Research and Publications
The Emergency Care Foundation has been associated with more than 200 publications to world-renowned medical journals, plus many other more general publications, as well as numerous presentations to various medical and non-medical groups. A direct consequence of this activity has been the improvement of access to, and accuracy of, emergency care in New Zealand.
One example of this was the New Zealand Medical Journal publication (and feature at conferences) of findings from research into the potentially dangerous and often-unnecessary interventions such as stomach wash-outs for patients poisoned by drugs. This resulted in a change in practice in Emergency Departments throughout the country.
Similarly patients with possible deep venous thrombosis (blood clot in the leg) or pulmonary embolus (blood clot in the lung) now have a diagnostic algorithm in Christchurch to ensure the most pertinent signs and symptoms are given due weight in decision making. The algorithms are a direct consequence of ongoing research by Emergency Care Foundation in this area.
Christchurch has been a leading centre in the world in developing understanding of the effects of ‘herbal highs’ and unlicensed recreational drugs such as BZP . The work of local researchers, supported by the foundation was a key factor in providing the evidence required to develop the recently introduced national legislation for the regulation of such recreational drugs.
Following the Christchurch earthquake in 2011 a unique opportunity existed to study, and learn important lessons from the disaster in relation to the provision of health care and the impact of earthquakes on individuals and populations health it was unclear how such important work would be funded and coordinated. Emergency care foundation was instrumental in helping to secure funds from the health research Council of New Zealand and the Canterbury medical research foundation to allow such research to take place. The foundation also helped in the creation of a dedicated group called RhISE (research into the health impact of seismic events). Rhise group now includes over 200 stakeholders and has over 40 project streams the results for some of which have already been published including in the prestigious medical Journal the Lancet.
Ethical decision making in emergency care is another area to benefit from research. People suffering an emergency illness or injury often find themselves in a position where it is difficult to exercise their right to determine which medical interventions they receive.
Providers of emergency care have found the application of medical ethics in this area to be particularly difficult. The presentation of an Ethics Toolkit for Emergency Care by Professor Ardagh has offered great assistance and has featured at conferences in New Zealand, Australia and the United Kingdom.
Chest Pain
Christchurch is a world leading centre in research into the assessment of possible heart attacks. Research is under way that will provide an innovative and workable change to the medical decision making process for patients presenting acutely to Emergency Departments with chest pain that might possibly be due to a heart attack. Randomised controlled trials are proceeding comparing current care with a new ‘fast-track’ pathway. Use of very early blood tests in a targeted low risk group of presenting patients, could possibly rule out heart attack approximately 10 hours earlier. This would then allow onward cardiac tests to be performed much sooner and make a tangible contribution to health care by preventing hospital admission and facilitating early discharge home. This outcome is beneficial for patients, who can be reassured earlier that heart attack has been ruled-out and who avoid the inconvenience and risks of hospital admission. It is beneficial for the health service, which avoids unnecessary admissions, duplication of staff activities and pressure upon urgent care services.
Christchurch was the co-ordinating centre. Of the 3,500 patient study ASPECT study, involving 9 countries in the Asia-Pacific region (published in The Lancet)
The Emergency Care Foundation is also collaborating with other researchers to undertake a new chest pain anxiety study which will involve patients who present to the emergency department with chest pain that is not cardiac related. These patients will be assessed and if suitable for the study will receive four sessions of therapy for anxiety. The study is hoping to get underway, subject to relevant funding, later in the year.
Fast Track for Chest pain
With funding from the Health Research Council and The Emergency Care Foundation’s support, ground breaking research is underway by Dr Martin Than (one of the three medical trustees for ECF). In 2009 the charity provided support staff time to help the construction of a grant application to the Health Research Council and was successful in obtaining funding to change the medical decision making process for patients arriving at the Emergency Department of a hospital with chest pain that might possibly be due to a heart attack. Trials compare current treatment with a new “fast-track” approach. Use of very early blood tests could possibly rule out heart attack approximately 10 hours earlier than it usually takes.
Pulmonary Embolism
Since 2003, researchers, led by Dr Martin Than have been collecting data of all patients that present to the Emergency Department with a suspected Pulmonary Embolism (PE) or Deep Vein Thrombosis. To date we have collected data on over 9500 patients resulting in the largest single hospital database for researching PE and DVT in the world.
The D-Dimer test is commonly used to help with diagnosis when patients have a suspected PE or DVT. Dr Than has recently received a research grant to set-up a computerised system for the ordering of the test which means that Christchurch Hospital will be only one of a few centres in the world that is using this technology. The system will enable us to streamline test ordering, capture more data on patients requiring testing and eventually help doctors with patient diagnosis.
Rhise
The Rhise Group is an inclusive Canterbury-wide collaborative established after the February 22nd earthquake in Christchurch, New Zealand.
The impact of the earthquake on the health system, and the system’s response, have provided insights of international interest. These will be important in planning future disaster responses.Aspects of interest will be:
1.Overview of the initial response
2.Detailed descriptions of particular patient groups (for example, patients with crush injury syndrome)
3.Longer term studies of some patient groups (for example, the evacuated elderly)
Note; the Emergency Care Foundation doesn’t do research itself, but it funds New Zealand’s only Emergency Nurse Researcher, and the activities of the Research Group in the Emergency Department at Christchurch Hospital and the University of Otago, Christchurch. The publications listed are those by members of this group, since the instigation of the Foundation.
This is an overview of the research activities supported by the Foundation. More academic detail can be obtained on the publications list.