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Over $1 million in funding has been allocated to help make Queensland the location of choice for emergency medicine physicians with an interest in research.
The Queensland Emergency Medicine Research Foundation has announced the first round of funding for grants to attract clinicians from interstate and overseas to Queensland, as well as to retain those already working here.
The following documents the list of successful applications. Please click on the titles for further information.
CT201 Research Protocol Development
CT202 Trial Designs
CT203 Project management and research coordination
CT208 Advanced statistical methods in clinical trials
PH204 Economic evaluation of health care
EP303 Epidemiology of non-communicable diseases
The Queensland Emergency Medicine Research Foundation has announced the first round of funding for grants to attract clinicians from interstate and overseas to Queensland, as well as to retain those already working here.
The following documents the list of successful applications. Please click on the titles for further information.
The Sepsis Registry
The Sepsis Registry: A prospective database to characterise and facilitate improved outcome for admitted patients with community-acquired infection
Principle Investigator: Dr Julian Williams
Co-investigators:
Prof David Paterson- RBWH, Department for Infectious Diseases
Prof Jeffrey Lipman- RBWH Intensive Care
Dr Jaime Greenslade- RBWH DEM
Prof Anthony Brown- RBWH DEM
Dr Jennifer Paratz- RBWH Intensive Care
Dr Joel Dulhunty- RBWH Intensive Care
Dr Kevin Chu- RBWH DEM
Institution: Royal Brisbane and Women’s Hospital
Infections, particularly serious infections, cost the Australian healthcare system millions of dollars every year and impose a significant burden of illness on the Australian community. Serious infections also have the capacity to cause tragedy at a much more personal level, with lethal outcomes possible even in young previously healthy individuals. Despite the significant consequences of these illnesses, we have very limited information about the best way to identify and treat infection in Australian Emergency Departments. Therefore, research that provides more information on infection is vital.
This study aims to improve our understanding of infection in Australian Emergency Departments. We will do this by analysing in great detail the spectrum of infection syndromes presenting to the Emergency Department of a typical large Australian hospital over a period of several years. This will allow us to:
1) Identify the number of patients presenting to hospitals each year with severe infections and the outcome of these presentations.
2) Analyse the factors and information available to doctors in the Emergency Department that are associated with overall prognosis in patients with infection.
3) Build a comprehensive picture of the spectrum of infective agents that cause patients to be admitted to Australian hospitals.
4) Identify the most appropriate combination of antibiotics which should be used in the early treatment of the most severely ill patients with infection.
The cornerstone of this project is a large database which will capture detailed information on all patients presenting to the Emergency Department of a typical large Australian hospital who are subsequently admitted with infection. The database will be used for a series of studies. The first will accurately quantify the number of people presenting to the Emergency Department with infection, and their outcomes with current treatment in a hospital representative of the Australian healthcare system. The second study will identify the types of historical, clinical and laboratory information available to doctors during the early stages of assessment that predict whether an individual is likely to become very ill with infection. Identifying these patients at risk of progression to severe illness can be difficult, and is important because certain potentially life-saving treatments are most effective when given early. The third study will identify the types of micro-organisms that cause infection in our community. The fourth study will involve an intervention in the form of a prescribed antibiotic order set for use in severely ill infected patients. The findings from these four studies will ultimately enable doctors to identify severe infection earlier and treat such infections most appropriately.
Principle Investigator: Dr Julian Williams
Co-investigators:
Prof David Paterson- RBWH, Department for Infectious Diseases
Prof Jeffrey Lipman- RBWH Intensive Care
Dr Jaime Greenslade- RBWH DEM
Prof Anthony Brown- RBWH DEM
Dr Jennifer Paratz- RBWH Intensive Care
Dr Joel Dulhunty- RBWH Intensive Care
Dr Kevin Chu- RBWH DEM
Institution: Royal Brisbane and Women’s Hospital
Infections, particularly serious infections, cost the Australian healthcare system millions of dollars every year and impose a significant burden of illness on the Australian community. Serious infections also have the capacity to cause tragedy at a much more personal level, with lethal outcomes possible even in young previously healthy individuals. Despite the significant consequences of these illnesses, we have very limited information about the best way to identify and treat infection in Australian Emergency Departments. Therefore, research that provides more information on infection is vital.
This study aims to improve our understanding of infection in Australian Emergency Departments. We will do this by analysing in great detail the spectrum of infection syndromes presenting to the Emergency Department of a typical large Australian hospital over a period of several years. This will allow us to:
1) Identify the number of patients presenting to hospitals each year with severe infections and the outcome of these presentations.
2) Analyse the factors and information available to doctors in the Emergency Department that are associated with overall prognosis in patients with infection.
3) Build a comprehensive picture of the spectrum of infective agents that cause patients to be admitted to Australian hospitals.
4) Identify the most appropriate combination of antibiotics which should be used in the early treatment of the most severely ill patients with infection.
The cornerstone of this project is a large database which will capture detailed information on all patients presenting to the Emergency Department of a typical large Australian hospital who are subsequently admitted with infection. The database will be used for a series of studies. The first will accurately quantify the number of people presenting to the Emergency Department with infection, and their outcomes with current treatment in a hospital representative of the Australian healthcare system. The second study will identify the types of historical, clinical and laboratory information available to doctors during the early stages of assessment that predict whether an individual is likely to become very ill with infection. Identifying these patients at risk of progression to severe illness can be difficult, and is important because certain potentially life-saving treatments are most effective when given early. The third study will identify the types of micro-organisms that cause infection in our community. The fourth study will involve an intervention in the form of a prescribed antibiotic order set for use in severely ill infected patients. The findings from these four studies will ultimately enable doctors to identify severe infection earlier and treat such infections most appropriately.
Accelerated pathway in the assessment of acute coronary syndrome
Accelerated pathway in the assessment of suspected acute coronary syndrome in the Emergency Department: A diagnostic accuracy study
Principle Investigator: Dr Louise Cullen
Co-Investigators:
Prof Anthony Brown- RBWH DEM
Dr Martin Than- Christchurch Public Hospital DEM
Dr Jaimi Greenslade- RBWH DEM
Dr Christopher Hammet- RBWH Cardiology
Dr Xiang-Yu Hou- RBWH DEM
Dr Jacobu Ungerer, Pathology Queensland, Department of Chemical Pathology
Dr Kevin Chu- RBWH DEM
Dr William Parsonage- RBWH, Cardiology
Institution: Department of Emergency Medicine, Royal Brisbane and Women’s Hospital
Chest pain is one of the most common conditions treated in the Emergency Department (ED), but making a diagnosis remains challenging and resource-intensive. Not all causes of chest pain are due to heart disease. Currently, doctors do a blood test to look for the presence of a cardiac chemical called Troponin I to assist them in making a diagnosis of heart disease. This chemical is released from heart muscles when they are damaged and is, therefore, a good indicator of heart attack. However, because Troponin I is released slowly, doctors have to wait for up to six hours to determine whether it is present in the blood. In this project, we hope to make a more rapid diagnosis of the patient’s chest pain by measuring a number of different heart hormones and chemicals two hours after an individual presents to the ED. These chemicals are known as creatine kinase-MB-isoenzyme (CK-MB), B-type natruiretic peptide (BNP), and myoglobin. If the diagnosis at two hours is accurate, we will be able to provide treatment to patients up to four hours earlier. Moreover, patients who do not require treatment can be quickly sent home from the ED. In this way, we may reduce overcrowding in EDs.
