Tasmanian Emergency Medicine Research: Research Highlights 2019-20

RESEARCH HIGHLIGHTS 2019-20

TASER: Tasmanian Emergency Medicine Research

Photography: Viet Tran

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Research Highlights 2019-20

Acknowledgement of Countr We acknowledge and pay respect to the Tasmanian Aboriginal people as the traditional and original owners, and continuing custodians of this land and acknowledge Elders – past and present.

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TASER: Tasmanian Emergency Medicine Research

CONTENTS 3

Acknowledgement of Country

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Contents

6-7

A Message from the Director

9

Introducing TASER

6-7

10-11 Key Accomplishments

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Researcher Spotlight

Lauren Reid

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Collaborative Spotlight PREDICT

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Research Spotlight

Registries

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Registry Spotlight

The Tasmanian Trauma Registry

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16-17 Pandemic Research

COVID-19

16-17

18-19 Research Spotlight

Mental Health

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Researcher Spotlight

Michael Jacques

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Strategic Partnerships Memberships & Collaborations

18-19

22-23 Research Convergence

36th Annual Scienti c Meeting

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Collaborative Spotlight The Royal Hobart Hospital Research Foundation

Front & Back Cover: Painted Cliffs, Maria Island, Tasmania. Photography: Zac Robinson

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22-23

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Research Strategy Grants

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Researcher Spotlight Katherine Davis

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Department of Health Research Governance

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Strategic Vision

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Researcher Spotlight Ashley Loughman

30-32 Appendix 1 Research Outputs

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Appendix 2 Current Projects

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Appendix 3 Grants

CONNECT WITH US taser@health.tas.gov.au bit.ly/taserinstitute facebook.com/taserinstitute linkedin.com/company/tasergroup

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@TaserInstitute

Disclaimer The opinions expressed in this publication do not necessarily represent the views of the University of Tasmania nor the Department of Health. Whilst every e ort has been made to ensure accuracy, no responsibility can be accepted by TASER for omissions, typographical or inaccuracies that may have taken place after publication. All rights reserved.

The editorial material published is copyright. No part of the editorial contents may be reproduced or copied in any form without the prior permission from TASER. © TASER 2021.

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Research Highlights 2019-20

TASER: Tasmanian Emergency Medicine Research

A MESSAGE FROM THE DIRECTOR As members of the Tasmanian emergency medicine community we have the privilege, honour and obligation to care for patients, often at their most vulnerable. In 2019-2020, across all Tasmanian Emergency Departments this care was represented by a total of 319,117 presentations.

H Image Supplied: Zachary Robinson

The bene its of inspiring a research culture goes beyond the direct research question. Such culture inspires the everyday practice of critical thinking, inquiry and advancement of a sharpened clinical instinct

ow we cared for these patients is developed through education and knowledge established through a wealth of research. Re ecting on how we care for patients, from the considered selection of analgesics, the best imaging modality to investigate a clinical question, development of a nurse navigator role as well as our various ‘code’ protocols, we nd that most are underpinned by decades of research.

As people who work in and around emergency care in Tasmania, the bene ts of inspiring a research culture goes beyond the direct research question. Such culture inspires the everyday practice of critical thinking, inquiry and advancement of a sharpened clinical instinct. It is not necessary for all of us to reach for the heights of principal investigator on an NHMRC grant. Instead, as practitioners of evidence-based medicine, our prerequisite is to understand the rules of evidence to enable appraisal of the strengths, weaknesses and applicability of research for the patients we care for.

By updating our knowledge using evidence-based sources through mediums such as journal clubs, conferences or social media, we are creating and contributing to this notion of critical thinking and acknowledging the importance of research in practice.

The inaugural publication of the Tasmanian Emergency Medicine

Research Group: Research Highlights 2019-20, celebrates the birth of this culture by heralding a coordinated e ort to promote research in Tasmania. This publication re ects on the e orts thus far and in doing so, acknowledges the fact that our research is part of the spirit of emergency medicine (EM) that drives excellence in care.

Emergency Medicine, Research & Tasmania Emergency medicine in Australasia is one of the youngest specialities, being recognised as such in 1993. For comparison, the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians were founded in 1927 and 1938 respectively.

Our youth as a specialty is therefore also represented in our presence and eminence in clinical research.

Other challenges with succeeding in research in our speciality includes the very nature of our craft. With the magni cation of access block, the rise of burnout and coupled with the limited ownership of speci c disease processes and limited contact time in the patient journey, how we practice EM research can often be dictated by less time-poor and more research-experienced specialities.

Although many of these factors may seek to exonerate EM from comparison

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Research Highlights 2019-20

with other research specialities, it should be seen as a manifesto of how to cultivate EM research. As a young speciality, we have the bene t of tailoring the successes and avoiding some of the mistakes encountered along the research journey to t the EM agenda.

As a state structured as ‘One health care service, One University’, Tasmania is well-positioned to act as a ‘living laboratory’ to deliver robust research thanks to the contained geographical and organisational environment.

The size and harmonic nature of EM health care delivery in Tasmania also enables an adaptable and e cient process of translation and tangible realworld impact. This will further inspire excellence in critical thinking and research.

A Recognisable Identity In order to progress our research agenda in an e cient, pragmatic and sustainable manner, our strategic priority has been to consolidate our research e orts under a coordinated and identi able entity. Through this need, the Tasmanian Emergency Medicine Research (TASER) group was created.

TASER also represents a signi cant collaboration between the University of Tasmania and the Tasmanian Health Service, pairing passionate and experienced EM care providers with equally dedicated and accomplished researchers. Through this partnership, we have and will be able to leverage the strengths of clinicians and researchers to promote practical research and expedite real-world translation.

Furthermore, these links will enhance our researcher development program for those chosen few who yearn for more. I would encourage you to read more

about TASER and our strategic vision on pages 8-9 and 28.

Collaboration the Cornerstone for Success

as well as contributing to multi-centred trials both nationally and internationally.

I implore anyone that works with and around our craft to join us as we seek to enhance emergency care in Tasmania through research and evidence-based medicine.

Our research strategy is also underpinned by collaboration from outside the walls of our EDs to enable, and empower our program through opportunity and mentorship.

Throughout this publication, you will see that our introduction into research has had the privilege of being helped by many expert researchers. Signi cant guidance and opportunity have come from the likes of Clinical Professor Simon Craig (Monash University, Monash Medical Centre), Associate Professor Amanda Neil (University of Tasmania) and Clinical Associate Professor Gerard O’Reilly (Monash University, Alfred Emergency and Trauma Centre) as well as organisations such as the Paediatric Research in Emergency Departments (PREDICT) network.

Dr Viet Tran

Director of Emergency Medicine Research, Royal Hobart Hospital and the Tasmanian Emergency Medicine Research Group, University of Tasmania

Discovering the Researcher in All of Us The platform of care that we deliver is built on the pillars of education, research, safety and quality. Our emphasis on each pillar determines its stability. As the Tasmanian EM community, our platform can only be strengthened by building more research into our clinical environment and fostering the spirit of inquiry to those that work in and around EM. This publication chronicles the start of the Emergency Medicine research journey for Tasmania, focusing on core research priorities and opportunities that have arisen in 2019-20 from the COVID-19 pandemic, to mental health

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TASER: Tasmanian Emergency Medicine Research

Image Supplied: University of Tasmania

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Research Highlights 2019-20

Research Strategy

INTRODUCING TASER Tasmanian Emergency Medicine Research

Through TASER our ambition is to create a perpetual culture of rigorous enquiry to enhance patient care

The Tasmanian Emergency Medicine Research Group (TASER) was established in 2019 to advance Emergency Medicine (EM) research in Tasmania through the provision of support and coordination with the ultimate goal of enhancing clinical care through a pragmatic and meaningful research-driven and evidence-based agenda.

Our Origins

Our Ambition

In 2018, following the recruitment of the Director of Emergency Medicine Research at the Royal Hobart Hospital, a needs analysis for EM research in Tasmania took place and formed the basis for our strategic priorities. This process identi ed the need for a recognisable statewide research identity in order to serve two of these priorities.

The challenges of competing priorities in an already access-blocked, emotionally and physically exhausting clinical environment is obvious. Our strategy to build a research ecosystem that bridges the gap between clinical care and research will consider these aspects of care. Through TASER our ambition is to create a perpetual culture of rigorous enquiry to enhance patient care. By creating a clinical culture of critical thinking and pursuing truly meaningful research, TASER will have the impact to create compelling and swift incorporation into clinical practice.

Firstly, having a coordinated statewide approach to EM research is economical, e cient and provides more equitable opportunity.

