequent flights, & identify steps within the patient journey.
b) Develop a better understanding of the aeromedical patient journey will help to develop appropriate health services delivery, in particular emergency departments whom most often are first point-of-service, thus ensuring better health outcomes.
Cairns Base Hospital Emergency Department is committed to attracting the best emergency physicians and trainees. Our research commitment over the years, particularly the ability to provide 4.10.70 direction and opportunities, has been recognised by our peers as significant, particularly in an environment of heavy clinical \workloads and limited funding opportunities. In the past two years the CBH executive has worked to balance this by increasing staff numbers and allowing more academic opportunities for Emergency Physician and trainees alike.
This Capacity building grant allows the Hospital to appoint, for three years, Associate Professor Jamie Seymour from the James Cook University, School of Medicine and Tropical Biology, as a Research Fellow. A/Prof Seymour has a history of involvement in research with the Hospital's ED -- primarily, but not restricted to, toxinology and advice in study design and analysis. This grant enabled the Hospital to considerably expand and formalise the collaboration.
In his role as Senior Research Fellow, A/Prof Seymour will provide the experience and expertise need to help the Department apply for successful grant applications and help attract and immerse Emergency Medicine trainees in a fertile research environment that actively encourages them with their 4:10:70 as well as research in thelr ongoing career. The department believes that this approach will also increase its attractiveness to emergency physicians in relation to job placement and has unanimous support from the consultants in the department.
The department envisages that the Research Fellow would conduct research training on a weekly basis as part of the present teaching protocol where research ideas and published studies are discussed and examined, where experimental design and statistical analysis of proposed research projects can be developed.READ MORE
Decompression sickness (DCS), commonly called the bends, involves formation of gas bubbles in the body following scuba diving. These bubbles can cause a variety of problems, ranging from minor aches and pain, to severe stroke-like symptoms. Providing pre-hospital oxygen therapy at the highest concentration possible provides needed oxygen to body tissues, reduces bubbles and can often relieve symptoms. Oxygen has been shown to reduce the number of hyperbaric treatments a diver with DCS will require so improving pre-hospital oxygen delivery will lead to decreased hospital costs. However, the ideal oxygen delivery system has not been determined.
Using new techniques and equipment, this research will identify the optimal device for delivering oxygen to divers with DCS leading to recommendations which will improve the health outcomes of injured divers. We will measure how effectively varied breathing devices deliver oxygen to the body tissues and remove bubbles from the diver’s blood while assessing innovative equipment. This study will assess a new commercially available oral mask to improve oxygen delivery with a demand system. A medical oxygen re-breather, which like an anaesthetic machine absorbs carbon dioxide and adds small amounts of oxygen to the breathing circuit, will be also assessed.
Assessing the use of these devices will not only determine their efficacy to deliver oxygen to injured divers but also provide guidance on appropriate systems to use for dive operators with limited medical oxygen. Assessing the change in bubble grade with oxygen delivery will add evidence for its use. This research will provide information that can guide pre-hospital and emergency clinicians when choosing the type of oxygen delivery devices used for injured divers improving patient outcomes and decreasing costs.READ MORE