Through funding support of the State Lead: Research and Evaluation (2025–2027) at the Royal Flying Doctor Service (Queensland Section) (RFDS (QLD)), this project aims to transform RFDS(QLD) from a historically service-oriented organisation into a research active, data-informed leader in regional and remote healthcare. Research will be embedded in everyday clinical practice, service innovation, and strategic decision-making, strengthening RFDS (QLD)’s ability to attract competitive grants and philanthropic funding.
Key anticipated outcomes include:
This capacity building grant aims to support novice researchers at the Queensland Children’s Hospital (QCH) Emergency Department (ED) and expand multidisciplinary research expertise across the ED, through:
Supporting novice researchers is crucial to future sustainability, allowing a broadened expertise base within the ED and overall growth in scope and scale of departmental research activities. QCH ED also plays a leadership and training role across the state. The positive first experiences and expertise gained by novice researchers at QCH should contribute to strengthening research capacity throughout Queensland.
This project aims to establish a structured research program within LifeFlight, enabling the organisation to contribute meaningfully to aeromedical retrieval research and evidence-based clinical practice. The primary objectives are to learn from established aeromedical research institutions, build formal research collaborations with Queensland based universities and institutions, and develop a structured research data platform using REDCap.
Expected Outcomes:
By leveraging knowledge-sharing, research collaborations, and robust data infrastructure, this project will transition LifeFlight into an active contributor to retrieval medicine research in Queensland.
This project aims to transform Logan Hospital Emergency Department (LED) 's promising research foundation into a sustainable centre of research excellence, by establishing the key infrastructure to bridge the current gap between clinical expertise and research productivity. A dedicated Clinical Research Coordinator (CRC) will serve as the catalyst for developing a self-sustaining research ecosystem within LED, by enabling efficient progression of research initiatives, fostering early-career researcher engagement, facilitating multi-site collaborations, and creating sustainable research processes.
The ASPIRE program is structured around five interconnected strategic elements:
The anticipated benefits include accelerated research output through concurrent project implementation, increased staff engagement in research activities, expanded participation in multi-center trials, expanded collaborative networks for joint grant applications, improved translation of research findings into clinical practice, and development of sustainable research capacity that endures beyond the project period.
Traumatic Brain Injury (TBI) is a leading cause of death and disability in prehospital trauma care(1,2). Avoiding hypotension during prehospital emergency anaesthesia (PHEA) is critical for neuroprotection and survival in moderate-to-severe TBI, yet hypotension remains a common complication(3,4,5). This retrospective cohort study will investigate the haemodynamic effects of various induction agents used during PHEA for isolated TBI by LifeFlight clinicians in Queensland over a 2.5-year period. The study will evaluate the prevalence of post-induction hypotension, linked to drug type and weight-based dosing, alongside key other neuroprotective targets. Findings will inform clinical practice and guideline iteration to reduce secondary brain injury. In particular, this research is critical for remote area trauma patients, including First Nations individuals who face disproportionate geographic barriers to definitive care in the setting of TBI.
Telehealth has emerged as a useful tool in rural and remote Emergency Medicine as a response to workforce shortage. More than a quarter of Australians live in rural and remote areas with a higher burden of disease, higher rate of avoidable deaths and lower life expectancy than urban-dwelling Australians. Despite this, they are serviced, per person, by fewer General Practitioners, nurses and medical specialists.
An ideal Emergency Telehealth (ET) model would provide real-time, expert advice for the care of rural and remote patients in their own setting. It would improve quality of care. Rather than undermining local medical services, ET would build on the skills, workplace satisfaction and overall quality of life of existing local providers and improve the viability of existing local medical services. ET would prevent unnecessary transfers, facilitate timely transfers where necessary, and consequently reduce costs.
We will assess clinician perceptions of whether rural Retrieval Services Queensland emergency telehealth (RSQ ET) consultation avoided the need to send patients to better resourced regional or metropolitan hospitals. Where patient transfer was required, we will ask clinicians if they felt RSQ ET changed the urgency of those transfers. Over a 6-month period, we will survey two groups of clinicians. Firstly, doctors and nurses who seek the assistance of RSQ ET will be asked to complete a survey for every patient. A selection of the case notes from this first group will be anonymously reviewed by Medical Coordinators employed by RSQ. Medical Coordinators are doctors who prioritise and coordinate air transfer of patients throughout Queensland. Both sets of clinicians will be asked whether the telehealth video call consultation avoided patient transfer or reduced the urgency to do so.
Patient’s presenting to the emergency department (ED) with suicide ideation, commonly have underlying social stresses including homelessness. These patient’s are often reviewed by mental health clinicians and social workers independently to facilitate management and support discharge and these patients often have prolonged ED length of stay and higher representation rates. However, little is know about how patients with suicidality complicated by homelessness are currently being managed in ED, and staff perceptions of potential gaps in ED management. Here we plan to perform a mixed method study to assess current ED assessment and management of patients with suicidality and homelessness. Notably, the results will provide insight into the key barriers and gaps in service provision that if identified, can support further research into service improvement.
Death from the heart stopping (cardiac arrest) remains a major cause of death in Australia. This study will examine a new way to look at the heart to guide resuscitation. Currently, doctors can use ultrasound (pictures using sound waves) to find why the heart has stopped and guide treatment. The traditional method places the ultrasound probe on the patient’s chest, but this can interrupt chest compressions and produce unclear images.
Our study examines a different approach that places the ultrasound probe down the food pipe (oesophagus), closer to the heart. This method allows for continuous monitoring without interrupting chest compressions and may provide clearer images. This method is called Trans-Oesophageal echocardiography or TOE. We’ll compare patients who had TOE performed during cardiac arrest to those who received standard care to see if it improves survival rates and helps identify treatable causes of the heart stopping.
Diabetes-related foot disease affects around 200 million people and causes 2% of the total global disease burden. This burden is driven by diabetes-related foot disease causing around 2% of all hospitalisations and 60% of all amputations worldwide. The largest focus of foot disease has been on those with diabetes, yet half of all foot disease hospitalisations are in people without diabetes.
Whilst foot disease is known to be a leading cause of all hospitalisations, little is known about Emergency Department (ED) presentations. To our knowledge there has been one population-based study exploring ED presentations for foot disease, finding very high presentation rates for foot ulcers, with >90% hospitalised. This project will explore trends in the incidence and outcomes of ED presentations for all foot disease conditions in Queensland. Findings will inform the foot disease demand and potentially care improvements for Australians presenting to EDs for foot disease.
Occupational violence, is a serious and growing problem in emergency departments. It not only harms staff, but reduces quality of care. Metro South Health hospitals see incidents every day, but current tools to identify high-risk patients lack clear guidance on what to do next. This project will bring together emergency doctors, nurses, and support teams to agree on standard responses for managing patients at risk of violence. By creating consistent best-practice guidelines, the study aims to improve safety for staff, provide better care for patients, and reduce the negative impact of violence on Queensland’s emergency departments.
Children frequently fracture their arm. Most of these fractures are minor and are placed into a plaster cast and referred to the fracture clinic. However, there is wide practice variation. Children are often put into an initial cast or splint that is not circumferential to avoid issues with circulation from initial swelling of the arm due to internal bleeding from the fracture site. These can vary from a prefabricated plastic splint, to fiberglass or plaster ‘backslab’ cast, or a variation of these in terms of shape, width and length. These provide rigidity for comfort and allow for swelling to subside before placement of a circumferential cast, if deemed to require a longer period of immobilisation. This survey intends on capturing practice variation across Australia and New Zealand through a series of clinical scenarios. Consumers will also be surveyed to explore their experiences and determine their willingness to accept alternative treatments.
Rapid sequence intubation involves administering medications to sedate and paralyse a patient’s muscles, followed by placing a breathing tube in the patient’s windpipe. This is a common and vital element in the treatment of critically ill or injured patients.
Adequate relaxation of the patient’s throat and respiratory muscles increases the safety of the intubation procedure. A medication called rocuronium is used to achieve this muscle paralysis. Research has shown that higher doses of this medication may result in ideal intubating conditions being reached sooner and more consistently in these patients. LifeFlight practice has recently changed in response to this new information. Our study will examine the safety and effect of this change to procedure. Our initial audit has captured over 700 intubations using Rocuronium and suggests an association with lower dosing and worse intubating conditions and more prolonged airway attempts.
Selecting the most appropriate antibiotic for emergency department (ED) patients with infection is challenging. Up to one-third receive inappropriate antibiotics. Clinicians rely on patient history, vital signs, and clinical data to guide decisions, but additional factors may improve antibiotic selection.
Patients who present to the emergency department with severe infection often have complex medical histories and prior hospital investigations for infection. While reviewing information about prior infections is recommended as part of a comprehensive clinical history, it is unclear whether previously cultured bacteria (e.g., from blood, urine, or wounds) aids antibiotic selection. This study aims to determine if past bacterial cultures help clinicians choose more effective antibiotics for future infections.
We will compare patients with prior bacterial cultures to those without and assess whether past cultures increase the likelihood of receiving effective antibiotics within six hours of ED arrival. In the time-pressured ED environment, emergency clinicians must quickly make treatment decisions for patients with severe infections, often with limited information. When patients present with infection, sepsis or septic shock, every effort is made to determine the source of the infection and choose the correct antibiotics to treat it. Determining whether previous testing can help clinicians select effective antibiotics may improve patient care and patient safety.
Child maltreatment is endemic in Australia, with alarming prevalence reported, resulting in significant harm and health burden persisting into adulthood. Emergency Department (ED) presentation is a critical opportunity for identification of child safety concerns to enable early intervention. Although up to 1% of paediatric ED presentations are related to child safety, cases are under-detected by clinicians, variably managed and poorly documented. Multiple screening tools have been developed, published and translated into practice in international research, with challenges of acceptability, sensitivity, specificity with no widely accepted or established gold standard. There is limited use of evidence-based screening tools in Australian EDs.
This research project will outline the facilitators, barriers and priorities for the design and utilisation of an evidence-based, digital child safety screening tool through a series of focus groups and interviews with clinical end-users and consumers. Qualitative data from this process will be used to inform Australian practice and future research aimed at co-design and implementation of a tool. Appreciation of clinician and consumer priorities is the first step towards co-designing an evidence-based, best practice child safety screening tool for Australian EDs which is acceptable, effective and able to be scaled across multiple services and states.
An understanding of what the most vulnerable older Australians genuinely want from emergency care remains under-discovered. The National Statement on Ethical Conduct in Research describes the importance of consumer input. Yet, current research on meeting needs primarily focuses on system-level outcomes, such as interventions to reduce emergency department (ED) presentations or shorten length of stay. While these metrics are valuable, they fail to capture and confirm what matters to the consumer. For example, aged care facility (ACF) residents’ decision to transfer to an ED for care is influenced by other considerations such as symptom relief and time spent alone. Furthermore, much of the existing research on older peoples’ preferences is focused on older people living in other countries and/or is outdated.
This project aims to understand what matters when older people – especially those living with frailty- need emergency care. It uses surveys, face-to-face interviews and focus group discussions with older Australian consumers and their caregivers to explore their perceptions of the pros and cons of different emergency service models of care. Existing models of care will be identified through an environmental scan. We will recruit consumers from the Australian Frailty Network, and supplement that national group with responses from Queensland older people attending Queensland EDs, and ACF leaders and residents. This project includes metropolitan, regional and rural consumer voices, providing a comprehensive description of what matters to older people to inform ED service delivery. Ultimately, a framework of consumer-identified aspects of quality emergency care delivery will be formulated.
The Queensland Ambulance Service (QAS) provides a 24/7 Clinical Consultation and Advice Line (CCAL) for paramedics to call for certain indications, out of scope practice and general advice. The most frequent general advice calls relate to complex capacity and non-transport decisions.
We propose a pilot study where senior paramedics perform 24-48 hour follow up calls with crews involved in non-transport decision making consultations with the QAS CCAL. The calls will involve a semi-structured interview and debrief to examine decision making, satisfaction with advice given, and ongoing questions and concerns the crews may have with regards to the consultation process. A subsequent 7-14 day follow up call would be made to discuss sentiments towards the next-day call, and answer any lingering questions. Responses to the structured questionnaire and follow up call will be used to perform a thematic analysis to better direct education and training surrounding capacity, inform the nature and content of non-transport consultation calls, and consider the ongoing utility of providing debrief for cases with complex decision making. The purpose of this research is to inform design of a clinical consultation process that is fit-for-purpose and assures clinician confidence to maximise appropriate non-transport decisions.
Fibrinogen is a key protein that helps blood to clot and stop bleeding. When a patient with bleeding arrives in the Emergency Department, doctors check their coagulation profile to measure fibrinogen levels. This guides decisions about giving treatments that replace fibrinogen and control bleeding.
In Queensland, the standard coagulation profile reports two different fibrinogen results. One is Fib C, measured using the Clauss method, which is considered the most accurate test. The other is Fib D, calculated from the Prothrombin Time (PT-derived). These two results are expected to be similar, but differences are often seen in practice. At present, there is confusion amongst clinicians about which result to use when making transfusion decisions. There are also no guidelines on using Fib D, which creates uncertainty in patient care.
This study will review all coagulation profiles performed in Queensland Health hospitals over the past five years. It will compare Fib D and Fib C results to assess how closely they match. If there is poor agreement, the study will inform Pathology Queensland whether Fib D should be removed and only Fib C should be reported.
The findings will help ensure that clinicians are guided by reliable test results when treating patients with bleeding. This has the potential to improve decision-making, reduce confusion, and enhance the safety and quality of transfusion care across Queensland.
A peripheral intravenous catheter (PIVC) is a small tube inserted into a vein using a needle. It is used to deliver fluids, medications, or blood products. While PIVCs are often necessary, their insertion is invasive, painful, and carries risks of infection and in rare cases, death. In emergency departments (EDs), PIVCs are frequently inserted early during a patient’s visit, even if they are not immediately needed.