Secondly, a statewide identity will act as a beacon to attract other researchers and care providers to form meaningful collaborations. The importance of this in research has always been obvious, the fact that the medicine that we practice is fundamentally based on partnerships in patient care provides further incentive to prioritise these relationships in research.

As the beacon of EM research in Tasmania, TASER intends to establish itself as a driver for excellence in emergency care on the apple isle and a signi cant contributor to emergency medicine research globally.

Of all these collaborations, the most signi cant is between health care and research itself. In our island state, organised as a ‘one health care, one university’ model, it is clear that for EM, partnering the University of Tasmania with the Tasmanian Health Service will provide the foundation required for TASER to succeed.

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TASER: Tasmanian Emergency Medicine Research

RESEARCH STRATEGY

KEY ACCOMPLISHMENTS 2019-20

INFRASTRUCTURE

‣ Appoint Director of Emergency Medicine Research ‣ Establish TASER ‣ Develop EM Research Strategic Plan for Tasmania ‣ Publication of 2019-20 highlights ‣ Credentialed for Higher Degree Research Supervision (UTas, PhD) ‣ State, National & International Collaborations

DISTINGUISHED RESEARCH APPOINTMENTS

‣ ACEM Clinical Trials Network Executive ‣ Editorial Board, Emergency Medicine Australasia ‣ Editorial Board, Australasian Emergency Care ‣ UTAS Health & Medicine Human Ethics Committee Membership ‣ Emergency Medicine Foundation Board Member

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Research Highlights 2019-20

PROJECTS

GRANTS

‣ 28 Active Projects ‣ 27 Completed ‣ 1 HDR Candidate

‣ Total $246,012 grant funding ‣ 3 NHMRC Grant Submissions

OUTPUTS

TRANSLATION

‣ 22 Scholarly Publications ‣ 5 Conference Presentations ‣ 2 Conference Posters

‣ ACEM 31st ASM Organisers ‣ 34 Articles presented at Journal Club ‣ 34 Appraised articles online

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TASER: Tasmanian Emergency Medicine Research

Researcher Spotlight

LAUREN REID The Pre-hospital Anti- brinolytics for Traumatic Coagulopathy & Haemorrhage Study The PATCH Trauma Study is an international multicentre, randomised, double-blind, placebocontrolled trial of pre-hospital treatment with tranexamic acid for severely injured patients at risk of acute traumatic coagulopathy (ATC).

In 10-25% of severely injured patients, bleeding is exacerbated by ATC characterised by hyper brinolysis detectable on hospital arrival. Patients with ATC are 3-4 times more likely to die and develop multiple organ failure, and have longer intensive care and hospital stays.1

A large international study (CRASH-2) showed TXA reduced all-cause mortality in adult trauma patients with, or at risk of, signi cant haemorrhage.

Almost all of the patients enrolled in CRASH-2 were treated in hospitals in low and middle income countries that have markedly di erent standards of care for the management of ATC, higher baseline mortality rates, and a younger patient population than trauma centres in Australia and New Zealand.

A post-hoc analysis of the CRASH-2 trial results also found there was an unexpected increase in the risk of death due to bleeding when TXA was given beyond three hours from injury.

The study therefore aims to determine the e ects of early administration of tranexamic acid on survival and recovery of severely injured patients treated within advanced trauma systems.

The primary outcome of the study is the proportion of patients with a favourable outcome at six months (moderate disability to good recovery, GOSE scores 5-8) compared to those who have died (GOSE 1), or have severe disability (GOSE 2-4).

Secondary outcomes include vascular occlusive events (AMI, stroke, DVT, PE),

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blood product use, 24 hour and 28 day mortality, and the e ects of TXA on coagulation, brinolysis and in ammatory mediators.

Progress The trial will nish on the 31st of March 2021.

At the end of 2020, PATCH has recruited a total of 1,193 across Australia and New Zealand, 90.7% of the target recruitment.

Following completion of recruitment, the study timeline will follow sequentially:

■ 6 months - Follow-up phase

■ 3 months - Data cleaning/lock

■ 2 months - Primary analysis

■ 2 months - Manuscript submission

research with a high rotation of sta , insu cient time, and an over-saturation of information. The nature of the PATCH trial research meant that training and education was delivered periodically over a few years to a wide group of ED sta ; this was often di cult to maintain due to workplace stressors. Despite the pressures and infrequency of trial activation, having the ED team successfully enrolling patients in the PATCH trial felt like a huge achievements and this was very rewarding. These small wins, despite the setbacks, are what makes ED research even more rewarding.

References 1. Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013;17(10).

Ethics: UTas H0014471 PI: R Gruen TAS PI: D Cooper TASER AI: V Tran

How I Became Involved With a special interest in trauma and resuscitation I was given the opportunity to take on the PATCH project at the RHH ED. My involvement included educating emergency nursing sta and disseminating easy-access information on how to undertake the clinical trial for the infrequent patient enrolments. The project has sparked my interest in emergency medicine research, and I look forward to future projects for clinical advancement.

A Rewarding Experience The ED appeals to my interest in high pressure, reactional and dynamic work.

However, this environment doesn’t always allow for e ective clinical

Want to know more? patchtrauma.org

Research Highlights 2019-20

Collaborative Spotlight

PREDICT Paediatric Research in Emergency Departments WHAT IS PREDICT?

PREDICT PROJECTS

The Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, was established in 2004 and includes research institutions, healthcare providers and researchers involved in paediatric emergency care across Australia and New Zealand. It is the largest paediatric emergency medicine network in the southern hemisphere and is currently a National Health and Medical Research Council funded Centre for Research Excellence (GNT 1171228).

1. The Kids are not ok: Emergency Department management of acute mental health crises in children and young people - A Retrospective study. UTAS HREC 20108

CI: S Craig Tas PI: V Tran, N Watkins

This study aims to generate new information about children and adolescents presenting to the ED with mental health concerns.

Speci cally, we hope to describe, in di erent settings and types of EDs: (a) current patterns and precipitants of ED mental health presentations; (b) prevalence of co-morbid conditions; (c) factors (including demographic, family and other social factors) associated with mental illness and suicidality; and (d) the care provided within the ED and on follow-up.

www.predict.com.au

Tasmania has been given the opportunity to be included within this membership and has been involved in a number of research projects.

Want to know more? predict.com.au

2. The Kids are not ok: A Delphi’s study to identify consensus research priorities and core outcome sets in paediatric emergency department mental health presentations. UTAS HREC 20131

CI: S Craig Tas PI: V Tran, N Watkins

This study aims to use modi ed Delphi methods to determine a prioritised list of research questions, and a set of core clinical and mental health outcomes that should be researched for children and adolescents attending the ED with mental health presentations.

3. Pain Management and Sedation in Paediatric Ileocolic Intussusception: A Global, Multicenter, Retrospective Study, UTAS HREC 23429

CI: I Shavit Tas PI: V Tran

Through retrospective review, this project will explore current global practices related to the provision of analgesia and sedation for reduction of intussusception. Furthermore, it will examine the association of sedation with outcomes of reduction of intussusception.

4. PERN: Predicting Severe Pneumonia in the Emergency Department: A Global Study of the Paediatric Emergency Research Network. UTAS HREC H001746

CI: T Florin Tas PI: V Tran, N Watkins, E Loughhead

The purpose of the study is to develop accurate, objective models of prognosis in pediatric CAP using a global cohort of pediatric emergency departments.

5. How are we managing acute asthma in children? UTAS HREC H0016548

CI: S Craig Tas PI: N Watkins

The primary aim of our research project is to determine the incidence, management of, and complications relating to acute severe asthma in children presenting to emergency departments across Australia and New Zealand.

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TASER: Tasmanian Emergency Medicine Research

Research Spotlight

REGISTRIES What Are Clinical Registries?

Current Registries

Registries in Development

Clinical Registries are repositories of clinical data that can be interrogated to help inform clinical care through benchmarking against standards as well as identifying gaps in care that would bene t from further research.

The following registries include data provided by Tasmanian Emergency Departments:

The following registries are currently under review with data input expected to start in the next 2 years:

1. COVED

1. Procedural Sedation Registry

Registry Lead: G O’Reilly

Registry Lead: A Loughman

The Australian Commission on Safety and Quality in Health Care commissioned an evaluation into the impact of registries (1) and found that substantial bene ts included greater survival of patients, improvements in quality of life after treatment and avoidance of unnecessary investigations, treatments or hospital stay.

Overview: A prospective cohort study of patients presenting to EDs with suspected COVID-19.

Overview: A registry of procedural sedations performed in the ED to monitor current/future practice and adverse events.

As Emergency Departments, our patient throughput is much higher than any other specialty and therefore rich with data and an ideal location in which to utilise registries.

