Queensland Ambulance Service Research Articles

Understanding emergency department frequent attenders.

Emergency Medicine AustralasiaVolume 33, Issue 3 p. 559-561 Trainee Focus Understanding emergency department frequent attenders Claire Bertenshaw, Corresponding Author Claire Bertenshaw claire.bertenshaw@ambulance.qld.gov.au High Acuity Response Unit, Queensland Ambulance Service, Brisbane, Queensland, Australia Correspondence: Dr Claire Bertenshaw, High Acuity Response Unit, Queensland Ambulance Service, 125 Kedron Park Road, Kedron, QLD 4031, Australia. Email: claire.bertenshaw@ambulance.qld.gov.auSearch for more papers by this authorRoxanne Dubash, Roxanne Dubash Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorJennifer Kozlovski, Jennifer Kozlovski Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, AustraliaSearch for more papers by this authorEmma Carlin, Emma Carlin Emergency Department, Wellington Regional Hospital, Wellington, New ZealandSearch for more papers by this authorLaksmi Govindasamy, Laksmi Govindasamy Emergency Department, Austin Health, Melbourne, Victoria, AustraliaSearch for more papers by this author Claire Bertenshaw, Corresponding Author Claire Bertenshaw claire.bertenshaw@ambulance.qld.gov.au High Acuity Response Unit, Queensland Ambulance Service, Brisbane, Queensland, Australia Correspondence: Dr Claire Bertenshaw, High Acuity Response Unit, Queensland Ambulance Service, 125 Kedron Park Road, Kedron, QLD 4031, Australia. Email: claire.bertenshaw@ambulance.qld.gov.auSearch for more papers by this authorRoxanne Dubash, Roxanne Dubash Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, AustraliaSearch for more papers by this authorJennifer Kozlovski, Jennifer Kozlovski Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, AustraliaSearch for more papers by this authorEmma Carlin, Emma Carlin Emergency Department, Wellington Regional Hospital, Wellington, New ZealandSearch for more papers by this authorLaksmi Govindasamy, Laksmi Govindasamy Emergency Department, Austin Health, Melbourne, Victoria, AustraliaSearch for more papers by this author First published: 22 April 2021 https://doi.org/10.1111/1742-6723.13784 Claire Bertenshaw, BN, MNurs (Critical Care), MBBS (Hons), Emergency Advanced Trainee; Roxanne Dubash, BMed, Emergency Advanced Trainee; Jennifer Kozlovski, BSc (Hons), MBBS (Hons), Emergency Advanced Trainee; Emma Carlin, MBBCh BAO, BA, Emergency Advanced Trainee; Laksmi Govindasamy, BMed, BA, MD, MPH, MIPH, DCH, DRANZCOG, Emergency Advanced Trainee. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume33, Issue3June 2021Pages 559-561 RelatedInformation

Exploring paramedics’ intention to use a specialist palliative care telehealth service

A large proportion of expected deaths do not occur at home, despite often being the dying person’s preference. Paramedics play an integral role in hospital admissions when someone is close to death. As illness worsens, paramedics are often called and ascertain whether hospitalisation is appropriate. In a 12-month period, Ambulance Victoria (Australia) recorded 4348 palliative related callouts, 70% resulting in hospitalisation. Paramedics throughout the world recognise the need for extra palliative care training or support. One solution is a specialist palliative care support telehealth service from palliative specialists (usually in tertiary hospitals) to paramedics on call-outs to people with life-limiting illnesses. However, to maximise uptake and sustainability, it is prudent to examine factors that influence acceptance of such a service. In the current study, 112 paramedics employed by the Queensland Ambulance Service completed an online survey examining their Intention to Use the Specialist Palliative Care telehealth service as a function of the Technology Acceptance Model constructs (Perceived Usefulness, Perceived Ease of Use and Attitudes toward technology) and Palliative Care Self-Efficacy. After controlling for age, a hierarchical multiple regression analysis demonstrated the predictive utility of Perceived Usefulness and Attitudes. Palliative Care Self-efficacy did not add any significant variance to the model. This research highlights the importance of addressing paramedics’ perceptions regarding the telehealth service and its usefulness when implementing a similar service model.

