Results for Trainee Grant Scheme


Prospective Observational study of cannulation of Kids in the Emergency (POKIE)

Paediatric peripheral intravenous cannula (PIVC) insertion is a frequently performed procedure in the emergency department (ED), which can result in significant distress for both the child and caregiver, particularly when there are multiple attempts. Children with difficult intravenous access (DIVA) are generally poorly recognised but several studies have developed prediction tools. Furthermore, the use of ultrasound (US) has been demonstrated to improve the success rate of paediatric DIVA patients when used as an adjunct.

This research will shine a spotlight on current practice in the largest mixed ED in Queensland, which aims to determine factors contributing to paediatric DIVA patients and attitudes towards the use of US to assist first pass success. Furthermore, this background data will lay the foundation to inform an interventional trial using US to improve PIVC practices for children in the ED. Novice researchers in this project will be well supported by a research team with a strong track record of completing projects that can impact patient care

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Point of care lung ultrasound in paediatric respiratory presentations

Emergency department physicians with no prior specialised ultrasound training can be taught to reliably identify bronchiolitis, pleural effusions, pneumothorax and pneumonia, in children presenting with cough, shortness of breath and hypoxia through the use of lung ultrasound after a brief training. In this study, we are assessing the effectiveness of trainees performing a lung ultrasound examination of children, capturing their images and recording their findings. No clinical decisions will be made based on these findings without consultation with the consultant on duty. We will consider to what extent the teaching was successful and try to determine whether the teaching resulted in a objectively verifiable benefit to the emergency department. We anticipate a reduction in the amount of time the child spends in the department. It is also anticipated that there will be decline in x-rays relative to the number of presenting patients.

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Antibiotics in the Emergency Department

In the Emergency Department (ED) deciding who does and who does not need antibiotics can be difficult. There is no quick test that an Emergency doctor can perform that accurately tells them who needs antibiotics or what type of antibiotic to prescribe. Our study aims to find out how many patients are given antibiotics in the ED and what proportion of those antibiotics are not required or have been given incorrectly (incorrect type or dose). Our study also aims to identify factors that are associated with poor antibiotic choices, including doctor experience and time of antibiotic prescription.

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Carotid doppler ultrasound with passive leg raise for fluid responsiveness

Fluid therapy is a valuable entity and a valuable clinical entity. However there is uncertainty regarding the fluid responsiveness of patients, particularly those with severe infections. Potential risks of fluid overload (i.e. too much fluid) exist. Excessive fluid administration is associated with increased morbidity and mortality.

Carotid doppler ultrasound and passive leg raise is a way of estimating fluid responsiveness. By using this technique we believe that it will tell us if a patient will tolerate an intravenous fluid bolus of 500ml.

The aim of this study is to determine if doppler ultrasound of the common carotid artery blood flow before and after PLR is a realistic method by which to determine fluid responsiveness in the acute care setting. Also the review the ease of which this can be taught to emergency doctors.

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Prescribing patterns and communication for oxycodone on ED discharge

Pain is a common symptom in ED patients, and is often the primary reason patients seek emergency medical attention. There are, however, growing public health concerns that opioid medications are being increasingly and excessively prescribed for pain. These medications may have a serious side effect profile including sedation, tolerance, and development of addiction, and may subsequently be diverted in the community for non-medical use.

A recent baseline audit of local prescribing records revealed oxycodone, an opioid pain medication, is prescribed in approximately 5% of patients discharged home from this ED (with an annual census of 77,500 presentations). Clinical documentation and discharge communication was either absent, incomplete, or inconsistent when discharge plans for dosing, duration of therapy, follow-up reviews and de-escalation of therapy were analysed.

The objective of this study is to evaluate the effectiveness of an intervention for discharge oxycodone prescribing relevant to Australian Emergency Departments. The principal aims are to decrease the amount of oxycodone prescribed, improve practitioner awareness of local opioid prescribing behaviour, and improve documentation around oxycodone use on discharge. This quality assurance evaluation study will measure the success of a multifaceted oxycodone prescribing intervention and its impact on oxycodone prescribing for patients discharged home from the Emergency Department (ED). The project is hypothesized to reduce oxycodone prescribing, improve discharge documentation, and ensure appropriate follow up plans are in place.

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Will a replicable ultrasound training intervention improve intravenous cannulation processes?

Most patients need intravenous access in the emergency department, but many suffer multiple attempts before the health provider is successful. This can cause patient distress and delays the time to potentially life-saving treatments. We believe an ultrasound-guided cannulation training program will enable better recognition of patients with difficult intravenous access and increase use of ultrasound during cannulation, hence decreasing time to cannulation, increasing success rates, and reducing the number of punctures required. In this study, we are examining the current practice of inserting intravenous (IV) cannulas in the Emergency Department at the Gold Coast University Hospital. We will consider how many people get cannulas, number of attempts required, who inserts them, how successful we are, how often ultrasound is used to guide this insertion, time to successful cannulation, who uses ultrasound and how successful is ultrasound-guided placement.