In addition to having an abundance of clinical data, perhaps the most challenging aspect of having a clinical registry is the transfer of this data from clinical care to the database itself. As we move closer to a paperless healthcare system in Tasmania, this will gradually become easier and forms an essential aspect of our research strategy for a more aware and sustainable research culture.

References

Year Established: 2019

2. ANZEDAR: The Australian and New Zealand Emergency Department Airway Registry

Registry Lead: T Fogg

Overview: A registry of intubated patients in Emergency Departments to monitor the safety of emergency airway management across participating sites, including rst pass success rats, and the incidence of adverse events.

Year established: 2019

3. RHH MET Call Database

Registry Lead: T Dunbabin

Overview: A registry of MET calls at the Royal Hobart Hospital, inclusive of the ED.

Year established: 2018

4. Tasmanian Trauma Registry/Australia New Zealand Trauma Registry

Registry Lead: A Mahoney

1. Economic evaluation of clinical quality registries.

Sydney, NSW: Australian Commission on Safety and Quality in Health Care; 2016.

Overview: A registry of Trauma patients (identi ed as an Injury Severity Score > 12) presenting to the Royal Hobart Hospital. A subgroup of the data variables collected are submitted to the ATR.

Year established: 2019

5. Australian & New Zealand Hip Fracture Registry

Registry Lead: ANZHFR steering group.

Overview: A registry of older people who have sustained a minimal trauma fracture of the proximal femur.

Year established: 2018

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2. Australian Emergency Department Registry

Registry Lead: S Craig

Overview: A national registry of Emergency Department presentations

3. EDNA: Emerging Drugs Network Australia

Registry Lead: L Pulbrook

Overview: A registry of patients presentations relating to the use of illicit substances.

Research Highlights 2019-20

Registry Spotlight

THE TASMANIAN TRAUMA REGISTRY

What Are Clinical Registries?

Clinical Registries are repositories of clinical that can be Collins interrogated to Adam data Mahoney, Clare help inform clinical care through

benchmarking against standards as well as identifying gaps in care that would bene t from further research.

The Australian Commission on Safety and Quality in Health Care commissioned an evaluation into the impact of registries (1) and found that

In April 2020, the Royal Hobart Hospital Trauma Service marked an important milestone as we commissioned the Tasmanian Trauma Registry.

What is a Trauma Registry?

A trauma registry is a comprehensive repository of clinical data relating to patients’ journeys through the trauma system, from point of injury to discharge from care.

Containing over 200 variables, our registry can paint a detailed picture of individual patient experiences and aggregated data can also allow us to draw conclusions about the e cacy, e ciency and accessibility of trauma care.

The Tasmanian Trauma Registry will form the foundation of local trauma quality improvement programs and already data from the registry has been used to evaluate episodes of care, inform resource allocation and guide revision of important clinical practice guidelines.

National Collaboration Registry commissioning is also signi cant in that it marks a renewal of the relationship between the Tasmanian Health Service and the broader Australian trauma community. In developing the registry, we have worked closely with mainland trauma centres, principally Gold Coast University Hospital.

The Tasmanian Trauma Registry will form the foundation of local trauma quality improvement programs the Royal Australasian College of Surgeons in coming years.

Evolution of the Registry Reporting from the Tasmanian Trauma Registry will continue to mature in 2021.

Processes have been developed to allow clinicians to access registry data for local quality initiatives and for research.

The Trauma Service is excited about the opportunity to collaborate with the Emergency Department, the University of Tasmania and all other clinical and community stakeholders in order to improve patient care.

Want to know more?

We are keen to hear from any clinicians and researchers who would like to initiate a project involving registry data.

Please address any research or quality improvement proposals to the Clinical Nurse Coordinator for Trauma, Clare Collins, at clare.collins@ths.tas.gov.au

Empowered by the registry, we are well positioned to conduct world class research relevant to local needs, with the ultimate aim of zero preventable trauma deaths in Tasmania.

The rst quarter of registry data was submitted to the Australian Trauma Registry in November and by mid-2021 we will be able to begin comparing the trauma outcomes of the Royal Hobart Hospital with de-identi ed peer institutions around the country.

This benchmarking process will support the Royal Hobart Hospital’s journey towards trauma centre veri cation by

Adam Mahoney is the medical director and Clare Collins is the clinical nurse consultant for the Royal Hobart Hospital Trauma Service

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Pandemic Research

COVID-19 The e ects of COVID-19 have created unprecedented times. As a health sector, it has led to heightened collegiality on all levels to prepare for an overwhelmed health care system and care for those that need to access it.

CI: G O’Reilly Tas PI: V Tran, A Loughman

UTAS HREC 21662

This study is a multicentred trial to establish a register of suspected COVID-19 patients to understand the clinical predictors of those who are COVID-19 positive and the outcomes of those that require endotracheal intubation for invasive ventilation.

CI: S Craig Tas PI: V Tran UTAS HREC 23566

The project will describe patterns of presentations to EDs across Australia and New Zealand.

Our hypothesis is that the COVID-19 restrictions imposed in New Zealand and Australia were associated with a reduction in presentations to participating EDs, and that this reduction varied according to the type of ED presentation, mode of arrival (self presentation, police or ambulance), or ED diagnosis. Within sub-groups, we also aim to assess patient outcomes at hospital discharge.

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3. A personalised ventilation hood: A phase I safety study of a new device - The McMonty CI: F McGain, J Monty, C French Tas PI: R Sistla, V Tran, R McAllister, A West

UTAS HREC TBA

2. Emergency Department Data to Assess the Impact of COVID-19 restrictions

This response has been fast-paced, inclusive, knowledgeable and profound.

Such a response has also exposed Tasmanian Emergency Medicine Research to opportunities to evolve its research experience.

The following are the research projects that we’ve been able to contribute to.

We also intend to describe changes to measures of ED ow (access block, waiting times) and e ectiveness of care, to determine whether there are inequities in care for particular patient groups.

1. CoV-ED-QI: Monitoring and Improving emergency Care for CoVID19

As the world faces the unknown, a considered evidence-based and research focused approach has been necessary to structure the systems required to create a calculated and robust response to counter the COVID-19 pandemic.

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TASER: Tasmanian Emergency Medicine Research

This is the rst trial of a new Therapeutic Goods Authority listed device. We aim to test the perceived physical safety of the McMonty hood and practical aspects of its use in clinical settings.

The McMonty is a plastic hood supported by a Perspex and stainless steel frame on wheels. The backing is connected to a fan, PVC hosing and a high e ciency particulate air (HEPA) lter. The HEPA lter removes 99.9% of >0.3 micron particles which is as good as an ICU ventilator. The hood works by providing a mechanical barrier to droplet spread. The fan creates a negative pressure environment by drawing air away from the patient. The air passes through the HEPA lter before being recirculated into the ICU/ hospital room environment. The entire

Research Highlights 2019-20

hood’s air volume is changed every 30 seconds (120 air changes/hour), much more rapidly than a negative pressure room (12 air changes/hour).

4. Health professionals knowledge, preparedness and experience of managing SARS-CoV-2 and COVID-19 in the Australian healthcare settings: A multidisciplinary cross-sectional study Emergency physicians

the Australasian College for Emergency Medicine (ACEM) working in collaboration with Safer Care Victoria. An expert group developed guidelines on the management of cardiac arrest, based on a review of the emerging literature related to COVID-19 and guidance from national and international resuscitation bodies

CI: R Shaban Tas PI: V Tran, B Doyle

6. Which personal protective equipment should I use while caring for children attending the ED? Paediatric emergency procedures in the COVID-19 era

This study will examine health professionals’ knowledge, preparedness and experiences of managing SARSCoV-2 and COVID-19 in the Australasian healthcare settings. The guiding research question is: What are health professional’s knowledge, preparedness and experiences of managing SARSCoV-2 and COVID-19 in Australian healthcare settings?

Lead Author: S Craig Tas Author: V Tran

We set out to determine – from emergency physicians and infectious disease specialists - recommendations for the use of PPE for paediatric ED procedures during the COVID-19 pandemic.

5. Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine Lead Author: S Craig Tas Author: JC Ascenio-Lane

In March 2020, clinical guidelines on many aspects of the ED response to COVID-19 were produced by a team of emergency physicians and by sta of

Artwork: Harryarts / Freepik

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TASER: Tasmanian Emergency Medicine Research

Mental Health Research

MENTAL HEALTH IN THE ED The emergency department means di erent things to di erent people.

For the community, it is somewhere that they turn to when they need medical care that they cannot nd anywhere else, be it a motorvehicle crash, a heart attack, deterioration in mental health, or broken bones that need setting & wounds that need suturing.