Clinicians use their own judgement to decide if a patient is likely to need a PIVC, but it can be difficult to determine. As a result, many patients leave the ED without their PIVC being used, which means they had unnecessary, invasive and painful procedures and were exposed to unnecessary risks of infection. However, pre-emptive PIVC insertion is deeply embedded in clinical practice, making it hard to eliminate entirely.
Improving the accuracy of predicting the PIVC needs in ED patients is challenging because the factors influencing PIVC use are not very well understood. Machine learning, a type of artificial intelligence, can help by analysing large amounts of clinical data to identify patterns and predict specific outcomes.
In this study, ED clinicians and researchers will develop a machine learning model to predict the need for a PIVC based on routine clinical information recorded in electronic medical records. The study will demonstrate how this model could assist clinicians in making better decisions about PIVC insertions. The findings will guide future research to test the safety and effectiveness of the model in real-world clinical settings.
When patients have severe bleeding, hospitals use a test called ROTEM to guide transfusions in real time. ROTEM is used in 16 hospitals in Queensland and relies on specific cut-off values to help doctors decide when to give certain blood products.
In June 2023, the manufacturer of ROTEM changed the chemical (reagent) used in one of its tests, FIBTEM, without informing doctors. FIBTEM helps guide decisions on giving fibrinogen, a protein that supports blood clotting. This change has likely lowered FIBTEM results, but hospitals are still using old thresholds that have not been validated for the new test, potentially leading to inappropriate transfusions. A study found a similar test change affected accuracy, requiring updated thresholds in the UK to avoid over-transfusion. This raise concerns that Queensland hospitals need updated thresholds. In January 2025, a safety notice alerted 16 Queensland hospitals urging all 16 hospitals to review their bleeding algorithms.
This study will analyse whether the change in the FIBTEM test has affected actual fibrinogen levels. It will compare test results before and after the change using data from 16 hospitals. If the findings show current thresholds are inaccurate, hospitals will be informed and supported in updating their bleeding guidelines.
This is an urgent patient safety concern, as blood products may be given using outdated cut-offs that were not validated for the new change. This study ensures accurate transfusion decisions to improve care for critically bleeding patients.
Hyperkalaemia is a potentially life-threatening condition that occurs when the level of potassium in the blood is too high. Typically, medication containing insulin and glucose is used to lower blood potassium levels. However, the downside to insulin is that it also lowers blood sugar levels. Therefore, patients being treated for hyperkalaemia are at risk of hypoglycaemia, where blood sugar levels fall too low. This can cause shakiness, headache, and confusion, and in more severe cases, loss of consciousness.
We wanted to know if hyperkalaemia could be treated without insulin, i.e., with glucose only. We suspect this is possible because glucose administration causes people to produce their own insulin from their pancreas. Since little is known about this, we designed a trial to test the safety and effectiveness of treating hyperkalaemia with glucose-only.
In the trial we will compare the safety and effectiveness of treating hyperkalaemia with standard insulin-glucose treatment to glucose-only treatment. The study will be conducted in adults with hyperkalaemia at the Royal Brisbane and Women’s Hospital Emergency and Trauma Centre. If we find that the glucose-only treatment is safer and just as effective as insulin-glucose treatment, then the trial will provide important evidence for changing the way we treat hyperkalaemia.
Childhood asthma, characterised by wheeze, and breathing difficulties, is the leading cause of ED visits for pre-school children. Despite the large burden of disease, there is considerable uncertainty regarding the optimal duration of one of the key acute treatments: systemic corticosteroids. The STeroids in preschool Asthma Reduction (STAR) study will directly address this critical question and provide world class evidence for this common condition.
We aim to compare the efficacy and safety of 1- versus 3-days of an oral steroid (prednisolone) for wheezy pre-school children presenting to ED. The hypothesis of our non-inferiority study is that a single dose of oral prednisolone is as effective as a 3-day course for prevention of symptom recurrence in the 7-days following treatment.
Assuming outcomes are equivalent, this will lead to simplification of treatment protocols for parents/caregivers, and a reduction of children's exposure to corticosteroids and their side-effects. These side-effects are potentially significant for children who experience frequent viral triggered episodes of wheezing and asthma each year.
Findings will be translated into Australasian wheeze and asthma management guidelines for pre-school children through the established knowledge translation processes in our research network.
Problem: ED access to care by CALD populations can be hindered by the complexity of language, cultural, social, system differences or discrimination. However, existing patient experience questionnaires fail to capture the cultural, linguistic and contextual dimensions that shape ED experiences for CALD communities. As a result, health services lack the data needed to inform targeted improvements for culturally safe emergency care.
Aim: The aim is to develop and validate the CALD ED patient-reported experience measure (CALD ED PREM) to measure CALD patients’ experiences in the ED.
Method: This is a multiphase study design guided by the principals of co-creation to develop and validate a CALD ED PREM in Australian EDs. From project inception to dissemination, the project will collaborate with consumer representatives, CALD consumers, and a stakeholder advisory group. This inclusive approach will ensure the development of a comprehensive CALD ED PREM reflective of CALD consumers’ experiences and perspectives.
Significance/innovation: This research is both timely and essential, addressing a growing need to improve care experiences for CALD populations within EDs. This is the first study to develop a CALD-specific ED PREM, tailored to capture the cultural, linguistic, and contextual factors that shape ED experiences. It builds on a foundational CALD-ED study, and has been shaped through a co-creation approach and ongoing consumer engagement.
Impact: The findings will inform policy change, resources and interventions to promote effective CALD consumer engagement practice and bridge the significant gap of health inequity and promote culturally and linguistically appropriate emergency service access for CALD populations.
The QAS is developing new response models to better meet the changing healthcare needs of Queenslanders and reduce unnecessary hospital attendance. The World Health Organization and the Australian Commission on Safety and Quality in Health Care (ACSQHC) recommend using patient experience data to evaluate and improve healthcare quality and safety.
To evaluate and refine these models, reliable person-centred patient feedback is essential. Patient surveys, such as Patient-Reported Experience Measures (PREMs), are widely used in hospitals. However, no validated PREM currently exists for ambulance service settings in Australia or globally. Existing PREMS were not designed for the unique and diverse nature of care provided by ambulance services which serve people of all ages and health conditions, nor for use where a patient are discharged on scene.
To ensure patient safety and service fit-for-purpose, this project aims to develop and test a PREM specifically for the QAS’s alternative ambulance response models using a gold-standard methodology. This project is co-designed with a Consumer Advisory Group (CAG) of 5 members recruited via Health Consumers Queensland, and partnership with the QAS Information Support, Research & Evaluation team and Medical Director’s office.
This project will create Australia’s first validated PREM for ambulance services. This will capture feedback from patients receiving care via innovative ambulance models, critical for improving patient experience, guiding paramedic education, and refining service delivery. This data will support performance reporting, demonstrating the value-based care provided by ambulance services, aligned with the ACSQHC accreditation standards.
Children frequently fall over and fracture their forearm. Most wrist fractures are routinely put into a plaster cast and are sent to fracture clinic for follow-up. Casts are effective but can cause pressure sores and need to be replaced when wet or damaged. Removal is done in fracture clinic with a plaster saw, which can provoke anxiety in children. Recent studies show that removable wrist splints work well for stable fractures in that they provide rigidity but can be removed for comfort and hygiene purposes. They are likely to reduce the number of days off school and work for families, without adversely affecting bone healing. This pilot study will explore the use of wrist splints to manage distal forearm fractures in children. It will primarily test whether we can successfully recruit enough families to participate in a larger trial, but will also inform estimates on safety of wrist splints. We will consider whether they may save families time and money. If wrist splints are a suitable alternative to casts this could also help the health care service, which can better focus on children with more complex fractures. If this pilot study shows we can efficiently recruit participants and that the treatment appears to be safe, this would provide the foundation for a larger clinical trial to evaluate effectiveness of splints compared to casts. Given that upper arm fractures in children are a common reason for presentation, a change in practice to splint use could have global impact.
Vertigo is a common reason people come to the emergency department (ED), but it can be hard to diagnose. One major concern is missing a stroke in the cerebellum, at the back of the brain, which can’t be reliably ruled out with tests in the first 24 hours. To help with diagnosis, doctors use clinical exams to assess stroke risk. The first was the HINTS exam (Head Impulse, Nystagmus, Test of Skew), which showed that combining these signs could help rule out stroke. However, it requires special training, and has not worked as well in real-world settings. Next came the STANDING algorithm, designed to be easier to use in the ED. It’s simpler to interpret but still needs special equipment. More recently, the Sudbury Vertigo Risk Score (SVRS) was developed. It’s designed for emergency doctors to use easily and doesn’t need extra tools. Early results showed it was as accurate as HINTS and STANDING. This study looks at patients who came to Sunshine Coast EDs with vertigo. It aims to test how well the SVRS works in real-world practice and compare it directly to the HINTS exam and STANDING algorithm.
Children often experience significant pain, stress, and fear during medical procedures in hospital emergency departments (EDs). While medicines help, many children continue to feel scared and distressed. New approaches, such as virtual reality (VR), may help. VR uses headsets to immerse children in interactive games and stories, providing distraction and reducing the focus on painful procedures.
Although VR has shown promise, it has not yet been widely used in paediatric EDs. Emergency departments are busy and unpredictable places, and what works in one hospital may not work in another. This project will explore whether VR can be a practical, effective, and affordable option across three very different Queensland hospitals: Queensland Children’s Hospital (tertiary), Caboolture Hospital (urban), and Roma Hospital (rural).
The project will run in two phases. In Phase 1, parents, children, nurses, and doctors will work together with researchers to design the best way to introduce VR into everyday ED care. They will help choose the most suitable VR content, and develop training and support resources for staff.
In Phase 2, we will test VR in real ED settings through a randomised controlled trial. We will measure children’s pain and distress, parent satisfaction, and staff feedback. We will also use simple saliva tests to measure stress hormones, giving us an objective marker of how VR affects children’s bodies.
This project aims to provide clear, practical evidence about how VR can be used to reduce children’s pain and distress in emergency care, ensuring ALL children receive the best support.
People living in regional and remote communities often face delays in accessing timely healthcare, especially in emergencies. The Royal Flying Doctor Service (Queensland Section) (‘RFDS(QLD)’) Medical Chest service aims to bridge this gap by making essential medical supplies available locally that can be used when needed on the advice of RFDS telehealth clinicians. While the service has operated since 1942, few empirical studies have examined how the medical chests are being used or the value of the service to communities and the health system.
This project will evaluate the Medical Chest service in three ways. First, we will speak with people who use or support the service, including patients, medical chest holders, community members, and clinicians. These conversations will help us understand what the service looks like in practice, what parts are important, and what challenges people face. Second, we will look at whether the service is working as intended. For example, whether people find it easy to use, whether supplies are reliable, and whether it is considered safe and appropriate. Finally, we will conduct an economic evaluation to assess the costs and benefits of the service including the outcomes it achieves for patients, and the healthcare visits, hospital admissions, travel and time away from work or family it may help to avoid.
Together, these findings will provide a clear picture of how the Medical Chest service contributes to the health and wellbeing of regional and remote Queensland communities and how it could be improved in the future.
Emergency department (ED) staff face more workplace violence and aggression than other hospital teams. They need effective training to prevent and manage these risks. In our study, ED staff will wear virtual reality (VR) headsets and practice calming upset or aggressive patients in realistic scenarios. We’ll gather feedback through surveys and interviews to see if VR training boosts their learning, attitudes, and confidence. It is anticipated that VR training will provide ED staff a safe space to rehearse de-escalation and practice decision-making in a safe space. Our hypothesis is that this form of training will bust staff’s confidence and better support and manage patients with occupational violence (OV) risk, ultimately reducing instances of violence and aggression. We will use our findings to build the best possible de-escalation training program for ED staff and to help spread benefits and learnings across healthcare.
When children need medical procedures in the emergency department (ED) – like stiches, IV lines or CT scans, it can be scary and painful.. Sedation helps them stay calm and still, but many require medicines which are usually given by injection and can have side effects (like slowing the child’s breathing).
This study looks at a needle-free alternative: intranasal dexmedetomidine (a sedative given as a nasal spray). It is already used in some hospitals, but we don’t yet have large, real-world data from EDs to show how well it works and how safe it is.
We will follow children aged 1–16 years who receive intranasal dexmedetomidine as part of their usual care in EDs across Queensland. We won’t give any extra medicines or tests. Using information routinely recorded by clinicians, we will find out:
By collecting consistent data from multiple hospitals, this project will show whether this nasal-spray sedative can offer children a calmer, safer and less invasive experience in the ED. The results will guide local practice and contribute to statewide and national sedation guidelines—helping Queensland families receive the safest, most effective care during necessary procedures.
Low-value diagnostic tests are unnecessary tests that are reflexively ordered by Emergency Department (ED) doctors. These tests are inefficient, ineffective and deplete finite healthcare resources. Furthermore, they cause patient harm by triggering unnecessary treatment and increasing ED length of stay. Urine culture is a prime example. A recent study at Townsville University Hospital (TUH-ED) showed that 47% of urine cultures were low-value.
Changing test ordering behaviour is necessary to enable doctors to reduce low-value diagnostic tests and to choose the right test for the right patient at the right time (also called diagnostic stewardship). Studies suggests that interventions to promote diagnostic stewardship are more likely to be effective if the interventions are informed by behavioral change theories, co-created with doctors, tailored to local contexts, made up of several components, and targeted to individual tests. The proposed study will therefore tackle low-value urine culture ordering behaviour at TUH-ED using a novel, theory-informed, co-created, 4-component, context-specific, diagnostic stewardship intervention over a 12-month period. Education, Nudge, Audit/Feedback and Clinical Champions will be the four intervention components.
