In this project we will evaluate a new pathway for assessing chest pain in the emergency department. The pathway is designed to reduce the costs of managing patients at low-risk of heart attack without compromising patient safety. The cost savings are estimated to be around $95 million if implemented Australia-wide, with the bulk of the cost reduction being through decreased length of stay in the emergency department.
The new pathway will be implemented at three Queensland hospitals. Data collected before and after the implementation of this pathway will be used to assess 1) whether it results in a shorter length of stay in hospital, 2) whether it is safe for identifying heart attack, and 3) whether it reduces healthcare utilisation and healthcare costs.
Over 450,000 patients present to an Australian emergency department with chest pain every year. The current approach to rule out heart attack for these patients is lengthy and costly, taking up to 26 hours at a cost of $2,127 per patient.
Improving patient experiences is part of Queensland’s 2016-2020 Strategic Plan to enable safe, quality healthcare services. Yet, current emergency department(ED) patient experience measures, including the burdensome 82-item Queensland Health (QH) ED patient experience survey, fail to reflect patient preferences for care experiences, inhibiting the design and evaluation of healthcare services that reflect patient preferences, and the delivery of value-based healthcare.
The aim of this project is to develop an ED patient experience classification system and accompanying scoring algorithm that can be used to both measure and value patient experiences in Queensland EDs. It will provide a proof of concept for an Australia-wide development, valuation and knowledge transfer study.READ MORE
Introducing a novel model of care to the emergency department may provide significant reductions in key performance indicators, such as patient length of stay, or the National Emergency Access Target (NEAT).
In previous studies, researchers have found that rostering a physician to work at triage can lead to significant improvements on a range of metrics, including time to treatment, patient length of stay and rate of patients who left before receiving treatment. However, in a regional hospital where staffing numbers and budgets are under pressure this model may not be possible.
The objective of this study is to implement a novel model of care at triage in the Hervey Bay Hospital Emergency Department. For a trial period of three months, junior doctors (PHO/registrar level) will be rostered to work at triage on alternate day shifts. A range of outcome measures will be compared with day shifts when junior doctors are not rostered at triage. This model may be relevant for other regional emergency departments.READ MORE
Grass pollen is the major outdoor allergen globally and grass pollen exposure has an important measurable and manageable impact on the medical burden of asthma. We propose investigating the role of allergy status on triggers for asthma in patients visiting hospital emergency departments in two regions of south east Queensland over a two year period, coinciding with NHMRC and ARC funded environmental health research led by collaborator CI Davies.
Data on weather and pollen exposure will be integrated with direct assessment of specific IgE profiles and respiratory viral triggers of asthma. Patients, including children over 12 years, presenting with primary diagnosis of asthma to a major urban hospital in a subtropical region and rural hospitals in the temperate regions of the Darling Downs will be recruited with informed consent.
Outcomes of this study are expected to inform need for utilising local current pollen exposure information to manage emergency department demand surges and underpin better management of pollen allergies outside of hospital by allergy physician and general practice.READ MORE
The Royal Brisbane and Women’s Hospital (RBWH) Emergency and Trauma Centre (E&TC) is committed to research as a way to improve both patient outcomes and the delivery of emergency care services. With the support of competitive grants from funding bodies, the E&TC has rapidly established a reputation for high quality, medically-oriented clinical and health services research. Our capacity and support for such work has resulted in international collaborations, publications in leading journals and translation of findings into clinical practice with tangible benefits to both patients and health services. Despite these successes, several years ago we recognised that there were still barriers to participation in research by emergency nursing and allied health clinicians.
It was evident that dedicated senior research support was required, which prompted our Capacity Building application to EMF in 2015. The resulting conjoint senior nurse research role was first occupied in 2017 and, in less than 18 months, has energized nursing and allied health clinicians to define key research questions, collaborate across disciplines and institutions, apply for funding, design and conduct research studies, publish manuscripts, present at professional meetings, and enrol in research higher degrees.
In applying to extend the funding for the conjoint senior nurse research fellow to a third year we acknowledge the essential contribution this position makes to our research capacity and to the development of individual nursing and allied health staff into effective clinician-researchers. Together with the commitments already received from RBWH and Queensland University of Technology, a third year of EMF funding will enable the full expectations of this conjoint position to be realized, thereby maximising the likelihood of attracting future recurrent funding.READ MORE
Syncope is a transient loss of consciousness with full recovery, and is a common presenting problem to the emergency department (ED). Most patients presenting with syncope have a benign cause, but others may be at risk for serious adverse outcomes. The problem is that there is currently no validated tool for knowing which patients are at risk and which can be safely discharged. Several clinical prediction rules have been developed over the years, however the sensitivity and specificity of these rules vary. This has led to an over-admission of patients who could otherwise be safely discharged, based on clinician discretion. These patients are subjected to multiple tests, including cardiac telemetry for monitoring which not only has low yield, but also results in significant costs to the healthcare system.
The Canadian Syncope Risk Score (CSRS) is the latest decision tool developed in an attempt to predict serious outcomes in patients presenting with syncope to the ED, but it has not yet been validated. This study aims to validate the CSRS at a single site, providing the first step in guiding clinicians to make better risk assessments and disposition decisions for patients with syncope. Furthermore, an innovative economic model will assess the impact of this decision tool on the healthcare system. This project is the first, critical phase toward better informed decision-making by clinicians for patients with syncope. Ultimately, this tool will enable a change to clinical practice that will result in improved patient outcomes and enhanced, targeted healthcare delivery.
