Research projects

MERC researchers are clinicians, scientists and academics. They work on ground-breaking research while providing emergency care services across the Emergency Departments of Monash Health sites. Currently, the following research projects are being undertaken:

A diagnostic pathway for acute coronary syndrome using high sensitivity troponin I levels: impact on emergency department decision-making

Aim: to compare a range of patient safety and hospital efficiency outcomes between a proposed, trial CPP and the current Monash Health CPP (based on the Beckman Coulter Access AccuTnI+3 assay).

Investigator:  Dr Robert Meek

Clinical decision making of doctors and nurses in the prescription and administration of antipsychotics for older people with delirium

Aim: to understand clinical decision making of doctors and nurses in the prescription and administration of antipsychotics for older people with delirium

Co-investigator:  Dr Emily Tomlinson

Exploring Stress Resilience in Emergency Service Personnel

Aim: to explore whether physical activity can promote stress resilience for emergency department nurses

Investigator:  Ms Samantha Armstrong (Federation University)

Palliative Care Impact On Patient Outcomes and Health Resource Utilisation: A retrospective case controlled study

Aim: to understand Palliative Care Impact On Patient Outcomes and Health Resource Utilisation.

Investigator:  A/Prof Peter Poon

Behavioural Disturbance in Elderly Patients in the Emergency Department

Aim: to assess and describe prevalence of the behavioural disturbance symptoms amongst elderly patients presenting to Emergency Departments.

Investigators:  Dr Gabriel Blecher, Dr Chhavi R. Bhatt, A/Prof Lisa Kuhn

Utility of lumbar puncture in Emergency department

Aim: to retrospectively analyse a cohort of patients presenting with headaches concerning for SAH, over a period of 5 years (2013-2018) whom underwent a non-contrast CTB +/- LP

Investigator:  Dr Pourya Pouryahya

Hypertension in children presenting to a tertiary care paediatric emergency department

Aim: to understand hypertension in children presenting to a tertiary care paediatric emergency department

Investigator: Dr Sheena Kaul

Headache in Emergency Departments (The HEAD Study)

Aim: to describe the epidemiology of non-trauma related headache in adults presenting to emergency departments including investigations, treatments and outcome

Investigators: Dr Neil Goldie; Prof Andis Graudins

Clinical decision making of doctors and nurses in the prescription and administration of antipsychotics for older people with delirium

Aim: to describe the epidemiology of non-trauma related headache in adults presenting to emergency departments including investigations, treatments and outcome

Investigators: Dr Emily Tomlinson

Reduction of oxygen after cardiac arrest: The EXACT Study

Aim: this multicentre trial will evaluate neurological outcomes for patients presenting to ED by ambulance, post-cardiac arrest, who will have been randomised to receive either 100% O2 or Targeted O2 to achieve 90-94% Sat O2 until transfer to ICU

Co-investigators: Dr Michaela Mee and Prof Andis Graudins

Access: Re-Design of Systems and Procedures

Aim: to prevent complications such as Staphylococcus Aureus Bacteraemia (SAB) infections as a result of venous access. Insight will be gained through the observation of clinicians and nurses involved in the care of patients with venous access. Short interviews with ED staff and patients will also be conducted to gain further insight into the equipment and procedures used for venous access, in order to identify re-design options.

Investigators: A/Prof Diana Egerton-Warburton, Prof Mark Armstrong, Prof Daphne Flynn and the team

Focussed ultrasound for suspected small bowel obstruction in the Emergency Department: A prospective cohort study

Aim: the primary objective of this study is to evaluate the implementation of clinician-performed Point of Care ultrasound (“PoCUS”) for suspected bowel obstruction in the Emergency Department in several Australian Emergency Departments.

Investigators:Dr Gabriel Blecher, Dr Daniel Crompton, & Dr Pourya Pouryahya

Driving Change Project –Using Emergency Department Data To Reduce Alcohol-related Harm

Aim: to reduce alcohol-related harm in communities and reduce the impact on EDs and ED staff, by using data collected in Emergency Departments to target the sources of the most alcohol-related harm.

Co-investigators: A/Prof Diana Egerton-Warburton

Bell's Palsy in Children: A Multi-centre. Randomised, blinded, placebo-controlled trial to determine whether prednisolone improves recovery at 1 month

Aim: to determine whether treatment with oral prednisolone for 10 days increases the proportion of children who have complete recovery at 1 month,

Co-investigator: Dr Adam West

Quality Assurance Title: What is the time to theatre of neck of femur (NOF) fractures within Monash Health? And are there any adverse outcomes related to this?

Investigators:  Julian Lim, Suong Le & Marion Waldsley

Emergency Department pharmacist's role in improving GP medication history accuracy

Aim: to examine whether pharmacists working in the ED can play a role in assisting GP's with updating patient medication lists by completing medication reconciliation and conveying this information back to the patient's clinic.

