Emergency Department Research Report 2009 - Austin Health

Austin Hospital Emergency DepartmentResearch Report 2009Compiled byA/Prof David TaylorDirector of Emergency and General Medicine Research

FOREWORDWithout question, 2009 was our most active and productive research year to date. Asour patient census continued to increase, so did our research activity. In all areas, weexceeded earlier achievements and broke new ground in other areas of research aswell. It is clear that our department is developing a reputation within the AustralasianCollege for Emergency Medicine (ACEM), and elsewhere, as a leader in emergencymedicine research.We extend our congratulations to Drs Anselm Wong, Mark Rugless, Kirsty Jackson,Peter Cheng and Saad Al-Noaman all of whom successfully completed theirRegulation 4.10 training requirements in 2009. This involved presentation of theiroriginal research projects at an ACEM national or regional conference.Congratulations are also extended to Simone Taylor and Andrew Harding, two of ourED pharmacists. As well as actively contributing to other research activities, bothsuccessfully completed the Pharmacist Independent Prescribers’ course offered by theRobert Gordon University, Aberdeen, Scotland.Our staff were fortunate to win three research prizes during 2009. Esther Chan,formerly our ED pharmacist and now Research Fellow, won the 2009 DBL YoungPharmacists Award from the Society of Hospital Pharmacists of Australia. JoRichardson and I won the 2009 John Gilroy Potts Award for the most significantpublication by an ACEM Fellow. I also won the Best Paper presented by a Fellow atthe ACEM Annual Scientific Meeting.Our Advanced Medical Science (AMS) student research program continued to dowell. Each of our 2008 students published their work and our 2009 students have theirresearch under peer review at the moment. Last year, Charles Xie investigated thediffering bacteriology and antibiotic sensitivity of nursing home and generalcommunity residents. Jeremy Kam investigated the effect of obesity on the difficultyof managing emergency department patients. Dean Page continued our department’sinterest in vapocoolant spray and undertook a randomised trial comparingvapocoolant directly with subcutaneous lignocaine to reduce the pain of intravenouscannulation.It is pleasing to note that the three AMS students who began with us in 2009 haveinteresting projects that are progressing well. John Chae is running a randomised trialcomparing the efficacy of metoclopramide and tropisetron for nausea and vomiting.Kathy Jao is running two pre- and post-intervention studies evaluating both adult andpaediatric nurse-initiated analgesia programs. Munad Khan is examining the effect ofcomplementary medicines on the INR stability of patients taking warfarin.The great majority of our research activity is undertaken on a shoestring budget. Lastyear, however, we were successful in being awarded a number of grants that aredescribed below. The most important was an NHMRC grant to support our ‘CodeGrey’ collaborative research into sedation of the acutely agitated patient. No doubtthis funding will afford us some breathing space as we look forward to other projects.Meanwhile, this large randomised trial is progressing well at its three sites (Austin,RMH, St V’s)

Last year saw the completion of the ‘Emergency Department Procedural Sedation’study, a national collaborative of 11 emergency departments run by the Austin.Although a lot of hard work, this project was immensely successful and took out a topaward at the ACEM national conference last November. Presently we are working onthree major papers for publication.While our success last year is very pleasing, it is likely that our activity will plateau inthe near future as a result of resource limitations. Herein lies the next challenge. Weneed to explore all possibilities that will allow us to consolidate and expand. Theseextend beyond grant funding and may include Fellowship programs, dedicatedregistrar research positions, and expansion of collaborations both within and outsideof the Austin.Finally, I would like to congratulate those staff who have had successful researchendeavours during 2009 and thank those who assisted and facilitated this good work.DT