We will recruit 1000 consecutive patients presenting to the Royal Brisbane Emergency Department with greater than 5 minutes chest pain. Patients will be managed and investigated as per standard care. However, we will take an additional blood test at two hours to assess the combination of heart chemicals. We will then follow-up on patients to determine whether the two hour test was accurate in diagnosing heart attack. The study has been approved by the Human Research Ethics Committee of the Royal Brisbane and Women’s Hospital. Results of the study will be presented at scientific meetings and published in medical journals.
Principle Investigator: Dr Louise Cullen
Co-Investigators:
Prof Anthony Brown- RBWH DEM
Dr Martin Than- Christchurch Public Hospital DEM
Dr Jaimi Greenslade- RBWH DEM
Dr Christopher Hammet- RBWH Cardiology
Dr Xiang-Yu Hou- RBWH DEM
Dr Jacobu Ungerer, Pathology Queensland, Department of Chemical Pathology
Dr Kevin Chu- RBWH DEM
Dr William Parsonage- RBWH, Cardiology
Institution: Department of Emergency Medicine, Royal Brisbane and Women’s Hospital
Chest pain is one of the most common conditions treated in the Emergency Department (ED), but making a diagnosis remains challenging and resource-intensive. Not all causes of chest pain are due to heart disease. Currently, doctors do a blood test to look for the presence of a cardiac chemical called Troponin I to assist them in making a diagnosis of heart disease. This chemical is released from heart muscles when they are damaged and is, therefore, a good indicator of heart attack. However, because Troponin I is released slowly, doctors have to wait for up to six hours to determine whether it is present in the blood. In this project, we hope to make a more rapid diagnosis of the patient’s chest pain by measuring a number of different heart hormones and chemicals two hours after an individual presents to the ED. These chemicals are known as creatine kinase-MB-isoenzyme (CK-MB), B-type natruiretic peptide (BNP), and myoglobin. If the diagnosis at two hours is accurate, we will be able to provide treatment to patients up to four hours earlier. Moreover, patients who do not require treatment can be quickly sent home from the ED. In this way, we may reduce overcrowding in EDs.
We will recruit 1000 consecutive patients presenting to the Royal Brisbane Emergency Department with greater than 5 minutes chest pain. Patients will be managed and investigated as per standard care. However, we will take an additional blood test at two hours to assess the combination of heart chemicals. We will then follow-up on patients to determine whether the two hour test was accurate in diagnosing heart attack. The study has been approved by the Human Research Ethics Committee of the Royal Brisbane and Women’s Hospital. Results of the study will be presented at scientific meetings and published in medical journals.
Impact of the Emergency Department Patient Admissions Predictive Tool (EDPAPT)
Evaluation of the Emergency Department Patient Admissions Predictive Tool: assessing its impact on access block, cancellation of elective surgery, work practices and patient outcomes.
Principle Investigator: A/Prof David Green
Co-Investigators:
Prof Marianne Wallis- School of Nursing and Midwifery, Griffith University
Prof Gerry Fitzgerald- School of Public Health, QUT
Dr James Lind- Gold Coast Hospital DEM
Dr Julia Crilly, Gold Coast Hospital, Southern Area Health Service Emergency Department Clinical Network
Dr Melanie Jessup- School of Nursing and Midwifery, Griffith University
Dr Justin Boyle- Australian E-Health Research Centre
Dr Peter Miller- Toowoomba Hospital DEM
Institution: Gold Coast Hospital (GCH) - Southport campus
Hospital occupancy rates regularly approach 100%, with resultant access block, ambulance bypass, and the last-minute cancellation of elective surgery patients. More efficient management of inpatient beds to reduce these predicaments is imperative. This project will evaluate the impact of a patient admission forecasting system - the
Emergency Department Patient Admissions Predictive Tool (EDPAPT) - that has been developed from analysis of historical admissions data at the Gold Coast Hospital and Toowoomba Hospital.
The aim of the project will determine whether a model that forecasts patient admissions
can assist with the allocation of inpatient beds to alleviate one of the major problems of most Emergency Department (ED)s: overcrowding and access block.
Specifically it will determine whether the number of elective surgery cancellations and ambulance bypass occurrences are impacted by using a prediction tool, and what impact there is on ED and bed management work practices. The study will also determine if bed managers will make use of prediction tools or whether there are barriers to their use of it, such as perceived inaccuracies, preferences to rely on own judgements or default to currrent, familiar modus operandi.
The study will comprehensively assess the EDPAPT. The impact of the tool on system processes and patient outcomes will be evaluated from selected comparisons over time of: elective surgery cancellations, ambulance bypass, access block, patient length of stay, and patient mortality.
This will be complemented by in-depth consultations with users of the system – particularly bed managers and ED staff – to capture, firstly, their initial responses and feedback, and secondly, their uptake of the tool and its impact on their practice and patient care.
Gold Coast Hospital has a bourgeoning ED that will be resited to the new, purpose-built University Hospital, and this presents a unique opportunity to contribute at its inception – particularly through research that addresses system organisation and flow, and patient outcomes.
Principle Investigator: A/Prof David Green
Co-Investigators:
Prof Marianne Wallis- School of Nursing and Midwifery, Griffith University
Prof Gerry Fitzgerald- School of Public Health, QUT
Dr James Lind- Gold Coast Hospital DEM
Dr Julia Crilly, Gold Coast Hospital, Southern Area Health Service Emergency Department Clinical Network
Dr Melanie Jessup- School of Nursing and Midwifery, Griffith University
Dr Justin Boyle- Australian E-Health Research Centre
Dr Peter Miller- Toowoomba Hospital DEM
Institution: Gold Coast Hospital (GCH) - Southport campus
Hospital occupancy rates regularly approach 100%, with resultant access block, ambulance bypass, and the last-minute cancellation of elective surgery patients. More efficient management of inpatient beds to reduce these predicaments is imperative. This project will evaluate the impact of a patient admission forecasting system - the
Emergency Department Patient Admissions Predictive Tool (EDPAPT) - that has been developed from analysis of historical admissions data at the Gold Coast Hospital and Toowoomba Hospital.