Assessing need for extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest using Power BI for data visualisation.

To estimate the number of patients in refractory out-of-hospital cardiac arrest (OHCA) potentially suitable for transport to an extracorporeal cardiopulmonary resuscitation (ECPR)-capable hospital in Brisbane, Queensland, Australia, based on outcome predictors for ECPR, ambulance geolocation and patient data. A retrospective cohort study was performed using data from all patients in OHCA attended by Queensland Ambulance Service between 1 January 2014 and 31 December 2018. The number of refractory arrest patients who could potentially be transferred to an ECPR-capable centre within 45 min of the time of arrest was modelled using theoretical on-scene treatment times. Of 25 518 ambulance-attended OHCA in Queensland during the study period, 540 (2%) patients met criteria of refractory arrest for study inclusion. Further age and arrest rhythm criteria for transport to an ECPR-capable hospital were met in 253 (47%) study patients, an average of 51 patients per year. In 2018, 72 patients met study criteria for transport to an ECPR-capable centre. Based on theoretical on-scene treatment times of 12 and 20 min, in 2018 only 14 (19%) and 11 (15%) patients respectively would potentially arrive at an ECPR-capable hospital within accepted timeframes for ECPR. Retrospective data collected from existing ambulance databases can be used to model patient suitability for ECPR. Relatively few patients with refractory OHCA in Queensland, Australia, could be attended and transported to an ECPR-capable centre within clinically acceptable timeframes. Further studies of the transport logistics and economic implications of providing ECPR services for OHCA are required to better inform decisions around this intervention.

Long-term outcomes of adult out-of-hospital cardiac arrest in Queensland, Australia (2002–2014): incidence and temporal trends

ObjectiveTo describe annual incidence and temporal trends (2002–2014) in incidence of long-term outcomes of adult out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology attended by Queensland Ambulance Service (QAS) paramedics,...

Incidence, bystander emergency response management and outcomes of out-of-hospital cardiac arrest at exercise and sport facilities in Australia.

Despite growing emphasis on automated external defibrillators (AEDs) at sport venues in Australia, the risk of cardiac events at such locations is unknown. The aim of the present study was to investigate the incidence of out-of-hospital cardiac arrest (OHCA) at exercise and sport facilities (ESF) in Australia and the impact of effective bystander-initiated CPR and AED use on return of spontaneous circulation (ROSC) to hospital admission. Data were obtained from the Queensland Ambulance Service for the 8-year period between January 2007 and January 2015. Data were analysed using descriptive statistics, non-parametric correlational tests and logistic regression. The OHCA incidence rate (IR) for ESF categories was standardised for 100 000 participant-years. Over the 8-year period, there were 250 OHCA events with a median age of 62 years (interquartile range 49-69) comprising mostly males (86.6%, n = 187). The risk of OHCA for 100 000 participants per year was highest at outdoor sports facilities (IR 5.1) followed by indoor sports or fitness facilities (IR 0.8). On arrival of paramedics, bystander-initiated CPR and AED was present at 12.4% (n = 31) of the cases achieving 33.3% (n = 9) ROSC to hospital admission. The odds of ROSC for effective CPR was 2.3 times the odds of ROSC for no CPR (P = 0.01). These findings have implications for policy development by government agencies and major sport and exercise organisations to improve bystander CPR and AED. This can help to ensure that ESF can properly respond to cardiac emergencies to save lives.

