The burden of mental illness on the Australian community and public health care system is substantial. (1) Every year in Queensland, approximately 300 people who present to a rural or remote ED location with acute behavioural disturbances (ABD) require aeromedical retrieval to an Authorised Mental Health Service (AMHS). ABD is “combined physical actions made by an individual which are in excess of those considered contextually appropriate and are judged to have the potential to result in significant harm to the individual themselves, other individuals or property” of rapid onset and a severe nature.(2)The transfer of people experiencing ABD is challenging due to difficulties in balancing patient rights and safety against that of the retrieval team. The aeromedical retrieval environment is restrictive, both in physical size and in relation to resource access, necessitating a heavy emphasis on risk-mitigation. Whilst research has established a safe approach to the sedation of people with ABD, other aspects of their retrieval remain lacking in evidence, and may contribute to suboptimal care and delayed access to specialist mental health services. This programme of research aims to explore those areas to ensure the management of people with ABD requiring aeromedical retrieval is optimal. Should changes in practice be required as a result, operating procedures and policies with Queensland's aeromedical network will occur.READ MORE
Major bleeding is a leading cause of death in trauma patients. Blood product replacement is a key component of damage control resuscitation aimed at limiting coagulopathy until definitive control of bleeding is achieved. Although Major Haemorrhage Protocols (MHP) are now widely used in the initial resuscitation of traumatically injured patients (1), protocols can vary based upon individual institutions' capabilities and processes.
Within Australia, the National Blood Authority 2011 Patient Blood Management Guideline Module 1: Critical Care/ Massive Transfusion (2) recommended institutions develop standardized MHP to guide clinicians regarding the dose, timing and ratio of blood component therapy for bleeding trauma patients. However, it is currently unknown if these guidelines are implemented and if so, what institutional variations occur. While the guidelines provide a robust review of the evidence base for MHP, there is little information about the logistics of MHP implementation.
Our project aims are firstly to compare the available trauma bleeding protocols across Queensland for content and quality. Secondly, we wish to understand the institution's capabilities of delivering an MHP in terms of the structure and processes available to them. Thirdly we want to explore the experiences of clinicians involved in delivering an MHP for trauma patients in both tertiary, rural and remote hospitals within Queensland.
Expected benefits are to identify potential disparity of care for trauma patients in terms of MHP content, availability of resources and access to blood products. This information can help guide improvements in education, blood products availability and cost-effective care across Queensland.READ MORE
This study will adopt a system-wide view to capture relationships and interactions between flow metrics to identify access issues and inform the design of interventions/solutions to improve patient flow at a system level. A system-wide approach covering prehospital and ED services offers the potential for improving patient flow at the ambulance/hospital interface. By integrating ambulance, ED and inpatient data, it is possible to identify blockages along the entire patient journey that have a flow-on effect on ED access. It is also possible to identify critical hospital and ambulance service levels when performance starts to degrade, suggesting where the system would benefit from revised strategies.
The project ‘Study on Patient Flow in Queensland’s public hospitals’ is conducted by a research team comprising experts from CSIRO, Queensland Health, UQ and QAS.READ MORE
Globally, road traffic accidents are a leading cause of death in younger adults, particularly as a result of traumatic brain injury (TBI). Patients in rural and remote locations who have suspected TBI may need transfer for definitive investigation and management. Despite established guidelines on the need for CT imaging in minor TBI, we believe low-value transfers of this population group occur, placing an unnecessary burden on the patient, their family, and the healthcare system. This project aims to explore the interhospital transfer of people with mTBI, in an attempt to identify if and how such low-value care can be avoided, with resultant financial and personal cost savings to the individual and the healthcare system.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
In order to understand the effectiveness of health service delivery, and the impact of changes in processes and procedures, it is important to first be capable of analysing the data that documents patients’ journeys through the hospital. This project will bring together key data from multiple disjointed information systems so that analysis can be undertaken on the flow of patients through the Gold Coast Hospital (GCH); from the ambulance, through the Emergency Department, and admission to a ward, including the operating rooms, radiology, pathology, and pharmacy that they encounter up to their departure. With this holistic view of patients’ journey of care, the baseline and measure impact of initiatives will be determined to ensure that patients flow through the environments with minimal delay and improved outcomes.READ MORE
This research aimed to investigate the impact of opening a new ED within a health service district. The study involved linking ambulance, emergency department (ED) and hospital data from three EDs to better understand the patient journey and patient and health service outcomes when a new ED opens within the health service. The project aims were to:
1. Describe and compare patient and health service outcomes at three EDs before and 12 months after Robina ED opening;
2. Describe and compare outcomes for patients arriving to ED by ambulance based on whether off stretcher time is/is not delayed by >30 mins.
Traumatic injury is the leading cause of death and the second highest contributor to the burden of disease of Australians aged between 12 and 24 years. In approximately 10-50% of trauma, blood does not clot properly, with these patients up to 4 times more likely to die from their injuries.
Researchers aim to determine the proportion of injured patients with clotting problems. Identifying these patients may enable life-saving treatment to commence enroute, and rapid intervention on arrival at hospital.
Servicing the greater Brisbane and Gold Coast areas, the Queensland Ambulance Service (QAS) High Acuity Response Unit (HARU) provides advanced trauma interventions including blood transfusions and ultrasound to detect internal bleeding. In 2014 the HARU treated approximately 370 moderate to severely injured patients.
In this study, HARU team members analysed blood from patients in the field to determine clotting abnormalities. The study also examined whether a simple blood test on a portable machine could accurately diagnose clotting problems.READ MORE
Increasingly, prisoners are requiring transfer to and assessment in the ED; some for illnesses that may be treated in the custodial environment with an appropriately trained health care professional. Optimising how health care is delivered in the watch house environment was the focus of this study, following recommendations in a recent (2012) Inquiry following the death of Herbert John Mitchell.
This study is underpinned by recommendations from deaths in custody, the literature and anecdotal experience. The study will provide a comprehensive outcomes evaluation of a 66 day trial of a model where emergency nurses were posted to the local watch house for an 8hr late shift and a 10hr night shift to supplement domiciliary nursing services to provide 24hr nursing presence in the watch house. This model of enabling experienced emergency nurses the opportunity to work within an 'out of hospital environment' but with the support from medical colleagues has not to our knowledge been trialed elsewhere and is therefore innovative.
The impact expected from this study is on the prisoners, health care staff and police staff working in this model. We expect the following main outcomes: less transfers of prisoners to ED from the watch house and a cost effective model.READ MORE
Queensland Health have recognised that patient flow strategies are required for emergency departments in order to i) improve the patient journey and experience; ii) reduce delays and increase access to health care services; and iii) provide best clinical practice across the state. An Emergency Department Ambulance Off-Load Nurse (EDAOLN) role was commenced on Friday 17 August 2012 at the Gold Coast Hospital. The aim of this advanced nursing role was to provide rapid triage and assessment for patients arriving to the ED by ambulance and to commence initial meaningful treatment as required (such as X-rays, pathology, analgesia) on a 24/7 basis.
A retrospective study of all ED presentations (n=21,454) made to the Hospital, during July 9, 2012 - November 2, 2012; 39 days before (T1), during (T2) and after (T3) the introduction of the trial of an EDAOLN role. The primary outcome of interest was time to be seen by a clinician.READ MORE
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