ÐÇ¿ÕÌåÓý

The overarching aim of this study is to estimate the magnitude of the need for care at the end of life care in the emergency department, and to describe care delivery practices, processes and outcomes for older people who present to the emergency department requiring end of life care.
Australians aged 65 years and over account for 22% of emergency department presentations. Currently, this group makes up 15% of the population, but this predicted to rise to 20% by 2037.

There are two trajectories of end of life in the emergency department: ¡®unexpected¡¯ and ¡®expected¡¯ deaths. Unexpected deaths stem from acute illness or sudden, traumatic events. Expected deaths stem from deterioration of chronic illnesses.
When expected deaths occur in the emergency department, staff dissatisfaction and distress as well as frustration for patients and their families can result. In Singapore, around 50% of deaths in people aged ¡Ý 65 who died in one emergency department were considered ¡®expected¡¯. This highlights the need to understand if the situation is the same here in Australia and to what extent quality end of life care is provided for both trajectories of dying (i.e. expected and unexpected). Our study will identify the ¡®unexpected¡¯ and the ¡®expected¡¯ deaths among people aged ¡Ý 65 who die within 48 hours of emergency department presentation.

Bronchiolitis, a lower respiratory tract infection which causes inflammation of the small airways in infants, imposes the largest health care burden on hospital admissions worldwide, with up to 15 % of admissions to intensive care.

Nasal High Flow (NHF) therapy has emerged as a new method to support the breathing of these infants avoiding intensive care admission. We have shown in a previous large study that NHF therapy can be used in regional and metropolitan hospitals and reduces the need to transfer infants to a specialised children¡¯s hospital. This new project entails working with six of the regional Queensland hospitals from the previous study to explore the optimal way to translate the new knowledge into practice.

We will compare three sites provided with structured educational support to three sites with no additional educational support. We suspect that the centres receiving the additional support will retain the knowledge and skill level to maintain and sustain optimal improved outcomes and have better uptake and adherence to evidence based NHF therapy guidelines for admitted infants with bronchiolitis.

Children frequently present to the emergency department with forearm injuries and often have an x-ray to assess if there is a fracture. Bedside ultrasound is a test that emergency practitioners can use to rapidly diagnose a fracture at the time of examination, without exposing children to ionising radiation. This trial will assess whether an x-ray is unnecessary when there is either a buckle fracture or no fracture seen on a portable ultrasound machine. We will also determine the time and cost implications of this new approach, which could enable families to go home earlier and could be more cost-effective, with less x-rays being ordered.