Results for Staff Specialist


ED diabetic ketoacidosis presentations in people with type 1 diabetes: a pilot to improve clinical and public health system outcomes

People with type 1 diabetes (T1D) require ongoing insulin administration. Insufficient administration results in hyperglycaemia and then diabetic ketoacidosis (DKA) which, if not treated urgently, can lead to death. It is vital that all people with T1D have timely access to acute care advice and service delivery.

Across Australia, DKA is the cause of a significant and increasing number of hospitalisations, especially when considering socioeconomic disadvantage. This project will explore current outcomes for people with T1D presenting to the Caboolture Hospital ED with DKA, explore factors associated with poor outcomes, and describe current barriers and enablers; to inform intervention development. Local diabetes support is provided through a diabetes education service which does not provide after-hours telephone support to provide timely assistance and determine the requirement for (and potentially preventing if unnecessary) hospital presentations.

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An evaluative study of a collaborative ED mental health program

Mental health is a nationally recognised priority area and significantly contributes to the burden of illness in the Australian community, with almost 50% of people aged over 16 experiencing a mental illness at some point in their life. Coordinating treatment and support for people with mental illness is a key priority area in the Fifth National Mental Health and Suicide Prevention Plan and is a key priority indicator.

Over the last decade several models of mental health service delivery have evolved in response to the need for specialised mental health assessment and care in EDs as client numbers and acuity increases. Research has shown that these models are effective at supporting staff and increasing consumer satisfaction. However, little is known about how well the services integrate into ED service delivery and the way in which these MH services augment ED care and processes or their cost. Nor is there any research that summarises the salient features of the various models in a way that health services may integrate them to improve service delivery.

This research project is in two parts. The first phase aims to describe and explore the structures and processes required to sustain an ED physician championed. By understanding the structure and process required and through identifying its salient features, it may allow health services to implement the model or redesign, or adapt, current practice to improve the care received by patients presenting to EDs with a mental illness. The second phase will involve three quantitative studies that will examine the performance of the model.

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Patterns of prescription opioid use following ED presentation for minor road traffic crash injury

Australia is five years behind the US’ opioid epidemic (>15,000 US deaths/year). General Practitioners and EDs frequently prescribe opioids for isolated musculoskeletal pain (e.g. “whiplash”) from RTCs, but this potentially inappropriate opioid prescribing likely leads to unnecessary opioid exposures. In the last decade, opioid overdoses in Australia have more than doubled. 75% of opioid overdose deaths involve prescription opioids; annual death rates exceed road traffic deaths.

Emergency Departments (EDs) commonly prescribe opioids on discharge for patients with non-serious road traffic crash (RTC) injury. This potentially compromises recovery and contributes to continued opioid use and potential misuse in the community.

The project will address the gap on whether, or for how long, short courses of opioids are continued following acute non-serious RTC injury, and to what extent this causes subsequent problems, by measuring patterns of use, impacts, and costs of opioid use in EDs and following discharge over a 12-month period.

The project will provide the first Australian data on opioid prescribing in ED for acute minor RTC injuries and link ED data to community data to explore longitudinal prescribing patterns post RTC.

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The Crystalloid versus Albumin in tThe Resuscitation of Emergency Department Patients with Septic Shock (CARESS) trial inflammatory marker pilot study.

The aim of this study was to determine whether 4% albumin solution is superior to saline for fluid resuscitation of patients presenting to the emergency department with septic shock.

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Improving blood culture collections in the emergency department

The primary aim of this study is to assess the effectiveness of an intervention designed to improve the quality of blood cultures collected in a busy emergency department.

Blood cultures are tests that are frequently ordered by emergency doctors to detect and identify bacteria present in the blood of patients who are unwell. The test requires a sample of blood to be collected from the patient. Like many tests, the quality of the results is related to the quality of the sample collection process.

Several factors may influence the quality of sample collection and increase the chance of sample contamination. These include not collecting enough blood and poor sterility of the collection process. Contamination of blood cultures may result in the patient staying longer in hospital, being prescribed unnecessary antibiotics and increasing the costs of care.