The aim of the project will determine whether a model that forecasts patient admissions
can assist with the allocation of inpatient beds to alleviate one of the major problems of most Emergency Department (ED)s: overcrowding and access block.
Specifically it will determine whether the number of elective surgery cancellations and ambulance bypass occurrences are impacted by using a prediction tool, and what impact there is on ED and bed management work practices. The study will also determine if bed managers will make use of prediction tools or whether there are barriers to their use of it, such as perceived inaccuracies, preferences to rely on own judgements or default to currrent, familiar modus operandi.
The study will comprehensively assess the EDPAPT. The impact of the tool on system processes and patient outcomes will be evaluated from selected comparisons over time of: elective surgery cancellations, ambulance bypass, access block, patient length of stay, and patient mortality.
This will be complemented by in-depth consultations with users of the system – particularly bed managers and ED staff – to capture, firstly, their initial responses and feedback, and secondly, their uptake of the tool and its impact on their practice and patient care.
Gold Coast Hospital has a bourgeoning ED that will be resited to the new, purpose-built University Hospital, and this presents a unique opportunity to contribute at its inception – particularly through research that addresses system organisation and flow, and patient outcomes.
The Robina Emergency Department Impact (REDI) Study
The impact of a new emergency department on patient presentations and ambulance service delivery in health service districts in Australia: a 12 month before and after study
Principle Investigator: Dr James Lind
Co-Investigators:
Dr Julia Crilly, Gold Coast Hospital, Southern Area Health Service Emergency Department Clinical Network
A/Prof Vivienne Tippett- Faculty of Health Science UQ and Australian Centre for Prehospital Research, QAS
Prof Marianne Wallis- School of Nursing and Midwifery, Griffith University
Dr Gerben Keijzers- Gold Coast Hospital DEM
Ms Marilla O'Dwyer- Australian E-Health Research Centre
Mr John O'Dwyer- Australian E-Health Research Centre
Ms Kerri Melki- Australian E-Health Research Centre
Ms Nerolie Bost- Gold Coast Hospital DEM
Dr Sue Shiels- Logan Hospital DEM
Institution: Gold Coast Hospital
This study involves tracking the ambulance, emergency department (ED) and hospital process for the Robina, Southport, and Logan hospitals.
Project Aims: (NB. AIMS 1 – 3 are complete)
1. Validate ambulance ramping time;
2. Compare patient outcomes for 'ramped' vs 'non-ramped' patients who arrive to ED via ambulance;
3. Pilot merging of three health information systems (ambulance, ED, and hospital) at one site (Southport hospital);
4.Describe the characteristics of patients presenting to Southport, and Logan EDs in 12 months before Robina ED opening;
5.Describe the characteristics of patients presenting to Southport, Logan and Robina EDs in 12 months after Robina ED opening;
6.Compare ED presentations at Southport and Logan EDs before and after Robina ED opening (accounting for population growth and other possible systemic factors);
7.Compare patient outcomes at Southport, Logan and Robina EDs before and 12 months after Robina ED opening;
8. Describe and compare ambulance 'ramping time' at Southport, Logan and Robina EDs before and 12 months after Robina ED opening.
Research Design: (STUDIES 1 and 2 ARE COMPLETE). This application relates to STUDY 3.
Involves three main studies:-
1. A retrospective pilot before and after design involving the collection and analysis of ambulance, ED and hospital data for Southport hospital only, for the month prior and post Robina ED opening.
2. A pilot case control study examining patient and ED outcomes for 'ramped' and 'non-ramped' patients who arrive at Southport hospital via ambulance.
3. A comparative, longitudinal, time series design involving examination of Ambulance, ED and hospital data from QAS, Southport, Logan and Robina hospitals for the 12 months before and after Robina ED opening.
Methods to achieve aims:
1.Liaise with key stakeholders to establish approval to be provided with data from the health information systems;
2.Meet with data managers to obtain specific data;
3.Pilot use of e-Health Research Centre Health Data Integration (HDI) software;
4.Clean and analyse data;
5.Validate ‘ambulance ramping time';
6. Collect, merge, clean and analyse data for study 2;
7. Collect, merge, clean, and analyse data for study 3;
8. Disseminate research findings.
Principle Investigator: Dr James Lind
Co-Investigators:
Dr Julia Crilly, Gold Coast Hospital, Southern Area Health Service Emergency Department Clinical Network
A/Prof Vivienne Tippett- Faculty of Health Science UQ and Australian Centre for Prehospital Research, QAS
Prof Marianne Wallis- School of Nursing and Midwifery, Griffith University
Dr Gerben Keijzers- Gold Coast Hospital DEM
Ms Marilla O'Dwyer- Australian E-Health Research Centre
Mr John O'Dwyer- Australian E-Health Research Centre
Ms Kerri Melki- Australian E-Health Research Centre
Ms Nerolie Bost- Gold Coast Hospital DEM
Dr Sue Shiels- Logan Hospital DEM
Institution: Gold Coast Hospital
This study involves tracking the ambulance, emergency department (ED) and hospital process for the Robina, Southport, and Logan hospitals.
Project Aims: (NB. AIMS 1 – 3 are complete)
1. Validate ambulance ramping time;
2. Compare patient outcomes for 'ramped' vs 'non-ramped' patients who arrive to ED via ambulance;
3. Pilot merging of three health information systems (ambulance, ED, and hospital) at one site (Southport hospital);
4.Describe the characteristics of patients presenting to Southport, and Logan EDs in 12 months before Robina ED opening;
5.Describe the characteristics of patients presenting to Southport, Logan and Robina EDs in 12 months after Robina ED opening;
6.Compare ED presentations at Southport and Logan EDs before and after Robina ED opening (accounting for population growth and other possible systemic factors);
7.Compare patient outcomes at Southport, Logan and Robina EDs before and 12 months after Robina ED opening;
8. Describe and compare ambulance 'ramping time' at Southport, Logan and Robina EDs before and 12 months after Robina ED opening.
Research Design: (STUDIES 1 and 2 ARE COMPLETE). This application relates to STUDY 3.
Involves three main studies:-
1. A retrospective pilot before and after design involving the collection and analysis of ambulance, ED and hospital data for Southport hospital only, for the month prior and post Robina ED opening.
