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.

Morris R, Bishop K, Local themed audits of ANZICS CORE dataset at SDMH.
Locations: Shoalhaven District Memorial Hospital.

This project will establish a process of periodically auditing admissions to ICU to improve clinical review and motivation of staff that enter data. A series of audits of ICU population subsets will be undertaken. These audits will be around themes such as admission diagnoses, treatments and outcomes and then reported to morbidity and mortality meetings.  The data will be extracted from the ANZICS routine data collection already in place. These audits provide a systematic approach to review and overcome the anecdote bias that can influence case discussions.  Providing feedback directly, in the M&M context, to the staff entering the data can also improve motivation and quality of data entry. Engaging with individual staff to help analyse particular groups can motivate further research and help fulfil trainee training requirements.

Carillo-Hayley J, Outmezguine J, Joseph K, Seth I, Curtis K, Krizanac J, Derflingher LP, Cleophas S, Implications of Language Barriers for Healthcare at New South Wales using Centre for Health Research Illawarra Shoalhaven Population database.
Locations: Wollongong Hospital, Shoalhaven District Memorial Hospital, Shellharbour Hospital, Milton-Ulladulla Hospital.
External Partners: Center for Health Research Illawarra Shoalhaven Population (CHRISP).

The aim of this project is to perform a retrospective analysis regarding the demographics of patients presenting in the Emergency Departments in the Illawarra Shoalhaven Local Health District (ISLHD) in order to identify any relationship between emergency health service outcomes for Non-English speaking and English speaking patients. 

Craig S, Dalziel S, Borland M, Buntine P, George S, Tham D, Perez S, Tran V, Forero R, Gangathimmaiah V, Foster K, O'Reilly G, Furyk J, Keijzers G, Carrigan T, Stella J, Salter M, Ben-Meir M, Knott J, Hutton J, Taylor D, Beck S, Cameron P, Mosley I, McNulty R, Halkidis L, Singh K, Wong A, Jones P, Celenza A, Mountain D, Walters K, Oakley E, Hannon L, Tagg A, Cheek J, Jani S, Wood J, West A, Macdonald S, Fong C, Arendts G, Mitchell R, Sri-Ganeshan M, Neutze J, Rogan A, Jones S, Tan E, Hiscock H, Ng R, Soeyland T, Davoren M, Phang SM, Akhlaghi H, Fatovich D, Greaves K, Lovegrove M, Mitra B, Kuhn L, Munro A, Anderson N, Egerton-Warburton D, Griffin B, Middleton P, Crilly J, Than M, Wood D, Jordan F, Howell T, Hansen K, Kochar A, Schutz J, Cheng N, Mitchell C, Zhang M, Foong LH, Parameswaran A, Watkins G, Richardson D, Philips N, Yates K, Steinmann K, Costa S, Gaddam R, Teo S, Ghedina N, Cleophas S, Emergency department data to assess the impact of COVID-19 restrictions.
Locations: Illawarra Shoalhaven Local Health District.
External Partners: Monash Health, South Western Sydney Local Health District, Alfred Health, Perth Children's Hospital, Barwon Health, Queensland University of Technology, Melbourne Health, Eastern Health, Gold Coast Hospital and Health Service, Cabrini Health, Royal Children's Hospital, University of Southern Queensland, Royal Perth Hospital, Canberra Hospital, University of New South Wales, Townsville University Hospital, Southern NSW Local Health District, Sir Charles Gardiner Hospital, Western Health, Monash University, Logan Hospital, Toowoomba Hospital, St Vincent's Hospital Melbourne, Austin Hospital, Werribee Mercy Hospital, Blacktown Mt Druitt Hospitals, Cairns Hospital, University of Western Australia, Bendigo Health, The Children's Hospital at Westmead, Flinders Medical Centre, Fiona Stanley Hospital, Tamworth Rural Referral Hospital, Murdoch Children's Research Institute, Westmead Hospital, Wagga Wagga Base Hospital, Mid-North Coast Local Health District, Joondalup Health Campus, Nepean Hospital, The Prince Charles Hospital, Women's and Children's Hospital SA, John Hunter Hospital, Bankstown and Lidcombe Hospital, Goulburn Hospital, Frankston Hospital, Queensland Children's Hospital, Ballarat Base Hospital, Australian National University, University of Auckland, Starship Children's Hospital Auckland, The University of Queensland, Griffith University, Royal Hobart Hospital, University of Tasmania, Dunedin Hospital NZ, University of Otago, Taranaki Base Hospital NZ, Wellington and Hutt Hospital NZ, Middlemore Hospital NZ, Port Macquarie Base Hospital, Nelson Hospital NZ, Christchurch Hospital NZ, Royal Darwin and Palmerston Hospitals, Waitemata District Health Board NZ, Hawkes Bay Hospital NZ, Western Sydney University, St John of God Midland Public Hopital WA.

