Emergency medicine research

• It is estimated that nearly 1 in 4 Australians seek emergency care each year.
• Around 10% of emergency presentations are to private hospital emergency departments. The St John of God Murdoch Hospital Emergency Department in Western Australia is the only private emergency department in the state conducting this type of research.

• Use of acupuncture for pain relief in the ED
• Quality of cardiopulmonary resuscitation (CPR) delivered by emergency doctors and nurses
• Why paramedics bring patients to a private ED
• Patient flow within the ED

CTPA in ED
Emergency physicians remain very concerned about both the overuse and underuse of computed tomography pulmonary angiogram (CTPA), the investigation of choice in the work-up of suspected PE in ED. In conjunction with colleagues across Australia and New Zealand, we performed a study to establish the range of CTPA positive yield which departments and individual clinicians can use as a clinical indicator against which to compare their own performance.

Why paramedics bring patients to a private ED?
The reasons why patients self-present to a private ED are well established, however, the role paramedics play in this decision for patients presenting via ambulance is unknown. This study investigated paramedic’s motivations for presenting to ED, and their perceptions and expectations of the visit, through paramedics participating in short structured interviews.

CPR skills in ED
Survival rates post cardiac arrest are impacted by the quality of cardiopulmonary resuscitation (CPR), with increasing evidence that high quality CPR improves survival and favourable neurological outcomes. There is documented evidence that healthcare providers, in ED or elsewhere, are not better than lay persons in adhering to the guidelines when performing CPR. This study aims to ascertain if the deficit is in ED staff knowledge of the guidelines or in their ability to translate their knowledge into practice.

Acupuncture in the emergency setting
Providing an alternative holistic viewpoint on pain management in the emergency department, Prof Andrew Jan’s PhD is designed to investigate the effect of acupuncture on acute pain management in the emergency setting. We are currently undertaking a pilot trial investigating the use of a brief, ED suitable technique known as battlefield acupuncture. This research will establish the role of acupuncture as a stand-alone or adjunctive technique in emergency medicine.

Patient flow in the ED
Efficient patient flow through the Emergency Department (ED) is important for quality of care, patient outcomes and patient satisfaction. Improving patient flow can be achieved by reducing the amount of time patients spend in the ED, thereby reducing departmental crowding. This study aims to observe the effects of operational changes on ED wait times, length of stay and patient satisfaction.

St John of God Murdoch Hospital

Jason Fitch – Director of Emergency Medicine
Professor Ian Rogers – Professor of Emergency Medicine
Professor Steve Dunjey – Professor of Emergency Medicine
Professor Andrew Jan – Adjunct Professor of Emergency
Medicine / PhD Candidate
Dr Katherine Mackie – Emergency Medicine Research Associate
Emogene Aldridge – Academic Support Offi cer
Natasya Raja Azlan – Registered Nurse / PhD Candidate
Hannah Root – Clinical Nurse
April Kruining – Clinical Nurse / Learning and Development Educator

Below is a select list of our publications.

Bray JE, Smith K, Hein C, Finn J, Stephenson M, Cameron P, Stub D, Perkins GD, Grantham H, Bailey P, Brink D, Dodge N, Bernard S, EXACT investigators. (2019) The EXACT protocol: A multi-centre, single-blind, randomized, parallel-group, controlled trial to determine whether early oxygen titration improves survival to hospital discharge in adult OHCA patients. Resuscitation. 139, 208-213.

Brown E, Tohira H, Bailey P, Pereira G, Finn J. Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after a major trauma in Perth. (2019) Emergency Medicine Australasia. [in press].

Aldridge ES, Lim A, Rogers IR, Hicks B, Bailey P. (2019) Why do paramedics choose to bring patients to a private emergency department? Emergency Medicine Australasia.
31, 262-265.

Brown E, Tohira H, Bailey P, Fatovich D, Pereira G, Finn J. (2018) Longer pre-hospital time was not associated with mortality in major trauma: A retrospective cohort study.
Prehospital Emergency Care. [in press].