RESEARCH ARTICLESArticles Published:Chan E, Taylor SE, Marriott J, Barger B. Exploration of attitudes and barriers tobringing patient’s own medications to the Emergency Department: A survey ofparamedics. J Emerg Primary Health Care 2009; 6: article number 990313Chan EW, Taylor SE, Marriott JL, Barger B. Bringing patients' own medications intoan Emergency Department by ambulance: effect on prescribing accuracy when thesepatients are admitted to hospital. MJA 2009; 191: 374-7Cabalag MS, Taylor DMcD, Knott JC, Buntine P, Smit DeV, Meyer A. Recentcaffeine ingestion reduces adenosine efficacy in the treatment of paroxysmalsupraventricular tachycardia.Published on line ahead of print: Acad Emerg Med 2009; 16: 1-6Hijazi R, Taylor DMcD, Richardson J. Topical alkane vapocoolant spray reducesintravenous cannulation pain in emergency department patients: a randomised,double-blind, placebo-controlled trial. Br Med J 2009; 338: 457-459 (b215)Hewat N, Taylor DMcD, MacDonald E. Pilot study of Random Finger Prick Glucosetesting as a screening tool for Type 2 Diabetes Mellitus in the EmergencyDepartment. Emerg Med J 2009; 26: 732-733Thom O, Taylor DMcD, Wolfe RE, Myles P, Krum H, Wolfe R. Comparison of asupra-sternal cardiac output monitor (USCOM) with the pulmonary artery catheterBr J Anaesth 2009; 103: 800-804Tran A, Taylor DMcD. Medical model for Hospital in the Home: effects on patientmanagement. Aust Health Rev 2009; 33: 494-501Taylor DMcD, Robinson J, MacLeod D, MacBean CE, Braitberg G. Therapeuticerrors involving adults in the community setting: nature, causes and outcomes.Aust NZ J Pub Health 2009; 33: 388-394Rajasagaram U, Taylor DMcD, Braitberg G, Pearsell J, Capp B. Paediatric painassessment: differences between triage nurse, child and parent.J Paed Child Health 2009; 45: 100-203Singh R, Taylor DMcD, D’Souza D, Gorelik A, Page P, Phal P. Injuries significantlyassociated with thoracic spine fractures: a case-control study.Emerg Med Australas 2009; 21: 419-423Chan E, Knott JC, Taylor DMcD, Phillips G, Kong D. Intravenous olanzapine –another potential option for the acutely agitated patient? (Letter)Emerg Med Australas 2009; 21: 241–242Yeoh BSK, Taylor DMcD, Taylor SE. An education initiative improves the evidencebaseduse of metoclopramide following morphine administration in the emergencydepartment. Emerg Med Australas 2009; 21: 178–183

Taylor DMcD, Taylor SE, Ho J, Cabalag M, Hijazi R, Howden B, Charles P. Theeffects of nebulised N-acetylcysteine on sputum quality and diagnostic yield.J Pharm Prac Res 2009; 39: 24-27Taylor DMcD, Robinson J, MacLeod D, MacBean CE, Braitberg G. Therapeuticerrors among children in the community setting: nature, causes and outcomes.J Paed Child Health 2009; 45: 304-309Simpson N, Page P, Taylor DMcD. Free fluid accumulation following bluntabdominal trauma: potential for expansion of the FAST protocol. HKJEM 2009; 17:1-6Mohd Rosli R, Taylor DMcD, Knott JC, Das A, Dent AW. Health smart cards:differing perceptions of emergency department staff and patients.Aust Health Rev 2009; 33: 136-143Yeoh M. ‘From other journals’ Emerg Med Australas 2008; 21: 524-5 Emerg Med Australas 2008; 21: 427-9 Emerg Med Australas 2008; 21: 336-8 Emerg Med Australas 2008; 21: 243-5 Emerg Med Australas 2008; 21: 163-5 Emerg Med Australas 2008; 21: 88-9Articles accepted for publication (In press):Taylor DMcD. Pre-procedural fasting for sedation. Do we need to do it? (InvitedEditorial) Accepted Emerg Med J November 15, 2009. In pressHo J, Taylor DMcD, Cabalag MS, Ugoni AM, Yeoh M. Factors that impact uponEmergency Department patient compliance with antibiotic regimens.Accepted Emerg Med J October 21, 2009. In pressThom O, Taylor DMcD, Wolfe RE, Myles P, Krum H, Wolfe R. Pilot study of theprevalence, outcomes and detection of occult hypoperfusion in trauma patientsAccepted Emerg Med J, August 25, 2009. In pressArticles undergoing peer reviewKam J, Taylor DMcD. The effects of obesity in increasing the difficulty of patientmanagement in the Emergency DepartmentSubmitted to Annals Emerg Med February 3, 2010Page DE, Taylor DMcD. Vapocoolant spray versus subcutaneous lidocaine injectionfor reducing the pain of intravenous cannulation: a randomized, controlled, clinicaltrial. Submitted to JAMA February 3, 2010