Epidemiology of Oxytocin Administration in Out-of-Hospital Births Attended by Paramedics

Aim Primary postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that can be mitigated through the administration of a uterotonic to actively manage the third stage of labor. This study describes the prehospital administration of oxytocin by paramedics following attendance of out-of-hospital (OOH) births. Methods A retrospective analysis was undertaken of all OOH births between the 1st January 2018 and 31st December 2018 attended by the Queensland Ambulance Service. The demographic and epidemiological characteristics of patients that were administered oxytocin and the occurrence of adverse side effects were described. Results In total, 350 OOH births were included in this study with the majority involving multigravidas women (94.3%) and all but two involving singleton pregnancies. Oxytocin was administered following 222 births (63.4%), while 67 patients (19.1%) declined administration preferring a physiological third stage of labor, and in 61 cases (17.4%) oxytocin was withheld by the attending paramedic. There were no documented adverse events or side effects following administration. Oxytocin administration occurred on average 14 minutes (interquartile range 9-25) following the time of birth. The median time from oxytocin administration to placenta delivery was 10 minutes (interquartile range 5-22). Conclusion Oxytocin is well accepted and safe treatment adjunct for the management of the third stage of labor in OOH births and should be considered for routine practice by other emergency medical services.

Prehospital study of survival outcomes from out-of-hospital cardiac arrest in ST-elevation myocardial infarction in Queensland, Australia (the PRAISE study).

Patients that experience an out-of-hospital cardiac arrest in the context of a paramedic-identified ST-segment elevation myocardial infarction are a unique cohort. This study identifies the survival outcomes and determinants of survival in these patients. A retrospective analysis was undertaken of all patients, attended between 1 January 2013 and 31 December 2017 by the Queensland Ambulance Service, who had a ST-segment elevation myocardial infarction identified by the attending paramedic prior to deterioration into out-of-hospital cardiac arrest. We described the 'survived event' and 'survived to discharge' outcomes of patients and performed univariate analysis and multivariate logistic regression to identify factors associated with survival. In total, 287 patients were included. Overall, high rates of survival were reported, with 77% of patients surviving the initial out-of-hospital cardiac arrest event and 75% surviving to discharge. Predictors of event survival were the presence of an initial shockable rhythm (adjusted odds ratio 8.60, 95% confidence interval (CI) 4.16-17.76; P < 0.001) and the administration of prehospital medication for subsequent primary percutaneous coronary intervention (adjusted odds ratio 2.54, 95% CI 1.17-5.50; P = 0.020). These factors were also found to be associated with survival to hospital discharge, increasing the odds of survival by 13.74 (95% CI 6.02-31.32; P < 0.001) and 6.96 (95% CI 2.50-19.41; P < 0.001) times, respectively. The administration of prehospital fibrinolytic medication was also associated with survival in a subgroup analysis. This subset of out-of-hospital cardiac arrest patients was found to be highly salvageable and responsive to resuscitative measures, having arrested in the presence of paramedics and presented with an identified reversible cause.

Insights into the epidemiology of cardiopulmonary resuscitation-induced consciousness in out-of-hospital cardiac arrest.

To describe the characteristics and outcomes of cardiopulmonary resuscitation (CPR)-induced consciousness patients from a large database of out-of-hospital cardiac arrest (OHCA). Included were adult patients, attended between January 2007 and December 2018 by the Queensland Ambulance Service, where resuscitation was attempted by paramedics. Manual review of records was undertaken to identify CPR-induced consciousness cases. Patients exhibiting purposeful limb/body movement during CPR, with or without displaying other signs, were considered to be CPR-induced consciousness. Characteristics and outcomes of CPR-induced consciousness patients were compared to those without CPR-induced consciousness. A total of 23 011 OHCA patients were included; of these, 52 (0.23%) were CPR-induced consciousness. This translates into an incidence rate of 2.3 cases per 1000 adult resuscitation attempts over 12 years. Combativeness/agitation was the most common sign of CPR-induced consciousness, described in 34.6% (18/52) of patients. CPR-induced consciousness patients had numerically higher rates of return of spontaneous circulation on hospital arrival (51.9% vs 28.6%), discharge survival (46.2% vs 15.1%) and 30-day survival (46.2% vs 14.7%), than those without CPR-induced consciousness; however, CPR-induced consciousness was not found to be an independent predictor of survival. Higher proportions of CPR-induced consciousness patients had arrest witnessed by paramedics, occurring in public places, of cardiac aetiology and initial shockable rhythm, than patients without CPR-induced consciousness. CPR-induced consciousness in OHCA appears to be associated with higher survival rates. Standardised guidelines on recognition and management of CPR-induced consciousness remain to be established.