2. A pilot case control study examining patient and ED outcomes for 'ramped' and 'non-ramped' patients who arrive at Southport hospital via ambulance.
3. A comparative, longitudinal, time series design involving examination of Ambulance, ED and hospital data from QAS, Southport, Logan and Robina hospitals for the 12 months before and after Robina ED opening.
Methods to achieve aims:
1.Liaise with key stakeholders to establish approval to be provided with data from the health information systems;
2.Meet with data managers to obtain specific data;
3.Pilot use of e-Health Research Centre Health Data Integration (HDI) software;
4.Clean and analyse data;
5.Validate ‘ambulance ramping time';
6. Collect, merge, clean and analyse data for study 2;
7. Collect, merge, clean, and analyse data for study 3;
8. Disseminate research findings.
Developing Disaster Health Education in Australia
Disaster Health Education in Australia – An Analysis of Current Status, Needs and Educational Strategies and the Development of Potential Future Models
Applicant: A/Professor Peter Aitken
Institution: The Townsville Hospital
Applicant: A/Professor Peter Aitken
Institution: The Townsville Hospital
Fellowship awarded for completion of Doctor of Public Health.
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.
MSc Clinical Trials
Master of Science Clinical Trials, University of London
Applicant: Dr Joseph Ting
Institution: Mater Public Hospital
The M Sc Clinical Trials at the University of London is a prestigious world class highly selective post-graduate degree that provides in-depth and practical clinical methodology Masters which will assist with future clinical and observational trials related to clinical, intervention, observational and epidemiological studies in emergency medicine. At completion, candidates are expected to be able to conduct and critically appraise complex intervention and non-intervention clinical studies. At present I am enrolled in second year of a full time M Sc at the University of London.
The M Sc aims to develop:
CT201 Research Protocol Development
CT202 Trial Designs
CT203 Project management and research coordination
CT208 Advanced statistical methods in clinical trials
PH204 Economic evaluation of health care
EP303 Epidemiology of non-communicable diseases
The London School of Hygiene and Tropical Medicine is Europe’s oldest public health institution and hosts world class Clinical Trials, Medical Statistics, Epidemiology, Public Health and Health Evaluation Units.
Pilot project to measure psychological stress in relatives of cardiac arrest victims
Pilot project to establish the feasibility of using the Horowitz Impact of Events Scale as a metric for psychological stress in relatives of cardiac arrest victims, with a view to determining whether providing CPR on a relative has an impact on psychological stress and severe adverse symptoms of grief.
Principle Investigator: Dr Iain McNeill
Co-Investigators:
Dr Frances Williamson- Princess Alexandra Hospital DEM
Dr Leo Nunnink- Princess Alexandra Hospital Intensive Care Unit
Dr Annette Broom- Princess Alexandra Hospital Department of Psychology
Insitution: Princess Alexandra Hospital
Cardiopulmonary resuscitation (CPR) provision by bystanders has a well recognised link to improved outcome in cardiac arrest sufferers. However, a victim of cardiac arrest is more likely to receive CPR from a non-related bystander than from a related witness. It is thought that there are psychological barriers to the provision of CPR by related persons.
The overall aim of the proposed study is to examine the effects of CPR provision on persons who are related bystanders of a victim of cardiac arrest. To do this a large study is planned which will measure the psychological impact of having a relative experience cardiac arrest, and then compare the responses of the relatives who do provide CPR with those who do not provide CPR. The outcomes should assist in clarifying two main issues: (1) whether there is an unrecognised population in the community who may be at risk of psychological harm – the individuals who provide CPR to a relative; and (2) whether the specific barriers that prevent individuals from commencing CPR on a relative who has had a cardiac arrest can be categorised.
However, prior to embarking on the large study there are several methodological issues that need to be examined and so a pilot study is required.
The three key purposes for the proposed pilot study, therefore, are: (1) to assess the proposed recruitment strategy; (2) to evaluate the usefulness of the selected test instruments in the context of the larger study and its aims; and, (3) to establish whether or not participants will perceive subjective psychological distress (or possibly even psychological benefit) through the administration of the selected assessment tools.
Registrar Night Shift Psychomotor Study
The effect of consecutive night shifts on the
psychomotor performance of registrars working in
the emergency department.
Principle Investigator: Dr James Tilleard
Co-Investigators:
Dr Julia Haire- Nambour General Hospital DEM
Dr Sally Ferguson- Centre for Sleep Research University of South Australia
Dr Matthew Thomas- Centre for Sleep Research University of South Australia
Mr Paul Negus- Nambour General Hospital DEM
Institution: Nambour General Hospital
Aim: To evaluate the effect of consecutive night shifts on the psychomotor performance of registrars working in the emergency department, to evaluate how well the registrars are able to judge how fatigue will affect their performance and to gather information on the amount of time that registrars spend asleep surrounding their night shifts.
Research Design
This will be a prospective observational study.
Methods
All registrars working night shifts in the Nambour Emergency Department will be informed about the study and invited to participate on a voluntary basis.
The registrars will be asked to complete a brief questionnaire to gather basic demographic information.
Each registrar will be asked to fill out a sleep diary for the 24 hours prior to each shift tested. They will be
asked to note the periods during the last 24 hours that they slept, the quality of sleep, when they ate, when they consumed caffeine, how fatigued they feel and how well they think they will perform on the psychometric tests. They will also be asked to complete a NASA workload scale to assess workload perception over the shift. They will be asked to wear the actigraphs during their night and day shift weeks in order to calculate the time spent asleep during that week.
The registrars will be tested with a battery of psychometric tests conducted on palm pilots in a quiet room at the beginning and end of each day and night shift. This will be done for 7 consecutive day and night shifts. The psychometric tests used will be a Psychomotor Vigilance test, a Delayed Span test and a Divided Attention Task. These tests will evaluate attention, concentration, reaction times and short term memory. The initial questionnaire, sleep diary data and NASA workload scale data will be collected on paper and then put into an Excel worksheet. The psychometric test results and information from the actigraphs will be downloaded on to computer. The relationships between prior sleep, prior wake, work hours, subjective fatigue and performance on the neurobehavioural tasks will be assessed using a Mixed Model ANOVA. This will take into account repeated observations on the same individuals.
psychomotor performance of registrars working in
the emergency department.
Principle Investigator: Dr James Tilleard
Co-Investigators:
Dr Julia Haire- Nambour General Hospital DEM
Dr Sally Ferguson- Centre for Sleep Research University of South Australia
Dr Matthew Thomas- Centre for Sleep Research University of South Australia
Mr Paul Negus- Nambour General Hospital DEM
Institution: Nambour General Hospital
Aim: To evaluate the effect of consecutive night shifts on the psychomotor performance of registrars working in the emergency department, to evaluate how well the registrars are able to judge how fatigue will affect their performance and to gather information on the amount of time that registrars spend asleep surrounding their night shifts.
