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

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

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

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

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

uSing Meditation App to Reduce ED occupational sTress (SMART) trial

Our study aims to test whether a mindfulness program delivered by a smartphone app can reduce occupational stress levels among Emergency Department (ED) staff. This study will recruit staff at two regional EDs. Staff will practice short session mindfulness daily, for four weeks, using a smartphone meditation app. The study will determine if, by using the app, staff levels of occupational stress are reduced and overall wellness increased. The levels of stress reduction will be compared before and after the intervention.

Working in an ED can be stressful. It has been suggested that up to half ED doctors and nurses may suffer from burnout due to high workload, overcrowding and limited resources. Staff stress and its negative consequence pose challenging issues to both individual clinicians and healthcare organisations. Sub-optimal wellness of staff is closely associated with poor patient care, more medical incidents and a high staff turnover rate. One way to reduce staff stress levels is by promoting staff coping skills and wellness. Mindfulness is a mental technique to focus self-awareness at the present moment and non-judgmentally. It has been used widely to promote staff workplace wellness. Smartphone apps are a relatively new delivery method for mindfulness that has not yet been tested among ED staff.

Paediatric Reduction in Emergency Cannula Accidental REmoval Trial – PRECARE trial

The aim of this study is to evaluate securement devices for peripheral intravenous catheters (PIVC) in the paediatric ED to determine which method is most effective for reducing PIVC failure, associated costs, acceptability and patient distress.

Infants and children depend on PIVCs for the provision of medical therapy within the emergency department and during hospitalisation. However, PIVC insertion and management is challenging and more than 25% of devices fail. PIVC failure is costly for both the patient and healthcare organisation. Failure may require the child to undergo traumatic reinsertion procedures, delay important medical treatment and prolong length of hospital stay. One way to reduce PIVC failure is with effective PIVC dressing and securement, by ensuring correct catheter position in the vein.

Our trial aims to test if new advances in catheter securement, medical grade superglue (Histoacryl) and an integrated dressing securement product (SorbaView SHIELD), are effective at preventing cannula failure and complications in paediatric patients. Using a three arm, randomised controlled trial, this study will recruit 460 paediatric patients at two regional emergency departments (Logan Hospital, Ipswich Hospital). Children will be randomised to receive PIVC securement by i) standard care, ii) advanced dressing or iii) medical grade superglue and advanced dressing. The main outcome of this trial is PIVC failure, with other important questions surrounding cost effectiveness and patient comfort also to be explored.

It is important for effective, improved cannula security to be explored as this is frequently a first line device choice for treatment, being highly effective in rapid treatment situations. A result in improved treatment delivery will benefit with cost savings in not only product but clinician time spent re-inserting, and a reduction in unnecessary, painful procedures for children.

Data Extraction from Electronic Health Records for a Chest Pain Clinical Data Registry: The Chest Pain DECoDeR Study

Patient health records contain a significant amount of information through each episode of care provided at a healthcare facility. However, due to the unstructured nature of the clinical information in each record, the clinical data is not readily accessible for research or administrative use unless an expensive and time-consuming manual process is used. Methods of data extraction through various algorithms are available but require training and testing a dataset of annotated health records.

To address this issue, my key aim is to generate structured clinical data from previously inaccessible and unstructured electronic records. I am attempting to develop a process of automatically extracting clinical data from electronic records of patients who present with chest pain to emergency departments in Queensland. The clinical data extracted will be composed of the documented cardiac risk stratification for each patient and major adverse cardiac events.

To develop this data extraction process, an annotation scheme was designed using a widely accepted standardized reporting guideline. Using the annotation scheme, emergency clinicians annotate patient records to produce an annotated dataset for both training and testing machine learning algorithms.

How are we treating severe childhood asthma in Australasia?

Most children with asthma presenting to an emergency department (ED) are managed with inhaled medications and oral steroids. Infrequently, those children that are very unwell may require assistance with their breathing, or intravenous medication. Currently, there is minimal information to guide clinicians on which treatment to choose for severe acute asthma. It is not known which is most effective and all have side-effects. Studies demonstrate significant variation in practice, while existing Australasian data is approximately 10 years old.

This project aims to determine current management practices for children with severe acute asthma and/or wheeze; how common the condition is, how frequently complications occur; and to understand differences in therapy between states and regions across Australia and New Zealand. When comparing treatments, it is important to determine the ability to reduce the risk of severe complications, or the difference in treatment outcomes. Once complete, this project will inform future research that will help to establish the best treatments for severe asthma.

This study is being run by the PREDICT network and its Chief Investigator is A/Prof Simon Craig. The EMF is funding Queensland sites taking part. The overall study will include 18,000 children aged between 1 and 18 years being treated for asthma in the ED.

Point of care lung ultrasound in paediatric respiratory presentations

Emergency department physicians with no prior specialised ultrasound training can be taught to reliably identify bronchiolitis, pleural effusions, pneumothorax and pneumonia, in children presenting with cough, shortness of breath and hypoxia through the use of lung ultrasound after a brief training. In this study, we are assessing the effectiveness of trainees performing a lung ultrasound examination of children, capturing their images and recording their findings. No clinical decisions will be made based on these findings without consultation with the consultant on duty. We will consider to what extent the teaching was successful and try to determine whether the teaching resulted in a objectively verifiable benefit to the emergency department. We anticipate a reduction in the amount of time the child spends in the department. It is also anticipated that there will be decline in x-rays relative to the number of presenting patients.

Carotid doppler ultrasound with passive leg raise for fluid responsiveness

Fluid therapy is a valuable entity and a valuable clinical entity. However there is uncertainty regarding the fluid responsiveness of patients, particularly those with severe infections. Potential risks of fluid overload (i.e. too much fluid) exist. Excessive fluid administration is associated with increased morbidity and mortality.

Carotid doppler ultrasound and passive leg raise is a way of estimating fluid responsiveness. By using this technique we believe that it will tell us if a patient will tolerate an intravenous fluid bolus of 500ml.

The aim of this study is to determine if doppler ultrasound of the common carotid artery blood flow before and after PLR is a realistic method by which to determine fluid responsiveness in the acute care setting. Also the review the ease of which this can be taught to emergency doctors.