Surviving out-of-hospital cardiac arrest: The important role of bystander interventions

BackgroundSubstantial variations exist in relation to the characteristics and outcomes of out-of-hospital cardiac arrest (OHCA). As such, an understanding of region-specific factors is essential for informing strategies to improve OHCA survival. MethodsAnalysis of a large state-wide OHCA database of the Queensland Ambulance Service, Australia. Adult patients, attended by paramedics between January 2000 and December 2018 for OHCA of medical origin, where the arrest was not witnessed by paramedics, and resuscitation was attempted, were included. Factors associated with survival were investigated. The number needed to treat (NNT) for bystander interventions was estimated. ResultsAcross a total of 23,510 patients, event survival, survival to discharge and 30-day survival was 22.6%, 11.9% and 11.5%, respectively. The corresponding figures for the Utstein patient group (initial shockable rhythm, bystander-witnessed) were 38.9%, 27.2% and 26.3%, respectively. Bystander cardiopulmonary resuscitation (CPR) and defibrillation substantially improved the likelihood of survival. The NNT for bystander CPR was 41, 63 and 64 for event survival, survival to discharge, and 30-day survival, respectively. The NNT for bystander defibrillation for these survival outcomes was 10, 14 and 14, respectively. ConclusionsBystander interventions are critical for OHCA survival. Effort should be invested in strategies to improve the uptake of these interventions.

Investigating Career Intentions of Undergraduate Paramedic Students Studying in Queensland, Australia

Introduction This study explores the career intentions of undergraduate university paramedic students. Other like studies have been completed before paramedicine registration, and this is the first career intentions study to focus on the Queensland perspective. Methods Second year Queensland University of Technology (QUT) undergraduate paramedic students (n=182) were invited to participate. Ethics approval was gained and consent to participate was implied by the completion of a mixed methods questionnaire developed from the extant literature. Data were coded and analysed using Stata 15.1 and NVIVO 12. Results The response rate was 47.3% (n=86). Findings indicated 82.35% of participants intend to pursue paramedic employment after graduating. Queensland Ambulance Service is the preferred choice of employer (78.05%), however 67.07% intended to apply to multiple services for employment, 62.2% are considering private industry employment and 59.76% are contemplating overseas work. Intended paramedicine career length revealed 39.5% of participants plan to work for 20 years or more, 29% for 6–10 years and 18.4% for 11–15 years. Qualitative findings suggest students are concerned about employment opportunities, dislocation from support networks, and feeling unprepared to work in other paramedic jurisdictions. Furthermore, the employer's reputation, culture, internship program and career development opportunities impact on employment decisions. Conclusion The paramedic landscape in Australia appears to be changing. Although the majority of participants intend to work for jurisdictional ambulance services, students are exploring a range of employment opportunities. Understanding the career intentions of undergraduate paramedic students is essential for universities when preparing students for the transition to a globally evolving profession.

Prehospital ST-Segment Elevation Myocardial Infarction (STEMI) in Queensland, Australia: Findings from 11 Years of the Statewide Prehospital Reperfusion Strategy

