How are hypertensive urgencies managed in emergency departments in Queensland?

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.

Retrospective analysis of GEDI impact on older adult patients presenting to the emergency department with a positive delirium screen (4AT)

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.

A retrospective cohort review study of patients with Primary Immune Deficiency (PID) who have presented to the emergency department (ED) with a fever

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:

1. A scoping Review of global standards and practices of febrile PID children presenting to ED, and
2. A retrospective review, of all paediatric patients with a PID who present to an ED with a fever. Data will include demographics, PID characteristics, ED diagnosis, procedures and disposition.

Ambulance Telehealth: Comparing Telehealth Outcomes of Non-English Speaking Patients to English Proficient Patients

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.

Safety and efficacy prehospital procedural sedation for fracture and dislocation reduction

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.

Point of care lactate testing for the earlier recognition, antimicrobial administration, and definitive management of Paediatric Sepsis in the Emergency Department

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.

Ultrasound-guided supraclavicular block versus Bier block for closed reduction of upper extremity injuries in the emergency department: an open-label, non-inferiority, randomised control trial

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.

Assessment of emergency presentations, outcomes and departmental impact of patients presenting after COVID-19 immunisation to a tertiary Paediatric Emergency Department.

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.

External Ventricular Devices in Aeromedical Retrieval- Are they Safe?

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.

Paediatric peripheral intravenous cannulation package to improve practice: the experience of a mixed metropolitan Emergency Department.

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.