The response to COVID-19 has led to a “lockdown” of varying degrees across Australia and New Zealand, mostly commencing in late March 2020. This has led to a significant reduction in emergency department (ED) presentations across both countries. Concerns have been raised about delayed presentations of patients and/or delayed assessment and management of those who may have benefited from earlier treatment. Patients who may have previously attended with illnesses better managed in primary care may be staying away. We have a unique opportunity to examine the impact of COVID-19 and its response on various aspects of acute hospital care by using EDs routinely collected administrative and clinical data from many participating hospitals in Australasia between 2017-2020. This is phase 1 of several projects and aims to rapidly obtain administrative data from >45 hospitals to determine the initial impact of COVID-19 response on ED presentations, ED patient flow and effectiveness of care.

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.

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.

Dennis M, Buscher H, Kruit N, Stedman W, Burns B, McCanny P, Keech T, Dyson S, Oliver M, Roy J, McNulty R, Davis R, Curtis K, Facer R, Bendall J, Ware S, Nichols M, Cracknell R, Kushwaha V, Mallows J, Risi D, Efficacy and Value In ExpeDited out of hospital arrEst care with End tidal CO2 (ETCO2) ECMO CPR (ECPR)  - The EVIDENCE Study.
Locations: Wollongong Hospital.
External Partners: Royal Prince Alfred Hospital, The University of Sydney, The Unversity of NSW, Westmead Hospital, Royal North Shore Hospital, NSW Ambulance Service, Northern Beaches Hospital, Liverpool Hospital, St George Hospital, Blacktown Hospital, Bankstown-Lidcombe Hospital, Concord Repatriation General Hospital, Campbelltown Hospital, Prince of Wales Hospital, Nepean Hospital.

The study will assess the potential benefits of expedited transfer from the scene of an out of hospital cardiac arrest to hospital, where participants receive standard of care at that hospital per current practice. The intervention is expedited transfer. 

Huckle R, Curtis K, Binks S, Gardner T, Ashford B, Ryan W, Evaluating changes to the trauma team standby response in Wollongong ED.
Locations: Wollongong Hospital.

This study aims to determine if assessment of Trauma Standby patients solely by the Emergency Medicine team impacts patient and health service outcomes, and results in decreased patient length of stay in the ED plus reduced use of advanced imaging.  It also aims to identify any problems and staff satisfaction with the change in practice to ensure sustained compliance and safe practice change.

MacLeod S, Curtis K, Beevors M, Critical Head Pathway - Team-based approach to streamline care of Emergency Department patients requiring urgent Neurosurgical Intervention.
Locations: Wollongong Hospital.

Patients with a ‘Critical Head’ have a time critical brain injury or condition caused by trauma, bleeding or hydrocephalus. The early identification of these patients may expedite the early diagnosis and definitive management of these patents, potentially improving patient outcomes. Currently there is no known rapid escalation process similar to this critical head pathway operating within Australian EDs. The aim of the current study is to evaluate the effectiveness of this pathway, by determining whether the ‘Critical Head’ pathway results in reductions in time to CT and time to Theatre as well as secondary outcomes of reduced ICU and hospital length of stay for eligible patients presenting to Wollongong ED.

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.

Outmezguine J, Seth I, Carrillo-Hayley J, Joseph K, Lower K, Curtis K, Derflingher LP, Putnis S, MacPartlin M, History of Mesenteric Ischaemia in a NSW regional health network: The impact of surgical delay on mortality and ICU admission.
Locations: Illawarra Shoalhaven Local Health District.
External Partners: Center for Health Research Illawarra Shoalhaven Population (CHRISP).