Background: Field identification and treatment of ST-segment elevation myocardial infarction (STEMI) by paramedics is an important component of the continuum of care for these patients. This study described real-world clinical practice in prehospital management of STEMI patients in Queensland, Australia. Methods: Retrospective analysis of data sourced from the STEMI database of the Queensland Ambulance Service, Australia. Adult STEMI patients identified by paramedics between February 2008 and December 2018 in Queensland were included. Key aspects of prehospital STEMI care were described. Clinically-important time intervals from symptom onset to reperfusion were reported. Results: A total of 8,388 patients were included. The proportion of patients receiving prehospital reperfusion treatment has improved markedly, increasing from 34% in 2008 to 65% in 2018 (p < 0.001). Direct referral of patients to a hospital for primary percutaneous coronary intervention (pPCI), and administration of preparatory antiplatelet and anticoagulant medications, was the main reperfusion treatment pathway, accounting for 75% of patients receiving reperfusion treatment. Time from paramedic arrival at scene to first 12-lead electrocardiogram has significantly reduced, from 11 minutes in 2008 to 6 minutes from 2012 onwards (p < 0.001). Median (interquartile range, IQR) time from prehospital STEMI identification to reperfusion was 88 (74–103) minutes for patients referred by paramedics to a hospital for pPCI. Fifty-five percent of patients who underwent pPCI achieved time from STEMI identification to reperfusion within 90 minutes. For patients receiving prehospital fibrinolysis, median (IQR) time from STEMI identification to administration of a fibrinolytic agent was 21 (12–33) minutes. Conclusion: The implementation of a statewide prehospital reperfusion strategy has markedly improved the rate of prehospital reperfusion treatment and key time metrics. Ongoing quality improvement efforts are required to further reduce delays in reperfusion.

Epidemiology of pre-hospital outcomes of out-of-hospital cardiac arrest in Queensland, Australia.

To describe incidence in pre-hospital outcomes of adult out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology, attended by Queensland Ambulance Service (QAS) paramedics between 2002 and 2014, by age, gender, geographical remoteness and socio-economic status. The QAS OHCA Registry was used to identify cases, which was then linked with Queensland Hospital Admitted Patient Data Collection and Queensland Death Registry. Population data were obtained for each calendar year by age and gender from the Australian Bureau of Statistics in order to calculate incidence rates. Four mutually exclusive pre-hospital outcomes were analysed: (i) no resuscitation (No-Resus); (ii) resuscitation, no pre-hospital return of spontaneous circulation (No-ROSC); (iii) resuscitation, pre-hospital return of spontaneous circulation not sustained to hospital (Unsustained-ROSC); and (iv) resuscitation, pre-hospital return of spontaneous circulation sustained to hospital (Sustained-ROSC). Over the 13 years, there were 30 560 OHCA cases for analyses. Incidence was significantly greater in males than females and incrementally increased with age, for each outcome. Incidence of total OHCA events generally increased as remoteness increased (major cities: 72.39 per 100 000 [95% CI 71.35-73.45]; very remote: 87.01 per 100 000 [95% CI 78.03-95.98]). There was an inverse association between incidence of OHCA events and socio-economic status (SEIFA 1 and 2: 81.34 per 100 000 [95% CI 79.28-83.40]; SEIFA 9 and 10: 61.57 per 100 000 [95% CI 59.67-63.46]). Rural-specific strategies should be continued. Prevention and management strategies for OHCA targeting lower socio-economic groups require focus.

Pre-hospital outcomes of adult out-of-hospital cardiac arrest of presumed cardiac aetiology in Queensland, Australia (2002-2014): Trends over time.

To describe temporal trends in incidence of pre-hospital outcomes from adult out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology attended by Queensland Ambulance Service (QAS) paramedics between 2002 and 2014, by age, gender, geographical remoteness and socio-economic status. Cases included in this retrospective cohort study were identified from the QAS OHCA Registry. Included cases were linked with Queensland Hospital Admitted Patient Data Collection and Queensland Death Registry. Population data were obtained from the Australian Bureau of Statistics to calculate incidence rates for each year. Analyses were undertaken by four mutually exclusive pre-hospital outcomes: (i) no resuscitation (No-Resus); (ii) resuscitation, no pre-hospital return of spontaneous circulation (No-ROSC); (iii) resuscitation, pre-hospital return of spontaneous circulation not sustained to hospital (Unsustained-ROSC); and (iv) resuscitation, pre-hospital return of spontaneous circulation sustained to hospital (Sustained-ROSC). Trends over time were analysed for crude and specific rates for total OHCA events and for each outcome. Between 2002 and 2014, there were 30 560 OHCA cases. Crude incidence significantly increased over time for No-Resus and Sustained-ROSC, and significantly decreased for No-ROSC. These trends were reflected in major cities, inner and outer regional areas. There was a significant increase in Sustained-ROSC in remote areas, and no significant trends in very remote areas. Incidence of withholding resuscitation and ROSC sustained to hospital have independently increased over time. Factors of middle age, more rural location and lower socio-economic status should all be targeted in the development and implementation of future strategies.

