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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
This is a multicentre, open-labelled diagnostic randomised controlled trial to comparing the use of portable ultrasound and x-ray imaging to diagnose a buckle fracture in children. The trial will determine if there are differences in functional outcomes, patient and care-giver preferences, and health system benefits.
Children frequently present to the emergency department with forearm injuries and often have an x-ray to assess if there is a fracture. Due to the soft and plastic nature of the bones in young children, injuries can cause their bones to bend, known as a buckle fracture. Bedside ultrasound is a test that emergency practitioners can use to rapidly diagnose a fracture at the time of examination, without exposing children to ionising radiation. Ultrasound in this setting is well tolerated, only requiring light touch and gentle manipulation of the forearm and has similar accuracy when compared with x-rays for diagnosing children’s forearm fractures.
This is the first trial of its kind to assess whether an x-ray is unnecessary when there is either a buckle fracture or no fracture seen on a portable ultrasound machine. This is important as they can be treated at the time of review without any further delay, which will avoid these children being exposed to ionising radiation. Children will be randomised to receive either an ultrasound or x-ray for their forearm injury. Both groups will be followed up to see whether there are any differences in their recovery and to determine any complications. We will also determine the time and cost implications of this new approach, which could enable families to go home earlier and could be more cost-effective, with less x-rays being ordered.READ MORE
The overarching aim of this study is to estimate the magnitude of the need for care at the end of life care in the emergency department, and to describe care delivery practices, processes and outcomes for older people who present to the emergency department requiring end of life care.
Australians aged 65 years and over account for 22% of emergency department presentations. Currently, this group makes up 15% of the population, but this predicted to rise to 20% by 2037.
There are two trajectories of end of life in the emergency department: ‘unexpected’ and ‘expected’ deaths. Unexpected deaths stem from acute illness or sudden, traumatic events. Expected deaths stem from deterioration of chronic illnesses.
When expected deaths occur in the emergency department, staff dissatisfaction and distress as well as frustration for patients and their families can result. In Singapore, around 50% of deaths in people aged ≥ 65 who died in one emergency department were considered ‘expected’. This highlights the need to understand if the situation is the same here in Australia and to what extent quality end of life care is provided for both trajectories of dying (i.e. expected and unexpected). Our study will identify the ‘unexpected’ and the ‘expected’ deaths among people aged ≥ 65 who die within 48 hours of emergency department presentation.
Sepsis is devastating infection, leading to organ dysfunction. Sepsis kills more children in Australia than road traffic accidents. One out of three survivors will suffer from long-term health problems. Faster recognition of sepsis can save lives. However, recognising sepsis in children can be difficult, as children with sepsis initially present with symptoms similar to common infections. Currently, the recognition of sepsis is based on physician assessment of patients, and laboratory tests. Sadly, a common finding in Coroner`s investigations of sepsis deaths is that parents represented several times to health-care facilities, stating their concerns that “something is wrong” with their child. There is at present great debate as to what role parental concern should have in sepsis recognition.
We hypothesise that parents as experts of their child provide important information to recognise disease severity in their child. We will perform questionnaires with parents, and with medical and nursing staff when a child is evaluated for sepsis. We will compare the value of measuring parental concern in comparison to healthcare worker assessment, clinical signs and symptoms, and routine infection markers.READ MORE
Improving patient experiences is part of Queensland’s 2016-2020 Strategic Plan to enable safe, quality healthcare services. Yet, current emergency department(ED) patient experience measures, including the burdensome 82-item Queensland Health (QH) ED patient experience survey, fail to reflect patient preferences for care experiences, inhibiting the design and evaluation of healthcare services that reflect patient preferences, and the delivery of value-based healthcare.
The aim of this project is to develop an ED patient experience classification system and accompanying scoring algorithm that can be used to both measure and value patient experiences in Queensland EDs. It will provide a proof of concept for an Australia-wide development, valuation and knowledge transfer study.READ MORE
Procedural sedation in emergency departments is performed on a daily basis. The current management plan arguably inflicts unnecessary pain and distress on children. This open label, multicenter, randomised control trial is investigating whether paediatric procedural sedation can be achieved with just one needle. The research team’s focus is the on determining the best outcome for the child in procedural sedation, prioritising psychological as well as medical consequences.READ MORE
Sepsis is a leading cause of death and disability in children, globally accounting for more than one million childhood deaths per year. Recommended sepsis treatment currently consists of intravenous antibiotics and aggressive fluid boluses followed by inotropes and consideration for intravenous steroids. However, the evidence for interventions other than antibiotics is limited and aggressive fluid administration may be associated with harm. Therefore, fluid-sparing algorithms using early inotropes to treat shock have been proposed. Another strategy to hasten shock resolution consists in intravenous steroids, alone or in combination with thiamine and vitamin C, postulated to support metabolic dysfunction in recent studies.
In this project, the research team is conducting a randomised controlled pilot trial in children presenting with septic shock. They are assessing the feasibility of a fluid-sparing algorithm using early inotropes and early intravenous administration of Vitamin C, Thiamine and Hydrocortisone and the impact on survival free of organ dysfunction.READ MORE