For researchers, it acts like a canary in the coal mine, providing insight into how the health system is coping. If we were seeing high rates of heart attacks, then we would look into how our preventative measures are being implemented. The amazing work at the Menzies in MS research over the last decade means that we rarely see emergency presentations relating to MS nowadays.

With regards to the mental health ‘canary’, through a variety of collaborative research projects, we have been able to quantify the gravity of this issue as well as develop pragmatic solutions and identify and prioritise areas of future research.

1. The Kids are not ok: Emergency Department management of acute mental health crises in children and young people - A Retrospective study CI: S Craig Tas PI: V Tran, N Watkins

UTAS HREC 20108

This study aims to generate new information about children and adolescents presenting to the ED with mental health concerns. Speci cally, we hope to describe, in di erent settings and types of EDs: (a) current patterns and precipitants of ED mental health presentations; (b) prevalence of co-morbid conditions; (c) factors (including demographic, family and other social factors) associated with mental illness and suicidality; and (d) the care provided within the ED and on follow-up.

2. The Kids are not ok: A Delphi’s study to identify consensus research priorities and core outcome sets in paediatric emergency department mental health presentations CI: S Craig Tas PI: V Tran, N Watkins UTAS HREC 20131

Our objectives are to utilise modi ed Delphi methods to: (1) develop a prioritised list of research questions relevant to children and/or adolescents presenting to the ED with acute mental health presentations; and (2) identify areas, domains or outcomes that should be measured in future research studies involving this group of patients.

These areas or domains will include general outcomes applicable to all patients, and speci c outcomes relevant to particular subgroups (e.g. acute behavioural disturbance, suicidal ideation / self-harm, drug and alcohol

presentations, eating disorders, and neurodevelopmental disorders such as autism spectrum disorder). Results of this study will guide the design of future research into child and adolescent mental health presentations.

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3. Trends in emergency department presentations in the paediatric population with suicidal ideation and self-harm during the COVID-19 pandemic CI: T Naidoo Tas PI: V Tran

UTAS HREC 23657

4. Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004–05 to 2016–17 CI: A Neil Tas PI: V Tran

To examine trends of ED presentations with a mental health (MH) diagnosis in Australia and its jurisdictions by diagnostic group between 2004-05 and 2016-17.

4. Emergency department presentations with a mental health diagnosis in Australia, by jurisdiction and by sex, 2004–05 to 2016 CI: A Neil Tas PI: V Tran

To examine trends in ED presentations with a mental health diagnosis in Australia by jurisdiction and by sex, between 2004–05 and 2016–17

6. Trends of emergency department presentations with a mental health diagnosis by age, Australia, 2004–05 to 2016–17: A secondary data analysis.

CI: A Neil Tas PI: V Tran

The present study aims to explore for Australia: (i) the trends of ED presentations with a mental health (MH) diagnosis by age group; and (ii) whether those trends di er from all ED presentations.

Research Highlights 2019-20

7. MAGNET: Mental Health Australia General Clinical Trials Network CI: M Berk Tas PI: V Tran

MAGNET is a new phase in Australian mental health. Guided by lived experience priorities, CIs have conceptualised four initial CTs that will

have immediate clinical outcomes, through generating de nitive evidence in areas of substantial need in mood and anxiety disorders, but with an outlook towards future transdiagnostic expansion. Moreover, these trials have been designed towards e ectively establishing a multidisciplinary collaborative structure, inclusive of

lived experience, and will leverage common platform resources that drive e cient, consistent and harmonised trial approaches across its CTs facilitating an unprecedented degree of scope, scale and impact.

Artwork: Lydia Birch

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Researcher Spotlight

MICHAEL JACQUES The Weekend Effect About the Research The Project ‘The Weekend E ect’ was originally part of some work to drive change in the Fast Track/Subacute area of the Royal Hobart Hospital Emergency Department (the ED), known internally as the ‘Mountain Area’.

Anecdotally, it was felt that on weekends, this area was busier than weekdays. We wanted to nd out if this were true and if so, what factors might be involved and how this quantitatively compared to other days of the week.

Based on some of the previous literature, we know that weekends and after-hours have less sta ng and higher rates of adverse events.

We cast a net with the help of the business intelligence unit and interrogated the period 2018-2019 (2 years).

Some of the factors we were interested in included patient demographics (eg age and gender), time of day presentations were made as well as Australasian Triage Scale, diagnosis (based on ICD-10) and disposition.

We worked with a biostatistician to determine statistically signi cant ndings inclusive of the question, ‘Is there really a weekend e ect when it comes to patient presentations to a tertiary emergency department?’

What We Found We found a mix of expected and unexpected things ones we distilled down the data.

Of all patients presenting to the ED, 65% were seen in the Mountain Area and of these, 30% were paediatric (≤ 17 years).

When it came to the busiest hours of the day, we found that the highest rate of change in presentations was between 0700 and 1000, yet the highest

This project was a rewarding experience and an example of a very easy and rewarding clinical initiative that aided change within our department and put us on the national stage presentations per hour was between 1000 and sustained until 2000.

For days of the week, Sunday and Monday saw the highest number of presentations per day with Wednesday and Thursday the least.

The most common diagnosis made was abdominal pain.

Another interesting nding was that unspeci ed abdominal pain (ICD-10AM R10.9) was the most common diagnosis. Reviewing the ED Nurse Practitioners scope of practice to include this category of complaint would make sense in enhancing e ciency through the Mountain Area.

A Rewarding Experience This project was a rewarding experience and an example of a very easy and rewarding clinical initiative that aided change within our department and put us on the national stage.

I hope that research no matter how small becomes an integral focus of the RHH ED and we start making the time with a real focus of energy here in the years ahead as a multidisciplinary team.

Our research team was made up of myself, Dr Viet Tran (Director of Emergency Medicine Research) and Dr Angela Jacques (biostatistician). This poster was presented at the Australasian College for Emergency Medicine 36th Annual Scienti c Meeting in 2019 and was awarded the best poster as voted by delegates of the meeting.

What This Means The magnitude of these di erences in number of patients was surprisingly low.

Some of the confounders to cause the experience that we face versus the data that we found may include weekend and after-hours rostering and shift times for nurses and doctors. This was unfortunately beyond the scope of this

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project but would certainly be interesting to look at in the future.

Finally, the answer to the original question of whether or not a weekend e ect exists, was that over the 24 month period, on average, there was an increase in 8.6 patients per day on the weekend vs weekday.

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TASER: Tasmanian Emergency Medicine Research

Mr Michael Jacques and Dr Viet Tran awarded ‘Best Poster’ at the 36th ACEM ASM. Photo: Supplied

Research Highlights 2019-20

Research Strategy

MEMBERSHIP & COLLABORATION As part of our strategic plan for TASER, we value the wealth of experience and mentorship and opportunities that meaningful collaborations o er.

In addition to collaborations, we recognise the need to make a meaningful contributions to the progression of emergency medicine research. Not only does membership show a way of giving back to the EM research community, but provides another avenue for an accelerated gain in experience.

The following are a list of stakeholder collaborations and memberships that our TASER team are part of.

Service to Medical Research

‣ Host, 2019 ACEM Annual Scienti c Meeting

‣ Health & Medical Human Research Ethics Committee

‣ UTas Higher Degree Research Supervisor Program (PhD)

‣ Cochrane Methods Network

‣ ACEM Trainee Review Panel

‣ ACEM Research Committee

‣ Tasmanian Collaboration for Health Improvement Establishment Reference Group

Editorial Boards

‣ Emergency Medicine Australasia

‣ Australasian Emergency Care

‣ Visual Journal of Emergency Medicine

‣ Signa Vitae

Peer Reviewers

‣ Emergency Medicine Australasia

‣ Visual Journal of Emergency Medicine

‣ Signa Vitae

‣ Emergency Medicine Journal

‣ NHMRC Postgraduate Scholarships scheme

‣ Australasian Journal of Ultrasound in Medicine

‣ The Australian & New Zealand Journal of Psychiatry

Collaborations

‣ Menzies Institute for Medical Research, UTas

‣ Monash Partners Academic Health Science Centre

‣ Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research

‣ ACEM Clinical Trials Network

‣ ACEM Emergency Departments Epidemiology Network

‣ QERC: Queensland Emergency Research Collaborative

‣ THCI: Tasmanian Collaboration for Health Improvement

‣ EDNA: Emerging Drugs Network of Australia

‣ PREDICT: Paediatric Research in Emergency Departments International Collaborative

‣ IFEM GEM SIG: International Federation for Emergency Medicine Geriatric Emergency Medicine Special Interest Group

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TASER: Tasmanian Emergency Medicine Research

Research Convergence

36th ANNUAL SCIENTIFIC MEETING Australasian College for Emergency Medicine Geo Couser

The Tasmanian faculty of the Australasian College for Emergency Medicine (ACEM) hosted the 36th Annual Scienti ic Meeting for the College in Hobart from November 17 – 21, 2019. Nearly 1000 delegates attended “The Changing Climate of Emergency Medicine” at the Hotel Grand Chancellor.