Xie C, Taylor DMcD, Howden BP, Charles PGP. Comparison of the bacterial isolatesand antibiotic resistance patterns of elderly nursing home and general communitypatients. Submitted to Clin Microbiol Infect February 2, 2010Wong A, Taylor DMcD, Ashby K, Robinson J. The changing epidemiology ofantidepressant drug overdose in Victoria, Australia.Submitted to Aust NZ J Psychiatry January 5, 2010Singh R, Taylor DMcD, D’Souza D, Gorelik A, Page P, Phal P. Mechanism of injuryand clinical variables associated with thoracic spine fracture.Revision submitted to Int J Emerg Med, November 25, 2009Bernard S, Smith K, Cameron P, Masci K, Taylor D, Cooper J, Kelly A-M. Inductionof therapeutic hypothermia by paramedics following resuscitation from out-ofhospitalventricular fibrillation cardiac arrest: A randomized, controlled trialRevision submitted to Circulation January 3, 2010

CONFERENCE/SEMINAR ORAL PRESENTATIONSSimon Judkins‘Emergency Care : 3-2-1. Improving Emergency Department Patient Flow at AustinHealth’ Redesigning Health Care Summit. September 2009Michael YeohNICS Evidence into Action workshop.Australasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009Simone Taylor‘Life in the Emergency Department - hardly ER, but never dull!’ New ZealandHospital Pharmacists' Association Conference, Nelson, NZ, Sept 2009.‘Some Emergency Medicine clinical vignettes.’ New Zealand Hospital Pharmacists'Association Conference, Nelson, NZ, Sept 2009.‘General practitioner referral letters - is the medication regimen accurate or not?’Australasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009‘Opioid tolerant patients: at risk for inadequate acute pain management.’ NICS ED Pain Initiative Wave 2 Workshop, June 2009 NICS Wave 1 Workshop, Dec 2009.‘Getting medications sorted in ED: what works and future directions’Improving medication safety in emergency departments - DoH Emergency CareClinical Network. Forum, 13 October 2009.‘Implementing the inpatient medication chart in ED at Austin Health: All singingfrom the same hymn book’Improving medication safety in emergency departments - DoH Emergency CareClinical Network. Forum, 13 October 2009.David Taylor‘Overcoming the frustrations and barriers in Emergency Medicine research’Australasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009‘Adverse events during procedural sedation in the Emergency Department’Australasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009‘Topical alkane vapocoolant versus subcutaneous lignocaine injection for reducing thepain of intravenous cannulation: a randomised, controlled, clinical trial’Australasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009‘Comparison of bacteria and antibiotic resistance of nursing home and communitypatients’. ACEM, Annual Scientific Meeting, Melbourne, November 2009

