Improved Respiratory Support in Remote Settings for Children: A Paediatric Acute Respiratory Intervention Study (PARIS), PARIS on Country

The next phase of studies, titled "Paris on Country," represents a continuation of efforts in Australia and New Zealand to enhance care for infants and children presenting with acute respiratory issues in emergency departments. Through these studies, we have successfully implemented changes in treatment protocols, aimed at alleviating respiratory distress and reducing anxiety for both patients and their parents.
In rural and remote areas of Queensland, approximately 38 percent of the state's total population resides. However, access to healthcare and emergency services in these areas can significantly differ from urban regions. The primary goal of this project is to elevate the standard of care for children experiencing acute respiratory distress in remote and regional settings to match the level of care available in larger cities.

Does a Vascular Access Specialist Model in the Emergency Department (VAS-ED) improve peripheral intravenous catheter outcomes? A Randomised Controlled Trial

More than 6 million peripheral intravenous catheters (PIVCs) are inserted in patients' veins in Australian emergency departments (EDs) annually. These devices can be challenging to insert, and over half will fail before the treatment is finished. Although ED clinicians regularly insert PIVCs, most inserters are junior medical or nursing staff who often default to short PIVCs because that is what they were trained to insert. These “generalist” inserters often don’t have the skills or knowledge to select alternate vascular access devices appropriate to the patient's needs. In contrast, Vascular Access Specialists (VAS) are experts with advanced assessment and expertise in inserting and managing vascular access devices, a model that has proven successful in inpatient wards, but hasn’t yet been tested in the ED setting.

In this study, we will compare the effectiveness and cost of using VAS specialists versus generalist inserters for peripheral IV device selection and insertion. In total, 320 ED patients will be recruited and randomly allocated to receive either a VAS or generalist inserter (standard care). We will compare outcomes including first-time insertion success, device failure rates, complications, patient satisfaction, and cost between the two groups. Additionally, we will interview clinicians to better understand the barriers and facilitators to implementing and using a VAS model.

We expect that patients who have a peripheral IV device inserted by a VAS will have higher first-time insertion success, and be more satisfied with their care than patients allocated to the generalist group.

The feasibility of point-of-care ultrasound conducted by physiotherapists for the diagnosis of ankle syndesmosis injuries in the Emergency Department: A diagnostic study

Syndesmosis injuries, also known as a high ankle sprain, due to ligamentous injury are relatively uncommon but can have devastating outcomes when missed. This includes chronic pain, instability and osteoarthritis. Early surgical fixation of these injuries is recommended in some cases. Magnetic Resonance Imaging (MRI) is the most accurate way to diagnose these, but not ordered in the emergency department (ED) due to its cost and poor availability. Although clinical tests can help to narrow down who needs an MRI, they are often inaccurate in the acute phase. Ultrasound performed by sonographers can visualise ligament to components of the syndesmosis complex to streamline MRI referrals but is under demand during the day and not available afterhours. Point of Care Ultrasound (POCUS) performed by clinicians is an alternative option for imaging.

Emergency physiotherapy practitioners (EPP) typically manage patients with musculoskeletal injuries in the ED and are well placed to perform musculoskeletal POCUS. This study will evaluate the feasibility and accuracy of ED physiotherapist-performed POCUS for the diagnosis of ligament injury in the ED, indicative of a syndesmosis injury, against radiology-performed ultrasound. This could guide MRI patient selection to allow for earlier detection of unstable ankle injuries and expedite outpatient orthopaedic expert review and management. If POCUS by ED physiotherapists is demonstrated to be feasible and accurate for these syndesmosis injuries, the results of this study could inform the development of a diagnostic pathway that could be implemented in EDs locally and throughout Australia.

Biomarkers for rapid diagnosis of paediatric sepsis

Sepsis is a time critical medical emergency that arises when the body starts to attack its own tissues and organs in response to an infection. Sepsis can result in organ dysfunction, multi-organ failure and death if not treated promptly, and is a leading cause of death in children worldwide. Sepsis often presents with non-specific signs common to many mild infections, making it difficult to detect early and accurately, leading to delaying appropriate treatments and resulting in severe sepsis. Therefore, it is vital to identify new approaches to rapidly identify the type of infection and predict the severity of the condition in patients presenting with suspected sepsis to enable early initiation of appropriate treatments.

Recent advances in genomic technologies have shown that gene expression based infection testing has the potential to provide much faster and more precise results. This results in more accurate diagnosis of infections and appropriate timely treatments. Our study will utilise an advanced gene expression analysis approach named single-cell RNA sequencing to identify new approaches for sepsis diagnosis. This could lead to development of a rapid testing method which can predict the type of infection (bacterial or viral) and the severity of the condition with a quick turnaround time for results, improving patient outcomes, reducing unnecessary antibiotic use, and shortening hospital length of stay.

Predicting in-flight hypotension in aeromedical trauma patients

In-flight hypotension (low blood pressure) leading to patient deterioration is a common and challenging clinical problem in aeromedical trauma patients. Predicting this risk is currently primarily based on clinical gestalt, without specific validated risk prediction tools. The Triage Revised Trauma Score (TRTS) is a clinical risk prediction tool calculated using only vital signs, making it well suited to the resource-limited pre-hospital environment.

A Life Flight Retrieval Medicine internal audit in 2021 suggested an association between the TRTS and in-flight hypotension for trauma patients. Based on these preliminary findings, this study will address the research question, “what is the relationship between pre-flight TRTS and in-flight hypotension in trauma patients undergoing aeromedical retrieval?”.

Knowledge gained from this study may allow aeromedical doctors to make more informed decisions about their patients before aeromedical transport.

Maximising the effects of feedback in regional emergency medicine

Feedback improves performance. Yet establishing effective feedback practices in emergency medicine (EM) is challenging. Supervisors need to balance delivering patient care with delivering feedback in fast-paced environments. These challenges are particularly burdensome in regional settings where the workforce is less experienced, and teams are less established.

To resolve this challenge, efforts are often directed towards developing supervisors’ feedback skills. Yet with the challenges experienced by regional EM supervisors, the model of ‘supervisor driving feedback’ is inefficient. What has been overlooked is developing trainees as active participants in feedback practices. Evidence suggests that this approach may improve feedback practices in EM and offers a way to alleviate the feedback burden experienced by EM supervisors in regional settings.

Study to Analyse Patient Flow in Queensland Public Hospitals

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.

Emergency department waiting time predictions in real-time

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.

Watch-house detainee emergency healthcare

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.

Patterns of prescription opioid use following ED presentation for minor road traffic crash injury

Australia is five years behind the US’ opioid epidemic (>15,000 US deaths/year). General Practitioners and EDs frequently prescribe opioids for isolated musculoskeletal pain (e.g. “whiplash”) from RTCs, but this potentially inappropriate opioid prescribing likely leads to unnecessary opioid exposures. In the last decade, opioid overdoses in Australia have more than doubled. 75% of opioid overdose deaths involve prescription opioids; annual death rates exceed road traffic deaths.

Emergency Departments (EDs) commonly prescribe opioids on discharge for patients with non-serious road traffic crash (RTC) injury. This potentially compromises recovery and contributes to continued opioid use and potential misuse in the community.

The project will address the gap on whether, or for how long, short courses of opioids are continued following acute non-serious RTC injury, and to what extent this causes subsequent problems, by measuring patterns of use, impacts, and costs of opioid use in EDs and following discharge over a 12-month period.

The project will provide the first Australian data on opioid prescribing in ED for acute minor RTC injuries and link ED data to community data to explore longitudinal prescribing patterns post RTC.