Research Design
This will be a prospective observational study.
Methods
All registrars working night shifts in the Nambour Emergency Department will be informed about the study and invited to participate on a voluntary basis.
The registrars will be asked to complete a brief questionnaire to gather basic demographic information.
Each registrar will be asked to fill out a sleep diary for the 24 hours prior to each shift tested. They will be
asked to note the periods during the last 24 hours that they slept, the quality of sleep, when they ate, when they consumed caffeine, how fatigued they feel and how well they think they will perform on the psychometric tests. They will also be asked to complete a NASA workload scale to assess workload perception over the shift. They will be asked to wear the actigraphs during their night and day shift weeks in order to calculate the time spent asleep during that week.
The registrars will be tested with a battery of psychometric tests conducted on palm pilots in a quiet room at the beginning and end of each day and night shift. This will be done for 7 consecutive day and night shifts. The psychometric tests used will be a Psychomotor Vigilance test, a Delayed Span test and a Divided Attention Task. These tests will evaluate attention, concentration, reaction times and short term memory. The initial questionnaire, sleep diary data and NASA workload scale data will be collected on paper and then put into an Excel worksheet. The psychometric test results and information from the actigraphs will be downloaded on to computer. The relationships between prior sleep, prior wake, work hours, subjective fatigue and performance on the neurobehavioural tasks will be assessed using a Mixed Model ANOVA. This will take into account repeated observations on the same individuals.
Comparing patient controlled versus physician controlled sedation in the ED
A randomized controlled trial comparing patient controlled versus physician controlled sedation with propofol in patients requiring procedural sedation in the Emergency Department.
Principle Investigator: Dr Anthony Bell
Co-Investigators:
Dr Kevin Chu- RBWH DEM
Dr Trent Lipp- RBWH DEM
Dr Jaimi Greenslade- RBWH DEM
Ms Alison Duncan- RBWH DEM
Dr Sean Rothwell- RBWH DEM
Institution: Department of Emergency Medicine, Royal Brisbane and Women’s Hospital
Emergency Department patients are often sedated before undergoing painful procedures such as manipulation of fractures and dislocations. Propofol is a sedative drug commonly used for this purpose. Presently, the drug is always given by the doctor. However, there is evidence to suggest that the drug can be safely administered by the patient to him or herself. The patient does this by pressing a button on a pump which delivers the drug on demand in a controlled manner. This is called patient controlled sedation. There are potential benefits when the patient gives the sedative drug to him or herself including getting the dose and therefore the sedation just right, and the satisfaction of being in control. Patient controlled sedation will avoid the discomfort associated with the painful procedure if the doctor does not give enough of the drug. It will also avoid an overdose along with its associated side effects if the doctor gives too much of the drug.
This study will compare patient controlled sedation with doctor administered sedation for painful procedures performed in the Emergency Department. Eighty patients will be randomly assigned to the patient controlled sedation group and eighty patients to the doctor administered sedation group. The overall dose of propofol administered during patient controlled and doctor administered sedation will be compared. The study will also examine how deeply the patients are put to sleep, how long they are put to sleep, how satisfied they are with the sedation, and the number of adverse events, if any, between the two groups. The study has been approved the Human Research Ethics Committee of the Royal Brisbane and Women’s Hospital. Results of the study will be presented at scientific meetings and published in medical journals.
Principle Investigator: Dr Anthony Bell
Co-Investigators:
Dr Kevin Chu- RBWH DEM
Dr Trent Lipp- RBWH DEM
Dr Jaimi Greenslade- RBWH DEM
Ms Alison Duncan- RBWH DEM
Dr Sean Rothwell- RBWH DEM
Institution: Department of Emergency Medicine, Royal Brisbane and Women’s Hospital
Emergency Department patients are often sedated before undergoing painful procedures such as manipulation of fractures and dislocations. Propofol is a sedative drug commonly used for this purpose. Presently, the drug is always given by the doctor. However, there is evidence to suggest that the drug can be safely administered by the patient to him or herself. The patient does this by pressing a button on a pump which delivers the drug on demand in a controlled manner. This is called patient controlled sedation. There are potential benefits when the patient gives the sedative drug to him or herself including getting the dose and therefore the sedation just right, and the satisfaction of being in control. Patient controlled sedation will avoid the discomfort associated with the painful procedure if the doctor does not give enough of the drug. It will also avoid an overdose along with its associated side effects if the doctor gives too much of the drug.
This study will compare patient controlled sedation with doctor administered sedation for painful procedures performed in the Emergency Department. Eighty patients will be randomly assigned to the patient controlled sedation group and eighty patients to the doctor administered sedation group. The overall dose of propofol administered during patient controlled and doctor administered sedation will be compared. The study will also examine how deeply the patients are put to sleep, how long they are put to sleep, how satisfied they are with the sedation, and the number of adverse events, if any, between the two groups. The study has been approved the Human Research Ethics Committee of the Royal Brisbane and Women’s Hospital. Results of the study will be presented at scientific meetings and published in medical journals.
Procedural Sedation in the Emergency Department
Procedural Sedation in the Emergency Department: A comprehensive analysis of a prospective registry of 2000 consecutive procedural sedations and telephone follow-up from Redcliffe and Caboolture Hospital Emergency Departments.
Principle Investigator: Dr Greg Treston
Co-Investigators:
Dr Anthony Bell- RBWH DEM
Ms Catrina Codd- QEMRF
Institution: Redcliffe Hospital
Patients frequently present to the Emergency Department (ED) requiring brief but painful procedures as part of their medical treatment. Completion of these procedures in a safe and timely manner should be a core competency of an Emergency Physician. Insufficient data currently exists to guide the Emergency Physician in the conduct of these procedures. A specific and highly comprehensive registry of patient related parameters, patient and physician satisfaction with the sedative episode is required.
This project will build on an existing registry containing almost 2000 episodes of ED procedural sedation with telephone follow-up of up to 66%. The quality of the data in the data base has been consistently reviewed by the Principal Investigator throughout the entire seven years. Because of the medium size of the Redcliffe ED there have been well defined sedation protocols for specific situations which have been consistently followed by doctors throughout the seven years.
These include:
• Titrated intravenous pre-mixed ketamine-propofol sedation
• Titrated intravenous/intra-muscular ketamine sedation.