CONFERENCE/SEMINAR POSTER PRESENTATIONS‘General practitioner referral letters - is the medication regimen accurate or not?’Taylor S, Welch S, Harding A, Abbott L, Riyat B, Morrow M, Buchan D, Roth S. Austin Health Research Week Poster SHPA Medicines Management Conference, Perth, Nov 2009. Poster‘The use of acupuncture as an adjunct to conventional treatment in the emergencydepartment.’ Smit D, Taylor DMcD, Cameron PAAustralasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009‘The introduction of an acupuncture program in an Australian emergencydepartment.’ Smit D, Taylor DMcD, Cameron PAAustralasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009‘A comparison of four methods for detecting occult hypoperfusion in traumapatients.’ Thom O, Taylor DMcD, Wolfe REAustralasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009‘Failure to successfully complete a procedure following Emergency Departmentsedation.’ Taylor DMcD for the Emergency Department Sedation Study Investigators Australasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009 Austin Health Research Week, October 2009‘The effects of obesity on patient management in the emergency department.’Kam J, Taylor DMcD Australasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009 Austin Health Research Week, October 2009‘Pilot project of procedural sedation in the Emergency Department: Is patientsatisfaction adequate?’ Ghosh A, Taylor DMcD. Austin Health Research Week, October 2009 Australasian College for Emergency Medicine, Autumn Symposium, GoldCoast, QLD. April 2009Topical alkane vapocoolant versus subcutaneous lignocaine injection for reducing thepain of intravenous cannulation: a randomised, controlled, clinical trialPage D, Taylor DMcD Austin Health Research Week, October 2009Comparison of bacteria and antibiotic resistance of nursing home and communitypatientsXie C, Taylor DMcD, Howden BP, Charles PGP Austin Health Research Week, October 2009

Emergency Department Abdominal Radiographs: Utility in the EmergencyDepartment.Jackson K, Taylor DMcD, Judkins S Austin Health Research Week, October 2009Adverse events during procedural sedation in the Emergency DepartmentTaylor DMcD, Bell A, Holdgate A, MacBean C, Huynh T, Thom O, Augello M,Millar R, Day R, Williams A, Ritchie P, Pasco J Austin Health Research Week, October 2009The changing epidemiology of intentional antidepressant overdose in Victoria,Australia.Wong A, Taylor DMcD, Ashby K, Robinson J. Austin Health Research Week, October 2009‘Evaluation of the primary contact physiotherapy service in the emergencydepartment.’ Crane J, DiNatale D, Taylor DMcD, Judkins S Austin Health Research Week, October 2009 Australasian College for Emergency Medicine, Annual Scientific Meeting,Melbourne, November 2009PRIZESEsther Chan2009 DBL Young Pharmacists AwardAwarded by the Society of Hospital Pharmacists of AustraliaThis prize supported 4 weeks or work experience in an emergency department inTuscon, Arizona and a conference in the US.David Taylor & Jo RichardsonThe John Gilroy Potts Award 2009Awarded for the most significant publication by a Fellow of the Australasian Collegefor Emergency Medicine:Hijazi R, Taylor DMcD, Richardson J. ‘Topical alkane vapocoolant spray reducesintravenous cannulation pain in emergency department patients: a randomised,double-blind, placebo-controlled trial.’ Br Med J 2009; 338: b215David TaylorBest Paper by a Fellow of the Australasian College for Emergency MedicineACEM Annual Scientific Meeting (Melbourne. Nov 2009)Paper entitled: ‘Adverse events during procedural sedation in the EmergencyDepartment’

RESEARCH FUNDING‘Droperidol and olanzapine as adjuncts to midazolam for the acutely agitated patient:a randomised clinical trial’$182,775 NHMRC (Project Grant 628501). November, 2009‘A randomised controlled trial of non-invasive cardiac output monitoring in criticallyill Emergency Department patients.’$300,000 grant from the Queensland Emergency Medicine Research Foundation(QEMRF-PROJ-2009-018-GRANT). September, 2009‘Investigating the current capabilities of the Victorian healthcare system to cope withpandemic outbreaks: A pilot study at the Austin Hospital emergency department’$14,980 grant from the Royal Melbourne Institute of Technology College of Business.July 2009‘Lateral versus anterior chest thrusts in the generation of airway pressure inanaesthetised dogs.’$10,000 grant from the Australian Resuscitation Council. May, 2009Best Paper by a Fellow of the Australasian College for Emergency Medicine (ACEM)ACEM Annual Scientific Meeting (Melbourne, Nov 2009). Paper entitled:‘Adverse events during procedural sedation in the Emergency Department’$1,000 prize, November 2009The John Gilroy Potts Award 2009 for the best publication by a Fellow of the College$1,550 from the Australasian College for Emergency Medicine. November, 2009