The proposed study will improve patient safety and resource stewardship by reducing low-value urine cultures at TUH-ED. If successful, the intervention will be expanded to other Queensland EDs through a multi-site study. This study is also anticipated to prove that a theory-informed, co-created, multi-component, context-specific, intervention can create effective and measurable change in clinical practice. This will allow similar interventions to be applied to other low-value diagnostic tests in Queensland and Australian EDs.
Children present to Emergency Departments (EDs) often needing procedures that cause pain which can be stressful for both children and families. One common procedure is insertion of a cannula, a small, flexible tube placed into a vein to collect blood or give medication. Unfortunately, a third of cannulas fail before treatment ends, usually caused by inadequate securement. Premature failure results in new cannula reinsertion, exposing children and families to further procedural anxiety and pain.
A recent trial by Charters et.el1, conducted in two regional hospitals in Queensland, successfully reduced cannula failure in younger children (6 months-8 years of age) by using a special dressing and skin glue at the cannula insertion site. This study seeks to translate that research into practice at one of Queensland’s busiest tertiary EDs. This study aims to explore the implementation strategy in a tertiary facility to inform a statewide implementation strategy. The impact of this approach will be examined among children aged 6 months to 8 years and 9 up to 16 years to determine if this technique is generalisable. Barriers to implementing will be examined through feedback and data collection on measurables including cannula dwell time, avoidance of repeat attempts, and implementation of technique and guideline changes with sustained practice.
The expected impact is to improve more precise and age-specific cannula securement best practice, reduced repeat invasive procedures among each child, while reducing cost of care. If successfully implemented, a cannula securement package will be developed to enable scalability at other health care facilities.
1. Problem.
Injury is the leading cause of premature death among young Australians, with North Queensland (NQ) reporting some of the highest injury rates in the state. While falls, contact with objects, and transport incidents dominate nationally, assault is the second leading cause of injury in NQ. Unique regional factors—such as a higher proportion of rural and First Nations populations, tropical climate, and long retrieval distances—shape distinct trauma patterns. Existing trauma data is limited, predominantly descriptive, and lacks regional specificity. Without a comprehensive situational analysis, it is difficult to develop evidence-based policy, ensure equitable access, or improve outcomes. A clearly defined trauma baseline is essential to inform region-specific care and benchmarking.
2. Question
What are the demographics, injury severity profiles, and outcomes of trauma patients presenting to NQ Hospital and Health Service jurisdictions (Torres and Cape, North West, Cairns and Hinterland, Townsville, Mackay) since 2022, and how do these compare with national trauma benchmarks?
3. Solution
This retrospective study will review major trauma cases from 2022 onward using data from the Queensland Trauma Data Collection (QTDC). Variables will include demographics, mechanism, severity scores, physiology, interventions, transfers, processes and outcomes in line with the Queensland Health Tier 1 Traumatic Injury Data Set Definitions. Findings will be compared to national benchmarks to highlight strengths and areas for improvement.
4. Impact
This will be the first comprehensive epidemiological analysis of major trauma for NQ, providing a critical baseline for ongoing quality improvement, guiding clinical practice, and supporting equitable trauma care across the region.
Most clinical staff working in the ED are clinical facing, allowing little to no time to develop research or their skills in research. The primary aim of the CBG is to support, develop, and undertake research of importance for Robina ED with Robina ED staff, HHS Executives, and consumers.
Our strategic vision for the CBG is to have research an integral part of clinical practice and education at Robina ED and that guidelines and policies are informed by our research. It will be guided by the GCH ED Research Strategy which has 4 goals: 1) Organise emergency care research; 2) Build and streamline research capacity; 3) Promote excellence, relevance, and impact of research; and 4) Develop, strengthen, and sustain research partnerships.
Structure: To build research capacity specifically for Robina ED staff, the structure will involve the employment of a Robina-based ED Research Fellow (part-time) and Research Nurse (part-time), as well as consultancy from a consumer advisor, and health economist/statistician (see budget); Engagement of health service executives, local and international university academics, collaborators from other agencies; and specific mentorship from other ED research leaders using tested frameworks (NASEM, 2019).
Expected benefits of the CBG include: active research engagement and collaboration leading to partnerships between Robina ED clinicians, researchers, HHS Executive, consumers and external collaborators in the development of 2 projects led by staff at Robina with support from researchers; the development and sustainment of capacity building mechanisms for: research involvement opportunities for Robina ED clinicians, dissemination of research updates and findings, and research mentorship.
The strategic vision for our research program is to support early and experienced clinical researchers to participate in and contribute to high quality, robust, research activities and develop their research skills and knowledge through enrolment into higher degrees in research and participation in Older Person Emergency Network (OPEN) implementation and evaluation activities.
The proposed Capacity Building Grant will provide the opportunity to build research capacity and capability whilst strengthening OPEN’s research culture and further embedding research into our everyday practice. Funding will support the employment of a suitably qualified research officer (RO) (health practitioner, nursing or academic stream) to be mentored by the OPEN research team. This will include supporting the clinical OPEN team’s novice researchers to develop their research skills, encourage individual pursuit of higher degrees, leading journal clubs, preparing ethics and governance applications, contributing to writing protocols, carry out data collection, assist clinicians with research studies and be responsible for leading the translation of research findings into practice. RO support will also enable OPEN senior researchers time to focus on preparing grant applications to further build capacity through grant funding.
The key measurable outcomes we expect to achieve include support for the currently active five funded and 19 unfunded research projects at various stages of preparation. All of these projects are underpinned by an implementation framework to understand the real-world applications of the proposed research. The RO role will be responsible for obtaining ethical, governance and contractual approvals, to carry out the data collection for key pilot projects to inform large multi-centre trials where competitive grants will be sort.
Our long-term goal is to prove the value of the RO role leading to a permanently funded position well beyond this grant period with sustained research growth within the OPEN team.
Emergency Departments (EDs) are under considerable strain with increasing demand for services by consumers (1,2). In 2020-2021, there were approximately 8.8 million presentations to Australian public hospital EDs, a 6.9% increase compared to 2019-2020 (2). Increasing patient presentations into already crowded EDs drives the search for alternative approaches to patient care that might expedite treatment. At The Prince Charles General Emergency Department (TPCH-GED), a process for advanced scope Emergency Physiotherapy Practitioners (EPP) by certifying them to perform digital ring blocks to assist more timely management of finger/toe fractures/dislocations has been developed. This study aims to compare EPP performed digital ring blocks versus the current standard of care within TPCH-GED (medical officer (MO) administration) with respect to pain score of injection, adequate analgesia, first pass success; need for escalation, with secondary outcomes of time to block, patient satisfaction and ED length of stay between the EPP group and the MO group.
Optimising communication in the Emergency Department (ED) waiting room is the best means of improving paediatric patient and caregiver satisfaction of their acute hospital experience. There are many different approaches to addressing this matter across Australian EDs, however, there is limited research assessing the effectiveness of individual strategies on improving patient and caregiver experience.
This study will aim to address this gap in literature through the following:
(1) A systematic literature review on effective communication strategies used in emergency department waiting rooms globally, and
(2) A qualitative approach, cross sectional single-centre study in the Queensland Children’s Hospital Paediatric ED waiting room to ascertain paediatric patient and caregiver perspectives and satisfaction regarding different communication strategies implemented.
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.
Acutely decompensated heart failure is a significant cause of morbidity and mortality worldwide. In 2020-21, it is estimated that around 34,400 presentations to the emergency department were due to heart failure. One of the most common ways in which patients present to the Emergency Department with this end diagnosis is with acute dyspnoea secondary to acute pulmonary oedema. Traditionally, acute pulmonary oedema is detected using a combination of history, physical examination findings and Chest XR (CXR). The recent widespread availability and use of point of care ultrasound (POCUS) has drastically changed the way patients are assessed in the emergency setting. Delays in completing X-rays and awaiting formal laboratory results (such as BNP) can result in delays in the diagnosis and management of patients in acutely decompensated heart failure. POCUS offers a bedside alternative that may be able to fast track a patient’s assessment in the emergency department. This study aims to determine the utility of POCUS by novice ultrasound users, to assist in detecting acute pulmonary oedema and to assist with diagnosing acutely decompensated heart failure in the emergency department. The outcome of this study may support the widespread training of medical officers working in emergency departments in the use of POCUS for detecting acute pulmonary oedema. If proven to be non-inferior to CXR and BNP, POCUS LUS will have a significant impact on the way patients with acutely decompensated heart failure are assessed.
The overall aim of this doctoral research is to transform the Cairns Emergency Department into a place of cultural safety, as determined by Aboriginal and Torres Strait Islander community. This research centres the voices of Aboriginal and Torres Strait Islander peoples in articulating cultural safety in the Cairns Hospital Emergency Department, positioning the community as expert knowers and teachers, to inform the delivery of emergency care across the country.
This study involves a research process, through Indigenous Storywork and Narrative Practice. Using Narrative therapy and community practice, stories of wisdom, skill and know-how of the community will be shared into the Cairns Hospital ED through focus groups and in-depth interviews. Cairns Hospital ED staff will bear witness to these stories, learning from them, then taking action within their practice. Alongside this, the study will gather, through review of minutes and researcher reflections, stories behind the action register of the Cairns Hospital ED Cultural Safety Reference Group (CSRG) to document historical change, and change as it occurs within the time frame of the study.
This research grant is sought, specifically to facilitate critical knowledge translation of research findings; translating the important wisdom, skill and know-how of the First Nations community into practice and policy transformation in the Cairns Hospital ED.
In Queensland, extreme heat and heatwaves lead to increased demand for public health services. Predicted increases in the frequency, intensity, duration, and spread of heatwaves necessitate urgent action to mitigate their impact and protect vulnerable populations. Queensland Health has recognized this threat, and in response are developing evidence-based policy to protect the health of Queensland residents. This study aims to explore the impact of heatwaves across different ages and medical conditions in Queensland emergency departments.
Using statewide data from Queensland Health and the Bureau of Meteorology, we will compare the incidence of emergency department visits during extreme heat and heatwave periods to normal periods by age and medical conditions. To date, no research has explored the impact of heatwaves and extreme heat periods on emergency department demand by age and medical conditions across Queensland. This research will extend our knowledge about the impact of heatwaves on emergency departments, which have shown to have increase by 9% according to preliminary results. This information will allow for forecasting and preparedness surrounding extreme heat events.
Drug overdoses are a common reasons for Emergency Department (ED) presentation. Overdoses may be intentional (self-harm), recreational, or accidental and often lead to reduced consciousness. Patients often need extra attention to their airway and breathing. They can be managed conservatively with oxygen, observation and regular nursing assessments. However, some require intubation: insertion of a breathing tube under sedation.
There is practice variation between doctors as to which overdose patients require intubation. Thus, the patient’s perspective becomes paramount, as their experiences influence management. We also need to understand clinician thought processes to ensure that care is standardised where possible.
This qualitative research is innovative in being the first to assess the patient experience around airway and breathing management for drug overdose with reduced consciousness, and assessing clinician attitudes. This will be done through patient and clinician questionnaires and semi-structured interviews.
AIM 1: To investigate the patient experience for an ED presentation with drug overdose and reduced conscious level. To understand the impact that interventions such as intubation can have on patients.
AIM 2: Explore clinician attitudes to the management of airway and breathing for these patients. Barriers to a conservative approach, triggers for intubation, departmental pressures and existing frameworks of care.
The research will provide insight into how this vulnerable patient population experience their care, and how clinicians reach critical decisions. It will inform development of a pathway of care to be used in the ED assessment of airway and breathing management for patients with drug overdose and reduced consciousness.
Snake bite affects thousands of Australians every year, but few die as a result due to high quality first aid and timely medical care. Good first aid should be simple, standardised, use minimal or readily available equipment, and be able to be utilised effectively with no or minimal training by the rescuer. Over time the first aid methods used to manage snake bite in Australia have been questioned due to issues with efficacy, and some emerging evidence of harm from their use. There is little experimental data in the literature to support current first aid practices, and what exists suggests further research is required. Our study aims to examine and compare the effectiveness of two first aid methods by tracking the movement of a mock venom through the body when each first aid method is used. This will provide important information about the suitability of current techniques used in Australia and whether a proposed simpler alternative technique is as effective. If this is demonstrated to be correct it provides a basis for modifying current snake bite first aid recommendations.
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.
Children and adults who experience injury from horses-related accidents can be at risk of severe trauma due to injury mechanism, i.e., falling from, being kicked, hit, trampled, or crushed by a horse. Despite a low incident rate of injury in horse-riding and equestrian sports when an accident occurs there is a high-risk of the injury being severe due to the mechanism. Injury risk from horses has been found among experienced horse riders and handlers to increase with frequency of interaction and over time.
There is a lack of current evidence on the impact from all mechanisms of horse-related injuries experienced by children and adults treated in the emergency department. And the examination of health-related recovery of children and adults after discharge from the emergency department and hospital has been rarely researched. The aim of this study is to examine horse-related injury and recovery from injury among children and adults.
This project will be conducted in two phases, a review of health care data from emergency department presentations including all types of horse-related injury from 2018 to 2024. The second phase of the study will be conducted prospectively from July 2025 to June 2026 to examine how children (eight-years-and-above) and adults have recovered from injury. Patients (or parent/guardian) will consent for health care data to be collected and for follow-up by research staff after discharge from the emergency department or hospital at three-and six-months, this will include completion of a health-related quality of life questionnaire.
