Just Say No to the 'Just in case' Cannula

Persuading ED staff not to insert a painful peripheral intravenous catheter (PIVC) that won’t be used is not rocket science, but it does take implementation science to achieve it nationally. The intervention Just Say No To The Just In Case Cannula has worked at two hospitals. The next step is implementation. This project, led by Prof Diana Egerton-Warburton (Monash University) aims to reduce unnecessary PIVC in Australian adult ED patients by 10%. The Royal Hobart Hospital has been lucky enough to be selected as one of the sites for this national roll out. 

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Emerging Drugs Network of Australia

The Emerging Drugs Network of Australia (EDNA) is a collaboration between emergency physicians, clinical toxicologists and forensic labs and researchers to combat the devastating effects of drug taking by improving the objective up-to-date data on illicit substances.  It gives emergency clinicians the knowledge required to treat the thousands of patients admitted to hospitals across Australia from an overdose.

This not only supports patients presenting with symptoms of drug use but ensures patients whose symptoms look similar but are unrelated, are quickly identified allowing doctors to treat them effectively. EDNA helps determine new illicit drugs and their clinical effects and works as an early warning system for public health systems across Australia and informs policy and decision-making processes.

This project is led by Professor Daniel Fatovich (Centre for Clinical Research in Emergency Medicine) from Western Australia. 

Regional and Rural Translation in Bronchiolitis

Led by Professor Franz Babl through the PREDICT network, this large-scale interdisciplinary research program will drive implementation of substantial improvements to healthcare and health system effectiveness. The RARRT-Bronch team will develop, implement, and evaluate a co-designed online RARRT platform for improving care in regional and rural hospitals in a sustainable and scalable way with a focus on bronchiolitis. Clinical leaders from most Australian states and territories are represented in the team and are supporting partners to lead state-wide change, navigate local barriers and foster a culture of co-operation and co-creation across hospitals to build upon for future improvement priorities.

This 5 year transformational research program aims to:

1. Co-design an innovative, sustainable, and cost-effective online RARRT platform to support implementation efforts at regional and rural hospitals. Accelerate the uptake of bronchiolitis evidence-based recommendations and reduce the inappropriate use of unnecessary, ineffective interventions. Provide hospital-level benchmarking and feedback data.

2. Evaluate the clinical-effectiveness, cost-effectiveness and implementation of high versus low intensity facilitation to scale-up implementation strategies to improve the acute care of infants with bronchiolitis at 30 sites.

3. Develop an implementation scale-up model for regional and rural hospitals. Increase implementation science and knowledge translation capacity through training and interaction with team members and state/national clinical research networks. Create an engaged regional and rural community of practice (CoP).

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The Kids are not Okay, Emergency Department management of acute mental health crises in children and young people

Across Australia, there has been an alarming increase in the number of children and adolescents presenting to emergency departments with concerns relating to mental health such as self-harm, depression, and behavioural disturbance. This project, led by Dr Simon Craig (PREDICT, Monash University) is an opportunity for us to work out why this is happening, and how we can improve their care.

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Study of Paediatric Appendicitis Scores and Management Strategies

This project, led by Prof Meridith Borland (PREDICT, UWA), will review the accuracy of clinical prediction scores compared to clinician impression in children with suspected appendicitis.

The aim of the study is to determine which (if any) score is the most accurate in diagnosing appendicitis with a plan to implement the best performing scores into management strategies in ANZ EDs. We will review the management and outcomes of children with suspected appendicitis.

This is an international study led by Perth Children’s Hospital that will involve 8 other Australian and New Zealand EDs within the PREDICT network. The study has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622001293752).

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FEBCON-ED A stepped- wedge cluster randomised controlled clinical trial of usual care vs regular antipyretics for children presenting with a FEBrile CONvulsion to the Emergency Department

Febrile convulsions are the most common form of childhood seizures and the most common neurological presentation to the Emergency Department (ED). Across Australia, they account for nearly 24,000 ED visits each year.

Unfortunately, one in every five to ten children will experience another seizure within the same illness, and one in three children will have at least one additional febrile convulsion in the future; a source of significant additional burden to both families and health care services. In addition to direct health costs, febrile convulsions cause considerable family distress, both during and after the event.

The purpose of this study, led by Dr Simon Craig (PREDICT, Monash University) and Dr Naomi Loftus, is to determine whether the use of paracetamol or ibuprofen makes any difference to the risk of another febrile convulsion (fit) within the same illness in children aged 6 months- 6 years old who have presented to the Emergency Department (ED) with a febrile convulsion. The study will also help determine if paracetamol or ibuprofen given regularly reduces hospital re-attendance with febrile convulsion, health care service use and costs. We are also interested in long-term follow-up of children who have had a febrile convulsion.

Information will be collected for the study via parent/guardian questionnaires, medical chart review and data linkage. Depending on our study findings, we will either confirm current practice, or provide definitive evidence to change practice to update clinical guidelines in Australia & New Zealand to recommend this simple, low-cost intervention to improve management of febrile convulsions.

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The Australian and New Zealand Emergency Department Airway Registry (Phase III) - ANZEDAR

The Emergency Care Institute is currently conducting a multi-centre observational study which forms the “Airway Registry”.

The Royal Hobart Hospital is a contributing site for this registry.

The data being collected is used to describe the practice of airway management in Australia and New Zealand Emergency Department and provide each participating department a detailed dashboard feedback.

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