Results for JumpStart


Buddy-up: research reach, adoption, and implementation

The “Buddy Study” funded in the EMF grant round 25 showed a common type of hand fracture can be treated without a plaster – a finding that if applied broadly could result in patients returning to work faster and significant healthcare savings. However, since the study was published in 2019 it is unclear to what degree there has been a change in how clinicians actually treat this fracture.

This follow up study will explore factors related to research reach, adoption, and implementation at two hospitals in Queensland to 1) inform a strategy to implement knowledge related to hand fractures and to 2) explore how participation in research affects implementation.

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Cellulitis in the emergency department

Cellulitis is an infection of the skin and underlying soft tissues and leads to redness, pain and sometimes fever. Once diagnosed, the emergency doctor needs to decide an appropriate type and dose of antibiotic and decide to give it orally (tables/capsules) or intravenously (via a drip).

Despite this being a common diagnosis in the ED, guidelines are not based on high-quality evidence making it difficult for doctors to make evidence-based choices and there is wide variation in how cellulitis is treated. This prospective cohort management study aims to describe the ED management and clinical outcomes of adult patients with cellulitis.

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Subculture: Investigating the frequency and outcomes of subsequent blood cultures

Blood cultures are tests performed to identify whether patients have pathogens in their blood, such as bacteria and fungi. Emergency clinicians frequently order blood cultures to prescribe appropriate antibiotics for patients. Blood cultures are particularly important to rapidly identify and treat severe infection.

For test accuracy, the best time to collect blood cultures is before a patient has received an antibiotic. However, patients with severe infections may have multiple sets of blood cultures taken over several days. It is unknown whether taking multiple blood cultures improves patient care.

This study will investigate how many patients have repeat blood cultures and whether subsequent blood cultures yield the same result. If found to be redundant, it may be possible to avoid unnecessary blood tests, improve patient comfort, decrease costs to the health service, and reduce practitioner workloads.

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Extent of self-harm behaviour presenting to Queensland ED with mental health problems

In 2018, there were 3046 deaths by suicide in Australia. Suicide was the leading cause of death among people age 15-44 in 2016-2018. In Queensland, rates remain highest in young men, particularly in rural areas.

The emergency department (ED) can be the only option for people in a mental health crisis. Presentations with self-harm and attempted suicide are recognised high-risk events for subsequent suicide.

This data-linkage study is the first of its kind in Queensland, examining ED presentations with self-harm between 2012 and 2017, utilising data from a collaboration examining broader mental health presentations. This ED data will be ‘linked’ to inpatient admissions and death records, allowing insight into the patient journey over several years.

Aligning with national and international calls to make suicide and self-harm a priority for research and policy innovation, the study will examine the demographics, co-morbidities and characteristics of these patients, and factors predictive of hospital admission to improve care and recognition around those presenting to ED with self-harm.

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Lamotrigine Poisoning: an Australian TOxicology Monitoring (ATOM) Study

Lamotrigine is an antiepileptic medication used in the management of seizure disorders and bipolar affective disorder but is being increasingly prescribed for many off-label indications including emotionally unstable personality disorder.

In overdose lamotrigine usually causes mild to moderate toxicity, however following large poisonings life-threatening cardiac and neurological effects can occur. There is limited research to guide clinicians both in the assessment and management of lamotrigine poisoning.

This is a study observing people who have taken lamotrigine overdoses and will compare the concentration of lamotrigine in their blood with the clinical effects that occur. We want to be able to know what the lowest dose is that can cause severe toxicity and also if there are treatments that we can give which can help clear lamotrigine from a person’s system more quickly.

Knowing these answers can help us better recognise which patients will have severe toxicity and better manage those patients in an effort to reduce harm and death. It is expected the results of this study will be incorporated into Poison Information Centre and national guidelines of the management of lamotrigine poisoning.

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Exploring the relationship between psychological safety in the workplace and in simulation based educational sessions for emergency department doctors and nurses

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.

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D.dimer adjusted to low clinical probability in the diagnosis of suspected pulmonary embolism – is it safe in the urban emergency department?

Pulmonary embolism (PE) is the third most common presenting acute cardiovascular syndrome behind myocardial infarction and cerebral vascular event, resulting in significant harm and death. Different clinical decision-making rules exist to guide clinicians investigating PE, to risk stratify patients based on presenting signs and symptoms; into low, moderate or high-risk. This helps direct further investigations and imaging, such as blood tests (D.dimer), computed tomography pulmonary angiogram (CTPA), and ventilation/perfusion scan (V/Q).

Currently, a blood test is a first line test used to help identify which lower risk patients might require further investigation with medical imaging. Medical imaging adds cost, prolongs hospital stay and exposes the patient to radiation and IV contrast. This retrospective study will determine in the Australian context, whether applying a higher cut off D.dimer to low risk patients who present to an urban emergency department is a safe strategy in ruling out PEs. An Australian study is important due to significant contextual issues in the D.dimer testing across different countries despite decision rules currently available.

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Relief of chest pain in the emergency department (RELIEF)

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.

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Emergency department waiting time predictions in real-time

Emergency department (ED) waiting times are a significant predictor of the patient experience.

Simple prediction methods, such as rolling average, are used by hospitals in Australia to predict waiting time for patients. Although this approach is inexpensive to implement, the forecasts have limited accuracy and consequently most Australian hospital EDs do not report expected waiting times to the public.

A solution that is capable of sourcing data from ED information systems and feed it into prediction models to generate waiting time forecasts would bring practical benefits for staff and patients. There is also potential to assist clinicians and nurses to estimate demand for care and calibrate workflow.

For patients, the knowledge may reduce anxiety associated with uncertainty about the waiting time and reduce the number of patients who leave before treatment.

This project aims to use advanced statistical models and machine-learning algorithms to capture dynamic fluctuations in waiting time, to implement and validate the prediction performance of these models. The project will also build ED research capacity by educating staff on forecast modelling and data management techniques.

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Can assessment of parental concern improve sepsis recognition in children?

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.

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Improving jellyfish sting treatment

EMF funding is improving emergency care for the elderly

Trauma: better treatment for severe bleeding

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