This study will implement a rigorous intervention to reduce contamination rates in blood culture samples collected at the Emergency and Trauma Centre at the Royal Brisbane and Women’s Hospital. The intervention comprises: education to staff that collect blood cultures; the introduction of blood culture collection kits; and regular feedback of quality indicators to the clinicians that collect blood cultures.

If the intervention is successful then a reduction in blood culture contamination rates and single sets of cultures should be seen. The average volume of blood cultured should increase. These outcomes should lead to a reduction in patients’ lengths of stay, costs of care, and positive effects in anti-microbial stewardship and patient flow.

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Can children be sedated effectively with only one needle?

Procedural sedation in emergency departments is performed on a daily basis. The current management plan arguably inflicts unnecessary pain and distress on children. This open label, multicenter, randomised control trial is investigating whether paediatric procedural sedation can be achieved with just one needle. The research team’s focus is the on determining the best outcome for the child in procedural sedation, prioritising psychological as well as medical consequences.

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Understanding why aged care residents are transferred to the ED

In Australia, the existing model of emergency department care is struggling to cater for the needs of the older population. A large proportion of older patients arriving at emergency departments are from residential aged care facilities (RACFs). Nursing staff in RACFs often participate in decision making pertaining to transfer of residents to the emergency department, but very little research has been done on the decision making involved in this process.

The proposed mixed methods study will engage with RACF nursing staff to understand their decision to transfer a resident, their perception of communication with the emergency department, and the services that influence the decision. The project outcomes will provide a detailed understanding of existing service provision, communication between facilities, and potential gaps in education and skills.

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Junior doctors at triage improve patient flow in the ED

Introducing a novel model of care to the emergency department may provide significant reductions in key performance indicators, such as patient length of stay, or the National Emergency Access Target (NEAT).

In previous studies, researchers have found that rostering a physician to work at triage can lead to significant improvements on a range of metrics, including time to treatment, patient length of stay and rate of patients who left before receiving treatment. However, in a regional hospital where staffing numbers and budgets are under pressure this model may not be possible.

The objective of this study is to implement a novel model of care at triage in the Hervey Bay Hospital Emergency Department. For a trial period of three months, junior doctors (PHO/registrar level) will be rostered to work at triage on alternate day shifts. A range of outcome measures will be compared with day shifts when junior doctors are not rostered at triage. This model may be relevant for other regional emergency departments.

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Developing a regional strategy for reducing non-urgent emergency department presentations

Many people who attend hospital emergency departments (EDs) are triaged as having non-urgent concerns, which could be managed by other health services such as the GP. The way regional health services are designed can contribute to the rate of non-urgent presentations in EDs. The impact of non-urgent patients in EDs can result in crowding, ambulance diversion and access block, which are linked to poorer patient outcomes, increased morbidity and staff burnout. While some recognition of this problem exists nationally, many policies or strategies implemented to reduce the incidence of these presentations have not been evidence-based, effective or economically evaluated. We aim to develop a draft regional strategy for reducing non-urgent presentations in emergency.

Prior research on this project was funded by La Trobe University ($20,000), the Clifford Craig Medical Research Trust ($5000) and a University of Tasmania Scholarship ($5000).

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Examining the effectiveness of Brown snake antivenom

The amount of Brown snake antivenom required to properly neutralise the venom delivered in a brown snake bite remains controversial. Using appropriate amounts reduces the risks and side effects of antivenom, while optimising its positive effects. One of the major clinical symptoms of Brown snake bite is massive bleeding. We aim to use a novel method for analysis of blood clotting (the ROTEM analyser) to study the effects of Brown snake venom on blood clotting and how different doses of antivenom affect this. This information may enable us to develop a simple point of care test to determine the optimal dose of antivenom to be given, reducing the amount of antivenom needed, the length of hospital stay, and therefore overall cost of snake bite management.

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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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