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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
In this project we will evaluate a new pathway for assessing chest pain in the emergency department. The pathway is designed to reduce the costs of managing patients at low-risk of heart attack without compromising patient safety. The cost savings are estimated to be around $95 million if implemented Australia-wide, with the bulk of the cost reduction being through decreased length of stay in the emergency department.
The new pathway will be implemented at three Queensland hospitals. Data collected before and after the implementation of this pathway will be used to assess 1) whether it results in a shorter length of stay in hospital, 2) whether it is safe for identifying heart attack, and 3) whether it reduces healthcare utilisation and healthcare costs.
Over 450,000 patients present to an Australian emergency department with chest pain every year. The current approach to rule out heart attack for these patients is lengthy and costly, taking up to 26 hours at a cost of $2,127 per patient.
The aim of this study was to determine whether 4% albumin solution is superior to saline for fluid resuscitation of patients presenting to the emergency department with septic shock.READ MORE
The primary aim of this study is to assess the effectiveness of an intervention designed to improve the quality of blood cultures collected in a busy emergency department.
Blood cultures are tests that are frequently ordered by emergency doctors to detect and identify bacteria present in the blood of patients who are unwell. The test requires a sample of blood to be collected from the patient. Like many tests, the quality of the results is related to the quality of the sample collection process.
Several factors may influence the quality of sample collection and increase the chance of sample contamination. These include not collecting enough blood and poor sterility of the collection process. Contamination of blood cultures may result in the patient staying longer in hospital, being prescribed unnecessary antibiotics and increasing the costs of care.
This study will implement a rigorous intervention to reduce contamination rates in blood culture samples collected at the Emergency and Trauma Centre at the Royal Brisbane and Women’s Hospital. The intervention comprises: education to staff that collect blood cultures; the introduction of blood culture collection kits; and regular feedback of quality indicators to the clinicians that collect blood cultures.
If the intervention is successful then a reduction in blood culture contamination rates and single sets of cultures should be seen. The average volume of blood cultured should increase. These outcomes should lead to a reduction in patients’ lengths of stay, costs of care, and positive effects in anti-microbial stewardship and patient flow.READ MORE
The Royal Brisbane and Women’s Hospital (RBWH) Emergency and Trauma Centre (E&TC) is committed to research as a way to improve both patient outcomes and the delivery of emergency care services. With the support of competitive grants from funding bodies, the E&TC has rapidly established a reputation for high quality, medically-oriented clinical and health services research. Our capacity and support for such work has resulted in international collaborations, publications in leading journals and translation of findings into clinical practice with tangible benefits to both patients and health services. Despite these successes, several years ago we recognised that there were still barriers to participation in research by emergency nursing and allied health clinicians.
It was evident that dedicated senior research support was required, which prompted our Capacity Building application to EMF in 2015. The resulting conjoint senior nurse research role was first occupied in 2017 and, in less than 18 months, has energized nursing and allied health clinicians to define key research questions, collaborate across disciplines and institutions, apply for funding, design and conduct research studies, publish manuscripts, present at professional meetings, and enrol in research higher degrees.
In applying to extend the funding for the conjoint senior nurse research fellow to a third year we acknowledge the essential contribution this position makes to our research capacity and to the development of individual nursing and allied health staff into effective clinician-researchers. Together with the commitments already received from RBWH and Queensland University of Technology, a third year of EMF funding will enable the full expectations of this conjoint position to be realized, thereby maximising the likelihood of attracting future recurrent funding.READ MORE