• Titrated intravenous propofol sedation
Human Research Ethics Approval has been obtained for this research and written informed consent has been obtained from all patients or their parent or guardian included in the Registry.
The registry is now at a stage where there are sufficient numbers to conduct more detailed analyses than has previously been done. Previously Emergency Medicine Registrars have completed research projects which have occurred because of the procedural sedation Registry [1, 2].
We will address the role of fasting prior to sedation, use of adjunctive narcotics with sedation, post discharge adverse events, intra-procedural adverse events, and the need for any basic or advanced life support measures during procedural sedation. The need for post procedural observation in the Emergency Department versus early discharge will also be analysed.
Databases existing both nationally and internationally have not been specific enough to address the many questions that we aim to answer.
Specific questions that need to be answered include:
1. Do children with attention deficit disorder (ADD) or Attention-deficit hyperactivity disorder (ADHD) have a greater rate of emergence delirium from ketamine than non-ADD (normal) kids?
2. Do adults have emergence delirium and what is that delirium when sedated with ketamine-propofol combination?
3. Does sublingual ondansetron decrease the rate of vomiting associated with IV/IM ketamine?
4. Does epilepsy increase the rate of myoclonus associated with ketamine use?
5. Is vomiting on recovery related at all to fasting status, for all sorts of sedation?
6. Does a history of asthma change the conduct of the procedure with ketamine?
7. When using ketamine sedation in a child with an upper respiratory tract infection (URTI), what (if anything) changes about the procedure?
8. Which fractures can be reduced definitively in the ED without need for further Manipulation Under Anaesthesia (MUA) or open reduction, internal fixation (ORIF) in the operating theatre.
9. Side effect profile of using ketamine, propofol, or a mix of both in ED procedural sedation. What needs to be done for each of those events?
10. Post-discharge adverse event profile of each of the agents.
11. Does the use of intra-procedural narcotic increase the rate of cardio-respiratory complication when performing procedural sedation in the ED?
12. Does the use of NSAIDs impair the rate of fracture healing?
The aim is to answer in a very definite way any question a practitioner might have regarding procedural sedation in the ED using those agents. There are many other questions, particularly directed at the patients themselves or their families with respect to satisfaction that will also be examined. In addition, we will try to provide Emergency Medicine Practitioners clinically useful classifications and guidelines for the conduct of safe and effective procedural sedation.
Principle Investigator: Dr Greg Treston
Co-Investigators:
Dr Anthony Bell- RBWH DEM
Ms Catrina Codd- QEMRF
Institution: Redcliffe Hospital
Patients frequently present to the Emergency Department (ED) requiring brief but painful procedures as part of their medical treatment. Completion of these procedures in a safe and timely manner should be a core competency of an Emergency Physician. Insufficient data currently exists to guide the Emergency Physician in the conduct of these procedures. A specific and highly comprehensive registry of patient related parameters, patient and physician satisfaction with the sedative episode is required.
This project will build on an existing registry containing almost 2000 episodes of ED procedural sedation with telephone follow-up of up to 66%. The quality of the data in the data base has been consistently reviewed by the Principal Investigator throughout the entire seven years. Because of the medium size of the Redcliffe ED there have been well defined sedation protocols for specific situations which have been consistently followed by doctors throughout the seven years.
These include:
• Titrated intravenous pre-mixed ketamine-propofol sedation
• Titrated intravenous/intra-muscular ketamine sedation.
• Titrated intravenous propofol sedation
Human Research Ethics Approval has been obtained for this research and written informed consent has been obtained from all patients or their parent or guardian included in the Registry.
The registry is now at a stage where there are sufficient numbers to conduct more detailed analyses than has previously been done. Previously Emergency Medicine Registrars have completed research projects which have occurred because of the procedural sedation Registry [1, 2].
We will address the role of fasting prior to sedation, use of adjunctive narcotics with sedation, post discharge adverse events, intra-procedural adverse events, and the need for any basic or advanced life support measures during procedural sedation. The need for post procedural observation in the Emergency Department versus early discharge will also be analysed.
Databases existing both nationally and internationally have not been specific enough to address the many questions that we aim to answer.
Specific questions that need to be answered include:
1. Do children with attention deficit disorder (ADD) or Attention-deficit hyperactivity disorder (ADHD) have a greater rate of emergence delirium from ketamine than non-ADD (normal) kids?
2. Do adults have emergence delirium and what is that delirium when sedated with ketamine-propofol combination?
3. Does sublingual ondansetron decrease the rate of vomiting associated with IV/IM ketamine?
4. Does epilepsy increase the rate of myoclonus associated with ketamine use?
5. Is vomiting on recovery related at all to fasting status, for all sorts of sedation?
6. Does a history of asthma change the conduct of the procedure with ketamine?
7. When using ketamine sedation in a child with an upper respiratory tract infection (URTI), what (if anything) changes about the procedure?
8. Which fractures can be reduced definitively in the ED without need for further Manipulation Under Anaesthesia (MUA) or open reduction, internal fixation (ORIF) in the operating theatre.
9. Side effect profile of using ketamine, propofol, or a mix of both in ED procedural sedation. What needs to be done for each of those events?
10. Post-discharge adverse event profile of each of the agents.
11. Does the use of intra-procedural narcotic increase the rate of cardio-respiratory complication when performing procedural sedation in the ED?
12. Does the use of NSAIDs impair the rate of fracture healing?
The aim is to answer in a very definite way any question a practitioner might have regarding procedural sedation in the ED using those agents. There are many other questions, particularly directed at the patients themselves or their families with respect to satisfaction that will also be examined. In addition, we will try to provide Emergency Medicine Practitioners clinically useful classifications and guidelines for the conduct of safe and effective procedural sedation.
Regulatory systems for occupational exposures in emergency care: (WPHS Regulations)
Regulatory systems for occupational exposures in emergency health care: Contemporary challenges for the emergency physician in prevention, control and management.
Principle Investigator: Dr Michael Sinnott
Co-Investigators:
Mr Ramon Shaban- Institute for Health and Medical Research Griffith University
Prof John Devereux- TC Beirne School of Law UQ
Instituition: Princess Alexandra Hospital
Healthcare workers in emergency departments are at high risk of exposure to blood-borne infections from occupational exposure. The financial and human costs of these injuries are significant. The risks such health care workers face are made more difficult in recent times because of three interconnected reasons. First, emergency care workers are at high risk of occupational exposures because of the nature of their work and the environment they operate in. They work in highly volatile and high-stakes situations. Second, emergency departments face unprecedented demands for emergency medical care. With increased numbers of patients, waiting times for medical treatment inevitably increase, leading to patient dissatisfaction, aggression and violence, larger and heavier workloads, decreased patient and staff satisfaction, and higher staff turnover and burnout. Third, emergency physicians are routinely called upon to manage healthcare workers who have sustained these occupational exposure injuries. The more patients there are, the more at risk emergency physicians and others are at risk of occupational exposures.
