Critical Care

Kalogeropoulos G, Ban C, Chuan A, Yam A, Varanasi S, Ben-Menachem E, Stevens J, Fisher A, Multi-site audit of COVID-19 airway interventions.
Locations: Wollongong Hospital.
External Partners: St Vincent's Hospital, Liverpool Hospital, Westmead Hospital, Royal Prince Alfred Hospital.

We will collect data on confirmed or suspected COVID-19 patients requiring an airway intervention in hospital. The data collected include reason for airway intervention, type of airway intervention, strategy used for airway intervention, availability of PPE and any complications. This will be done via a questionnaire completed by the medical practitioner performing the airway intervention.

Curtis K, Arnolda L, Phang SM, Gray G, Yu P, The Impact of Practice Changes on Emergency Services at the Wollongong Hospital Informed by Health Data Analytics.
Locations: Wollongong Hospital.
External Partners: NSW Health Pathology, University of Wollongong.

Hospitals have generated large amounts of data, driven by record-keeping, compliance and regulatory requirements, and patient care. Therefore, big data analytics in healthcare can provide enormous promise and potentials for providing insight for the improvement of hospital service quality while reducing costs.

Pradhananga B, Masoud M, Fraser N, Fenton W, Curtis K, The Block Study: Prospective Comparative Study on the Efficacy of Various Local Anaesthetics for Haematoma Block.
Locations: Wollongong Hospital.

Wrist fractures are common orthopaedic injuries seen in ED and hematoma block assists in controlling pain in closed reductions of these fractures. However, it is unclear what type of anaesthetic for hematoma block is most effective. In this study we are proposing to compare pain ratings before, during and after reduction of distal radius fracture among patients who undergo hematoma block with: 1) lidocaine and; 2) lidocaine and bupivacaine used in combination. If we can identify which anaesthetic is associated with the lowest ratings of pain, we could more effectively treat distal radius fractures in the ED. We will compare self-reported ratings of pain among two distinct groups of patients with distal radius fracture who receive hematoma block with: 1) lidocaine and; 2) lidocaine and bupivacaine.

Curtis K, Brown J, Sharwood L , Elphick T-E, Eyles M, Risi D, Implementation effectiveness of playground injury prevention to inform the national injury prevention strategy. #stopkidsinjury.
Locations: Wollongong Hospital.
External Partners: The George Institute, University of Sydney.

Playground fall injury hospitalisations cost the Australian hospital system almost $2 million annually in acute care costs alone. Playground falls in particular are a common source of upper limb fractures, also with the potential for adverse long-term functional outcomes (64.9%). The hospitalisation rates for playground fall injuries in NSW children aged 14 years or less have been steadily increasing since 19932 and have been projected to increase substantially to 2021. In 2020-21 the Federal Government will develop a new national injury prevention plan focussed on children. This plan needs to be informed by evidence. This study will contribute to that evidence using a case study: the Illawarra Shoalhaven. Our team will partner with government to achieve this. Firstly using local government data to determine the uptake of AS4685 at 401 playgrounds in the Illawarra Shoalhaven. Then, using hospitalisations data, will we determine the rate of hospitalised playground related injury and demographic targets for future interventions.

Curtis K, Eyles M, Elphick T-L, McKenzie J, Yu P, Moules P, Implementation evaluation of an early activation hip fracture care bundle to improve outcomes of frail older persons (eHIP).
Locations: Wollongong Hospital.
External Partners: University of Wollongong.

Does an early activation hip fracture care bundle (eHIP) improve patient outcomes? The human cost of a hip fracture is enormous - 25% of patients are dead at 1 year and 50% do not regain their previous level of function. The Australian Commission on Safety and Quality Hip Fracture Clinical Care Standard consolidates the evidence to manage this patient group in 7 Hip Fracture Clinical Care Standards. In ISLHD in 2018, only 13% of patients received at least 6 of these Standards. This translational pre-post research will compare the outcomes of 654 patients with hip fractures who received (or did not receive) eHIP, the collective implementation of the Hip Fracture Standard. We hypothesise eHIP will result in at least 50% of hip fracture patients receiving all components of the Standard and a 10% reduction in complications.

Munroe B, Curtis K, Royston K, Balzer S, Tuala E, Improving Emergency Department patient safety: Implementation evaluation of an Emergency Department Clinical Escalation Response System (EDCERS).
Locations: Shoalhaven District Memorial Hospital, Wollongong Hospital.

In 2010 the Clinical Excellence Commission implemented the Between the Flags (BTF) program across NSW to trigger recognition of clinical deterioration. In the Illawarra Shoalhaven Local Health District (ISLHD) a tiered-inpatient rapid response system was introduced to the wards using the BTF criteria. A Tier 2 call triggers an immediate response from the rapid response team comprising of a medical doctor (specialty team during hours), ICU doctor and nurse, and at some hospitals an ED doctor and nurse. This system works well on the wards, negating the need for multiple phone calls and mandates a response within a specific timeframe, decreasing delays to treatment. However, if an admitted patient who is located in the ED deteriorates, they are not afforded the same response. To address this gap, EDCERS (ED Clinical Emergency Response System) was developed and implemented at Shoalhaven District Memorial Hospital (SDMH) ED on the 26th June 2019. EDCERS introduced a tiered response to clinical deterioration triggered by the BTF observation charts, including escalation to senior ED clinicians (for ED patients) and specialty / intensive care teams (for admitted patients only). EDCERS now requires evaluating to determine uptake, effectiveness, and, enable refinement (if needed) prior to translation to other Australian EDs.

Varndell W, Ruperto K, Impact of triage training delivered by distance learning on emergency nurse confidence and triage decision accuracy: an observation study.
Locations: Wollongong Hospital.
External Partners: Prince of Wales Hospital, University of Technology Sydney.

The primary objective of this study is to examine and compare participant learning experiences, confidence and triage decision accuracy who have attended a triage training course  delivered using either distance learning technology, or traditional face-to-face classroom teaching.

Cheng A, Nayyar V, Britton P, Reddi B, Rashid A, McKenna T, Lugsdin J, Eidan A, Choy WH, Sterba M, Lavana J, Bhadange N, Geng W, Short Period incidence study of Severe Acute Respiratory Infection (SPRINT-SARI).
Locations: Wollongong Hospital.
External Partners: The Alfred Hospital, Gold Coast University Hospital, St Vincent's Hospital (Melbourne), Nepean Hospital, Concord Hospital, St Vincent's Hospital (Sydney), Westmead Hospital, The Children's Hospital at Westmead, Royal Adelaide Hospital, Calvary Mater Newcastle, Bundaberg Hospital, Hervey Bay Hospital, Prince Charles Hospital, Ipswich Hospital.

Severe acute respiratory infection (SARI) continues to be of major relevance to public health worldwide. In the last 10 years there have been multiple SARI outbreaks around the world. This is a multi-centre, prospective, short period incidence observational study of patients in participating hospitals and intensive care units (ICUs) with SARI. The primary aim of this study is to establish a research response capability for future epidemics / pandemics through a global SARI observational study. The secondary aim of this study is to describe the clinical epidemiology and microbiology profiles of patients with SARI.