Overcrowding and access block is a common problem across many Australian Emergency Departments (ED) resulting in poor patient outcomes (Morley et al., 2018). Consequently, patients streamed through the acute part of the ED who ideally require an acute bed are instead moved to temporary triage rooms or wait in the waiting room as Acute Overflow (AO). Monitoring for deterioration for the AO patient is therefore restricted due to lack of appropriate monitoring, staff availability, overcrowding in these areas, and bed capacity potentially resulting in poor patient outcomes. However, there is no study that has examined the impact of acute patients streamed to AO. Here, we aim to conduct a retrospective matched-cohort study, across a six-month period, to examine the clinical sequelae including any adverse events of acute ED patients streamed to AO. The findings from this study will provide insight into the potential impact of streaming patients to the AO, and may provide underlying evidence to advocate for improved monitoring and staffing of this potentially vulnerable and yet often forgotten area of the ED.
Problem: Emergency Medicine research faces significant challenges due to outdated data collection methods, particularly when it comes to the use of clinical data. These issues lead to incomplete datasets and inaccuracies, negatively affecting research quality and patient care. Clinical Toxicology, a sub-specialty of Emergency Medicine, is an excellent example, where currently crucial clinical datasets are compromised by inconsistent practices and manual entry.
Research Question: How can we improve access to emergency care, improve the burden that toxicology patients place upon the emergency care system, and enhance data collection and efficiency in toxicology services by developing automated data extraction methods and standardized practices?
Proposed Solution: We propose the development of the STREAM, an automated clinical data extraction system designed to enhance data collection and analysis in emergency medicine.
Significance: This project addresses the enormous burden that toxicology patients place on emergency care. Toxicology is an area of emergency practice which relies on clinical information contained in databases to support the delivery of quality patient care. By improving data quality and standardizing practices, we aim to enhance research accuracy and optimize resources.
Innovation: The project introduces an innovative, cutting-edge automated tool to overcome current inefficiencies in data collection. This approach will enhance data management and research capabilities, providing a model for other clinical research areas.
Expected Impact: The project will improve the management of poisoning and toxic exposure, benefiting other emergency clinical research areas that rely on detailed data analysis. We anticipate higher-quality data, reduced manual workload, and better patient outcomes.
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.
Emergency department (ED) overcrowding and subsequent impacts on patient safety and quality of care is a global public health challenge. Capacity measurement and risk assessment tools play a vital role in capturing and communicating ED overcrowding to trigger escalation strategies, mitigate risk and facilitate patient safety and flow. Currently, there is no universal definition of ED crowding and tools developed to measure crowding and quality of care in paediatric EDs are largely based on research undertaken in the adult setting.
The Queensland Children’s Hospital (QCH) ED currently use the Staffing Acuity Physical Transfer/Disposition Environment (SAPhTE) tool, manually calculated by the Emergency Flow Coordinator (EFC) and designed to assess and escalate ED capacity, access block and departmental risk. Audits and staff surveys have identified challenges in the SAPhTE tool including timely completion especially during peak ED activity, inter-operator variability in interpretation and scoring, limited central visibility and poor shared understanding around escalation. QCH ED have co-designed the Acuity Level and Flow Report - Emergency Department (ALFRED) dashboard which provides near real-time capacity metrics from FirstNet to provide an automated and visual report of ED capacity, patient flow challenges and risk assessment. As a measure of overcrowding, ALFRED incorporates the single-site validated Pediatric Emergency Department Overcrowding Scale (PEDOCS). Further research is required to evaluate the acceptability, feasibility and efficacy of the ALFRED tool in a paediatric ED. This will facilitate potential translation to other pediatric centers and mixed emergency departments to promote a proactive approach to capacity risk assessment and improve patient flow.
Hospitals and in particular, emergency departments (ED) are often overcrowded and unable to meet ever-increasing demand. The leading cause of overcrowding is access, or ‘bed-block’. This is a serious issue as it impacts the ability of staff to provide quality care to their patients.
Hospital patient flow is a nationwide problem that has attracted attention from researchers and policymakers, yet solutions to improve it, have been ineffective. As ED and Intensive Care Units (ICU) treat the most critically ill patients, it is unsurprising that the patient’s journey through these departments is closely connected. ED patient flow can be impacted by ICU bed capacity, delayed admission into ICU, and delayed and after-hours discharge from ICU. Bed-block can have significant consequences for the patient - including increased waiting time, prolonged length of ICU and hospital stay, more hospital-acquired complications, higher mortality and increased financial burdens for the health system. It is estimated that delayed discharges from ICU alone costs Australia $40 million/year.
The proposed study aims to co-design and test a multi-component intervention to address patient flow, building on a foundation of our preliminary collaborative research looking at hospital priorities, current strategies and practice, and barriers and enablers to ICU discharge processes.
We expect the impacts of this work will include,
Emergency Departments (EDs) in Queensland hospitals are often overcrowded, leading to long wait times and reduced patient satisfaction. At Logan Hospital, patients with surgical problems currently go through a full ED assessment before seeing a surgical specialist, causing unnecessary delays. To address this, we’re creating a Surgical Rapid Assessment Unit (SRAU). This unit will be open on weekdays from 8 am to 4 pm and will directly assess stable patients with surgical issues, bypassing the usual ED process. This means patients will be seen faster by the right specialist.
Our research aims to evaluate how well the SRAU works. We’ll look at:
This project is innovative because it fundamentally changes the patient journey, allowing direct surgical assessment without the usual step of ED evaluation. This approach could improve care quality and use hospital resources more efficiently. If successful, the SRAU model could significantly reduce ED congestion and improve patient flow. This model of care could be applied statewide and nationally to other Australian hospitals facing similar challenges.
We’ll use multiple research methods, including comparing data before and after SRAU implementation, surveying patients and staff, and analysing costs. The results will provide strong evidence on whether this model works and how it could be adopted by other Queensland hospitals, potentially leading to widespread improvements in emergency surgical care across the state.
Emergency departments (EDs) are overcrowded and unable to meet the ever-increasing demands for healthcare. Access block is the most significant contributor to ED overcrowding. Access block refers to delays in admitted patients leaving the ED due to an unavailability of inpatient beds. The consequences of access block can be catastrophic, including adverse events, higher mortality rates, reduced quality of care, and increased costs.
Large numbers of patients who occupy acute beds are non-acute and considered safe and ready for discharge. These patients are predominantly waiting for residential aged care facility (RACF) placement. In addition to financial and patient flow strain, hospital stays longer than required creates significant risk of functional decline.
As the largest public health service in Queensland, Metro North Health has made significant investments in various successful hospital avoidance, substitution and navigation programs. However, timely access and flow of patients to RAC, which increases availability of inpatient beds for patient admission from ED, remains a significant issue. Therefore, this research investigates: How can we reduce discharge delay from acute wards to RACFs to improve access block?
This research will characterise the cohort of patients who are ready for discharge and waiting for RACF placement, and understand the barriers and solutions to discharge delay. These findings can then be used in future phases of this research program to predict patients who will have a delayed discharge, target strategies and pathways at admission, model the impact of released acute bed capacity on access block, and develop metrics for inpatient stays.
People living in regional, rural, and remote areas are more likely to experience poor health outcomes and to suffer traumatic injuries than those living in cities. When help is needed, patients, their families or carers can contact the Royal Flying Doctor Service(Queensland Section) (‘RFDS(QLD)’) directly using their 24/7 telehealth service. Doctors are available to provide advice remotely, and if needed, prescribe medications and potentially lifesaving treatments that are immediately accessible from the 1,300+ medical chests located across the state while an air retrieval is arranged. Between July 2022 – June 2024, RFDS(QLD) received 9,700+ calls of this kind. To ensure that people are getting the best care available, we need to better understand, who, when, and why people called RFDS(QLD) directly including how many needed help because of traumatic injuries and motor accidents. This research will conduct large-scale analyses of all these patients, their clinical presentations, treatments provided by the RFDS(QLD), and retrieval outcomes. Front-line emergency clinicians will also share their experiences about what works well and what could improve trauma management in regional, rural, and remote areas. Results will be used to improve what is known about trauma management and inform how the RFDS(QLD) designs and monitors its services on an ongoing basis. A RFDS(QLD) Trauma Research Network will also be established. This Network will increase research capability and capacity by supporting knowledge generation and skills development. Doing so, will enable clinicians to evaluate and influence RFDS(QLD) services beyond the life of this project.
The aim of the proposed EMF grant is to enable Townsville University Hospitals' emergency department (TUH DEM) to create a stable platform for prolific, innovative and translational research. Further more, it will contribute to the strategic vision of TUH DEM being a centre of excellence in EM research and innovation that delivers high-quality emergency care. The research capacity building grant will support an Emergency Medicine Clinical Research Coordinator to assist research active emergency clinicians in sustaining ongoing projects, designing and conducting new high-quality, outcome-oriented projects, nurturing the next generation of EM researchers and embedding research into daily business of TUH-DEM.
The proposed Research Capacity Building grant aims to increase participation in research, strengthen the research culture and ensure that research becomes core business within The Prince Charles Hospital Emergency Department (TPCH-ED). The strategic vision includes strengthening of systems and structures that enable researchers, both novice and experienced, across all disciplines to participate in high-leverage, practice-changing research activities, with a view to embedding a research culture into day-to-day practice. A core element is the strengthening of collaborations between departments, across disciplines and with other health facilities. The proposed strategy is the training of a group of research nurses to equip them with the foundation skills, knowledge, and preliminary experience to actively promote and support research in the department. The model is one of appointment of experienced clinical nurses, new to research roles, in part-time sequential appointments. Recruitment from existing ED workforce would be ideal, allowing retention of a substantive position which the researcher would return to after the research immersion. This would assist in embedding a research culture amongst clinical nurses and provide opportunity for continuation of research engagement on return to clinical duties. The expected benefit of this approach is that there will be a highly visible research focus within the ED, with multiple opportunities for engagement, underpinned by the premise that depth and breadth in a research group, rather than reliance on a few key individuals, is paramount. This proposal would ensure that research enthusiasm and knowledge is shared across a multidisciplinary group of dedicated individuals and retained within the organization.
Paramedics are increasingly having to provide culturally competent care to non-English speaking (NES) patients as a result of growing multiculturalism in our communities. Despite this, healthcare literature continues to highlight poorer levels of access to healthcare and overall poorer health outcomes in NES individuals. Since the COVID-19 Pandemic, expansions in the realm of ambulance telehealth have highlighted complexities with providing culturally appropriate care to NES speaking patients due to inherent communication barriers associated with telecommunication. Although there is existing research exploring the disparities in conventional telehealth use among NES patients, there is limited research of this cohort in the setting of ambulance telehealth where presentations tend to be more acute in nature. Therefore, the aim of this study is to explore the challenges of providing ambulance telehealth services to NES patients by identifying how telehealth specific key performance indicators (KPIs) of this cohort compare to English proficient patients.
Primary Immune Deficiency can develop into frequent and in some cases severe infections, and inflammation. With this cohort of patients being so vulnerable, they should be treated and assessed promptly when presenting to an emergency department with a fever. There remains a critical need in this specific population to optimise strategies aiming to improve the recognition as to which febrile patients require immediate intervention, and to identify if treatment can be withheld/de-escalated safely.
Currently there are limited guidelines and knowledge surrounding this specific population when they present to an ED creating a gap in research. This dissertation will aim to address this via:
Delirium in the older adult population is a common hospital complication linked to multiple adverse outcomes including longer lengths of stay, increased morbidity and mortality, greater cognitive and functional decline, and increased risk of re-presentation to the emergency department (ED). Patients with delirium can increase healthcare expenses by up to $30,000 extra per patient. This places a significant burden on the patient and the health system. The Geriatric Emergency Department Initiative (GEDI) has shown benefits in the ED management of older patients including reduction of re-presentations to the ED. However, the effectiveness of GEDI for older patients with delirium remains unclear. The aim of this research project is to compare clinical outcomes of older patients presenting to the ED with positive 4AT scores who received GEDI input versus those who did not, across a six-months period. The outcome measures will include ED length of stay and time to geriatric review.
Hypertension is a highly prevalent, chronic cardiovascular disease with considerable impacts to population health. Although hypertensive urgencies are common encounters in emergency departments (ED), there is a lack of clear guidance for their clinical management. A poorly managed hypertensive urgency can leave the patient with continuing severe hypertension and at increased risk of end-organ damage. The objective of this study is to determine the current management strategies for hypertensive urgencies in Queensland EDs, and to better understand the reasons for their use. We will survey Queensland ED physicians about their use of and opinions about current management strategies for hypertensive urgencies. We will also conduct a pilot single-site observational study of management strategies for hypertensive urgencies. The findings of this study will inform the design of future research to improve management of hypertensive urgencies in EDs.
Soon after injury, some individuals develop a condition where their body doesn't clot properly, leading to increased blood transfusions and increased mortality. An important aspect of clotting is a protein called fibrinogen which forms the scaffolding on which clots are formed. Fibrinogen is the first aspect of clotting that is impaired, but it is easily replaced if it is recognised with a specific blood test. Unfortunately this blood test may not be available rapidly in rural hospitals, which may lead to a delay in recognition. A scoring system called the Fibrinogen on Admission for Trauma (FibAT) has been developed in France, but includes criteria/interventions which we don't routinely do in Australia. In this study we will evaluate the FibAT's accuracy in detecting low levels of fibrinogen using data from 3 Queensland trauma centres. We will only use criteria that is available in rural settings.
This study is expected to show that even a modified FibAT is quite good at ruling in low fibrinogen so that it can be replaced early when a patient arrives in a rural hospital.
