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.READ MORE
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.READ MORE
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.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
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.READ MORE
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.READ MORE
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.READ MORE
Peripheral intravenous cannulation (PIVC) is a vital part of modern medicine, however the use of cannulas has become prolific, with many never used. The patient risks that are associated with PIVC are well documented, including pain and even infections, which can be severe and lead to death.
PIVCs which are inserted but never used (idle PIVC), have risks and downsides, but no potential benefits. Reducing the rate of idle PIVC may reduce the overall rate of risks, side-effects and infections associated with PIVC, but may also lead to patients who require PIVC not receiving one.
This study will look into the reasons why clinicians decide to insert a PIVC. Researchers aim to describe: I) the proportion of PIVCs placed that do not get used within 24 hours (idle PIVCs), II) differences between the pre-hospital setting and the emergency department and III) the factors associated with clinicians’ decision making regarding PIVC insertion.READ MORE
This research project is looking at cellulitis in the Torres Straits. Cellulitis is a bacterial infection of the skin that requires antibiotics. People with cellulitis usually have an area of red and hot skin and sometimes can have fevers and become really unwell. Germs called Staphylococus aureus and Streptococcus pyogenes typically cause cellulitis. It potentially can cause serious infections and are a common presentation to emergency departments and admission to hospital.
In a tropical environment such as the Torres Strait cellulitis is extremely common and contributes to a significant burden on the healthcare system. Often patients present to health care facilities in the Torres Strait with cellulitis and are transported into Thursday Island Hospital for intravenous antibiotics. This is associated with significant retrieval, emergency and hospital costs. However the treatment of cellulitis in the community has been found to be practical, safe, and cost effective. We want to find out if cellulitis can be treated at home instead of in the hospital here in the Torres Straits.
The aim of this study is to validate outpatient intravenous antibiotic management of cellulitis in the Torres Straits. We anticipate that results from this study will improve preventable emergency and hospital admissions thus having significant health economic savings here in the Torres Straits.READ MORE