The theme of the meeting led to broad discussions based around how the practice of emergency medicine is changing and how it will evolve to meet the needs of a twenty- rst century health system and patient population. In particular, the meeting focused upon discussion of the following themes.

Climate change, biodiversity and their impacts upon human health Keynote speakers drew attention to evolving disease patterns and their impact upon vulnerable populations in both Australia and the surrounding Paci c region. The conference heard from experts not just in medicine but from other disciplines – including UTAS Professor David Bowman who described his research into bush re ecology, and UTAS IMAS Professor Gretta Pecl who outlined the critical connections between ocean health and human health. It was impressive that we were able to tap into quality local experts to assist us understand the health implications of climate change.

Low Value Care Re ecting the leading role that the Australasian College for Emergency Medicine has played at a national level and the leading role that the specialty of Emergency Medicine in Tasmania has played at a state level in drawing attention to this critical yet only recently recognised issue. Up to 40% of delivered health care is wasteful and causes demonstrable harm to patients, so it is imperative that we as healthcare providers act from a safety and quality, moral, and economic perspective. The conference discussed recent research and methods that can be used to reduce low value healthcare, namely through national programs such as Choosing Wisely.

Mental Health Emergency Medicine has long taken up the slack around failures in delivery of care to some of the most vulnerable members of our community, and this conference presented research into new models of care and solutions to this very prominent issue.

Indigenous Health Closing the Gap and implementation of the ACEM Reconciliation Action Plan have long been goals and policies of the College and discussion of research relating to these topics featured prominently at the meeting.

International Health ACEM has supported the development of Emergency Medicine in low and middle-income countries, particularly in the Asia-Paci c region. We hosted six international scholars from Fiji, Tuvalu and Burma in Hobart who used the opportunity to tour the RHH ED and the RHH Hyperbaric chamber, thus improving our connection with our international colleagues

Emergency Medicine Research A large program of research was presented at plenary, concurrent and poster sessions, highlighting the active research being undertaken in Emergency Departments around such diverse topics such as clinical decision making and clinical redesign.

In summary the meeting was a success, and highlighted Hobart as a vibrant and active community of emergency medicine practitioners who participate in quality research and scholarly activities.

It was impressive that we were able to tap in to quality local experts to assist us understand the health implications of climate change

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Research Highlights 2019-20

Organising Committee Convenor:

Geo Couser

Deputy Convenor:

Brian Doyle

General Members:

Viet Tran, Marielle Ruigrok, Lucy Reed, Rohan Church, Domnhall Brannigan, David Rigg, Bryan

Walpole, Terry Brown, Victoria Trubody, Melinda Venn

Tasmanian Presenters

Tasmanian Chairs

‣ Opening Remarks: G Couser

‣ Outside the Comfort Zone - Medical

‣ Open Plenary: M Ruigrok

‣ Digital Informatics and Emergency

‣ Aerospace Medicine - Emergency

‣ Calming Adolescent Storms: E

‣ Prescribed Medicines - The Good,

‣ In uential Papers of 2019: B Doyle

‣ 2050 - An Emergency Odyssey: JC

‣ Ultrasound Hackathon: B Doyle

‣ Original Research (Clinical Mix): L

‣ Special Populations: L Coulson

‣ Paediatrics: N Watkins

‣ Original Research (ED

‣ Original Research (Clinical Mix): B

‣ Low Value Care and how to Avoid it:

‣ Closing Plenary: M Ruigrok

Support of the Antarctic Diving Program 2014-15: D Smart

‣ LEX Program - AN ACEM Wellbeing Award Winner: R Siauw

‣ The Changing Climate of Gender Equity: K Field & L Reed

‣ Changing the Climate in Emergency Medicine Practice - How to have Career Flexibility and Sustainability (Panel): T Lawler

‣ Between a Rock and a Hard Place:

Ethical Dilemmas at the Coalface of Global Emergency Care: B Tassicker

‣ Lobbying for Success - The

Medicine: V Tran

Loughhead

Ascenio-Lane

Administration): T Brown

L reed

the ED: Literature Review and Current Practice at a Tertiary Burns Referral Centre: K Davis

‣ Organ Donation and the emergency

Created Equal?: K Davis

‣ Oh, the places you’ll go: J Kippax

‣ Rambling through life - what it has taught me: M Ruigrok

Pulbrook Thinking Outside the Box: The Changing Climate of Pre-hospital Emergency Medicine: D Brannigan

Walpole

& Others): V Tran

‣ Readiness, Reaction and Recovery -

‣ Space Medicine: A Tucker

‣ Are all Oxycodone Prescribers

The Bad and the Ugly: M Rogers

‣ Original Research (Trainee Research

Essentials: How to get what you want: B Walpole & R Church

‣ Pain relief for Major Burns Patients in

Medicine is Out of this World: D Smart

Th Emergency Medicine Response to Events of Community Violence: T Lawler

Physician: D Rigg

‣ 2050 Vision: Plans & Priorities: M Ruigrok

‣ Original Research (Airway,

Resuscitation & Trauma): M Venn

‣ Closing Plenary: R Church

‣ Closing Remarks: G Couser

To catch up on everything to do with the 36th ACEM ASM you can

‣ ‣ ‣

Search #ACEM19 on twitter

View all conference recordings free of charge at bit.ly/acewm19resources

View the published abstracts at bit.ly/acem19abstracts

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TASER: Tasmanian Emergency Medicine Research

Research Collaborations

RHH RESEARCH FOUNDATION Heather Francis, CEO

Since establishment in 1997, the RHH Research Foundation has become the largest local and independent funder of medical research in Tasmania, seeking to make strategic investments into studies that will make a di erence to health and wellbeing across communities statewide.

Pursuing a vision of better health through research, the Foundation has demonstrated strong success for over two decades in achieving its mission of actively engaging the community in order to facilitate and fund health and medical research of relevance to Tasmanians.

In early days, annual grant rounds were in the order of approximately $75k, providing vital support to around seven studies each year. But as the Foundation moves closer to celebrating its silver anniversary in 2022, just under $1.1m will be invested into twenty new investigations in 2021, recognising that the growth in desire for funding has been matched by support from individuals and organisations from throughout Tasmania.

Each year, our small team undertakes a range of initiatives designed to encourage the generosity of our community so that, in turn, the Foundation can inject funding into the research aspirations of clinical researchers. Members of the broader community will be familiar with largescale events delivered by the Foundation – the annual abseil o Tasmania’s tallest building is certainly a highlight, as is the Easter Egg Hunt and family picnic day attracting several thousand participants year on year. But

most often, it is the ‘quiet and enduring’ relationships that the Foundation holds with donors, large and small, from across the state that fuel the neverending need for more investment into local medical research. There are so many from across our community who are inspired to support our goal of improving the health and wellbeing of those around us and those of generations to come.

with a core requirement that there is a bene t to the care and service delivery provided by the RHH too. Building local research capacity is particularly important to the Foundation, especially in providing support to those early and mid-career researchers who face the challenge of crafting an e ective evidence base as the ‘track record’ required to access funds from higherorder national schemes.

Every year the Foundation is inundated with applications for funding through its annual grant round. In fact, submissions often exceed the volume of funds available by over 400%. This makes for an intensely competitive process of selection, ensuring that the grant funds are stewarded into highlevel medical research studies that are assessed on the basis of merit along a range of key factors.

Naturally, the potential signi cance of intended outcomes is a major aspect of the assessment criteria, but this is also balanced by an understanding that medical research is not always a linear process. Sometimes challenges arise mid-study that can disprove or confound the intended impacts – but that’s an important part of medical research too!

Guided by its Scienti c Research Advisory Committee, a group of ten highly skilled medical researchers (each endorsed by the National Health and Medical Research Council) who volunteer their time, the process of assessment requires considerable hours of work, ensuring the decision-making role of the Foundation’s volunteer Board is well-based.

Key criteria are focused on bene t to the health and wellbeing of Tasmanians

The Foundation is strongly focused on applied research, seeking to invest carefully into those studies that will make a di erence in the most e icient and immediate way possible

Fundamentally, the Foundation seeks to respond to those clinical researchers who feel that, in their practice, there must be a ‘better way’ – to care for, to prevent, to support, to plan for healthcare ie to deliver health services across our community in a way that enhances clinical practice while simultaneously improving the health and wellbeing of those around us.