An Evaluation of the Self-Reported Knowledge Base of Disaster Management Core Competencies of Australian Paramedics

Introduction:Evidence-based training and curriculum are seen as vital in order to be successful in preparing paramedics for an effective disaster response. The creation of broadly recognized standard core competencies to support the development of disaster response education and training courses for general health care providers and specific health care professionals will help to ensure that medical personnel are truly prepared to care for victims of mass casualty events.Aim:To identify current Australian operational paramedic’s specific disaster management education and knowledge as it relates to disaster management core competencies identified throughout the literature and the frequency of measures/techniques which these paramedics use to maintain competency and currency.Methods:Paramedics from all states of Australia were invited to complete an anonymous online survey. Two professional bodies distributed the survey via social media and a major ambulance service was surveyed via email.Results:The study population includes 130 respondents who self-identified as a currently practicing Australian paramedic. Paramedics from all states except South Australia responded, with the majority coming from Queensland Ambulance Service (N= 81%). In terms of experience, 81.54% of respondents report being qualified for greater than 5 years. Initial analysis shows that despite the extensive experience of the practitioners surveyed when asked to rate from high to low their level of knowledge of specific disaster management core competencies a number of gaps exist.Discussion:Core competencies are a defined level of expertise that is essential or fundamental to a particular job, and serve to form the foundation of education, training, and practice for operational service delivery. While more research is needed, these results may help inform industry, government, and education providers to better understand and to more efficiently provide education and ongoing training to paramedics who are responsible for the management of disaster within the Australian community.

Getting There: Evidence-Based Decision-Making in Road Trauma Prehospital Transport and Care in Queensland

Introduction:Process mining, a branch of data science, aims at deriving an understanding of process behaviors from data collected during executions of the process. In this study, we apply process mining techniques to examine retrieval and transport of road trauma patients in Queensland. Specifically, we use multiple datasets collected from ground and air ambulance, emergency department, and hospital admissions to investigate the various patient pathways and transport modalities from accident to definitive care.Aim:The project aims to answer the question, “Are we providing the right level of care to patients?” We focus on (i) automatically discovering, from historical records, the different care and transport processes, and (ii) identifying and quantifying factors influencing deviance from standard processes, e.g. mechanisms of injury and geospatial (crash and trauma facility) considerations.Methods:We adapted the Cross-Industry Standard Process for Data Mining methodology to Queensland Ambulance Service, Retrieval Services Queensland (aero-medical), and Queensland Health (emergency department and hospital admissions) data. Data linkage and “case” definition emerged as particular challenges. We developed detailed data models, conduct a data quality assessment, and preliminary process mining analyses.Results:Preliminary results only with full results are presented at the conference. A collection of process models, which revealed multiple transport pathways, were automatically discovered from pilot data. Conformance checking showed some variations from expected processing. Systematic analysis of data quality allowed us to distinguish between systemic and occasional quality issues, and anticipate and explain certain observable features in process mining analyses. Results will be validated with domain experts to ensure insights are accurate and actionable.Discussion:Preliminary analysis unearthed challenging data quality issues that impact the use of historical retrieval data for secondary analysis. The automatically discovered process models will facilitate comparison of actual behavior with existing guidelines.