Investigators:  Dr Phillip Bergen & Stephen Louey

Escalating Deteriorating Patients' Care in the ED: Characteristics and Safety Cultures

Aim: To examine the organisation's safety culture to escalate care of the deteriorating patients

Investigator: Jennifer Jackman

Anaphylaxis management in Emergency Department presentations

Investigator: Nadishani Ratnayake

A case series of pre-hospital management and outcome in music festival patrons presenting with drug-induced hyperthermia

Aim: to combine clinical data from patients with moderate and severe drug-induced hyperthermia who presented to St John Ambulance Australia (Victoria) at music festivals during the study period, and hospital management and outcome data to map the clinical course of these patients.

Investigator: Prof Andis Graudins

Analysis of clinical and haemodynamic outcomes after overdose with amlodipine, ARB or ACE-I combination drug formulations: A retrospective case series

Aim: to undertake evaluation of clinical and haemodynamic outcomes after overdose with amlodipine, ARB or ACE-I combination drug formulations

Investigator: Prof Andis Graudins

A retrospective descriptive case series of lurasidone overdoses presenting to Monash Health emergency departments

Aim: to describe the patient presentations of lurasidone overdoses presenting to Monash Health emergency departments.

Investigators: Dr Maddy Jona, Prof Andis Graudins

A retrospective review of the management of red back spider envenoming at Monash Health emergency departments – Pre and post-RAVE-2

Aim: to identify all patients presenting to Monash Health emergency departments with red back spider envenoming and compare treatment pre-2014 to post-2014, when recommendations for antivenom use for treatment of envenoming changed.

Prof Andis Graudins

Companion participation in the care of the older person in the emergency department: A mixed method study

Aim: to explore and describe companion perceptions of their participation in the care of an older person discharged home from the ED (including the Short Stay Unit)

Investigator: A/Prof Bernice Redley

Compensable billing in the Emergency Department – an analysis of efficiency of a manual system of entry

Aim: to quantify the inefficiency of an existing manual billings system that is reliant on the doctor’s intrinsic motivators for compliance in a public hospital Emergency Department setting

Investigator: Dr Andy Lim

Corneal foreign body in emergency department

Aim: to find the incidence and outcome of patients presenting to emergency department with corneal foreign body

Investigator: Dr Pourya Pouryahya

Diagnostic yield of computed tomography scan in the emergency department

Aim: to describe the indications, clinical categories and positive yield rates of patients receiving CT scans in the ED.

Investigator: Dr Pourya Pouryahya

Assessment of adult eating disorder in ED

Aims:

  1. to evaluate the parameters measured and investigations carried out in the emergency department for patients presenting with an eating disorder (anorexia nervosa or bulimia nervosa) being the key issue, as compared to the parameters recommended in the RANZCP Clinical Practice Guidelines for treatment of eating disorders when considering weather patients require inpatient admission
  2. to use this data to identify possible gaps in the assessment of adult eating  disorder patients, and allow this to guide education of emergency department staff, and potentially develop of a local guideline for health service.

Investigator: Dr Georgina Tuck

Emotional Support in the Monash Health Emergency Department

Aim: to elicit the perceptions of patients, family members and/or carers regarding the provision of emotional support in the emergency department setting.

Investigators: Prof Alison Hutchinson, A/Prof Bernice Redley

How effective is the Monash Health SHRFV family violence education for helping staff to identify, respond and refer patients experiencing family violence?

Aim: to review education from September 2017 and to the end of May 2019, 3097 Monash Health employees received family violence training.

Investigators: Glenda Bawden, Jessica Bermudez

DeFining Lumbar Extension, FleXion And Rotation in the workplace (FLEXAR)

Aim: to undertake real time monitoring of low back movement with motion sensor equipment to quantify lumbar movements of nurses working in intensive care and the emergency department within a teaching hospital. A secondary aim is to ascertain the prevalence of low back pain within the cohort.

Investigator: A/Prof Julia Morphet

Hospital healthcare professional perceptions and experiences of emergency readmissions of older people- The PEER review

Aim: to explore the perceptions and experiences of health professionals working in the hospital setting, regarding the identification and management of older patients (aged 65 years and over) who are at the highest risk of early, unplanned hospital readmission (within 28 days of discharge) following an inpatient stay.

Investigators: Josephine McGuiness, A/Prof Julia Morphet, Dr Kelly-Ann Bowles, Dr Mehmet Özmen

Palliative Care Impact On Patient Outcomes and Health Resource Utilisation: A retrospective case controlled study

Aims:

  1. to explore and map the illness journey of palliative and non-palliative patients across care settings and over time and identify patterns in disease trajectory and palliative care implementation
  2. to compare resource utilisation and clinical outcomes in PC vs PC naïve cohorts in an Australian healthcare setting.

Investigator: A/Prof Peter Poon

Accuracy of Emergency physicians in diagnosis of thoracic aortic dissection

Aim: To examine the Incidence and outcome of patients with thoracic aortic dissection as well as accuracy of emergency physicians in diagnosis of thoracic aortic dissection and time to diagnosis.

Investigator: Dr Pourya Pouryahya

Appendicitis but not appendicitis

Aim: to identify patients underwent unnecessary investigation that might delay diagnosis.

Investigator: Dr Pourya Pouryahya

Are vital signs really vital to suspect pulmonary embolism?

