Data Extraction from Electronic Health Records for a Chest Pain Clinical Data Registry: The Chest Pain DECoDeR Study

Patient health records contain a significant amount of information through each episode of care provided at a healthcare facility. However, due to the unstructured nature of the clinical information in each record, the clinical data is not readily accessible for research or administrative use unless an expensive and time-consuming manual process is used. Methods of data extraction through various algorithms are available but require training and testing a dataset of annotated health records.

To address this issue, my key aim is to generate structured clinical data from previously inaccessible and unstructured electronic records. I am attempting to develop a process of automatically extracting clinical data from electronic records of patients who present with chest pain to emergency departments in Queensland. The clinical data extracted will be composed of the documented cardiac risk stratification for each patient and major adverse cardiac events.

To develop this data extraction process, an annotation scheme was designed using a widely accepted standardized reporting guideline. Using the annotation scheme, emergency clinicians annotate patient records to produce an annotated dataset for both training and testing machine learning algorithms.

Mixed methods study of the Geriatric Emergency Department Intervention (GEDI)

As the population of Australia grows the percentage of those aged >65years is expected to double over the next 30 years. This will lead to more patients presenting to emergency of which a significantly larger portion will be frail and/or from residential care facilities (RCF). This vulnerable population is at significant risk of hospital acquired complications including acute confusion, falls, and infections if they suffer prolonged stays in the emergency department (ED) or on admission to hospital.

The GEDI program is an innovative nurse led intervention designed to improve emergency care of frail older persons who develop an acute medical problem. GEDI's are trained in geriatrics and have excellent communication skills liaising with RCF staff, families, general practitioners, ED medical officers/nurses and inpatient teams. Their role also involves patient centred geriatric risk assessment and management to minimise the negative impact of the older person’s emergency visit. The program has already been shown to led to a decrease in ED and hospital length of stay, improved patient and staff satisfaction and decrease in overall cost of care.

In this research project, we will evaluate the structures, processes and outcomes of the GEDI intervention relevant to the RCF cohort. This study will look specifically at the RCF dwelling cohort as they have often been excluded from previous studies. We hope to use the outcomes of this research to gain a greater understanding of the problems faced by our frail ED RCF population and with this knowledge develop innovative evidenced based healthcare solutions.

Research Scholarship Grant Dr Jeremy Furyk

Status epilepticus (SE) occurs when seizures do not stop spontaneously and can result in long-term disabilities and occasionally death. There is a paucity of high quality evidence on SE, particularly in children and causes and outcomes are different from adults. This program of research on SE uses mixed methods to address this gap in knowledge. The research includes identifying consensus research priorities among experts and a qualitative evaluation of alternatives to informed consent (which is a potential barrier to prospective emergency research).

Research Scholarship Grant: Dr Jeremy Furyk

The importance of good quality clinical trials in health care is being increasingly recognized worldwide. The London School of Hygiene & Tropical Medicine (LSHTM) is the leading postgraduate medical institution in Europe in the subjects of public health and tropical medicine.
The Master of Science in Clinical Trials, conducted online, aims to provide those with some experience in the area of clinical trials to broaden their role in design, management, analysis and reporting of clinical trials.

The first year of the course covers the core topics of; fundamentals of clinical trials, basic statistics for clinical trials, clinical trials in practice and reporting and reviewing clinical trials. Techniques, and methods learnt from the course will directly benefit the Emergency Department at Townsville and with emergency medicine research activities at the hospital and within the region.

Noel Stevenson Research Scholarship: Dr Colin Page

Dr Colin Page was awarded the Noel Stevenson Fellowship (in honour of eminent Queensland emergency medicine physician, Dr Noel Stevenson) to undertake a Doctorate of Philosophy (PHD). Dr Page is studying the antidotes and treatments that are commonly used by medical staff when looking after patients who are affected by drug toxicity. The PhD will be based at Princess Alexandra Hospital within the clinical toxicology unit with extension to other toxicology units/hospitals within Australia. It will be undertaken through the University of Newcastle (NSW) under the supervision of A/Prof Geoff Isbister and Prof Nicholas Buckley, who are both leaders in clinical toxicology research publications.

Dr Page has developed a clinical toxicology service at Princess Alexandra Hospital and Queensland through a locally run clinical toxicology unit and is the honorary medical director of the Queensland Poisons Information Centre. Clinical toxicology is the speciality that manages patients who are affected by drug toxicity either accidentally or in overdose. The project will primarily research antidotes and other treatments that are used in the management of toxicology patients. This will allow the introduction of safer treatments, new treatments and progressing the scientific basis behind treatments used in clinical toxicology.

Frank Garlick Research Scholarship: Dr Joseph Ting

The Frank Garlick Research Scholarship enabled Dr Joseph Ting to complete the Master of Science (Clinical Trials) at the University of London.

Noel Stevenson Research Scholarship: Prof Louise Cullen

This study is important because it will more rapidly move patients out of acute beds. It will do this by diagnosing patients with heart attacks up to four hours earlier and allowing earlier testing of patients without a heart attack but with potential heart disease, thus preventing overnight admissions. Approximately 80 per cent of patients who present to our ED each year with chest pain do not have a heart problem. Therefore, early discharge or admission of these patients would free up significant hospital resources, improve hospital flows and reduce the economic burden on the health care system. It may also reduce mortality associated with overcrowding. Given that overcrowding is associated with an excess of approximately 1,500 deaths per year one, the potential decrease in mortality may be significant.
Testing very low-risk patients frequently wastes time and resources and subjects patients to unnecessary provocative testing (e.g. treadmill testing). Provocative testing carries a risk of life-threatening heart rhythms or heart attack and if the test gives a false positive result further tests may be unnecessarily performed each with their own risk and complications. Identifying a very low risk cohort, who do not require extensive investigation, is the key.

Noel Stevenson Research Scholarship: A/Prof Peter Aitken

Disasters have caused the loss of more than 12 million lives and affected more than 50 million people in the past 50 years alone. Disasters involve not just more patients, but a different type of patient in a system under extreme stress. Emergency Departments (ED), as the ‘front door’ to the health system are a key part of the disaster response and a well prepared ED is essential to save lives. Being prepared involves education and training however disaster health education is not well developed in Australia. The research program aim is the development of a disaster education framework for the health workforce in Australia. This framework will incorporate learning needs and identify strategies to meet them in a manner which is both cost and outcome effective. A key outcome will be development and evaluation of a post graduate qualification in disaster health consistent with this framework. The current state of education in disaster health in Australia will be reviewed including a comparison of strategies used, relative effectiveness and barriers to success. Common problems will be identified from literature and Australian experience to help target educational priorities. This will include ED and Australian teams deployed overseas, many of whom were ED staff. A secondary aim is development of a network to strengthen both emergency medicine response to disasters and disaster health research.