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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
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.READ MORE
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.
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