Another key factor in the assessment process is the formation of collaborative teams who can engage in not only the research process, but also the subsequent translation of ndings into clinical practice. The Foundation is strongly focused on applied research, seeking to invest carefully into those studies that will make a di erence in the most e cient and immediate way possible.

One such study funded in 2019 is led by Dr Viet Tran, Emergency Medicine Sta Specialist at the RHH’s Department of

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Research Highlights 2019-20

Research Strategy

GRANTS The Kids Are Not Okay

Funding Body:

Funding Scheme:

Royal Hobart Hospital Research Foundation

Incubator Grant

Total Funding:

$19,950

Research Team:

Tran V; Watkins N; Craig S

Project Outline:

There has been an alarming recent increase in emergency department (ED) mental

health presentations (self-harm, depression, and behavioural disorders) by children and

adolescents. Our research will help us understand why these high-risk vulnerable

patients attend the ED, how they are treated, and their outcomes after discharge.

The Hobart Clinical School Trauma Weekend Program

Funding Body:

Funding Scheme:

Motor Accidents Insurance Board, Tasmania

Injury Prevention and Management Foundation

Total Funding:

$76,062

Project Team:

Tran V; Zoldi J; Giltjes S; Merri eld J

Project Outline:

The Trauma Weekend is an interdisciplinary residential weekend for nal year medical

students and nal year paramedic students. Education is delivered by a

multidisciplinary team and include both academic sta from the University of Tasmania

School of Medicine and Paramedicine, State Emergency Services, Ambulance

Tasmania (including aeromedical retrieval), Royal Hobart Hospital Emergency

Department, General Practice as well as the Australian Antarctic Division.

PISTACHIO - The Primary Trauma Care Course Impact and Outcome study in Vietnam

Funding Body:

Funding Scheme:

Elphinstone Group Donation

Donations - Individual

Total Funding:

$150,000

Research Team:

Nelson MR; Tran V; Blizzard CL; Skinner MW; Palmer AJ; Tu NH; Thang CQ

Description:

A before and after study in 2 Vietnamese hospitals of the e ectiveness of a trauma

management course for the reduction of morbidity and mortality of road trauma in that

country.

Emergency Medicine. His study, funded entirely by a local Tasmanian family who provides signi cant support to the Foundation, will provide vital baseline data which can then be used in years to come to ascertain the success of subsequent healthcare advancements that are guided by this study.

Collaboration with others into discovering ‘a better way’ is pivotal to Dr Tran’s study and, although modest, he knows that the outcomes of his work will help to support these most vulnerable members of our community.

This study at the RHH enables Dr Tran and his team to become a vital part of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, ensuring that Tasmanian adolescents and local trends and issues are part of this important study. The bene ts are deep, enduring and multifaceted – our local clinicians remain active at the very peak of their practice, they gain access into cuttingedge research agendas with impact nationally and internationally while, most signi cantly, the young people from across Tasmania can gain bene t from

improved health and wellbeing as a consequence of locally tailored practice that is in line with globally leading care.

The partnership between the Foundation, its generous supporters and the clinical research community is as valuable as it is vibrant. But of course, more always need to be done!

rhhresearchfoundation.org

For more information,

including how to donate, visit

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TASER: Tasmanian Emergency Medicine Research

Research Spotlight

KATHERINE DAVIS Opioid Stewardship Sparking a Research Interest I rst became interested in research as a medical student, when I realised that it has the potential to both improve outcomes for patients and enhance experiences for medical professionals at all levels. Research is a way of disseminating ideas and knowledge to the wider medical community, with the aim of improving outcomes for patients, which of course is what we strive to do every day in medical practice. It also provides an academic challenge outside of the constraints of work and allows you to think, and test, your own ideas.

Research is a way of disseminating ideas and knowledge to the wider medical community, with the aim of improving outcomes for patients, which of course is what we strive to do every day in medical practice.

Local Relevance

The Opioid Epidemic As part of my career progression as a prevocational doctor, I sought out research opportunities and was intrigued by the data behind the opioid epidemic, but moreso the questions it raised.

Opioid medications have been under the spotlight in recent years, with evidence that the harms associated with their use may actually outweigh their bene ts in many situations.

In the United States of America, opioid prescribing in Emergency Departments have been associate with increased harm, including progression to long term use in 7-10% of patients and a 3-fold increase in opioid related deaths since 2018 when 47,590 were recorded.

In Australia, dispensing of opioids has increased four-fold from 1990 to 2014.

As a research topic, I wanted to characterise prescribing practices of emergency physicians, with the secondary aim of identifying the prescriber groups with the highest levels of opioid prescribing, to potentially target education and training for these groups and improve quality of opioid prescribing.

The RHH ED research team provided excellent support through mentorship, protocol development, ethics approval and dissemination of ndings.

I presented our ndings at registrar teaching, and also at the Australian College of Emergency Medicine Annual Scienti c Meeting in November 2019, in Hobart.

What we found We collected data on opioid prescriptions to 215 patients being discharged from the ED over a period of 3 months.

Our ndings included:

•

• •

Registrars were more likely to prescribe oxycodone than any other prescriber demographic, including when adjusted for the number of doctors at each level of seniority

Consultants prescribed the fewest, but the most per prescription

Junior doctors (interns and resident medical o cers) issued fewer

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prescriptions for oxycodone, and were more likely to prescribe lower quantities of 5 or 10, rather than the maximum allowed 20

We hypothesised that opioid stewardship is becoming a more prominent feature in undergraduate education than previously, in line with increasing amounts of published research identifying the harms associated with opioid prescribing.

Where to from here There are many ways that this research could be taken in the future. It would be interesting to nd out about emergency doctor perceptions on opioid prescribing, including barriers to improving the quality of prescribing and reducing the quantity prescribed.

Patient outcomes are also of interest. In Australia, what proportion of these patients prescribed opioids from the emergency department go on to long term use? How many tablets should we be prescribing? Do patients understand the harms associated with even shortterm opioid use, and are they taking their opioid medications appropriately as part of a multimodal regime?

With these thoughts in mind, I have continued with my interest in opioid stewardship this year, leading an ongoing project at the Austin Hospital in Melbourne looking at patient understanding of their analgesic medications and post operative pain management, after day case surgery.

Research Highlights 2019-20

Department of Health

RESEARCH GOVERNANCE Tanya Harley, Jodi Glading

Whilst 2020 was a year best forgotten for many, it was a year where health services worked extremely hard, and indeed sta in research equally did not down tools.

In April, Royal Hobart Hospital enrolled its rst patient under a Teletrial Model for clinical trials. Several patients have since then had their clinical trial treatment transferred from Victoria to RHH as travel restrictions came into e ect from COVID. The Department of Health has secured $1.8m from the Medical Research Future Fund (MRFF) to implement a teletrial model here in Tasmania and support a broader national Australian Teletrial Program.

The Research Governance Policy Framework (RGPF) was implemented in July 2020 and the DoH website launched. The policy framework brought the di erent health areas in Tasmania into alignment under one agency wide policy framework and indeed then align Tasmania with other jurisdictions in having a statewide policy. The RGPF will enable Tasmania to engage in other reforms, such as National Mutual Acceptance (NMA) with a view to

increasing the number of clinical trials in Tasmania.

In late October 2020 the Royal Hobart Hospital participated in the National Clinical Trials Governance Framework Pilot. Organisations across Australia were provided mentoring sessions in the lead up to the pilot site assessment and were assessed using a scale that ranged from 'initial systems' to 'growing systems' to 'established systems'. The RHH achieved 'established systems' for several action items assessed in the framework and an overall rating of 'growing systems'. The feedback from the accrediting agency was overall positive and an endorsement for sta working in clinical trials.

The Research Governance intranet is the platform for internal sta to see what documents are open for consultation and training sessions, including the meeting agendas and minutes of the Research and Innovation Committee.

In 2021, the Department will continue policy and information sessions and is undertaking a training needs analysis, so have your say here.

Tanya Harley is the Research Governance O cer for CQRA, Department of Health Jodi Glading is the Deputy Medical O cer for Tasmania

The Research Governance Policy Framework will enable Tasmania to engage in other reforms, such as National Mutual Acceptance with a view to increasing the number of clinical trials in Tasmania

What is Research Governance?