Riou M, Ball S, Whiteside A, Bray J, Perkins GD, Smith K, O’Halloran Kl, Fatovich DM, Inoue M, Bailey P, Cameron P, Brink D, Finn J. (2018) ‘We’re going to do CPR’: A linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement. Resuscitation. 133, 95-100.

Brown E, Williams TA, Tohira H, Bailey P, Finn J. Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia (2018). Emergency Medicine Australasia. 30, 827-833.

McKenzie N, Williams TA, Ho KM, Inoue M, Bailey P, Celenza A, Fatovich D, Jenkins I, Finn J. (2018) Direct transport to a PCI-capable hospital is associated with improved survival after adult out-of-hospital cardiac arrest of medical aetiology. Resuscitation. 128, 76-82.

Riou M, Ball S, Williams TA, Whiteside A, Cameron P, Fatovich DM, Perkins GD, Smith K, Bray J, Inoue M, O’Halloran Kl, Bailey P, Brink D, Finn J. (2018) ‘She’s sort of breathing’: What linguistic factors determine call-taker recognition of agonal breathing in emergency calls for cardiac arrest? Resuscitation. 122, 92-98.

Jan AL, Aldridge ES, Rogers IR, Visser EJ, Bulsara MK, Hince D. (2019) Patient attitudes towards analgesia and their openness to non-pharmalogical methods such as acupuncture in the emergency department. Emergency Medicine Australasia. 31, 475-478.

Jan AL, Rogers IR, Visser EJ. Re: Cohen MC S et al. (2018) Letter re: Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. Medical Journal of Australia. 208, 188-189.

Aldridge ES, Rogers IR, Mountain D, Jones P. (2018) Establishing an indicator rate for CTPA positivity [yield] in ED PE investigation. Emergency Medicine Australasia. 30, 134-135.

Jan AL, Aldridge ES, Rogers IR, Visser EJ, Bulsara MK, Niemtzow RC. (2017) Does ear acupuncture have a role for pain relief in the emergency setting? A systematic review and meta-analysis. Medical Acupuncture. 29, 276-289.

Talikowska M, Tohira H, Inoue M, Bailey P, Brink D, Finn J. (2017) Lower chest compression fraction among patients with lower downtime and ROSC was not due to perishock pause. Resuscitation. 119, e17-e18.

Jan AL, Aldridge ES, Rogers IR, Visser EJ, Bulsara MK, Niemtzow RC. (2017) Does acupuncture have a role in providing analgesia in the emergency setting? A systematic review and meta-analysis. Emergency Medicine Australasia. 29, 490-498.

Riou M, Ball S, Williams TA, Whiteside A, O’Halloran KL, Bray J, Perkins GD, Cameron P, Fatovich DM, Inoue M, Bailey P, Brink D, Smith K, Della P, Finn J. (2017) The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol. BMJ Open. 7, doi: 10.1136/bmjopen-2017-016510.

Riou M, Ball S, Williams TA, Whiteside A, O’Halloran KL, Bray J, Perkins GD, Smith K, Cameron P, Fatovich DM, Inoue M, Bailey P, Brink D, Finn J. (2017) ‘Tell me exactly what’s happened’: When linguistic choices affect the efficiency of emergency calls for cardiac arrest. Resuscitation. 117, 58-65.

Aldridge ES, Rogers IR. (2017) Computed tomography pulmonary angiogram positivity rate as a clinical indicator in the emergency department. Emergency Medicine Australasia. 29, 123-124.

Talikowska M, Tohira H, Inoue M, Bailey P, Brink D, Finn J. (2017) Lower chest compression fraction associated with ROSC in OHCA patients with longer downtimes. Resuscitation. 116, 60-65.

Dunjey S. Shock. In: Emergency Medicine: The Principles of Practice. 7th Edition. Churchill Livingstone, 2017.

Dunjey S. CT scanning in emergency medicine. Textbook of Adult Emergency Medicine. 5th Edition. Elsevier, 2017.