The aim of this project is to perform a retrospective analysis regarding the incidence of acute MI per year at the ISLHD and examine surgical delay association with mortality and ICU admission over a 20 year period. 

Partyka C, Berry M, Ferguson I, Asha S, Burns B, Tsacalos K, Gaetani D, Luscombe G, Curtis K, Coelho N, Maytom N, Rijsdijk J, Serratus anterior plane block in addition to protocolised care bundles for patients with rib fractures in the Emergency Department - a prospective cohort study.
Locations: Wollongong Hospital.
External Partners: Liverpool Hospital, NSW Ambulance, University of New South Wales, Orange Base Hospital, University of Sydney, St George Hospital, Northern Beaches Hospital, The Sutherland Hospital, Campbelltown and Camden Hospitals, University of Western Sydney, George Institute for Global Health.

Pain from rib fractures can splint the chest wall, decreasing the ability to clear respiratory secretions and increasing rates of pneumonia.  At present, pain relief options include simple analgesics (paracetamol, ibuprofen), opiates (including morphine and fentanyl). Many of these contribute to in-hospital falls, delirium and are addictive. The serratus anterior block is an ultrasound-guided, regional anaesthesia technique utilising a single-injection method to anaesthetise the chest wall in patients with multiple rib fractures. They are being utilised at increasing rates across emergency departments worldwide. The limited evidence available on these blocks suggests they reduce pain scores and may improve respiratory function. The block has not specifically been investigated in an older population. This study aims to evaluate the effectiveness of an ED-administered, serratus anterior plane block at reducing pain scores in patients with multiple rib fractures following blunt thoracic trauma who are also receiving protocolised rib fracture care. 

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.

Seth I, Derflingher LP, Outmezguine J, Joseph K, Lower K, Carrillo-Hayley J, McKenzie J, Curtis K, Hip fracture characteristics and outcomes during COVID-19 in the Illawarra Shoalhaven Population.
Locations: Illawarra Shoalhaven Local Health District.
External Partners: Center for Health Research Illawarra Shoalhaven Population (CHRISP).

This study aims to compare the health and characteristics of patients with hip fractures during the 2020 COVID-19 pandemic to those with past 2 years (2018 – 2019) of hip fractures in Illawarra Shoalhaven population. Studied outcomes include length of hospital stay (LOS), admission to an Intensive Care Unit (ICU), use of mechanical ventilation, in-hospital mortality, time of transfer to hospital ward from Emergency department, wait times for surgical treatment, 3 months readmission, discharge disposition, cost analysis of management and compositive variable of postoperative complications (haemorrhage, urinary tract infections, delirium, deep vein thrombosis, pulmonary embolism, surgical site infection and/or sepsis).

Trostian B, Curtis K, McCloughen A, Hirst E, Burns C, Davis W, Presentations, characteristics of and service delivery for women who presented to the Emergency Department with early pregnancy bleeding in Illawarra Shoalhaven Local Health District. A 10 year retrospective study.
Locations: Wollongong Hospital, Shoalhaven District Memorial Hospital, Shellharbour Hospital, Milton-Ulladulla Hospital.
External Partners: The University of Sydney.

The ED environment is often overcrowded and chaotic, contributing to excessive pressure on staff and stress for women experiencing early pregnancy bleeding. Limited information is known of the characteristics and presentation trends of women experiencing bleeding in early pregnancy seeking care in the ED. Without this information, it is difficult to identify how best to direct and develop resources in the ED and improve the quality and safety of emergency care. 

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.

Deane A, Finfer S, Saxena M, Venkatesh B, Chapman M, Thompson K, Bass F, MacPartlin M, Elgendy A, Sterba M, Davey-Quinn A, Davis M, Jagarlamudi V, Purdon A, Patil M, Costello C, Re-EValuating the Inhibition of Stress Erosions and prophylaxis against gastrointestinal bleeding in the critical ill (REVISE) trial.
Locations: Wollongong Hospital.
External Partners: Royal Melbourne Hospital, Royal North Shore Hospital, St George Hospital, Royal Adelaide Hospital, Princess Alexandra Hospital, The George Institute for Global Health.

This is a prospective, multicentre, parallel group, concealed, blinded, randomised trial in critically ill mechanically ventilated adult patients to determine the effect of daily IV Pantoprazole administration on 90 day mortality and clinically important GI bleeding in ICU or resulting in ICU readmission.