The Queensland Ambulance Service (QAS) provides out-of-hospital medical services to approximately 900,000 patients annually, and as the publicly funded provider of prehospital emergency care is called to respond to persons incarcerated within correctional facilities. The primary complaint of patients attended by QAS in this setting are minor orthopaedic injuries to the upper arm and hand. In current practice, paramedics provide short-lasting analgesia and temporary limb splinting or bleeding control, before conveying the patient to an emergency department for further management. Transport of patients from correctional facilities to public hospitals is complex, presenting potential risks to staff and the public, and is time consuming and resource intensive. As these injuries are predominately uncomplicated fractures or simple lacerations, it has been postulated these patients may be more appropriately managed by enhancing the care that can be provided onsite by the QAS, with the patient subsequently managed through an outpatient clinic and thereby avoiding an unnecessary presentation to hospital. This project proposes developing a new collaborative treatment pathway involving the QAS, QLD Health and QCS for patients with minor orthopaedic injury. The aim is to reduce unnecessary, time and resource intensive transports to hospital emergency departments for this cohort of patients. Grant funding is sought to undertake an evaluation of this initiative. This model of care provision, if proven effective, could potentially be considered for implementation in other correctional facilities or austere healthcare settings where primary health care resources are stretched, and consequently additional demands are placed on emergency care settings.
Emergency Departments are experiencing an ever increasing volume of patients presenting for medical care. At times, the number of patients in Emergency Departments can exceed the number of available beds. When this happens, sicker patients are allocated to treatment areas while those less unwell are required to wait in the waiting room. Some waiting room patients will inevitably become more unwell before being seen by a doctor. Measuring vital signs - blood pressure, heart rate, breathing rate, blood oxygen levels, temperature - is a proven method for early detection of deterioration in unwell patients. Emergency triage clinicians endeavour to measure vital signs of waiting room patients, however, their ability is significantly limited during period of insufficient staffing and overcrowded waiting rooms. Innovative, camera-based advanced sensor technology could facilitate automatic, contactless, vital sign measurement during periods where available resources are limited or overwhelmed. Contactless vital sign measurement could thus enable early detection of patient deterioration and improve patient safety in emergency department waiting rooms. Such technology has shown promise in recent studies but has not been rigorously tested in an Australian Emergency Department. This project will study one such technology to determine its reliability and accuracy in measuring vital signs in waiting room patients at Townsville University Hospital Emergency Department. If this technology is found to be reliable and accurate, this study will improve quality of care and safety for patients in emergency department waiting rooms.
Chest pain is a very common presentation to emergency departments and has wide variety of causes including life threatening conditions such as a heart attack and benign causes such as a muscular strain. Often the biggest challenge is to appropriately identify an individual's risk of suffering a heart attack, while ensuring that the harms associated with potential over-investigation are minimised. This requires an efficient and systematic risk stratification process, and has been the focus of a lot of research. Currently, in Queensland the approach to this challenge is to use a blood test called troponin, along with ECG, to determine an individuals level of risk. This allows a large number of patients to be discharged quickly, but also results in many people falling into an intermediate risk group. The Sunshine Coast Health Service has recently started using the internationally validated HEART Score to further risk stratify this intermediate risk group, to identify those who do not require further testing and those that are at a level of risk that do require further investigation. These patients are then seen in a rapid access chest pain clinic. This study assesses the safety of this pathway which is unique in the way it combines the two approaches, and in that it assessing patients who are intermediate risk by HEART Score in an outpatient setting when normally they would be admitted to hospital.
Nausea and vomiting are common reasons for people to call an ambulance. In Queensland, paramedics can provide a medication called Ondansetron to reduce the severity of nausea and vomiting. Alternative medicines, such as metoclopramide and droperidol, are also used in the emergency department or by ambulance services in other states. Despite the widespread use of medications for nausea and vomiting, little is known about their effectiveness in the prehospital setting. The limited evidence that exists comes from small studies in the emergency department setting, and indicates that medications may be no more effective than placebo for reducing nausea and vomiting. In this study, we aim to determine the effectiveness of medicines for nausea and vomiting in the prehospital environment. We will randomly assign patients who have nausea and/or vomiting to receive either ondansetron, metoclopramide, droperidol or a placebo as a prehospital treatment. Patients will rate the severity of their symptoms before and after receiving the medication, and we will compare these symptoms between groups to identify the most effective medicines. The study will help to optimise the treatment provided to the large number of patients who call an ambulance for nausea or vomiting.
Injury and trauma are common presentations to Queensland Emergency Departments. Clinicians caring for trauma victims must maintain competency with trauma procedures and interventions to apply them in a time-critical context, accurately, and therefore achieve the best outcome for individual patients. Engagement with traditional educational approaches, such as face-to-face training, is challenged by workload, shift patterns, clinician location and lack of opportunity to attend dedicated training events. A previous learning needs analysis of trauma education programs has highlighted that the greatest challenges are often faced by clinicians in rural and remote locations. One solution is to include the use of online learning platforms, to connect and assess clinician knowledge, with positive feedback regarding the engagement and experience for the learner. This study aims to use high-fidelity interactive online education, using a range of technologies including 360 videos with user interaction capabilities to design and develop a scalable model for future-proofing trauma education across Queensland. The research will test the effectiveness of (1) the approach to design and development in terms of scalability and (2) the online resources and assessment procedures in terms of the impact on knowledge and skill development.
Older persons from residential aged care homes (RACF) have unique needs that are often overlooked in our traditional emergency departments (EDs). This can lead to under triage, prolonged length of ED stays, unnecessary investigations and iatrogenic hospital acquired complications (1). The Residential Aged Care District Assessment and Referral Rapid Response (RADAR RR) model is a pre-hospital Queensland Ambulance Service (QAS) co-responder model providing ED equivalent care in the resident’s home for acute illness and injury. RADAR RR model operates between 0800 and 2000, 7 days a week. We hope to evaluate the clinical and cost outcomes of the RADAR RR model and determine if it is equivalent to the care provided by traditional ED models of care in an urban setting. We will also review the structures and processes required for effective service delivery which will in turn guide the development of a toolkit to assist other hospitals in adopting the RADAR RR model if appropriate for their area. Finally, given increasing pressure for high value models of care we will undertake an economic evaluation to determine if the RADAR RR model is more economically efficient than the traditional ED model of care.
Although pain is the most common reason for children to come to the emergency department (ED), it is frequently under-treated and under-recognised. We know children are particularly vulnerable to inadequate pain care, relying on adults to interpret their pain and act as advocates. A recent audit of children presenting in pain at Redcliffe ED found that many children with broken arms waited for prolonged periods (48 – 174 minutes) for pain medicine. The Redcliffe ED team identified significant barriers to pain care: staff’s inability to identify pain in children, lack of parental/clinician advocacy and lack of knowledge around paediatric medicines. To address this deficit in pain care, the Kids Pain Collaborative (KPC), an interdisciplinary collaboration of experienced ED clinicians, academic nurse researchers and ED consumers, has been established to transform paediatric pain care in Redcliffe ED.
The KPC is committed to optimising ED pain care at the systems level so that no child has to wait in pain. Our aim is to co-design, implement and evaluate an innovative evidence-based model of paediatric pain care which will begin with the child and family at triage. Engaging families in pain care assessment, optimising pain care processes and facilitating a workplace culture of prioritising pain is key to the success of this project. This project aims to reduce suffering for children and their families and inform paediatric pain care practice and policy at a State level. Research design draws on recent successful implementation research undertaken at the Queensland Children’s Hospital ED (1).
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.
Arterial injuries to the lower limb, such as from a shark bite or deep laceration, can lead to catastrophic bleeding and death. Current first aid measures involve trained personnel applying an arterial tourniquet. However, even a short delay in haemorrhage management can lead to significant blood loss, brain injury or death. There is growing evidence that the simple technique of applying pressure to the groin can effectively occlude blood flow through the femoral artery, buying time for medically trained personnel to attend. One potential application of this technique is the treatment of shark attack victims with lower limb injuries, where beachgoers without medical training who have only seen a sign on a beach could apply life saving first aid. There is plethora of other potential applications outside marine encounters where this technique could be critical in reducing blood loss such as limb trauma from motor vehicle accidents, workplace injuries or military settings. The benefits are the simplicity of the technique which may be both easily and effectively performed by bystanders with no medical training. Using a non-clinical environment, we intend on performing a randomised trial to evaluate the efficacy of non-medically trained beachgoers performing pressure points compared with the application of a commercial arterial tourniquet after reading an infographic. We will measure the reduction in arterial blood flow using doppler ultrasound. The project aims to generate translatable research with the goal of influencing local, national, and international first aid guidelines.
Pulmonary embolism (PE) refers to blood clots in the lung. They can cause sudden death, collapse, chest pain, shortness of breath yet sometimes they cause no symptoms at all and are discovered incidentally. As they can be severe, they have become regarded as a not-to-miss diagnosis. As they can present with a variety of symptoms, emergency clinicians consider the possibility of PE on a frequent basis.
When considering whether a patient has a PE, the clinician may confirm or exclude the diagnosis directly with definitive chest scans. However, these scans are time consuming, costly and have other side effects including exposure to radiation and to chemical contrast agents. When patients are assessed to be less likely of having a PE, it is often possible to safely exclude PE by applying a set of clinical decision rules or doing a blood test called a D-dimer. If the level of D-dimer is below a certain threshold, then PE can be excluded.
We aim to safely exclude PE without scans where possible. Evidence has been building that employing a higher D-dimer threshold is reasonable, yet uptake of this newer approach is limited. We hope to demonstrate that a higher threshold can work in Australia without compromising safety. This will be a large study that answers this question and if shown to be the case, then patient care can be improved while using less resources in busy emergency departments.
We propose to conduct a multi-centre blinded cluster cross over randomised clinical trial (RCT) of plasmalyte (PL), a balanced salt solution versus normal saline (NS) in patients admitted to an Intensive Care Unit (ICU) with diabetic ketoacidosis (DKA), a life-threatening complication of diabetes mellitus. DKA results in elevated acid levels in the blood leading to severe dehydration and electrolyte imbalance.
ICU admission rates for patients with DKA in Australia has risen annually. In 2019 and 2020, there were 2751 and 2812 admissions to ICUs respectively. Almost all patients present through the Emergency Departments and in regional hospitals, they are often admitted to the ICU.
NS is often used as the first line fluid for dehydration, but NS use frequently results in persistent acidosis. We have shown in a pilot trial, conducted in 7 Queensland regional Emergency departments and ICUs, that the use of a balanced salt solution such as PL resulted in a more rapid resolution of acidosis with trends to shorter length of ICU and hospital stay as compared to NS. The efficacy of PL in DKA needs evaluation in a large clinical trial.
We plan to study 480 patients from Australia of whom a third will be expected to be enrolled in Queensland. Patients will be randomised to receive either NS or PL and the primary end point is hospital length of stay. This proposed trial will answer a fundamental clinical question and will inform policy and practice in Australia and New Zealand and around the world.
Abdominal pain is one of the commonest reasons for children to attend the emergency department (ED), and acute appendicitis is the most common cause of abdominal pain requiring surgery. There are various clinical prediction scores that have been developed to help doctors diagnose appendicitis; however, most scores were developed overseas and are not routinely used in Australian EDs. The aim of this project is to review different published scores and compare them with overall clinician impression in diagnosing acute appendicitis in children presenting to ED.
The project will include all patients presenting to the ED with abdominal pain that are having investigations for possible appendicitis. The treating doctor will be asked to complete a case report form detailing patient history, examination findings, investigation results, as well as their overall clinical impression of the patient’s likelihood of having the diagnosis of appendicitis. Data collected will be analysed by project researchers to determine which scores are the most helpful for clinicians in diagnosing acute appendicitis in children presenting to Australian EDs, with the expectation that this will improve future care provided to children with abdominal pain.
Injuries confer a substantial burden on ambulance services. Ensuring optimal pain management for injured patients in the out-of-hospital setting is imperative, and even more so for those living in rural/remote areas, where transportation times to hospital may be longer. There is evidence for the potential for improvement in pain relief in the out-of-hospital setting. Inadequate pain relief has lasting negative physiological and psychological implications and decreases overall quality of life. While there is little research focusing specifically on management of pain incurred through trauma in regional/rural/remote environments, there are several reasons that pain management may be suboptimal in rural/remote trauma patients, compared with patients in major cities. This research aims to describe pre-hospital pain management for trauma patients in regional/rural/remote Queensland and to compare this with pain management provided in major cities. Secondarily, we aim to identify and describe perceived barriers/facilitators of optimal pain management among paramedics in rural/remote areas, compared with those in major cities. This study will incorporate three components:
Ultimately our goal is to identify explicit opportunities to mitigate barriers and enhance enablers to optimise pain management for those experiencing trauma in rural/ remote settings.
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.
Fibrinogen is a component of blood that is vital in the formation of blood clots, and low levels are often found in trauma patients who are bleeding. Low levels of fibrinogen cause problems with blood clotting and result in ongoing bleeding. Replacement fibrinogen has only been available in major hospitals which has been a problem given that the majority of trauma patients (most from the result of road accidents) treated by pre-hospital medical services are in rural and remote areas where this has not been available. Fibrinogen concentrate (FibC) is being introduced into Queensland’s pre-hospital and retrieval services to improve equity of access and facilitate early administration to patients that are critically bleeding. This study aims to evaluate the effectiveness of early FibC administration for bleeding trauma patients in the pre-hospital and retrieval setting and is the first study of its kind to do so. Should the study find a significant benefit of this early administration it will result in improved outcomes for such trauma patients, and has the potential to modify international medical practice in the management of bleeding trauma patients.
The aim of this application is to increase participation in research, strengthen research culture and systematize research processes within SCHHS ED. The strategic vision is the development of systems and structures that encourage and support researchers and invite participation in research. The central element of this application is the implementation of a Research Manager who will establish processes for tracking and applying for grants, completing research governance requirements, recruiting and supporting new researchers, and developing networks. To ensure there is minimal disruption to the ongoing research activity of SCHHS ED while the Research Manager role is being implemented this grant will also include funding for a 0.1 FTE Research CN. The support from these positions will be extended to the SCHHS Trauma Service, which is an important partner to the ED and is early stages of developing research capability. The expected benefit of this grants is that there will be a more prominent research culture in the ED, there will be more research projects within the ED, and the ED will achieve greater success in applying for research grants.
