Hospitals & Services
Christchurch Hospital Emergency Department (ED) has a strong academic core, and research has been a significant part of that. Research is recognised as both a formal requirement for some staff and an anticipated academic and professional strategy for all. The Christchurch Hospital ED Research and Development Governance Group (ED R&DG Group) [formerly EMNRG - Emergency Medicine and Nursing Research Group] has been established to:
The aim of the group is to facilitate the establishment and recognition of the Christchurch Hospital's ED as a centre of excellence for emergency research.
The members of EMNRG seek to identify research strands to help focus the use of the available resources. It is envisaged that these strands will encompass the existing interests of the department, while aligning to reflect government priority health objectives and to relate to funding priority objectives. This is not to imply that these guidelines will necessarily be exclusionary, as worthwhile research that falls outside these boundaries will still be considered by the research committee.
Areas of research interest can be grouped into four main categories:
Given the fluctuating workload for staff in the department, it is necessary to limit the number of projects that can be accepted at any one time. Priority will go to those necessary for ED staff training and education requirements. Examples of this prioritising include the ED Registrar research requirements and emergency nurses studying at Masters Level or above for qualifications in emergency nursing.
In this context, research needs to be carefully planned and implemented so that it has minimal impact on the provision of services, and recruitment needs to be smooth and efficient. As a result, a formal protocol has been developed, to provide a guide for those individuals or organisations wishing to undertake research that involves the staff, facilities or recruitment of patients in the ED.
We are continuing to conduct research into the toxicology of synthetic recreational drugs as part of a multicentre collaborative. This area of research has produced many important publications in the Emergency and Toxicology literature.
The ARISE-RCT is a multi-centre, un-blinded, randomised, controlled trial of Early Goal-Directed Therapy (EGDT®) versus standard care in patients with severe sepsis presenting to the Emergency Departments (EDs) of hospitals in Australia, New Zealand, Finland and Hong Kong. The study will test the hypothesis that EGDT®, compared to standard care, reduces 90-day mortality in patients presenting to the ED with severe sepsis. The null hypothesis is that there is no difference in the risk of death between patients assigned to either EGDT® or standard care. The ARISE-RCT, along with the NIH-funded PROCESS trial, will look to validate the findings of the single-centre Rivers et al. study.
Rationale: Severe sepsis is a major public health problem. In 2004, the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) reported that the adult incidence of severe sepsis (a complication of severe infection) is 77 cases per 100,000 of population per year in Australia and New Zealand; representing over 15,000 patient episodes per year. Similar population incidence rates have been reported elsewhere. Importantly, 11.8% of all admissions to Australian and New Zealand ICUs are associated with severe sepsis and in-hospital mortality is 37.5%. In patients with septic shock, mortality approaches 60%. The burden of death is approximately 3 times the annual national road toll. The death rate also exceeds other diseases which significantly impact on the Australian community such as breast and colorectal cancer. Given the pressing need to reduce the mortality from severe sepsis and the class II evidence that EGDT may be an effective treatment that is not currently used in the majority of Australian and New Zealand hospitals, a phase III study to examine the effectiveness of EGDT in Australasian patients is imperative. Unless a trial specifically comparing EGDT and Australasian standard care is performed, ED and ICU specialists will remain uncertain about the benefits of EGDT to our patients and will be unlikely to adopt this potentially life-saving strategy.
Collaboration: The ARISE-RCT is being conducted in collaboration with the Australasian College for Emergency Medicine (ACEM) Clinical Trials Group. The ARISE-RCT is endorsed by the ANZICS CTG.
Contact: For further information about this study, please contact the ANZIC-RC ARISE-RCT Project Manager, Belinda Howe, on email: email@example.com / http://www.anzicrc.monash.org/process.html
EDAKI is a prospective observational study of urinary and plasma biomarkers in the ED, Intensive Care Unit (ICU), and at a 30 day follow up with the primary aim to reduce the false negative rate for prediction of Acute Kidney Injury (AKI) by sampling on entry to the ED compared with on entry to the ICU.
Urinary biomarkers are taken from urine collected from catheterised patients in the ED, on entry to the ICU, then 4, 8, 16 hours, and 2, 4, 7 days later. Plasma biomarkers are taken from blood sampled at the same time points, with the exception of the 4 and 8 hour samples, these samples are taken along with routine clinical blood collections. Mortality will be assessed at one year.
For further information about this study, please see http://www.anzctr.org.au/ACTRN12610001012066.aspx
This research investigates an innovative and workable change to the medical decision making process for patients presenting to Emergency Departments with chest pain that is possibly due to a heart attack. This randomised trial aims to prove the effectiveness of a new 'fast-track' (2-hour) pathway compared with current, standard care. It uses a specially developed Australasian Low Risk Score to identify a low-risk group of patients, doubling the number that might have heart attack ruled out up to 10 hours earlier than is currently possible. This would make a tangible contribution to health care by preventing unnecessary hospital admission and facilitating early discharge home in a large group of patients. This outcome is beneficial to both patients and the health service, by reassuring patients earlier that heart attack has been ruled-out and by avoiding unnecessary admissions, duplication of staff activities, and reducing pressure upon urgent care services.
To facilitate understanding of the health impact of the Canterbury earthquakes through the coordination and collaboration of research.
The roles of the RHISE group are oversight and facilitation of research related to the health implications of the Canterbury earthquakes and, specifically, to enable collaboration and sharing of resources where appropriate. An initial task has been the establishment of RHISE as a central reference point for activities of the group and its members, the introduction of a web-based resource for sharing information, resources and providing a list of research projects and contact details for primary investigators. A core activity has been to establish a rich database of information regarding patients injured as a result of the earthquake events.
RHISE is a large, inclusive group with a membership identified by its mailing list. Membership is open to any person or persons undertaking, or intending to undertake research regarding the health implications of the Christchurch earthquakes since September 2010. The members have access to the shared web-based resources of the group. This website encourages collaboration through communication and sharing of resources and information. Membership of the RHISE Group, and access to this website, is tacit agreement to the group's mission – in particular to the commitment to collaboration. To administer the activities of RHISE there is a working group consisting of Professor Mike Ardagh (Chair), Viki Robinson (Coordinator) and others as required.
The RHISE group is housed by the Canterbury District Health Board (CDHB) and has membership from many parts of CDHB, and a number of other organisations including University of Otago, University of Canterbury, and Pegasus Health (among others). The relationship with these organisations is informal, but collaborative, through its members.
The part time coordinator position has been a result of funding received from the Emergency Care Foundation (ECF), with support from the Emergency Care Co-ordination Team (ECCT) and the Canterbury District Health Board (CDHB). The subscription to the web-based resource (Basecamp) has also been funded by the ECF. This resource acts as a hub for sharing resources, providing general information, updates, and has the capacity to allow individual researchers and groups to establish project support and organisational sites.
The establishment of the database of information regarding patients injured as a result of the earthquake events has been made by possible following a grant from the Health Research Council of New Zealand (HRC) and the Canterbury Medical Research Foundation (CMRF).
For further information on conducting research in the ED please contact: firstname.lastname@example.org
For further information on the RHISE Group or to register with the RHISE Group Basecamp website, please contact: email@example.com
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