Prof Julia Crilly OAM, Prof Gerben Keijzers, Dr Kairi Kolves, Dr David Painter, Dr Jesse Young
In 2018, there were 3046 deaths by suicide in Australia. Suicide was the leading cause of death among people age 15-44 in 2016-2018. In Queensland, rates remain highest in young men, particularly in rural areas.
The emergency department (ED) can be the only option for people in a mental health crisis. Presentations with self-harm and attempted suicide are recognised high-risk events for subsequent suicide.
This data-linkage study is the first of its kind in Queensland, examining ED presentations with self-harm between 2012 and 2017, utilising data from a collaboration examining broader mental health presentations. This ED data will be ‘linked’ to inpatient admissions and death records, allowing insight into the patient journey over several years.
Aligning with national and international calls to make suicide and self-harm a priority for research and policy innovation, the study will examine the demographics, co-morbidities and characteristics of these patients, and factors predictive of hospital admission to improve care and recognition around those presenting to ED with self-harm.
Walker K, Jiarpakdee J, Loupis A, Tantithamthavorn C, Joe K, Ben-Meir M, Akhlaghi H, Hutton J, Wang W, Stephenson M, Blecher G, Buntine P, Sweeny A, Turhan B. 2021. Emergency medicine patient wait time multivariable prediction models: a multicentre derivation and validation study. Emergency Medicine Journal.
White, B., Willmott, L., Del Villar, K., Hewitt, J., Close, E., Ley Greaves, L., Cameron, J., Meehan, R. and Downie, J. 2021. Who is eligible for voluntary assisted dying? Nine medical conditions assessed against five legal frameworks. University of New South Wales Law Journal.
Kusakabe, A., Sweeny, A. and Keijzers, G. 2021. Early compared to later commencement of vasopressors in the management of Emergency Department patients with sepsis and hypotension, a multi-centre observational study. Archives of Medical Research.
Hamill, L.M., Bonnett, J., Baxter, M.F., Kreutz, M., Denny, K.J. and Keijzers, G. 2021. Antimicrobial Prescribing in the Emergency Department; Who Is Calling the Shots?. Antibiotics, 10(7), p.843.
Etheridge, N. and Keijzers, G. 2021. Cellulitis: Treatment failure or failure to define treatment failure?. EMA-Emergency Medicine Australasia, 33(1), pp.180-181
Rousseau, G., Keijzers, G., van Meer, O., Craig, S., Karamercan, M., Klim, S., Body, R., Kuan, W.S., Harjola, V.P., Jones, P. and Verschuren, F. 2021. Epidemiology, treatment and outcome of patients with lower respiratory tract infection presenting to emergency departments with dyspnoea (AANZDEM and EuroDEM studies). Emergency Medicine Australasia, 33(1), pp.58-66.
Kelly, A.M., Keijzers, G., Klim, S., Craig, S., Kuan, W.S., Holdgate, A., Graham, C.A., Jones, P. and Laribi, S. 2021. Epidemiology and outcome of older patients presenting with dyspnoea to emergency departments. Age and Ageing, 50(1), pp.252-257.
Dr Pauline Stehlik
Dr Pauline Stehlik, Dr Rachel Bourke, Professor David Henry, Dr Caitlin Brandenburg, Dr Christy Noble, Dr Caitlin Withers, Professor Adrian Barnett, Professor Sharon Mickan, Professor Paul Glasziou, Dr Alexandra Bannach-Brown, Professor David Ellwood
High quality healthcare research underpins quality patient care. It asks patient relevant questions and measures meaningful outcomes, uses appropriate study design and statistical analysis, along with open and transparent publishing methods. This enables clinicians to access, understand, and apply the findings to their patients and provide them the best possible care.
However, it has been estimated that up to 85% of all research is of low quality, with poor research questions, inadequate designs and unnecessary duplication, costing ~$100 billion annually. This number is likely even greater as poor research then leads to low-value healthcare, such as unnecessary tests, procedures, and treatments.
There have been international efforts to combat this crisis in research. However, there has been little to no focus on professional medical associations, such as specialty training colleges and their educators. All specialist doctors in Australia are trained through these Colleges, including in research skills and produce ~3,000 new fellows each year.
Our review of 58 Australian and New Zealand specialist medical training colleges and their subspecialty divisions found that, while 55 require trainees to complete a project as their primary method of learning about research, the majority did not require formal research methods training, nor supervision by a research experienced supervisor. This is likely to be counterproductive, placing trainees at risk of conducting poor quality projects and producing fellows that may not appreciate how quality research contributes to positive patient care.
Several other colleges in Australia and overseas have begun to question the value of the current system and have been calling for change. We do too.
This study will inform a larger program of work that aims to improve this research training system and by understanding what is happening in practice; namely the quality of trainee experience and the quality of the research itself."
Prof Gerben Keijzers, Mr Adam Brand, Dr Zoe Michaleff, Prof Paul Glasziou, Ms Laetitia Hattingh, Dr Paulina Stehlik, Prof David Henry, Prof Sharon Mickan, A/Prof Rae Thomas, Ms Hannah Larsen, Dr Joan Carlini
Everyday, clinicians in emergency departments make hundreds of decisions about the care of patients. Often these decisions are made in rapidly changing, time-pressured and complex conditions which can leave the clinician uncertain about the required tests and/or treatments.
Clinical decision aids are research-based “tools” about patient care, tests, and treatments that can guide clinician’s decisions. Routine use of these tools has been found to benefit:
1.patients by ensuring they receive the right care and reducing waiting time
2.clinicians by assisting with reliable and research-informed decisions and,
3.healthcare system by improving the value and efficiency of care i.e. ensuring patients receive the best care, at the right time, every time.
Despite these benefits, clinical decision aids are underused. Research knowledge that is not used in clinical practice is a problem because it means that patients are not receiving the best care, at the right time, every time. A solution is to integrate clinical decision aids into the electronic health system for clinicians to use with the right patient, at the right time, every time. This can improve patient outcomes and increase the quality and reliability of the care provided by clinicians and the health service.
Clinical decision aids are not currently integrated in the electronic health system at the Gold Coast Hospital and it is not known which “tools” emergency clinicians use and how regularly. Our research has two phases. Funding is sought for Phase 1 - a survey of clinicians’ current use of clinical decision aids, and an audit of medical records to check if these tools are recorded. The findings from Phase 1 will be used to inform Phase 2 - developing and testing the integration of clinical decision aids into the electronic health system for use by emergency clinicians."
