Results for Leading Edge

From Big Data to the Bedside: answering big questions in emergency department pain care using artificial intelligence and patient-reported outcomes

One of the main reasons that acute pain is not well treated in the emergency department (ED) setting is that pain is difficult to measure. While patient-reported outcome measures (PROMS) are commonly used to help guide treatment of pain in settings such as chronic pain care, cancer care and migraine care, there are no similar tools available for patients with acute pain in the ED. Further hampering efforts to provide better ED pain care is poor overall understanding of the numbers and types of patients that experience pain.

Since it is a symptom rather than a diagnosis, information about pain is not systematically collected and is often obscured within free-text clinical notes. The lack of readily-available data makes it difficult to determine who exactly has experienced pain, and to design research studies to evaluate new and existing treatments.

Researchers aim to validate a PROM for pain care in the ED by administering to 400 patients who present with pain to one of two large hospital EDs. The aim is to find out the incidence and characteristics of patients who present with pain to the Royal Brisbane and Women’s Hospital ED, by using novel machine- and deep-learning techniques to process free-text information from clinical notes. This study will provide new knowledge and techniques that are essential for clinician-researchers to design and conduct studies that will ultimately improve pain care in the ED.


How long can a clinician wearing personal protective equipment (PPE) safely work in a high-risk isolation area during one continuous shift?

Patients with COVID-19 symptoms are isolated and treated in a high-risk zone (HRZ) within the emergency department. Entry is restricted to essential staff wearing personal protective equipment (PPE).

HRZ doctors and nurses typically work 5-10 hour shifts, during which meal and toilet breaks must be taken outside the HRZ. Doffing (taking off PPE) and repeated donning (putting on PPE) are discouraged to conserve PPE. Doctors and nurses often work continuously with minimum breaks because they must doff before exiting and don before entering the HRZ. PPE traps body heat generated by physical activity, adding to mental and physical fatigue, and potential breaches in infection control precautions.

This study will investigate the length-of-time doctors or nurses can safely work in HRZ in one continuous shift.


Interaction of hyperdynamic septic shock and sepsis endotypes: a new paradigm

Sepsis is an emergency medical condition that is caused by an abnormal response of the body to the presence of harmful microorganisms in the blood. It can lead to injury of body organs, shock and loss of life. Every year, 11 million people worldwide die due to sepsis.

Despite advances in the treatment of infections, management strategies for sepsis remain suboptimal. Inadequate understanding of immune system response to severe infection is partly to blame. Patients present to hospital with different signs that may include having warm peripheries and low blood pressure (hyperdynamic shock). Critically ill patients with sepsis who present with these signs, commonly receive medications to support blood pressure (vasopressors) but it is unclear whether starting vasopressor early, will result in better patient response or outcomes.

This study will investigate whether starting early vasopressor is better compared to delayed initiation. As clinicians working in the emergency department and intensive care, researchers will be able use study findings to develop better ways of treating septic patients.


Emergency department treatment of the drowning victim

Drowning has a major global impact, with approximately 300,000 deaths each year. Yet the treatment of drowning victims has received limited investigation. This lack of evidence means that guidelines for the treatment of drowning victims are largely based on case reports or on other conditions such as acute respiratory distress syndrome (ARDS), on the premise that there may be similarities between the two conditions.

We are proposing to create a comprehensive database of information on drowning patients presenting to the emergency departments at the Sunshine Coast Hospital and Health Service. We will utilise a standardised list of data (Utstein-style guidelines for Drowning) to explore the treatment and outcomes for drowning patients over an eight-year period 2015-2022 inclusive. This will allow us to answer questions on the best ways to assist the breathing of drowning patients, if the treatment and outcomes in female drowning differ from males and why (there is some evidence females have better survival outcomes after being admitted to hospital), and to determine if the classification of drowning severity in common use around the world is useful in an Australian population.


PaNURAMA Inter-facility Transfer Tool: a validation study of the Paediatric Non-Urgent, Risk Assessment, Management and nurse escort Assessment Tool for safe children’s inter-facility Transfer

Most paediatric inter-facility transfers within Australia are for children that do not qualify for specialist paediatric retrieval services but still require access to specialised paediatric care not offered at the local healthcare facility.

Evidence-based transfer guidance for children requiring retrieval are well established. However, for children who do not meet retrieval criteria, there is little guidance for referring and accepting clinicians on how to coordinate safe transfer. Nurse escorts are often deployed but may not be trained sufficiently to deal with arising complications during transfer. Additionally, with the availability and scope of paramedics, the deployment of nurse escorts may not be required, and unecessarily deplete valuable resources at referring facilities.

A risk stratification tool has been developed to determine which non-urgent transfers require higher level consultation and management prior to and during transfer, and nursing escort. The validation of this tool may assist to accurately identify higher-risk children, enabling application of appropriate safeguards, an appropriate level of consultation and escort, and supporting clinician decision-making surrounding transport Australia-wide.


Intervention with concentrated albumin for resuscitation of undifferentiated sepsis (ICARUS): a randomised controlled trial

Global estimates suggest that approximately 5 million people die from infection each year. Research into improved management and treatment for patients with infection is essential for reducing mortality.