Pictured to the right: Members of the Syncope research team from left to right: Ms Helena Cooney, Dr Alan Yan, Dr Jason Chan, Dr Emma Ballard (QIMR), Dr Jonathan Hunter and Dr David Brain (AusHSI)READ MORE
Mild traumatic brain injury (mTBI) is a common injury with potentially profound consequences. Although many patients recover within a few days to a few weeks, an estimated 15-40% develop post-concussion syndrome (PCS), which consists of an array of cognitive, emotional, and physical symptoms.(TBI symptoms that persist beyond three months often develop into a chronic, potentially life-long, health problem.) PCS is associated with problems returning to work, social difficulties, higher healthcare utilisation, and poorer quality of life. The mitigation of PCS represents a significant clinical problem. An effective evidence-based early intervention to prevent PCS is sorely needed.
There is a growing consensus that differences in patient outcomes from mTBI are due to a range of biopsychosocial factors. For example, stress, anxiety, cognitive biases, sleep disturbance, and structural brain damage are among a number of factors that influence PCS symptom report. A focus on modifiable psychosocial factors (e.g., thoughts and behaviours) offers a promising solution: Cognitive Behavioural therapy (CBT) is well suited to altering the maladaptive beliefs, misattributions, cognitive biases and coping behaviours that promote chronicity in PCS.
The purpose of this study wass to examine the feasibility and effectiveness of a Cognitive-behavioural psychotherapy (CBT)-based early intervention for patients at high-risk of developing PCS after mTBI.READ MORE
The Royal Brisbane and Women’s Hospital (RBWH) Department of Emergency Medicine (DEM) is constantly looking for better ways to improve the care of the sick and injured. Patients are cared for by a team of professionals including doctors, nurses and other allied health professionals. Improvements in care come largely from high quality research.
Our medical specialists in Emergency work on a wide range of challenging, innovative emergency medicine research topics. Their results are reported in some of the top professional journals, including the Lancet. Research led by other team members including nurses, however, is scarce despite the fact that these clinicians play an integral part in emergency care. We believe one of the main reasons for this is the lack of senior research mentors accessible to all clinicians in our department.
We propose creation of a dedicated research position to enhance capacity, develop grants and opportunity for research among our multidisciplinary team. She/he will identify key research questions, design scientific studies, write and submit proposals for funding, supervise the collection and analysis of study data, and support the preparation of reports for presenting and publishing in medical, nursing, and other professional meetings and journals. He/she will also provide training, guidance and encouragement to all ED staff to participate in research; liaise with other investigators (external to DEM) to facilitate optimum conduct of all departmental interdisciplinary projects. Furthermore, she/he will establish collaboration and professional partnerships with academic institutions and other research bodies to attract funds, grants and research to the department.
This position will help to improve the quality of emergency medicine research outputs from the RWBH and boost multidisciplinary team focused research in the department. It will also help build the knowledge base and provide the evidence to guide interventions by all health care workers in the emergency department.READ MORE
This wa a national collaborative research project approved by the National Health and Medical Research Council Partnership Projects scheme. This project aims to identify how the four-hour rule is effective in reducing access block and the adverse effects of emergency department overcrowding on patients. In particular, it assessed the impact of the four-hour rule as a policy intervention in reducing emergency department length of stay (EDLOS) over time in WA and compare the outcomes against comparable hospitals in NSW, Qld and ACT.
This project hypothesised that effective intervention for reducing EDLOS would translate into improved patient outcomes, particularly in subgroups identified as associated with the most harm from overcrowding.READ MORE
The current project will involve the implementation and evaluation of a pioneering protocol for the online clinical assessment of practical skills (eCAPS) for medical residents and registrars training in Emergency Medicine. It will use a variety of web-based video technologies to facilitate the learning and innovative assessment of physical examinations of the musculoskeletal system initially targeting the knee and shoulder joints. Specifically, eCAPS includes three interdependent elements with a progressive (asynchronous to synchronous) organization of online instructor and learner-generated video resources to allow formative and summative assessments of practical competencies of Emergency Medicine residents and registrars performing selected physical examinations of the musculoskeletal system. This includes:
1. an integrated series of web-based video lectures and tailored clinical demonstrations of practical skill sets (musculoskeletal examinations) by experts in the field;
2. resident/registrar (“learner”) generated video demonstrations of selected, clinically relevant practical skills recorded with portable USB cameras (asynchronous) uploaded to a secure response and feedback online repository for personal and peer-community access; and
3. real time (synchronous) video assessment of residents/registrars completing practical skill sets for physical examination of the musculoskeletal system within a simulated OSCE (Objective Structured Clinical Examination) scenario using readily accessible web-based technologies (e.g. Skype).
The evaluation of the proposed implementation of the eCAPS protocol will provide important baseline information on aspects such as the flexibility, viability and generalizability of emerging online learning options for developing and assessing practical/procedural skills within an Emergency Medicine training program.
Furthermore, the current project will provide insights into the learning outcomes of the eCAPS protocol and the potential applications of this online approach for facilitating the standardization, validation and recording of clinical competence across a range of training levels and settings including rural and remote Emergency Medicine contexts.