Leveraging Data Quality to Better Prepare for Process Mining: An Approach Illustrated Through Analysing Road Trauma Pre-Hospital Retrieval and Transport Processes in Queensland.

While noting the importance of data quality, existing process mining methodologies (i) do not provide details on how to assess the quality of event data (ii) do not consider how the identification of data quality issues can be exploited in the planning, data extraction and log building phases of any process mining analysis, (iii) do not highlight potential impacts of poor quality data on different types of process analyses. As our key contribution, we develop a process-centric, data quality-driven approach to preparing for a process mining analysis which can be applied to any existing process mining methodology. Our approach, adapted from elements of the well known CRISP-DM data mining methodology, includes conceptual data modeling, quality assessment at both attribute and event level, and trial discovery and conformance to develop understanding of system processes and data properties to inform data extraction. We illustrate our approach in a case study involving the Queensland Ambulance Service (QAS) and Retrieval Services Queensland (RSQ). We describe the detailed preparation for a process mining analysis of retrieval and transport processes (ground and aero-medical) for road-trauma patients in Queensland. Sample datasets obtained from QAS and RSQ are utilised to show how quality metrics, data models and exploratory process mining analyses can be used to (i) identify data quality issues, (ii) anticipate and explain certain observable features in process mining analyses, (iii) distinguish between systemic and occasional quality issues, and (iv) reason about the mechanisms by which identified quality issues may have arisen in the event log. We contend that this knowledge can be used to guide the data extraction and pre-processing stages of a process mining case study to properly align the data with the case study research questions.

Collaborative, Innovative Quality Improvement Activity: Development of Queensland Ambulance Service Stickers: Drivers, Approaches, Implementation, and Outcomes.

This article discusses the implementation of 3 targeted interventions aimed at reducing infection rates in patients due to prolonged in situ intravascular catheters (IVCs) during their admission to the hospital. These IVCs are inserted by paramedics with Queensland Ambulance Service (QAS) in prehospital settings. The 3 interventions involved were the application of "QAS-IVC" stickers by QAS paramedics to indicate QAS-inserted IVCs, the implementation of mandatory IVC documentation during patient handover, and clinician engagement to provide patient education on IVC infection signs. Audits undertaken in wards reflected that the interventions were apparent and beneficial; this is evident from the limited number of patients having in-dwelling QAS-IVC and increased awareness among medical staff and patients alike. We, however, did not have comparative data to objectively quantify the success of the interventions implemented.

The Use of Magnesium Sulphate and Morphine Vs. Morphine-Only in Irukandji Syndrome: A Retrospective Review of Ambulance Data

Introduction In 2006, the Queensland Ambulance Service (QAS) approved the use of magnesium sulphate for the management of patients with Irukandji syndrome (IS). The aim of this study was to compare pain scores and hypertensive (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg) patients who received intravenous morphine as their treatment (morphine group) over those who received a combination of intravenous morphine and magnesium (magnesium group). Methods A retrospective case review of all IS patients attended by the QAS between 2007 and 2014. A search of the QAS electronic data base found 112 patients had IS. Analyses in IBM SPSS v.22 was undertaken to determine the outcome in final pain scores and blood pressure between the two groups. Results Pain reduction was statistically different (F=29.18; p&lt;.01), between the morphine group and the magnesium group with mean numerical pain scores post-treatment of 4.91 (95% CI: 4.02–5.81) and 2.21 (95% CI: 1.66–2.76) respectively. There was a lower frequency of patients in the magnesium group who remained hypertensive on arrival at a medical facility, with a significant difference between mean arterial BP of 101 mmHg (95% CI: 96–105; p=.028) and diastolic BP of 84 mmHg (95% CI: 80–88; p=.029) post-treatment. Of the 54 cases in the magnesium group, 32 were normotensive post-treatment compared to only six from the morphine group (n=17). Conclusion There has been considerable difference of opinion as to the utility of magnesium in IS and a marked difference in the results of case series versus a small randomised control trial. This study suggests that the combination of morphine and magnesium is more effective in treating patients with IS than morphine alone.