ONGOING RESEARCH PROJECTS‘IV droperidol and olanzapine as adjuncts to midazolam for the acutely agitatedpatient in the emergence department: a multi-centre, randomized, double blindcontrolled trial.’Chan E, Taylor DMcD, Knott J, Georgina Phillips, Kong D, Castle D‘Nature and outcomes of chemical eye injuries reported to the Victorian PoisonsInformation Centre’Sher L, Taylor DMcD, Robinson J, Browning J, Colbridge M, MacLeod D,McCracken H, McKenzie C‘Fascia iliaca block versus femoral nerve block for femoral neck fractures in theEmergency Department: a randomized, clinical trial.’Visser P, Greene S, Taylor DMcD, Lee V, Martin C, Bolch S.‘The use and toxicity of Complementary and Alternative Medicines amongEmergency Department patients taking warfarin’Khan M, Taylor DMcD, Taylor SE, Harding A, Chae J, Jao K.‘Evaluation of Nurse-initiated Pain Management for adults in the EmergencyDepartment’Jao K, Taylor DMcD, Taylor SEEvaluation of Nurse-initiated Pain Management for paediatrics in the EmergencyDepartment’Jao K, Taylor DMcD, Taylor SE‘Management of acute agitation in the Emergency Department: A national survey ofpractice.’Chan E, Taylor DMcD, Kong D, Knott J.‘Tropisetron versus metoclopramide for nausea and vomiting in the emergencydepartment: a randomised, double blinded, clinical trial’Chae J, Taylor DMcD, Frauman A‘Communication regarding the reasons for Emergency Department waiting times’Taylor DMcD, Kerr F, Jao K, Chae J, Khan M‘Investigating the current capabilities of the Victorian healthcare system to cope withpandemic outbreaks: A pilot study at the Austin Hospital’Cheong F, Cheong C, Corbitt B, Taylor DMcD, Judkins S, Johnson P.‘The resource implications of vital signs monitoring in the Emergency Department’Ferma M, Taylor D, Cochrane C, Petre I, Yeoh M‘National Institute of Clinical Studies - Pain Management Initiative’ (to address arange of pain management issues in Emergency Departments)Richardson J, Yeoh M

‘Call-back study investigating paediatric dog bite injury cases that occurred in thedomestic setting’Ashby K, Cassell E, Taylor DMcD‘Evaluation of the Primary Contact Physiotherapy Service in the EmergencyDepartment’DiNatale D, Crane J, Taylor D, Judkins S‘Emergency Department procedural sedation practices and factors associated withadverse events’Taylor D for the ED sedation study investigators (a national collaborative)‘Utility of abdominal Xrays among emergency department patients’Sullivan K, Taylor DMcD, Judkins S.‘The epidemiology of absenteeism among public hospital staff’Rugless M, Taylor DMcD.‘Evaluation of ED medical, nursing and allied health staff attitudes towards the use ofcomplementary medicines’Taylor SE, Welch S, Barbour L, Ainsworth J.‘Patient transfer from hospital to Aged Care facilities: Common medication problemsand possible solutions.’Taylor SE, Chu M, Tanner FCURRENT COLLABORATIONS WITH EXTERNAL INSTITUTIONSUniversity of MelbourneMonash UniversityLa Trobe UniversityRMIT UniversityDiver Alert Network (Asia-Pacific)Royal Melbourne HospitalSt Vincent’s HospitalBox Hill HospitalAlfred HospitalCasey HospitalThe Northern HospitalEpworth HospitalLiverpool Hospital (NSW)Royal Brisbane and Women’s Hospital (QLD)Redcliffe Hospital (QLD)Prince Charles Hospital (QLD)