These injuries are largely preventable. Emergency physicians have key roles to play with their prevention, but lack a rigorous reporting system and sensitive data management system with a universal regulatory framework to do so. While national guidelines exist to govern the clinical management of such injuries, there is no consistency of regulatory and legislative workplace health and safety frameworks in which emergency physicians are required to operate across the country, making their prevention, control and management by emergency physicians highly problematic. This study will provide a definitive systematic review of the legislative and regulatory workplace health and safety frameworks governing the management, control and prevention of occupational exposures across Australia. Moreover, the study will provide baseline data and pilot research for a larger study that suggests the development of a culture of patient safety within the emergency department and the wider hospital environment first requires a culture of staff safety. For the true financial and human costs of occupational exposures to be known, it is critical to gauge the extent the problem. When we consider the estimated under-reporting in the United States or Australia, where it is estimated that up to 85% of occupational exposures are not reported due to the systematic under-reporting of sharps injuries, the financial and human costs associated with occupational exposures are significant.
Principle Investigator: Dr Michael Sinnott
Co-Investigators:
Mr Ramon Shaban- Institute for Health and Medical Research Griffith University
Prof John Devereux- TC Beirne School of Law UQ
Instituition: Princess Alexandra Hospital
Healthcare workers in emergency departments are at high risk of exposure to blood-borne infections from occupational exposure. The financial and human costs of these injuries are significant. The risks such health care workers face are made more difficult in recent times because of three interconnected reasons. First, emergency care workers are at high risk of occupational exposures because of the nature of their work and the environment they operate in. They work in highly volatile and high-stakes situations. Second, emergency departments face unprecedented demands for emergency medical care. With increased numbers of patients, waiting times for medical treatment inevitably increase, leading to patient dissatisfaction, aggression and violence, larger and heavier workloads, decreased patient and staff satisfaction, and higher staff turnover and burnout. Third, emergency physicians are routinely called upon to manage healthcare workers who have sustained these occupational exposure injuries. The more patients there are, the more at risk emergency physicians and others are at risk of occupational exposures.
These injuries are largely preventable. Emergency physicians have key roles to play with their prevention, but lack a rigorous reporting system and sensitive data management system with a universal regulatory framework to do so. While national guidelines exist to govern the clinical management of such injuries, there is no consistency of regulatory and legislative workplace health and safety frameworks in which emergency physicians are required to operate across the country, making their prevention, control and management by emergency physicians highly problematic. This study will provide a definitive systematic review of the legislative and regulatory workplace health and safety frameworks governing the management, control and prevention of occupational exposures across Australia. Moreover, the study will provide baseline data and pilot research for a larger study that suggests the development of a culture of patient safety within the emergency department and the wider hospital environment first requires a culture of staff safety. For the true financial and human costs of occupational exposures to be known, it is critical to gauge the extent the problem. When we consider the estimated under-reporting in the United States or Australia, where it is estimated that up to 85% of occupational exposures are not reported due to the systematic under-reporting of sharps injuries, the financial and human costs associated with occupational exposures are significant.
Tertiary Survey Tool
The effects of implementation of a tertiary survey tool for multi-trauma patients
Principle Investigator: Dr Gerben Keijzers
Co-Investigators:
Dr Don Campbell- Gold Coast Hospital DEM
Dr Don Pitchford- Gold Coast Hospital Orthopaedic Department
Dr Jeffrey Hooper- Gold Coast Hospital DEM
Dr Julia Crilly, Gold Coast Hospital, Southern Area Health Service Emergency Department Clinical Network
Ms Christina Jennekens- Gold Coast Hospital DEM
A/Prof Marie Cooke- School of Medicine And Midwifery Griffith University
Institution: Emergency Department, Gold Coast Hospital, Southport
Missed injuries in trauma patients are a well recognised phenomenon. Currently at Gold Coast Hospital there is no formalised process for review of multi-trauma patients who are admitted to the general ward. Anecdotal evidence from the emergency department’s monthly trauma review meeting suggests that there are multiple factors that contribute to missed injuries. Commonly patients with an altered level of consciousness, those that are intoxicated or those that are unstable and require immediate operation, have injuries that may not be recognized in the ED. Also at risk are patients transferred from other facilities that have been assessed and managed elsewhere.
The idea of a tertiary survey has been proposed as one strategy to reduce the incidence of missed injuries in trauma patients. This involves a re-evaluation within 24 hours of admission with a complete head to toe examination, review of laboratory results and radiologic studies. This is frequently documented on a tertiary survey form that is filed in the medical record.
The aim of this study is to implement and evaluate the introduction of a tertiary survey tool in three wards (ICU, orthopaedic and ED observation ward) where multi-trauma patients are admitted.
Objective:
A holistic approach to the trauma patient needs to include a tertiary survey. This study aims to improve clinical practice and aims for completion of tertiary surveys in close to 100% of patients. By implementing this tertiary survey tool, we aim for a broader change in culture to achieve a holistic approach to the trauma patient, and to reduce their missed injuries and improve their functional outcomes. It will improve continuity of care of trauma patients from the Emergency Department through to the wards
Research Design and methods:
The study will consist of three phases. Initially, a six month retrospective chart review of trauma patients will be conducted to estimate the incidence of tertiary surveys being conducted.
All trauma patients with: 1) multiple injuries, 2) high impact mechanism, 3) chest and abdominal injuries and 4) patients with a fractured neck of femur under 65 years of age who presented to the GCH ED and required at least 24 hours of hospital admission are included.
After this first phase, a prospective, observational study, incorporating a before and after design will comprise phase 2 and 3. For both pre-intervention (phase 2) and post-intervention (phase 3) we intend to consent all enrolled trauma patients for telephone follow up at 1 and 6 months. This will give an estimate of the baseline incidence before the introduction of the survey tool of missed injuries, further ongoing medical appointments and level of physical and social functioning.
Introduction of the intervention will consist of introduction of the tertiary survey tool (see attachment), and education of its use to select medical and nursing staff that will conduct the tertiary surveys.
The post-intervention phase will prospectively assess effect of the tertiary survey tool on incidence of tertiary surveys performed, delayed injuries detected and during the 1 and 6 month telephone follow up the incidence of missed injuries, further ongoing medical appointments and level of physical and social functioning can be compared.
We believe that the introduction of this system will improve continuity of care of trauma patients from emergency through to the wards.