We propose to establish a 0.4FTE Research Coordinator role at RSQ to lead development of research capacity and culture within the agency, and provide support across our partner organisations – Lifeflight Retrieval Medicine (LRM) and the Royal Flying Doctor Service (RFDS) – QLD Section.
The Research Coordinator will provide a dedicated research focused role that will form part of the Research Leadership Team within RSQ, reporting to the RSQ Clinical Director for Research and Evaluation. They will be a key liaison with research partners and collaborators across the broader health sector, working closely with the Clinical Director.
It is anticipated that through the provision of dedicated research expertise and resourcing this position will greatly assist with the development of research capacity and culture within RSQ, and in turn RFDS and LRM. The proposed contribution of this role to the development of an RSQ Research Strategy will support identification of areas of research priority for the agency and provide a platform to foster collaborations with clinicians and researchers with shared interests, thereby building RSQ’s research network. Importantly, establishment of a Research Governance Framework will increase accessibility to RSQ data, staff and patients for the purpose of research, whilst providing a clear and risk managed process for overseeing all research activities, which is a vital function in supporting the agency’s growing research capacity.
Insertion of intravenous (IV) cannulas (often called a drip) in children is difficult and potentially distressing for the child and their family. The goal of this project is to use the best evidence available to improve and standardise the procedure of placing the drip, so we improve our success on the first attempt and reduce complications. The evidence-based bundle includes a decision-making guide, visual pictures, and resources to support staff performing the procedure. Best practice techniques include appropriate pain relief, holding and distracting the child well, and dressing the drip securely so it is less likely to fall out. The project will describe how well the resources are used, and will hopefully show improved practice, meaning it is more likely the drip is inserted successfully on the first attempt, less likely to fall out, and there are less complications such as infection, excessive pain, or reinsertion.
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.
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.
Nationally, 1-2 % of the population will sustain a significant bleed due to the rupture of an abnormal ballooning of the blood vessels within the brain. A complication of this, called hydrocephalus, requires a drain to be inserted into the brain to reduce excessive fluid build-up, until the definitive management is achieved. Advances in interventional radiology techniques such as endovascular coiling have become common practice in the management of these patients. In Queensland, endovascular coiling is mostly performed in Brisbane, and therefore patients outside of the Brisbane area are required to travel for this treatment. For critically unwell patients in North Queensland, the only option is aeromedical retrieval. This area of aeromedical retrieval has not been previously explored therefore this project will look at the safety of aeromedical transports of patients with an invasive drain in a patient’s brain to work towards statewide guidelines.
Since the introduction of COVID-19 immunisations for young people aged 0-16yrs, patients and families have presented to the Emergency Department (ED) with concerns about possible side-effects. There have been rare but potentially serious complications of these immunisations reported worldwide including inflammation of the heart muscle and lining. These patients therefore need careful assessment and investigation in the Emergency Department.
This study will measure the number of patients presenting with these concerns, how they have been cared for and the outcomes of these assessments. It will assess the impact on Emergency Department (ED) resources and whether guidelines for assessment and reporting side effects have been followed. This information will be used to improve care pathways for this group of patients in the future.
Upper limb injuries including bony fractures/dislocations, are sometimes deformed and require realignment in the emergency department (ED). Numerous techniques are available to allow this procedure to be painless. Bier block (BB) involves placing a band on the upper part of the affected arm to constrict blood flow, with injection of numbing agent into a hand vein on the same side to make the entire arm numb. An alternative technique is ultrasound guided supraclavicular blocks (UGSCB), which involves introducing a needle under ultrasound guidance to nerves situated just above the collar bone and injecting numbing agent around these nerves to make the arm go numb. However, the effectiveness of UGSCB when performed by ED doctors is unknown and patients might recover more quickly. We aim to conduct a randomised trial to compare UGSCB versus BB for re-aligning fractures/dislocations of the upper limb in the ED.
This research project will examine the impact of implementing a point of care lactate machine on the earlier administration of antibiotics in paediatric patients diagnosed with sepsis in the Emergency Department. Elevated lactate levels have been shown to be an accurate prognostic factor in predicting morbidities among patients with sepsis. Current practice requires serum lactate samples collected via intravenous cannulation, a task that is both time consuming and challenging for paediatric patients and clinicians. The point of care lactate machine is a portable, single operator handheld device, requiring finger-prick blood sample to obtain an accurate lactate result. This negates the need for intravenous cannulation to obtain objective data to aid clinical decision making. This may result in the earlier recognition of sepsis, administration of antibiotics and transfer to definitive care.
Queensland Ambulance Service (QAS) Critical Care Paramedics are authorised to perform reduction of displaced fractures and dislocations in the presence of neurovascular compromise. This is frequently facilitated by procedural sedation with ketamine. Performance of this procedure in the prehospital setting is not well reported in the medical literature
Using the QAS database of electronic Ambulance Report Forms we will identify all cases where fracture or dislocation reduction was performed and report on the efficacy of this procedure using resolution of neurovascular compromise as the primary endpoint. We will use the requirement for further sedation and reduction in the emergency department as a secondary measure of the success of the procedure. The incidence of adverse events related to the sedation or to the procedure will also be reported.
Shock is an umbrella description for poor blood supply to vital organs, and can lead to multi-organ failure and death. Emergency department (ED) patients with shock are amongst the sickest, with 1/3 being admitted to an intensive care unit (ICU). Low blood pressure, a key feature of shock which causes the poor blood supply to vital organs, can be treated with medications called vasopressors. Vasopressors traditionally have been given through a so-called 'central line'. Central lines are invasive to insert and require skill, and the actual insertion can lead to complications. More evidence has emerged that so-called peripheral lines (aka 'drip') are safe for vasopressor infusion. Randomised controlled trials (RCT) to compare the two strategies will provide high quality data to inform clinicians as to which approach is best for patients, staff and the healthcare budget. We propose a feasibility RCT to test processes and inform a large phase-III RCT to definitively answer this question.
Consumer engagement in research is a local, national and international priority and has been described as research being carried out ‘with’ or ‘by’ consumers, rather than ‘to’, ‘about’ or ‘for’ them. Our recent scoping review on patient and public involvement in international emergency care research (under review) found only two (of the 28) studies were undertaken in Australia and reported consumer engagement in Emergency department (ED) research, illustrating that the vision of integrated consumer and community engagement in research is a long way from the current reality.
Consumer engagement can improve the quality and relevance of research, identify unmet needs, reduce wasted research efforts, and improve ED services and patient experiences, particularly for vulnerable and high-risk patient groups. Whilst there has been an increase in consumer engagement in international research, opportunities for consumers to contribute to emergency care research in Australia are scarce and there are very few documented studies of consumer engagement in ED research.
This project aims to understand the current challenges and barriers to consumer engagement being undertaken in ED research, both in Queensland and nationally in Australia. The project will also identify readiness for consumer engagement, exploring the factors which influence, drive and support researchers to engage consumers in ED research. In addition, it will also scope the potential for a statewide / National Emergency collaborative network for Consumer Engagement and assess support among key stakeholders in emergency care in Queensland and nationally.
There is a need to focus on the vulnerable type 1 diabetes (T1D) population who represent a disproportionate burden on the Australian healthcare system and who require better standards of care. Building upon our previous work, the project is an important step in determining the supports available to patients with T1D around diabetic ketoacidosis (DKA) prevention and management, outside of traditional emergency department (ED) settings and regular business hours. This is in addition to perceptions around the use of a telephone or virtual service to help prevent diabetes ketoacidosis presentations. The analysis will provide baseline comparative data for later intervention studies, and in helping to provide the evidence-based solution, perhaps in the form of clinical pathways of acute and preventative healthcare services that can be tested in later projects. We expect the impacts of this project will include: a reduction in DKA presentations (which would potentially reduce morbidity and mortality), and lessened ED presentations, workload, and both hospital admissions and economic impact. Collectively, this would attract national and international interest in Queensland emergency healthcare research.
Many patients who present to the Emergency Department with painful conditions have extensive delays to receive pain relief. This may result in unnecessary discomfort for patients and can also mean that patients have an extended length of stay. This study focusses on improving the pain relief given to patients who present to the Emergency Department with chest pain. The study has multiple aims. The first is to identify how long patients presenting to emergency department with chest pain wait to receive adequate pain relief. The second is to document how delays to pain relief impact on the patient and on the healthcare system (in terms of greater hospital admissions, longer length of stay and the types of cardiac testing that can be performed). The third aim is to see whether a novel education campaign highlighting the importance of providing pain relief as soon as possible after the patient presents to the Emergency Department can reduce the length of time before a patient is provided pain relief. This campaign will particularly focus on the nursing staff and will empower them to advocate for rapid pain relief. It is anticipated that this campaign will reduce the time taken to provide pain relief to patients. It is also hoped to reduce hospital length of stay and hospital admissions. This study is important for improving patient comfort and improving patient and health service outcomes.
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.
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.
Aboriginal and Torres Strait Islander (A&TSI) people presenting emergency departments are more likely to experience difficulty in communicating with healthcare providers, feel isolated, and experience shame and distress. These feelings lead to them leaving before they have been seen, or leaving before their treatment is completed, and they experience poorer health outcomes. Cultural safety is the ability of an organisation to meet the cultural needs of a group of people, and improved emergency department cultural safety has been shown to reduce rate of Aboriginal and Torres Strait Islander people leaving without being treated or before their treatment is completed. The 15 Steps Challenge Toolkit was developed in the NHS and is effective in assisting healthcare providers to see a clinical space “through the eyes of consumers”. This project aims to adapt the NHS 15 Steps Challenge toolkit to make it relevant to the experience of Aboriginal and Torres Strait Islander peoples using co-design methodology based on the “Yerin Dilly” model, which outlines values and processes to make research culturally safe. The project will be conducted in three phases to develop, trial and evaluate the Deadly Steps process. It will use both qualitative and quantitative methodologies to evaluate the process. The impacts of this project will be an improved process for evaluating and identifying opportunities to improve cultural safety, new cultural safety educational materials for healthcare providers, and improved experiences for Aboriginal and Torres Strait Islander people attending emergency departments in the Redcliffe, Caboolture, Sunshine Coast University, and Nambour hospitals.
The emergency department (ED) is a stressful workplace. The stressful work environment has resulted in high levels of psychological distress with some using mal-adaptive coping strategies. High staff turnover is evident in some EDs. To guide the development of strategies for clinicians, health services, policy makers, and emergency colleges, this research will provide a national picture regarding the impact of stressors on health and performance.
The well-being of staff is a priority for Emergency Medicine and Nursing colleges in Australia. Research reports have emerged highlighting concerns with post-traumatic stress, sleeping problems, cardiovascular disease and increasing rates of suicide among healthcare staff. This research is critical to address such concerning trends.
This multi-disciplinary research collaborative is new, consisting of expert clinical and academic leaders from emergency nursing and medicine coming together to provide a robust approach to understand, from a national perspective, where opportunities exist to enhance clinician wellbeing and the effectiveness of local, state, or national practice or policy measures, through the longitudinal design.
This research will provide a comprehensive Queensland, as well as a national understanding of the impact of stressors on the health and performance of ED staff. When applied longitudinally, the questionnaire can be used to evaluate the outcomes of interventions and policies that seek to promote positive coping strategies for ED clinicians.
Chronic liver disease (CLD) is prevalent in Australian society and is the 11th leading cause of premature death (1). Thirty eight percent of patients experience gastrointestinal bleeding (GI) as a complication(2). The underlying balance between bleeding and clotting tendency is altered in chronic liver disease, making management of acute bleeding challenging in the emergency setting(3). There is a lack of high-quality evidence to guide the best combination of blood products and other medications to stop bleeding(4).
Prothrombinex®-VF is a blood product which can help to improve the level of clotting factors in the body thereby reducing bleeding tendency. It is indicated for anticoagulant reversal in acute bleeding(5). In practice many emergency physicians have used the product for patients with chronic liver disease who present with acute bleeding, although it is not licensed for this indication(6).
A retrospective Queensland study performed by this author showed that half of Prothrombinex®-VF usage for liver disease was in the emergency department by emergency physicians. It suggested that the product makes little impact on reversal of laboratory blood clotting tests and it raised important safety concerns regarding the develop of a syndrome of accelerated bleeding and clotting concurrently(6).
This expanded statewide audit of Prothrombinex®-VF in chronic liver disease in Queensland seeks to define efficacy and safety of the product. There is no statewide guideline for Prothrombinex®-VF and this data will contribute valuable information to developing future guidance for clinicians.
Acute severe behavioural disturbance (ASBD) is an emergency situation where a patient experiences severe agitation or aggression. These individuals commonly present to the emergency department (ED) for treatment. Medications are often provided to assist the person to feel calmer. In most instances, oral medications are used. When the patient is extremely agitated, an intramuscular (IM) injection will be given.
In individuals less than 18 years, there is minimal available evidence to guide doctors about which medications work best. It is also not known how well these medications are tolerated by these young people. Therefore, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network is running two trials across a number of Australian EDs to create evidence to be used to guide the treatment for these young people.
The first study (PEAChY-O) compares two oral medications - olanzapine and diazepam - to determine which medication works better. The second study (PEAChY-M) compares two IM medications – olanzapine and droperidol. These medications were chosen because they are used as standard of care in Australian EDs and are recommended on current Clinical Practice Guidelines (CPGs). These are important studies because they will be the first trials to compare any medications head-to-head in a randomised trial across either the oral or IM routes.
Once the results are available, they will be used to guide future clinical practice including influencing the recommendations made in Australian guidelines, ensuring that these young people receive evidence-based treatments.