Research governance refers to the processes used by institutions to ensure that they are accountable for the research conducted under their auspices. To be properly governed, research must be conducted according to established ethical principles, guidelines for responsible research conduct, relevant legislation and regulations and institutional policy. Research governance is also about credentialing and training of researchers and managing institutional risk.

australianclinicaltrials.gov.au/researchers/research-governance

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TASER: Tasmanian Emergency Medicine Research

FUTURE RESEARCH

STRATEGIC VISION INFRASTRUCTURE

‣ ‣ ‣ ‣

Recruit statewide representation

Establish governance process for quality assurance

Resource and recruit Research Administrator and Nurse roles

Establish areas of research priorities

CULTURE

‣ ‣ ‣ ‣ ‣

Institute professional development opportunities for researchers, mentors and auxiliary services

Promote research outcomes through various media

Create research opportunities that cater to the spectrum of research expertise

Foster an evidence based approach to care

Promote library services

PARTNERSHIPS

‣ ‣

Maintain & Extend current partnerships

‣ ‣

Extend our contributions in multicentred trials and grants applications

Pursue constructive relationships with state-based research organisations such as the Department of Health Research Governance O ce, Tasmanian Health Service Research Council and the Tasmanian Collaboration for Health Improvement

Seek further international collaborations and opportunities

TRANSLATION

‣ ‣ ‣ ‣ ‣ ‣

Monthly Emergency Medicine Journal Club

Appraisal of Research online

Research-infused education and training

Emergency Tasmania Conference

Support for ACEM research requirement

Using evidence to inform guidelines

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Research Highlights 2019-20

RESEARCHER SPOTLIGHT

ASHLEY LOUGHMAN Destination Hobart When I nished my Fellowship in 2018, I was looking for the consultant job that would combine all my interests and keep me in one place for the foreseeable future. Having been a bit of a rolling stone for most of my training, I had worked in a variety of settings across much of the country including WA, NSW, Victoria and the Northern Territory.

Hobart had always been alluring, with a busy emergency department and a growing Helicopter Emergency Medical Service set amongst the beautiful Tasmanian scenery, so after a quick trip down for the ASM in late 2019 I decided to take the plunge.

Getting into Research After moving down in January 2020, my goals of exploring the Tasmanian wilderness in my days o were rapidly dashed by the arrival of Covid 19 and the closure of the national parks. Unable to satisfy my need for adventure and excitement, I instead plunged headlong into the heady world of Emergency Medicine Research. While I had dabbled in several projects as a trainee, having

My focus has been on research that is readily translatable into improving clinical care to put the hard yards in my spare time had never appealed. Instead, I now I found myself locked down, with spare time to boot and growing enthusiasm to contribute to the broader emergency medicine community.

Without much of a background in research, the next several months o ered a steep learning curve. Any hopes I had that the biostatistics and epidemiology units done as part of my MPH 4 years earlier had given me

su cient grounding were dashed early on, but the helpful guidance of Viet assisted with answering all my questions.

Research Interests I believe that above all else, research has to be clinically relevant. With that in mind, my focus has been on research that is readily translatable into improving clinical care.

I am currently involved in several projects in various stage of implementation. These include the Australian and New Zealand ED Airway and Covid-19 ED registry. I have also had the opportunity to lead the ED procedural sedation registry project with the aim of starting mid 2021.

Future projects include examining the role of metaraminol for undi erentiated shock in the ED as well as exploring strategies to avoid unnecessary ambulance utilisation in conjunction with Ambulance Tasmania.

Dr Ashley Loughman atop Mt Baudin evaluating the bene ts of exercise research on the human psyche. Photo: Supplied.

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TASER: Tasmanian Emergency Medicine Research

Appendix 1

RESEARCH OUTPUTS Published O’Reilly G, Mitchell R, Mitra B, Akhlaghi H, Tran V, Furyk J et al.

Epidemiology and clinical features of emergency department patients with suspected COVID ‐19: Insights from Australia's ‘second wave’ ( COVED ‐4). Emergency Medicine Australasia. 2020

1.

O'Reilly G, Mitchell R, Mitra B, Akhlaghi H, Tran V, Furyk J et al.

Epidemiology and clinical features of emergency department patients with suspected and con rmed COVID ‐19: A multisite report from the COVED Quality Improvement Project for July 2020 (COVED 3).

Emergency Medicine Australasia.

2020.

2.

Handley SA, Tran V. Analysis of Cerebrospinal Fluid for Xanthochromia in the Investigation of Subarachnoid Haemorrhage: Experience of a State-Wide, Tertiary Referral Trauma Centre. Australian Journal of Medical Science. 2020; 41(4):121-124

3.

mental health diagnosis in Australia by diagnostic group, 2004–05 to 2016–17. Emergency Medicine Australasia. 2020;32(2):190-201.

7.

Kee LCK, Tran V. Only credentialed physicians should be performing ultrasound in emergency department: No. Emergency Medicine Australasia. 2020 [ahead of print]

8.

Tran Q, Lambeth L, Sanderson K, de Graa B, Breslin M, Huckerby E, Tran V et al. Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004–05 to 2016–17. Emergency Medicine Australasia. 2020; [ahead of print].

9.

Tran Q, Lambeth L, Sanderson K, Graa B, Breslin M, Tran V et al.

Emergency department presentations with a mental health diagnosis in Australia, by jurisdiction and by sex, 2004–05 to 2016–17. Emergency Medicine Australasia. 2019 [ahead of print].

10.

Stevens L, Fry M, Jacques M, Barnes A. Perceptions and experience of emergency discharge as reported by nurses and medical o cers. Australasian Emergency Care. 2020;23(1):55-61.

4.

Simon Craig, Mya Cubitt, Ashish Jaison, Steven Troupakis, Natalia Hood, Christina Fong, Adnan Bilgrami, Peter Leman, Juan Carlos Acencio-Lane, Guruprasad Nagaraj, John Bonning, Gabriel Blecher, Rob Mitchell, Ellen Burkett, Sally M McCarthy, Peter Alley, Amanda M Rojek, Kim Hansen and Peter A Cameron. Management of adult cardiac arrest in the COVID-19 era.

Interim guidelines from the Australasian College for Emergency Medicine. MJA. 2020 Preprint.

5.

Tran Q, Lambeth L, Sanderson K, Graa B, Breslin M, Huckerby E, Tran V et al. Trend of emergency department presentations with a

6.

11.

12.

13.

14.

Veal F, Thompson A, Halliday S, Boyles P, Orlikowski C, Huckerby E et al. Does prescribing of immediate release oxycodone by emergency medicine physicians result in persistence of Schedule 8 opioids following discharge?. Emergency Medicine Australasia.

2019;32(3):489-493.

Turner, RC, Tran, V. Acute Lacerations: Assessment and nonsurgical management. Aust J Gen Pract. 2019;48(9):585-588.

Wilson I, Tran V. Emergency department registrar transformation: It is not all about the medicine.

Emergency Medicine Australasia.

2019;31(5):874-875.

Coulson L. Tran V. Regident: A rural and regional enigma. Emergency Medicine Australasia.

2019;31(5):876-877.

Forbes J, Brichko L, Tran V. One for all, not all for one: Emergency

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medicine training beyond the metropolis. Emergency Medicine Australasia. 2019;31(3):459-462.

15.

Dryden A, Tran V. Is it possible to make a meaningful environmental di erence in the emergency department? No. Emergency Medicine Australasia. 2019 [ahead of print].

16.

Tran Q, Lambeth L, Sanderson K, de Graa B, Breslin M, Tran V et al.

Trends of emergency department presentations with a mental health diagnosis by age, Australia, 2004– 05 to 2016–17: A secondary data analysis. Emergency Medicine Australasia. 2019;31(6):1064-1072.

17.

Cobbett J, Brichko L, Humphrey K, Tran V. Making the night shift the right shift. Emergency Medicine Australasia. 2019;31(1):117-119.

18.

Church R, Briggs D, Tran V. Climate emergency: Towards a greener emergency department. Emergency Medicine Australasia. 2019 [ahead of print].

19.

Moore R, Scollard Z, Tran V. Night terror: When is the best time to start leading the night team? Emergency Medicine Australasia.

2019;31(1):120-121.

20.

Tran V, Ho, JH, Kozlovski J, Cobbett J, Dubash R. The ne line between emergency resident and registrar.

Emergency Medicine Australasia.

2019;31(5):869-871

21.

Tran V, Humphrey K, Cobbett J. Climate corrosion: Heroes wanted Enquire within. Emergency Medicine Australasia.

2019;31(2):271-273

22.

Tran V, Cobbett J, Brichko L. Procedural competency in emergency medicine training.

Emergency Medicine Australasia.

2018;30(1):103-106

23.

Brown S, Ball E, Perrin K, Asha S, Braithwaite I, Egerton-Warburton D et al. Conservative versus Interventional Treatment for

Research Highlights 2019-20

Spontaneous Pneumothorax.

New England Journal of Medicine. 2020;382(5):405-415.