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Effect of Buddy Taping vs Plaster in Boxer’s Fractures (5thMC) –Buddy Study.

Fractures of the metacarpal bones are the most common hand injuries. Fractures through the neck of the 5th metacarpal (little finger hand bone) account for the majority of these. They are known as Boxer’s Fractures, as they are often sustained during a punch. Boxer’s fractures are traditionally managed in plaster, but in recent years there has been some suggestion that to simply ‘tape’ the little and ring fingers together will allow similar recovery with the advantage of full mobilisation. Currently there is not enough evidence to recommend one treatment over another. Potential benefits of buddy taping include: earlier return to work, less time spent in emergency, simple community follow up at the patient’s discretion. There is an economic benefit for the patient (they don’t miss work through being in a cast) and for the hospital (less time in ED and no need for orthopaedic follow up).

Our study is randomised and prospective. We enrol patients in the EDs of Robina and Gold Coast University Hospitals and randomise the patient to either receive a cast or buddy strapping. The patients are followed up in the orthopaedic fracture clinic at 1, 3 and 6 weeks, with phone follow up at 12 weeks. We are measuring hand function (using the quickDASH score of function), pain, satisfaction, economic analysis of return to work and sports, as well as objective strength and movement in the affected hand.

The study will improve the way that we manage a common injury. Patients who previously had to attend multiple busy outpatient clinics will potentially follow up with their GP at their discretion. Where patients would previously have spent 4 weeks in a cast, if buddy taping is effective, they can return to work immediately. This will result in time and resources saved in both the ED (assessment and application of plaster) as well as in orthopaedic outpatients (fewer follow up appointments and no need to replace plasters). Our aim is to optimise the care of our patients in a busy and time-pressured environment, and if the functional outcome is the same in both arms, we can choose the arm that most benefits the long-term economic, and social outcomes.

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Paced Electrocardiogram Requiring Fast Emergent Coronary Therapy (PERFECT) Study

The aim of this study is to assess the performance characteristics of the modified Sgarbossa criteria for diagnosis of ACO in VPR. This is a multi-centre international trial. The number of patients presenting to our Emergency Departments with pacemakers continues to increase. Investigating whether such patients are having a heart attack is challenging. For patients without pacemakers, ECG criteria can be used to identify a subset of patients who are having a heart attack. However, for patients with pacemakers, there are no accurate electrocardiograph (ECG) criteria to diagnose heart attacks.

This research has the potential to identify AMI in patients with VPR and improve Emergency Medical care in a time critical management decision. As such, it will develop emergency medicine research in Queensland and internationally by improving patients care and outcomes. It also will develop education and knowledge that will be recognised worldwide.

Smith et al have derived criteria (modified Sgarbossa’s criteria) for diagnosing heart attack using ECG characteristics in patients with a known abnormal ECG trace. This study will assess the accuracy of the Sgarbossa’s criteria in patients with pacemakers. We will collect data on demographics and ECG criteria for patients with pacemakers who present to the Emergency Department at the Royal Brisbane and Women’s Hospital with potential heart attack. We will then examine the results from the patient’s angiogram. The data will combined with data from multiple sites around the world to help validate ECG criteria for diagnosing heart attack in patients with pacemakers.

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Evaluation of therapeutic subclavian atrial compression

Two-thirds of people who sustain trauma to the upper limb proximal artery die from traumatic blood loss before reaching hospital. Timely stabilization of the injury, control of bleeding, and rapid transportation to an emergency department could dramatically improve the rate of survival. We know from research that these measures dramatically approval the rate of survival for traumatic injuries of other parts of the body. In this study, we will test the safety and efficacy of a particular procedure that we predict will improve the management of these injuries in the pre-hospital setting. We predict that the use of this procedure by paramedics on patients while in transit can improve patient outcomes. The study will test the safety and efficacy of a technique we refer to as therapeutic subclavian artery compression (TSAC). We argue that this relatively simple procedure may successfully control arterial bleeding in the proximal part of the upper limb, and prevent death from traumatic blood loss.

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Blind Prescribing and the prescribing preparedness of doctors in Emergency Departments.

“Blind Prescribing” describes the situation where a medical practitioner prescribes a medication they know little about.
Theoretically, ‘blind prescribing’ could lead to higher rates of medication error and unsafe medical practice. The project aims to determine if Blind Prescribing occurs in emergency medicine, to identify the prevalence of the practice, and propose situational and contextual factors pertinent to Emergency medicine that are thought to enable this practice.

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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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