Impact of an emergency department-run clinical decision unit on access block, ambulance ramping and National Emergency Access Target.

ED access block is an ongoing significant problem and has been associated with excess mortality. Multiple models of care have been studied in an effort to improve access block and other key performance indicators (KPIs) of ED. This present study describes the impact of a new model of care using an ED led, consultant run clinical decision unit (CDU) on performance, using a retrospective analysis of data for 9 month periods before and after the introduction of the CDU model of care. Primary outcomes were access block (percentage of patients admitted >8 h), discharge National Emergency Access Target (NEAT) adherence and Queensland Ambulance Service level three escalations. After the implementation of the CDU, access block significantly improved. There was a significant improvement in NEAT adherence. Total ambulance ramping time fell by 58% and ambulance service level three escalations fell from 21 to 5 post-CDU implementation. Overall there was no change to hospital mortality numbers. The percentage of patients that did not wait and 30 day representations showed a small but statistically significant decrease. In summary, this ED led, consultant run CDU model of care resulted in significantly improved performance on a range of KPIs, including improvement in access block and NEAT figures. The substantial improvements in ambulance ramping and escalations also indicated that the department was able to cope better with periods of high activity.

Caring Together 2 Breathe Easy: an integrated care trial to reduce readmission and improve the health care experience for people with COPD

Introduction: As evidenced in “Perils of Place – Identifying hotspots of health inequality” (Duckett, 2016), Caboolture (Queensland) was highlighted as having a 10 year history of higher than average readmission rates for patients with Chronic Obstructive Pulmonary Disease (COPD). A new Integrated Pathway of Care is being trialled for COPD patients (n=30). Key collaborators include: the Caboolture Hospital Emergency Department and Respiratory Service; GP practices, Queensland Ambulance Service and key community services. The model of care, known as Caring Together 2 Breathe Easy was developed in collaboration with Canterbury Health in New Zealand. This model employs a patient focus to improve QoL by implementing COPD Action Plans and ensuring that the patient, their GP, Ambulance and the Emergency Department utilise this plan, including alternatives for acute care. A “Breathe Easy” team: GPLO, Clinical Nurse; Physiotherapist and Psychologist, work with the participants to implement action and intervention plans. Participants are provided with a pack which includes their COPD action plan, contact plan and educational materials. Aims and Measures: Reduced ED presentations and re-admission rate within 28 days Improved QoL measured by COPD Assessment Tool (CAT) and meeting individual goals Identification of secondary anxiety and depression (K-10) and linkage to supports Improved GOLD Score Increased access and connection to health and community services Developing integrated pathways with health and community services. Targeted Population and Stakeholders: Patients with a diagnosis of COPD and a history of re-presentations and/or re-admissions to the Caboolture Hospital within 28 day within the past two years (N=30) Participants reside in the Caboolture community which has recognised unmet health needs and high levels of socioeconomic disadvantage (Source: The Social Health of Australia: Data by population area, Population Health Information Data Unit 2016) Timeline 2017: Feb: Cohort selected March- April: Recruitment, Assessments May-Jun: Action Plans July-October: Interventions Nov-Dec: Evaluation Highlights: COPD Action Plans developed for all patients; High levels of consumer engagement with Breathe Easy Team and Project; Interventions commenced; Improved engagement and co-operation across secondary hospital, primary care, ambulance and community agencies. Sustainability: The intention is to upscale and embed the “Breathe Easy” pathway trial at an organisational and local community level. Transferability: If successful, the “Breathe Easy” trial outcomes will contribute to models of integrated care that can be applied to a range of patient groups requiring integrated care. Conclusions: Caboolture Hospital “Breathe Easy” project is demonstrating high levels of engagement and support from consumers, health care providers and the community. The multi-level evaluation data will provide evidence and inform viability for up-scaling and consolidation as an alternative health care service model in Caboolture and more broadly in Metro North HHS.