24.

Treatment for Pneumothorax.

New England Journal of Medicine.

2020;382(18):1765-1767.

25.

Isbister G, Mirajkar N, Fakes K, Brown S, Veerati P. Phospholipase A2 (PLA2) as an Early Indicator of Envenomation in Australian Elapid Snakebites (ASP-27). Biomedicines.

2020;8(11):459.

26.

Wanandy T, Honda-Okubo Y, Davies N, Rose H, Heddle R, Brown S et al. Pharmaceutical and preclinical evaluation of Advax adjuvant as a dose-sparing strategy for ant venom immunotherapy. Journal of Pharmaceutical and Biomedical Analysis. 2019;172:1-8.

Undergoing Peer Review 1.

Li C, Sotomayor-Castillo C, Nahidi S, Kuznetsov S, Considine J, Curits K, Fry M, Morgan D, Walker T, Burgess A, Carver H, Doyle B, Tran V, Varshney K, Shaban R. Cecilia Li, PhD. Emergency clinicians’ knowledge, preparedness and experiences of managing COVID-19 during the 2020 global pandemic in Australian healthcare settings.

Submitted to Australsian Emergency Care.

Published Abstracts (Posters) 1.

Jacques M, Jacques A, Tran V. Is there a 'weekend e ect' in subacute and minor injuries at a mixed tertiary emergency department? Emergency Medicine Australasia, 2020; 32(supp. 1): 31.

Poster abstract from Australasian College for Emergency Medicine 2019 36th Annual Scienti c Meeting “The Changing Climate of Emergency Medicine”, November 17-21, Hobart.

2.

Tran Q, Herlihy D, Tran V, Puttaswamy V. Ruptured abdominal aortic aneurysms a study of prevalence, associated comorbidities, intervention techniques and mortality, Emergency Medicine Australasia, 2020; 32(supp. 1): 39. Poster abstract from Australasian College for Emergency Medicine 2019 36th Annual Scienti c Meeting “The Changing Climate of Emergency Medicine”, November 17-21, Hobart.

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TASER: Tasmanian Emergency Medicine Research

Appendix 1 (continued)

RESEARCH OUTPUTS Presentations

Emergency Medicine 32nd ASM, QLD Australia, 2019

1.

Tran V, Invited Speaker, The Hobart Statement in 2020, Australasian College for Emergency Medicine 33rd ASM, Virtual, 2021

2.

Tran V, Invited Speaker, The BlueSky ED, Australasian College for Emergency Medicine 33rd ASM, Virtual, 2020

3.

Tucker A, Plenary Speaker, Emergency Medicine is Out of this World. Australian and New Zealand Burn Association 43rd ASM, 2019

4.

Tucker A, Invited Speaker, Launch into the Future of Burns Care in Space, Australian and New Zealand Burn Association 43rd ASM, 2019

5.

Tran V, Church R, Couser G. The Hobart Statement. Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

6.

7.

Davis K, Hamilton S, Schrale R, Tran V. Pain relief for major burns patients in ED: Experience at a tertiary burns referral centre and literature review. Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

Tran Q, Herlihy D, Tran V, Puttaswamy V. Medical management of blood pressure and heart rate in acute type b aortic dissections: A single quaternary Centre perspective. Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

8.

Q Tran, D Herlihy, V Tran, V Puttaswamy. Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

9.

Siauw, Invited Speaker, LEX Program - AN ACEM Wellbeing Award Winner, Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

10.

Field K & Reed, L, Invited Speaker, The Changing Climate of Gender Equity, Australasian College for

11.

Field K, Invited Speaker, Career Longevity and Transition Workshop: Parallel Careers, Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

12.

Tassicker, B, Invited Speaker, Between a Rock and a Hard Place: Ethical Dilemmas at the Coalface of Global Emergency Care, Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

13.

Church R, Walpole B, Invited Speakers, Lobbying for Success The Essentials: How to get what you want, Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

14.

Tucker A, Invited Speaker, Space Medicine, Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

15.

Davis K, Invited Speaker, Are all Oxycodone Prescribers Created Equal? Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

16.

Kippax J, Invited Speaker, Oh, the places you’ll go. Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

17.

Ruigrok, M, Invited SPekaer, Rambling through life - what it has taught me, Australasian College for Emergency Medicine 32nd ASM, QLD Australia, 2019

32

Appendix 2

CURRENT PROJECTS Research Projects 1. ANZEDAR: The Australia & New Zealand Emergency Department Airway Registry. UTAS HREC 23257

healthcare settings: A multidisciplinary cross-sectional study - Emergency physicians.

2. CoV-ED-QI: Monitoring and Improving emergency Care for CoVID19. UTAS HREC 21662

13. Predicting Severe Pneumonia in the Emergency Department: A Global Study of the Paediatric Emergency Research Network (PERN). UTAS HREC H001746

3. Emergency Department Data to Assess the Impact of COVID-19 restrictions. UTAS HREC 23566

14. How are we managing acute asthma in children? A PREDICT Study. UTAS HREC H0016548

4. Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion.

UTAS HREC H0015959

15. EDNA: Emerging Drugs Network of Australia

5. PATCH: Pre-hospital Antibrinolytics for Traumatic Coagulopathy and Haemorraghe.

UTAS HREC 14471

6. Trends in emergency department presentations in the paediatric population with suicidal ideation and self-harm during the COVID-19 pandemic. UTAS HREC 23657

7. The Kids are not ok: Emergency Department management of acute mental health crises in children and young people - A Retrospective study. UTAS HREC 20108

8. The Kids are not ok: A Delphi’s study to identify consensus research priorities and core outcome sets in paediatric emergency department mental health presentations. UTAS HREC 20131

9. Pain Management and Sedation in Paediatric Ileocolic Intussusception: A Global, Multicenter, Retrospective Study, UTAS HREC 23429

10. Evaluating the use of computed tomography pulmonary angiography in Tasmanian emergency departments. UTAS HREC TBA

11. A personalised ventilation hood: A phase I safety study of a new device - The McMonty. UTAS HREC TBA

12. Health professionals knowledge, preparedness and experience of managing SARS-CoV-2 and COVID-19 in the Australian

16. Sensitivity and Speci city of mental health-related diagnostic codes in Tasmanian public hospital emergency department: a pilot study using the Conception to Community (C2C) Database (H0017825)

17. MAGNET: Mental Health Australia General Clinical Trials Network

18. PISTACHIO: The Primary Trauma Care Course Impact and Outcome study in Vietnam

19. The Tasmanian Procedural Sedation Registry

Quality Improvement Audits 1. Evidence-based ordering of Coagulation studies in ED - A choosing wisely project

2. Evidence-based ordering of Urine Drug Screens in ED - A choosing wisely project

3. Hip Fracture Care in ED following the introduction of a Hip Fracture protocol

4. Adherence to the Chest Pain Pathway at the Royal Hobart Hospital Emergency Department

Higher Degree Research Supervision 1. Evaluating the use of computed tomography pulmonary angiograms in Tasmanian emergency department

Candidate: L Thurlow Supervisors: P Van Dam, S Prior, V Tran

20. ARISE FLUIDS: Australasian Resuscitation In Sepsis Evaluation: Fluid or vasopressors in emergency department sepsis

21. Learning from Excellence - A 3 year review of an excellence reporting system

22. Learning from Excellence - A protocol for reporting excellence

23. The partnered pharmacist medication charting project at the Royal Hobart Hospital emergency department: Evaluation of a process change

24. Review of Ankle Fracture Reduction techniques in ED

25. Technical validation of the EMMA capnometer under hyperbaric conditions.

33

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Research Highlights 2019-20

TASER: Tasmanian Emergency Medicine Research

Appendix 3

GRANTS The Kids Are Not Okay

1.

Funding: Royal Hobart Hospital Research Foundation; Incubator Grant; $19,950

Research Team: Tran V; Watkins N; Craig S

The Hobart Clinical School Trauma Weekend Program

2.

Funding Body: Motor Accidents Insurance Board, Tasmania; Injury Prevention and Management Foundation; $76,062

Project Team: Tran V; Zoldi J; Giltjes S; Merri eld J

PISTACHIO - The Primary Trauma Care Course Impact and Outcome study in Vietnam

3.

Funding Body: Elphinstone Group Donation; Donations Individual; $150,000

Research Team: Nelson MR; Tran V; Blizzard CL; Skinner MW; Palmer AJ; Tu NH; Thang CQ

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Research Highlights 2019-20

Photography: Viet Tran

35

TASER: Tasmanian Emergency Medicine Research

If you would like more information about our research programs, collaborations or education opportunities, please contact us.

Tasmanian Emergency Medicine Research Email: Web:

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36

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