Principle Investigator: Dr Gerben Keijzers
Co-Investigators:
Dr Don Campbell- Gold Coast Hospital DEM
Dr Don Pitchford- Gold Coast Hospital Orthopaedic Department
Dr Jeffrey Hooper- Gold Coast Hospital DEM
Dr Julia Crilly, Gold Coast Hospital, Southern Area Health Service Emergency Department Clinical Network
Ms Christina Jennekens- Gold Coast Hospital DEM
A/Prof Marie Cooke- School of Medicine And Midwifery Griffith University
Institution: Emergency Department, Gold Coast Hospital, Southport
Missed injuries in trauma patients are a well recognised phenomenon. Currently at Gold Coast Hospital there is no formalised process for review of multi-trauma patients who are admitted to the general ward. Anecdotal evidence from the emergency department’s monthly trauma review meeting suggests that there are multiple factors that contribute to missed injuries. Commonly patients with an altered level of consciousness, those that are intoxicated or those that are unstable and require immediate operation, have injuries that may not be recognized in the ED. Also at risk are patients transferred from other facilities that have been assessed and managed elsewhere.
The idea of a tertiary survey has been proposed as one strategy to reduce the incidence of missed injuries in trauma patients. This involves a re-evaluation within 24 hours of admission with a complete head to toe examination, review of laboratory results and radiologic studies. This is frequently documented on a tertiary survey form that is filed in the medical record.
The aim of this study is to implement and evaluate the introduction of a tertiary survey tool in three wards (ICU, orthopaedic and ED observation ward) where multi-trauma patients are admitted.
Objective:
A holistic approach to the trauma patient needs to include a tertiary survey. This study aims to improve clinical practice and aims for completion of tertiary surveys in close to 100% of patients. By implementing this tertiary survey tool, we aim for a broader change in culture to achieve a holistic approach to the trauma patient, and to reduce their missed injuries and improve their functional outcomes. It will improve continuity of care of trauma patients from the Emergency Department through to the wards
Research Design and methods:
The study will consist of three phases. Initially, a six month retrospective chart review of trauma patients will be conducted to estimate the incidence of tertiary surveys being conducted.
All trauma patients with: 1) multiple injuries, 2) high impact mechanism, 3) chest and abdominal injuries and 4) patients with a fractured neck of femur under 65 years of age who presented to the GCH ED and required at least 24 hours of hospital admission are included.
After this first phase, a prospective, observational study, incorporating a before and after design will comprise phase 2 and 3. For both pre-intervention (phase 2) and post-intervention (phase 3) we intend to consent all enrolled trauma patients for telephone follow up at 1 and 6 months. This will give an estimate of the baseline incidence before the introduction of the survey tool of missed injuries, further ongoing medical appointments and level of physical and social functioning.
Introduction of the intervention will consist of introduction of the tertiary survey tool (see attachment), and education of its use to select medical and nursing staff that will conduct the tertiary surveys.
The post-intervention phase will prospectively assess effect of the tertiary survey tool on incidence of tertiary surveys performed, delayed injuries detected and during the 1 and 6 month telephone follow up the incidence of missed injuries, further ongoing medical appointments and level of physical and social functioning can be compared.
We believe that the introduction of this system will improve continuity of care of trauma patients from emergency through to the wards.
Validation of Caring Criteria
Validation of CARING criteria: A diagnostic accuracy study for predicting who should have an Advance Health Directive (AHD).
Principle Investigator: Dr Philip Richardson
Co-Investigators:
Dr Kevin Chu- RBWH DEM
Dr Jaimi Greenslade- RBWH DEM
Institution: Royal Brisbane and Women’s Hospital
Advanced health directives are legal documents that outline patients’ desires for end-of-life care. For individual’s nearing the end of their lives, advanced health directives are an important part of their treatment plan. This is because they tell health care providers about the patient’s wishes regarding treatment near the time of death. However, very few patients hold these documents. This study looks to see whether we can easily identify individuals who are nearing the end of their lives, and therefore, should have an advanced health directive. The research is an initial step in increasing the number of individuals who hold advanced health directives.
In identifying those people who are nearing the end of their lives, we will utilise a clinical tool called the CARING criteria. This tool was designed in the United States and uses demographic and clinical information to identify patients who are likely to die within twelve months. In its original setting, the CARING criteria was highly accurate. However, no research has examined whether this tool is valid in the Australian Emergency Department setting.
Therefore, we will assess the tool by looking at the medical charts of 1000 patients presenting to the Emergency Department. We will use the information in these charts to determine which patients meet the CARING criteria, and therefore, likely to have a limited life expectancy. After 12 months, we will conduct a search of the state death registries to determine whether individuals have deceased. We will then determine how accurate the CARING criterion is for predicting mortality. If the tool is accurate, we can apply it to all patients presenting to the Emergency Department and provide advanced health directive counselling to those who meet the criteria. This will ensure that the care provided to patients at the end of their lives is sensitive and meets the needs of patients.
Principle Investigator: Dr Philip Richardson
Co-Investigators:
Dr Kevin Chu- RBWH DEM
Dr Jaimi Greenslade- RBWH DEM
Institution: Royal Brisbane and Women’s Hospital
Advanced health directives are legal documents that outline patients’ desires for end-of-life care. For individual’s nearing the end of their lives, advanced health directives are an important part of their treatment plan. This is because they tell health care providers about the patient’s wishes regarding treatment near the time of death. However, very few patients hold these documents. This study looks to see whether we can easily identify individuals who are nearing the end of their lives, and therefore, should have an advanced health directive. The research is an initial step in increasing the number of individuals who hold advanced health directives.
In identifying those people who are nearing the end of their lives, we will utilise a clinical tool called the CARING criteria. This tool was designed in the United States and uses demographic and clinical information to identify patients who are likely to die within twelve months. In its original setting, the CARING criteria was highly accurate. However, no research has examined whether this tool is valid in the Australian Emergency Department setting.
Therefore, we will assess the tool by looking at the medical charts of 1000 patients presenting to the Emergency Department. We will use the information in these charts to determine which patients meet the CARING criteria, and therefore, likely to have a limited life expectancy. After 12 months, we will conduct a search of the state death registries to determine whether individuals have deceased. We will then determine how accurate the CARING criterion is for predicting mortality. If the tool is accurate, we can apply it to all patients presenting to the Emergency Department and provide advanced health directive counselling to those who meet the criteria. This will ensure that the care provided to patients at the end of their lives is sensitive and meets the needs of patients.
If you require any further information or have any comments or feedback,
please contact the research manager Catrina Codd.