Severe infection (sepsis) takes the lives of over 2000 Queenslanders every year. Despite this toll and intense global research, few advances and innovations have improved sepsis management for decades. The TEAM SEPSIS project comprises three studies to improve the diagnosis and treatment of patients with sepsis in the Emergency Department (ED).
ICARUS-MD is a randomised controlled trial assigning patients to receive or not receive albumin in addition to standard sepsis care. Albumin will be commenced in the early phase of emergency treatment and continued each day for ten days. Albumin has the potential to improve outcomes if started early in the ED - ICARUS-MD may provide much needed evidence.
ARTEMIS is an observational study in a subset of ICARUS-MD patients with blood samples taken across several time points to determine the effect of albumin on the function of the critical lining of small blood vessels – the endothelial glycocalyx.
BETTER aims to improve the investigation of septic patients in ED by validating a novel test for bacteraemia in patients at highest risk for this condition. The study will use patients from the ICARUS-MD cohort as well as other emergency patients with low white cell count and suspected infection. Earlier diagnosis of bacteraemia enables directed therapy, improves patient outcomes, and conserves our most powerful antibiotics for patients who need them.
This programme of collaborative research involving ED and infectious diseases clinicians promises to advance knowledge of the best approach to diagnosis and treatment for emergency patients at highest risk from sepsis.
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.
Wheeze is one of the most common emergency department presentations for pre-school aged children. The typical treatment regime involves early review by a medical officer or nurse practitioner and an intensive “burst” of inhaled salbutamol therapy, followed by an admission to a short stay unit to wean inhaled salbutamol therapy to 3-hourly. The medical officer or nurse practitioner will review the child hourly to establish the need for further treatment or the capacity to increase the interval between salbutamol therapy. As they manage a concurrent case load in both the emergency department and short stay unit, there are often delays in bedside assessment and administration of salbutamol. During the COVID-19 pandemic, the substantial increase in wheezing presentations caused significant bed pressure, waiting room overcrowding and poor patient flow. Nurse Led Stretching of Inhaled Salbutamol (NLSIS) is a pathway that optimises registered nurse’s skills and scope of practice to perform a detailed respiratory assessment on a child presenting with a wheezing illness and determines when the next dose of salbutamol should be administered. The aim of the project is to evaluate whether NLSIS reduces short stay unit length of stay optimising patient care and patient flow in a children’s emergency department and short stay unit.
The Emergency Department Short stay unit (EDSSU) is used to facilitate flow through the Emergency department (ED) for patients requiring further investigations, treatment or period of observations, with the likely disposition of home. Current access block issues and increasing patient presentations means the SSU is consistently full, with multiple patients waiting to be transferred to this unit. Furthermore, limited medical staffing with only one junior doctor to follow up on these patients creates an exit block during periods of increased activity. Criteria Led discharge (CLD) is a proposed strategy that allows for safe and timely discharge of patients by nursing staff from the EDSSU once diagnosis-specific criteria have been met without the need for final medical review. Post initial assessment and investigations, medical staff can identify specific patient cohorts for the CLD pathway. Nursing staff can then discharge patients once criteria is met. CLD is not a new concept; being used among wards and paediatric centres statewide, however it has not been utilised within the adult emergency space in Queensland to the best of our knowledge. This process will decrease length of stay (LOS) within the ED and EDSSU, increasing patient satisfaction with the healthcare service, redirecting medical resources allowing medical staff to prioritise acute patient presentations or perform critical emergency procedures, and alleviate pressures created by medical sick leave when no residents can be allocated to SSU as nursing staff can manage and discharge this cohort of patients using the CLD pathway.
The physical health equivalent of a relapse in a mental health patient would be a repeat stroke or heart attack. Episodes may be fatal and the chances of full recovery decreases with each episode. Every effort must be made to detect and prevent emerging crisis in the community. Currently, patients present to Emergency Department (ED) despite being open to community case management, using precious ED resources. There is limited evidence regarding reducing unplanned ED presentations, with some needing psychiatric inpatient care. Princess Alexandra Hospital employed a Transition Coordinator to support the care of people who are deteriorating in the community. The Transition Coordinator has been collating a unique dataset, names of patients who have been flagged as deteriorating and have received support successfully, as well as those who have had unplanned presentations to ED or have needed admission. Our proposed study will analyse this dataset and identify key defining characteristics of planned and unplanned admissions. We will also survey patients, families and staff regarding what helps in a crisis and why they presented to the ED rather than to the community clinic. A clinical audit of the notes will also provide information on what happened in the lead up to an unplanned admission. In-depth interviews with patients and supporting family and staff will provide further insights. The findings will inform service changes. They will be pulled into a replicable package to free up ED resources and inpatients beds through provision of early detection and treatment in the community.
There have been significant increases in system pressure for unscheduled public healthcare in Australia. Likewise, ambulance services have seen an unprecedented increase in demand for services along with a change in ambulance utilization. These pressures affect all aspects of patient flow, from triple zero call through to hospital admission and discharge. Improvements in the integration of prehospital services into the healthcare system can reduce time delays at their interface. Triage and clinical deterioration tools guide clinicians' decisions when directing patients to clinical streams within the emergency department whilst balancing patient safety. Paramedics are highly trained clinicians, that are well placed to assess and determine a patient’s clinical priority and potential for deterioration. If paramedics can demonstrate their application of validated triage and clinical deterioration tools to efficiently and safely direct patients to the most appropriate facility and/or clinical stream within a facility, then there would be potential time savings across the system. Furthermore, this would provide a validated tool to identify patients that are safe to be referred to the virtual emergency department. This study proposes to assess paramedics' ability to apply triage and clinical deterioration tools to identify the clinical stream either within an emergency department or via the virtual emergency department. If successful, this process could improve patient safety while reducing delays at the ambulance and emergency department interface.
Older patients with minor head injury routinely get a head scan in emergency departments due to the risk of a brain bleed. Recent studies have suggested that some of these patients may not need a head scan. However, doctors do not currently have an accurate method to identify those patients who do not need a scan.
This research aims to identify a subgroup of older patients with minor head injury who do not have a brain bleed and can be safely managed without a head scan. As there are no known Australian studies in this area, this innovative project addresses a common problem in a vulnerable group of patients with several potential benefits.
The study will inform emergency doctors about the feasibility of larger Australian studies to develop a reliable and accurate method to identify older patients who do not have a brain bleed and do not need a head scan. Such a method could benefit patients by reducing transfer from rural and remote communities to bigger hospitals for a head scan, reducing waiting times in emergency departments and reducing exposure to radiation. Such a method could also have significant cost savings to the Australian healthcare system by reducing costs associated with patient transfers, head scans and prolonged emergency department wait times.
Queensland’s dispersed population poses significant challenges to emergency trauma system design, requiring both road and aeromedical retrieval services, trauma outreach services and specialist transfer protocols for time critical injuries to maximise survival.
Road trauma is one of the main mechanisms causing traumatic brain injury (TBI). Pinpointing geographic regions with significant disadvantage for timely access to neurosurgical services is needed for targeting education, treatment and outreach services to Queensland regions most in need.
The Injury Treatment and Rehabilitation Accessibility Queensland Index (iTRAQI) is a tool being developed by this team, and piloted for TBI. iTRAQI maps aeromedical/road transport access routes and uses travel time to acute neurosurgical and rehabilitation services to rank accessibility among Queensland localities under realistic scenarios.
This project will map actual pathways to definitive neurosurgical care for moderate-to-severe road trauma-related TBI and compare them to modelled iTRAQI pathways using linked prehospital, emergency, hospitalisation and compensation data.
Falls in the elderly community-dwelling population are a common presentation to Australian Emergency Departments (ED). The Australian Institute of Health and Welfare reported an estimated 125,000 people aged 65+ were hospitalised due to falls in 2016/17. Fallers presenting to the ED that are elderly and frail, may then be discharged directly home.
The Clinical Frailty Scale (CFS) has been widely used and is associated with mortality, comorbidity, increased length of stay and falls (Church 2020). Despite its expansive utilisation, no studies have assessed the correlation of CFS scores with re-presentation to the ED following a fall.
Improving the ability to identify patients who are at risk of re-presenting with falls could aid in focusing physiotherapy and allied health resources towards these patients during their initial ED presentation.
Stroke is a leading cause of death and one of the most common causes of disability in Australia. For ischaemic strokes occurring secondary to a large vessel occlusion (LVO), mechanical thrombectomy is an effective intervention, with the outcome largely dependent on time to thrombectomy.
This study will analyse the assessment, management, and clinical outcomes of patients presenting to the ED with acute stroke, with a particular focus of those undergoing mechanical thrombectomy. Researchers aim to determine variability of workflow and decision-making processes that may occur after-hours. Based on current literature, variability may have a corresponding deleterious effect on patient outcomes.
By reviewing workflow processes and identifying relevant time barriers in a Queensland Comprehensive Stroke Centre, researchers aim to inform the future design and implementation of “Code Stroke” clinical pathways in Queensland.
Healthcare in general and Emergency Departments (ED) in particular are stressful environments associated with excessive work demands, long hours and often limited support.
These pressures are compounded by staff shortages, fiscal constraints and increased ED presentations and patient acuity. Against this background where resources are so stretched, the COVID-19 pandemic poses intense and prolonged pressure.
The cumulative impact of chronic stress adversely affects the physical, mental, and social wellbeing of ED staff, leading to burn-out and to difficulties with staff recruitment and retention, decreased morale and job satisfaction.
Promoting staff wellness may enhance their ability to cope with occupational stress through support systems, development of resilience and building social connection. However engaging staff who are chronically stressed is a challenge.
It has never been timelier to identify effective evidenced based strategies that promote wellness and can be rigorously evaluated for the ED context. This project aims to qualitatively assess ED staff perceptions of Workplace Wellbeing activities, their views on measures to improve engagement, and perceptions of how to improve staff engagement with these interventions, especially in the context of chronic workplace stress.
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.
Blood cultures are tests performed to identify whether patients have pathogens in their blood, such as bacteria and fungi. Emergency clinicians frequently order blood cultures to prescribe appropriate antibiotics for patients. Blood cultures are particularly important to rapidly identify and treat severe infection.
For test accuracy, the best time to collect blood cultures is before a patient has received an antibiotic. However, patients with severe infections may have multiple sets of blood cultures taken over several days. It is unknown whether taking multiple blood cultures improves patient care.
This study will investigate how many patients have repeat blood cultures and whether subsequent blood cultures yield the same result. If found to be redundant, it may be possible to avoid unnecessary blood tests, improve patient comfort, decrease costs to the health service, and reduce practitioner workloads.
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.
The “Buddy Study” funded in the EMF grant round 25 showed a common type of hand fracture can be treated without a plaster – a finding that if applied broadly could result in patients returning to work faster and significant healthcare savings. However, since the study was published in 2019 it is unclear to what degree there has been a change in how clinicians actually treat this fracture.
This follow up study will explore factors related to research reach, adoption, and implementation at two hospitals in Queensland to 1) inform a strategy to implement knowledge related to hand fractures and to 2) explore how participation in research affects implementation.
Communities of practice (CoP) are widely used to strengthen and enhance healthcare, by generating and sharing knowledge and improving organisational performance. In Australia CoPs have been used in fields such as healthcare improvement, mental health and mental health literacy, and workplace health and wellbeing and more recently in response to COVID 19.
This project will assess the possible scope for a CoP, and the extent to which a CoP might find support among collaborating service organisations, to focus attention on issues surrounding emergency mental health presentations to hospital emergency departments (EDs) in north Queensland.
Head injury results in a high degree of ongoing disability. Risk of Traumatic Brain Injury (TBI) is higher in the 15-19 and 75+ age groups with older Australians having a three times greater incidence compared to the general population (Pozzato, Tate, Rosenkoetter, & Cameron, 2019).
There are two distinct aspects to a severe head injury - the primary injury and the secondary injury that occurs as a result of deranged brain functioning. Treatments are targeted at minimising the damage occurring during the secondary stage and to protect damaged brain tissue by optimising blood flow, oxygen delivery and reducing the metabolic needs of the brain.
There is currently no way to closely monitor the 'real-time' physiologic changes beyond clinical symptoms such as changes in pupil size, heart rate, blood pressure etc. and, in the case of rising pressure in the brain, treatment is initiated on clinical suspicion alone. Electroencephalograms (brain wave monitors) have shown promise in their ability to detect brain oxygen starvation, seizure presence and increased pressure in the brain.
This pilot of Quantitative EEG (qEEG) will measure these changes during prehospital care of TBI, the results of this research would be used to guide larger studies into the use of this technology.
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.
The current assessment for emergency department (ED) patients with chest pain focuses on the short-term risk of heart attack, to differentiate low risk patients from those at high risk and requiring further treatment. This has been shown to be safe and effective for non-Indigenous patients, however, deaths from heart attack in Indigenous Australians occur, on average, at younger ages than non-Indigenous Australians.
Due to the high lifetime prevalence of heart attack in Indigenous Australians, ED investigations that focus on both short- and long-term risks may improve outcomes. Understanding rates of, and the types of patients who have coronary artery disease in this cohort would provide additional information about who requires further testing.
The aim of this study is to measure the rate of coronary artery disease in Aboriginal and Torres Strait Islander people who present to the ED with chest pain. By identifying how many Indigenous patients with chest pain in the ED have coronary artery disease, researchers aim to establish foundational knowledge to develop a heart attack risk assessment that is specific to Indigenous patients.
Each year 40,000 Australians suffer a stroke, most of which arise from interruptions in the blood supply to the brain. Treatments for stroke focus on restoring the brain’s blood supply to limit the number of brain cells which die. Patients who suffer stroke due to a blockage of the arteries supplying the brain (LVO-stroke), benefit from surgical restoration of the blood supply (known as endovascular clot retrieval, ECR), but this is only effective if performed within 24 hours of stroke onset.