Aim: to assess variation of vital signs in patients with confirmed pulmonary embolism.

Investigator: Dr Pourya Pouryahya

Clinical accuracy of Emergency physicians in diagnosing renal colic before imaging

Aim: to evaluate the accuracy of Emergency physicians in diagnosing renal colic before imaging.

Investigator: Dr Pourya Pouryahya

Incidence of PE in pregnancy and post-partum

Aim: to examine the incidence of pulmonary embolism during pregnancy and in post-partum.

Investigator: Dr Pourya Pouryahya

Hi, Is It Me You’re Looking For

Aim: to observe the practices of the ED consultants/clinicians in charge (CIC) with respect to answering the phone. Informal observations have suggested that callers often do not know to whom they spoke with over the phone, which can become problematic if there is information that needs to be followed up.

Investigator: Dr Pourya Pouryahya

PRimary health and Aged Care Translation and Interpreting Services (PRACTIS)

Aim: to evaluate the relationship between linguistic discordance and avoidable ED admissions for limited English proficiency residents of aged care homes.

Investigator: Prof Suresh Sundram

Clinical Audit of Restrictive Interventions in the Emergency Department

Aim: to contribute to the growing evidence base to gradually reduce the use of restrictive practice not only in the emergency department but also to other areas of the mental health service.

Investigator: Dr Al-amin Hoque

SNOTWATCH: Mapping real-time respiratory microbiology information to inform health outcomes

Aims:

  1. to examine and describe organism specific epidemiology of respiratory and gastrointestinal positive tests from all participating laboratories
  2. to describe the association of organisms in time and place with health service utilization and presentations.

Investigator: Prof Jim Buttery

Emergency Department Nurses Perceptions of Working with Substitute Decision Makers

Aim: to explore and understand how ED nurses work with Substitute Decision Makers within the emergency department setting.

Investigators: A/Prof Susan Lee, A/Prof Cheryle Moss

Empiric antibiotic management of UTI in paediatric patients presenting to Monash Health

Aim: to review current empiric prescribing in paediatric UTI and assess changes post implementation of an antibiogram

Investigators: Kaman Cheung, Prof Jim Buttery

Acute behavioural disturbance in paediatric health services: retrospective observational study of Code Grey incidents

Aim: to examine recent code grey incidents occurring at Monash Health sites to develop an understanding of how acute behavioural disturbances arise and are managed in these paediatric health services.

Investigator: Prof Simon Craig

How are we managing acute asthma in children? A PREDICT study

Aims:

  1. to determine current management practices for children with severe acute asthma and/or wheeze across Australia and New Zealand
  2. to determine the incidence of (and complications relating to) severe acute asthma requiring IV bronchodilator therapy or ventilator support across Australia and New Zealand
  3. to determine where differences in therapy exist between states / regions across Australia and New Zealand given our previous research.

Investigator: Prof Simon Craig

Acute behavioural disturbance in paediatric health services: retrospective observational study of Code Grey incidents

Investigator: Prof Simon Craig

Treatment decisions for children with acute severe exacerbations of asthma: interviews with clinicians. A Pediatric Emergency Research Networks (PERN) study.

Investigators: Prof Simon Craig, Erin Mills

A Multicentre Randomized Controlled Trial Comparing Epinephrine (Epinephrine (Adrenaline)) And Dexamethasone to Placebo in the Treatment of Infants with Bronchiolitis. BIPED

Investigator: Prof Simon Craig

Nasal High Flow Therapy for Children with Acute Hypoxemic Respiratory Failure – a Randomised Controlled Trial – PARIS II Trial

Aim: To investigate in a randomised controlled trial performed in children aged 1-4 years presenting with acute hypoxemic respiratory failure if the early use of NHF therapy reduces the hospital length of stay when compared to standard oxygen therapy.

Investigators: Prof Simon Craig, Rhiannon Barrow

The utility of blood and urinary ketones in the assessment of abdominal pain (KIAPP Study)

Aim: to determine Whether blood and urinary ketones can be used to assist in the diagnosis of appendicitis, and
If ketone measurements assist with discriminating between simple and complex appendicitis in children prior to operation.

Investigator: Prof Simon Craig

Factors affecting parental experience of investigations for suspected sepsis in neonates

Investigator: Prof Simon Craig

Nasal High Flow Therapy for Children with Acute Hypoxemic Respiratory Failure – a Randomised Controlled Trial – PARIS II Trial

Aim: To investigate in a randomised controlled trial performed in children aged 1-4 years presenting with acute hypoxemic respiratory failure if the early use of NHF therapy reduces the hospital length of stay when compared to standard oxygen therapy.

Investigators: Prof Simon Craig and Rhiannon Barrow

Equity of allergy resource distribution in Victoria

Aims:

  1. to assess the geo-temporal distribution of allergy services compared to the apparent prevalence of allergy in Victoria
  2. to characterise the allergy burden and needs of the Monash Health catchment areas to inform the establishment of an allergy immunology service at Monash Health.

Investigators: Prof Simon Craig, Prof Jim Buttery