Patients presenting to the emergency department with severe infections are treated with fluids in the vein to maintain optimal blood volume, to keep the heart working properly and tissues well oxygenated. Fluids administered to patients include crystalloids (water-based fluids that include salts and other water-soluble molecules), and albumin (a fluid manufactured from human plasma). Crystalloids are most commonly used by emergency physicians in standard care however initial evidence indicates that albumin may result in better outcomes for patients with severe infections, but further quality trials are required for validation.

In this study, researchers will randomise emergency department patients with severe infection to receive either albumin or crystalloids. The aim of the study is to provide emergency doctors with important information about how to best treat patients with infections to improve blood pressure, prevent organ failure, reduce the need for intensive care and potentially reduce the number of deaths.


Watch-house detainee emergency healthcare

In the acute phase of police detention, health concerns can emerge for detainees, especially around drug dependence, mental health conditions, and physical injury. In addition are system complexities including crowding.

In the event of an infectious disease outbreak (such as COVID-19), crowded conditions amongst a population with greater underlying burden of disease than the general population creates significant public health and economic concern. Furthermore, access to resources and expertise to manage health concerns in this environment can be challenging, especially in rural areas.

Researchers will interview key stakeholders involved with the care delivery and decision making of detainees, to identify innovative strategies to delivering healthcare in watch-house settings. This research will consider the decision making processes and costs associated with the delivery of healthcare in police watch-houses that may reduce the need for transfer to hospital emergency departments or reduce the potential for deaths in custody.

This research addresses the World Health Organisation’s (WHO) recommendation to understand how evidence-based health services can be provided for those requiring treatment, care and illness prevention whilst in police custody. It also identifies ways in which the need for expensive hospital stays can be minimised.

The expected impact of this research is the capability to identify and inform joined-up approaches so that cost-effective, safe, quality emergency care can be provided to detainees in police watch-house settings.


Modelling emergency department patient flow under normal operating conditions and in a pandemic

Patient flow in emergency departments (ED) is impeded when the number of patients exceed physical and/or staffing capacity. This is often referred to as crowding, and is common problem for EDs across the country, adversely impacting patients, staff and the healthcare system.

While many strategies have been reported and trialled to mitigate the consequences of crowding and address its causes, there is no one solution that fits all EDs.

Researchers propose to develop and test a computer model to mimic the ED, simulating patient flow to provide forecasts that can inform policy makers. This is especially important in periods of anticipated high demand for emergency services such as in the current COVID-19 pandemic.

Emergency doctors will team-up with academic researchers to model patient flow in the emergency department to consider operational changes and provide knowledge to guide decision-making for improvement strategies that will lead to faster, more effective patient care, better outcomes and more effective, economical choices.

This innovative collaboration between doctors and university researchers aims to solve real-life system-level problems affecting patient care. The research will generate practical outcomes that improve clinical practice at a system level so that we can better care for our patients.


Classifying the type and severity of traumatic injury in North Queensland: a multicentre retrospective study

Queenslanders living in regional, rural and remote areas have a higher incidence of traumatic injury and poorer access to health services than their urban counterparts.

Researchers propose to undertake a first-of-its-kind study to classify and characterise trauma patients from these areas serviced by Townsville, Cairns, Mt Isa, and Mackay Hospitals over the three-year period 2016-2018. Using patient records, researchers will examine the clinical therapies and interventions used and patient outcomes from point-of-injury through to hospital discharge.

The study will capture, collate and compare patient data from Queensland Health, Retrieval Services Queensland (RSQ), LifeFlight Retrieval Medicine (LRM) and the Royal Flying Doctor Service (RFDS) to assess the current state of emergency trauma care in the Queensland Tropics, and any potential gaps in aeromedical healthcare delivery. The results will also provide a springboard for a wider system and processes assessment of emergency trauma care for the benefit of patients in North Queensland.


Understanding end-of-life care for older people presenting to the ED

The overarching aim of this study is to estimate the magnitude of the need for care at the end of life care in the emergency department, and to describe care delivery practices, processes and outcomes for older people who present to the emergency department requiring end of life care.
Australians aged 65 years and over account for 22% of emergency department presentations. Currently, this group makes up 15% of the population, but this predicted to rise to 20% by 2037.

There are two trajectories of end of life in the emergency department: ‘unexpected’ and ‘expected’ deaths. Unexpected deaths stem from acute illness or sudden, traumatic events. Expected deaths stem from deterioration of chronic illnesses.
When expected deaths occur in the emergency department, staff dissatisfaction and distress as well as frustration for patients and their families can result. In Singapore, around 50% of deaths in people aged ≥ 65 who died in one emergency department were considered ‘expected’. This highlights the need to understand if the situation is the same here in Australia and to what extent quality end of life care is provided for both trajectories of dying (i.e. expected and unexpected). Our study will identify the ‘unexpected’ and the ‘expected’ deaths among people aged ≥ 65 who die within 48 hours of emergency department presentation.


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