Rapid detection of patients with LVO-stroke is key, however many unrelated conditions can mimic stroke symptoms. Patients suspected of suffering a stroke therefore require intensive examination and brain scans to confirm diagnosis before treatment can begin. This delays care provision, particularly for patients in regional areas who must travel to access specialist equipment. Furthermore, the sensitivity of brain scans during the early stages of stroke is poor, increasing the potential for misdiagnosis.
Researchers propose developing a blood test to rapidly screen patients for stroke. Previous research identified 11 new markers in the blood of stroke patients, suggesting diagnostic potential. In this study, researchers we will screen blood samples collected from patients with LVO-stroke to discover markers specifically associated with ECR requirement. The study will also compare the diagnostic performance of identified markers to the screening tool currently used by emergency teams to assess clinical usefulness.
Mild Traumatic Brain Injury (mTBI) is a significant burden to Queensland emergency departments (EDs) in adults and children. Between 2019-2020, there were 958 presentations of isolated mTBI to Gold Coast Hospital Health Service EDs, of these 73% presented outside of usual business hours and 26% re-presented within 3 weeks of their initial presentation, complaining of persistent symptoms.
The Occupational Therapy (OT) Outpatient Service identified an innovative medical substitution practice model involving specialist follow up for patients to facilitate recovery, link into appropriate specialty referrals where indicated, and prevent ED representations. It is anticipated that the implementation of the OT pathway will lead to enhanced clinical outcomes (including quality of life and return to work/school), decreased ED length of stay for monitoring of symptoms and decreased ED readmission.
The primary aim of this research is to evaluate the impact of this Occupational Therapy (OT) intervention pathway for patients presenting to ED with a mTBI outside of business hours compared to pre-implementation care. The study also aims to evaluate the feasibility of implementing the pathway in relation to adherence, patient and staff acceptability and satisfaction.
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.
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.
Lamotrigine is an antiepileptic medication used in the management of seizure disorders and bipolar affective disorder but is being increasingly prescribed for many off-label indications including emotionally unstable personality disorder.
In overdose lamotrigine usually causes mild to moderate toxicity, however following large poisonings life-threatening cardiac and neurological effects can occur. There is limited research to guide clinicians both in the assessment and management of lamotrigine poisoning.
This is a study observing people who have taken lamotrigine overdoses and will compare the concentration of lamotrigine in their blood with the clinical effects that occur. We want to be able to know what the lowest dose is that can cause severe toxicity and also if there are treatments that we can give which can help clear lamotrigine from a person’s system more quickly.
Knowing these answers can help us better recognise which patients will have severe toxicity and better manage those patients in an effort to reduce harm and death. It is expected the results of this study will be incorporated into Poison Information Centre and national guidelines of the management of lamotrigine poisoning.
Many emergency department (ED) patients with painful conditions have extensive delays to receive pain relief, which may result in unnecessary discomfort and an extended length of stay.
This study will focus on how long patients who present to the ED with chest pain wait for adequate pain relief. This study is important for improving patient comfort and health service outcomes.
Emergency department teams need to perform urgent and high stakes patient care. This requires individual expertise and effective teamwork underpinned by trust, respect and shared values.
Psychological safety is a “shared belief held by members of a team that the team is safe for interpersonal risk taking”. The factors affecting the development of psychological safety in emergency department teams are not well understood and we aim to explore this within the emergency departments at Gold Coast Health.
Learning more about how to develop psychological safety in teams will inform team training strategies, including but not limited to simulation-based training, and subsequently better care for patients presenting to emergency departments where high performing teams are critical.
Pulmonary embolism (PE) is the third most common presenting acute cardiovascular syndrome behind myocardial infarction and cerebral vascular event, resulting in significant harm and death. Different clinical decision-making rules exist to guide clinicians investigating PE, to risk stratify patients based on presenting signs and symptoms; into low, moderate or high-risk. This helps direct further investigations and imaging, such as blood tests (D.dimer), computed tomography pulmonary angiogram (CTPA), and ventilation/perfusion scan (V/Q).
Currently, a blood test is a first line test used to help identify which lower risk patients might require further investigation with medical imaging. Medical imaging adds cost, prolongs hospital stay and exposes the patient to radiation and IV contrast. This retrospective study will determine in the Australian context, whether applying a higher cut off D.dimer to low risk patients who present to an urban emergency department is a safe strategy in ruling out PEs. An Australian study is important due to significant contextual issues in the D.dimer testing across different countries despite decision rules currently available.
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.
Global estimates suggest that approximately 5 million people die from infection each year. Research into improved management and treatment for patients with infection is essential for reducing mortality.
Patients presenting to the emergency department with severe infections are treated with fluids in the vein to maintain optimal blood volume, to keep the heart working properly and tissues well oxygenated. Fluids administered to patients include crystalloids (water-based fluids that include salts and other water-soluble molecules), and albumin (a fluid manufactured from human plasma). Crystalloids are most commonly used by emergency physicians in standard care however initial evidence indicates that albumin may result in better outcomes for patients with severe infections, but further quality trials are required for validation.
In this study, researchers will randomise emergency department patients with severe infection to receive either albumin or crystalloids. The aim of the study is to provide emergency doctors with important information about how to best treat patients with infections to improve blood pressure, prevent organ failure, reduce the need for intensive care and potentially reduce the number of deaths.
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.
Patient flow in emergency departments (ED) is impeded when the number of patients exceed physical and/or staffing capacity. This is often referred to as crowding, and is common problem for EDs across the country, adversely impacting patients, staff and the healthcare system.
While many strategies have been reported and trialled to mitigate the consequences of crowding and address its causes, there is no one solution that fits all EDs.
Researchers propose to develop and test a computer model to mimic the ED, simulating patient flow to provide forecasts that can inform policy makers. This is especially important in periods of anticipated high demand for emergency services such as in the current COVID-19 pandemic.
Emergency doctors will team-up with academic researchers to model patient flow in the emergency department to consider operational changes and provide knowledge to guide decision-making for improvement strategies that will lead to faster, more effective patient care, better outcomes and more effective, economical choices.
This innovative collaboration between doctors and university researchers aims to solve real-life system-level problems affecting patient care. The research will generate practical outcomes that improve clinical practice at a system level so that we can better care for our patients.
Sepsis is an emergency medical condition that is caused by an abnormal response of the body to the presence of harmful microorganisms in the blood. It can lead to injury of body organs, shock and loss of life. Every year, 11 million people worldwide die due to sepsis.
Despite advances in the treatment of infections, management strategies for sepsis remain suboptimal. Inadequate understanding of immune system response to severe infection is partly to blame. Patients present to hospital with different signs that may include having warm peripheries and low blood pressure (hyperdynamic shock). Critically ill patients with sepsis who present with these signs, commonly receive medications to support blood pressure (vasopressors) but it is unclear whether starting vasopressor early, will result in better patient response or outcomes.
This study will investigate whether starting early vasopressor is better compared to delayed initiation. As clinicians working in the emergency department and intensive care, researchers will be able use study findings to develop better ways of treating septic patients.
Drowning has a major global impact, with approximately 300,000 deaths each year. Yet the treatment of drowning victims has received limited investigation. This lack of evidence means that guidelines for the treatment of drowning victims are largely based on case reports or on other conditions such as acute respiratory distress syndrome (ARDS), on the premise that there may be similarities between the two conditions.
We are proposing to create a comprehensive database of information on drowning patients presenting to the emergency departments at the Sunshine Coast Hospital and Health Service. We will utilise a standardised list of data (Utstein-style guidelines for Drowning) to explore the treatment and outcomes for drowning patients over an eight-year period 2015-2022 inclusive. This will allow us to answer questions on the best ways to assist the breathing of drowning patients, if the treatment and outcomes in female drowning differ from males and why (there is some evidence females have better survival outcomes after being admitted to hospital), and to determine if the classification of drowning severity in common use around the world is useful in an Australian population.
Most paediatric inter-facility transfers within Australia are for children that do not qualify for specialist paediatric retrieval services but still require access to specialised paediatric care not offered at the local healthcare facility.
Evidence-based transfer guidance for children requiring retrieval are well established. However, for children who do not meet retrieval criteria, there is little guidance for referring and accepting clinicians on how to coordinate safe transfer. Nurse escorts are often deployed but may not be trained sufficiently to deal with arising complications during transfer. Additionally, with the availability and scope of paramedics, the deployment of nurse escorts may not be required, and unecessarily deplete valuable resources at referring facilities.
A risk stratification tool has been developed to determine which non-urgent transfers require higher level consultation and management prior to and during transfer, and nursing escort. The validation of this tool may assist to accurately identify higher-risk children, enabling application of appropriate safeguards, an appropriate level of consultation and escort, and supporting clinician decision-making surrounding transport Australia-wide.
Patients with COVID-19 symptoms are isolated and treated in a high-risk zone (HRZ) within the emergency department. Entry is restricted to essential staff wearing personal protective equipment (PPE).
HRZ doctors and nurses typically work 5-10 hour shifts, during which meal and toilet breaks must be taken outside the HRZ. Doffing (taking off PPE) and repeated donning (putting on PPE) are discouraged to conserve PPE. Doctors and nurses often work continuously with minimum breaks because they must doff before exiting and don before entering the HRZ. PPE traps body heat generated by physical activity, adding to mental and physical fatigue, and potential breaches in infection control precautions.
This study will investigate the length-of-time doctors or nurses can safely work in HRZ in one continuous shift.
One of the main reasons that acute pain is not well treated in the emergency department (ED) setting is that pain is difficult to measure. While patient-reported outcome measures (PROMS) are commonly used to help guide treatment of pain in settings such as chronic pain care, cancer care and migraine care, there are no similar tools available for patients with acute pain in the ED. Further hampering efforts to provide better ED pain care is poor overall understanding of the numbers and types of patients that experience pain.
Since it is a symptom rather than a diagnosis, information about pain is not systematically collected and is often obscured within free-text clinical notes. The lack of readily-available data makes it difficult to determine who exactly has experienced pain, and to design research studies to evaluate new and existing treatments.
Researchers aim to validate a PROM for pain care in the ED by administering to 400 patients who present with pain to one of two large hospital EDs. The aim is to find out the incidence and characteristics of patients who present with pain to the Royal Brisbane and Women’s Hospital ED, by using novel machine- and deep-learning techniques to process free-text information from clinical notes. This study will provide new knowledge and techniques that are essential for clinician-researchers to design and conduct studies that will ultimately improve pain care in the ED.
Currently in Australia, children with suspected neck injuries undergo neck scans such as x-rays, computed tomography (CT) or magnetic resonance imaging (MRI). However these scans may carry risks from radiation exposure, and are often associated with discomfort and distress for young patients and the need for sedation.
Considerable emergency department time and costs are also associated with these scans and it is unclear when it can be safely avoided. Rules and tools can help doctors decide when scans are necessary. The SONIC study aims to look at whether existing rules for adults are also appropriate for use in children, and to develop and test a specific tool to help doctors decide which children need a neck x-ray or scan. The study will involve a large number of children across multiple hospitals in Australia and New Zealand. The research is expected to help researchers learn more about looking after children with neck injuries and hopefully allow us to safely limit the number of scans that need to be done.
The SONIC study is also supported by the Commonwealth of Australia through a MRFF Grant ID1199748 administered by the Murdoch Children’s Research Institute.
Since COVID-19 was declared a pandemic by the World Health Organization (WHO), the elderly population globally have been identified as a vulnerable group, yet there is limited literature exploring the effect of pandemics on Emergency Department (ED) presentations in this cohort.
Healthcare systems have rapidly adapted and made changes to prepare for a potential healthcare crisis that has largely targeted our frail older population. The impact of the pandemic and changes in health care delivery need to be evaluated, to ensure the measures taken did not have unforeseen negative consequences and subsequent positive consequences.
This research aims to describe the clinical profiles, patterns of presentations and factors associated with outcomes of patients, aged 60 years and over, presenting to Queensland EDs before, during and after the COVID-19 pandemic. The results of this study will assist clinicians and policymakers to better respond to the challenges of acute care provision for this complex population during future pandemics.
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.
COVID-19 has impacted healthcare provision in Australian emergency departments (EDs). Infection control precautions, including isolation of patients with respiratory symptoms and methodical use of Personal Protective Equipment (PPE), are of paramount importance to reduce the risk of transmission within the healthcare setting.
Patients presenting to Australian EDs with epidemiological or clinical features suggesting risk of COVID-19 illness are isolated into a physically separate, high risk-zone (HRZ) within the ED. Entry into HRZ is restricted to essential staff wearing appropriate personal PPE. Consequently, interactions between patients and clinicians, particularly allied health, are limited.
Mobile robotic telepresence (MRT) has the potential to maintain quality of care while facilitating contactless communication between patients and staff in the HRZ and the external multidisciplinary team. MRT is a wifi-enabled wheeled devices with audio-video capabilities controlled remotely by a clinician. This study aims to determine the feasibility of using MRT to support clinical care in the HRZ of the ED.
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.
COVID-19 is an infectious respiratory pathogen with significant capacity to spread within the healthcare environment which has been highlighted by the number of healthcare staff internationally that have died or suffered significant morbidity through transmission while caring for patients. Guidelines recommend distancing between healthcare staff and patients and the need for personal protective equipment (PPE).
The majority of hospitalised and unwell patients with COVID-19 will receive some type of respiratory support, however very little is known in regard to how differing devices mitigate or exacerbate spread of respiratory droplets during coughing. Inadequate information has led to restrictions on certain types of therapies being offered to patients at risk for COVID-19. This study aims to clarify the extent of environmental contamination from droplet spread during coughing and the effect of different types of standard respiratory support on this.