Dennis M, Stedman W, Buscher H, Kruit N, Austin D, Burns B, Dyson S, Southwood T, Curtis K, Resuscitation for Refractory Cardiac Arrest with End-tidal CO2 and ECMO (RESURRECT Cohort Study).
Locations: Wollongong Hospital.
External Partners: Royal Prince Alfred Hospital, The University of Sydney, Royal North Shore Hospital, The University of New South Wales, Westmead Hospital, Liverpool Hospital, NSW Ambulance Service, Northern Beaches Hospital.

Over 8000 out of hospital cardiac arrests (OHCA) occur in NSW each year and over 3000 receive cardiopulmonary resuscitation (CPR) attempts. The survival rate for OHCA in NSW is only 12%. Patients who do not obtain return of spontaneous circulation with conventional CPR (CCPR) have abysmal survival rates. New South Wales Ambulance, St Vincent's Hospital and Royal Prince Alfred Hospital, have previously trialled a new bundle of care for OHCA that are refractory to CCPR in the 2CHEER study, with very promising results. This includes the use of ECMO - a mini heart lung bypass machine when patients arrive into the emergency department. We now seek prospectively analyse the same protocol of expedited transfer to hospital, measurement of End Tidal CO2 and ECMO for refractory cardiac arrests amongst more sites

Gales M, Nonu M, Costello C, Assessment of potential for organ donation after circulatory death (DCD) in palliative patients with Motor Neurone Disease. (MND).
Locations: Wollongong Hospital.

This project is an assessment of potential for organ donation after circulatory death (DCD) in palliative patients with Motor Neurone Disease (MND). It focuses on the palliative care plans and the circumstances surrounding the deaths of patients with MND.  The rationale and the calibrating of such data, will give insight into the implementation of strategies for end of life goals, to enable organ donation to proceed with patient with MND. 

McQuilten Z, Poole A, Young M, Bellomo R, Power P, Brewster D, O'Connor S, Azad R, Marella P, Barrett J, Morrison L, Winerals J, Tabah A, Reade M, McAllister R, Triplett K, French C, MacPartlin M, International Point Prevalence Study of Intensive Care Unit Transfusion Practices.
Locations: Wollongong Hospital.
External Partners: Monash University, The Alfred Hospital, Austin Hospital, Barwon Health, University Hospital Geelong, Cabrini Hospital, Royal Adelaide Hospital, Coffs Harbour Health Campus, Caboolture Hospital, Epworth Hospital Richmond, Gold Coast Hospital, Gosford Hospital, Launceston Hospital, Logan Hospital, Redcliffe Hospital, Royal Brisbane and Women's Hospital, Royal Hobart Hospital, Royal Prince Alfred Hospital, Sunshine Hospital, Footscray Hospital.

The InPUT study is an international multicentre prospective observational point prevalence study of transfusion practice in ICUs across Australia, Europe, North America and Asia. We will perform the Australian component and collect data from approximately 47 ICUs around Australia over a one- week period in 2021, and our international collaborators will do similar in their respective countries. This research will provide the most comprehensive and up to date understanding of current transfusion practice, alignment with patient blood management guidelines, and areas for practice improvement in ICUs in Australia and New Zealand.

Young P, Seppelt I, Linke N, Whitehead C, Masters K, MacPartlin M, Elgendy A, Davey-Quinn A, Sterba M, Purdon A, Davis M, Costello C, Jagarlamudi V, Patil M, The Mega Randomised Registry Trials Comparing Conservative vs. Liberal Oxygenation Targets (The Mega-ROX Trials).
Locations: Wollongong Hospital.
External Partners: Wellington Hospital NZ, Nepean Hospital, The University of Sydney, The Alfred Hospital, Monash University.

The study is designed to compare two approaches to oxygen therapy in adults requiring mechanical ventilation in the ICU in emergency circumstances. The study compares a conservative approach to oxygen therapy to a Liberal approach. This 40 000 participant trial will be conducted in multiple countries and includes innovative design features. This includes linkage to identify enrolled patients in national ICU registries and response adaptive randomisation giving trial participants an increased chance of being assigned to the oxygen  regimen associated with the lowest mortality risk while the trial is ongoing.