Author: Marian Chandler

The Kids are Not Ok: Emergency Department management of acute mental health crises in children and young people – A retrospective study

Aim

Retrospective audit of medical records of children and young people below 18 years of age who presented to the ED with mental health concerns in 2018 (index presentation) and 1 year pre and post. The information will be used to describe, in different settings and types of EDs:

(a) current patterns and precipitants of ED mental health presentations;

(b) prevalence of co-morbid conditions;

(c) factors (including demographic, family and other social factors) associated with mental illness and suicidality; and

(d) the care provided within the ED and on follow-up.

Participants/Records

• All sites required to enter 100 patient records or as many as they have available.

Current status

Main Retrospective study

• So far as of 30.05.2022, we have 1427 complete entries.
• To date data entry has been completed by the following sites:
  • VIC – Austin hospital, University hospital Geelong, Frankston Hospital, Royal Children’s Hospital, Sunshine Hospital
  • QLD – Sunshine Coast University Hospital
  • WA – Perth Children’s Hospital, Albany Hospital
  • SA – Women’s and Children’s Hospital, North Adelaide
  • TAS – Royal Hobart hospital
• Data entry is currently progressing at the following sites:
  • VIC – Monash Health, Ballarat Base Hospital, Eastern Health
  • NT – Royal Darwin hospital
  • QLD – Gold Coast University Hospital
  • NSW – Tamworth Rural Referral Hospital

Covid retrospective study arm

• The COVID arm of the Retrospective study has commenced with data entry.
• Aiming to recruit 100 records from 2019 and 100 records from 2021 at each participating site.
• Data entry is currently progressing in VIC – Monash Health, Royal Children’s Hospital and TAS – Royal Hobart Hospital.
• So far as of 30.05.2022, we have 49 complete entries.

We are hoping to complete data collection for these studies by the end of August. Please let us know how you are going, and whether you might need a little more time.

 

The Kids are Not Ok: A Delphi Study to identify consensus research priorities and core outcome sets in paediatric emergency mental health presentations

Aim

• To determine a prioritised list of research questions and identify a set of core clinical and mental health outcomes for children and adolescents presenting to the ED with mental health concerns.

Participants

• Children/young people under 18 who attended ED with mental health concerns and their parents/carers.
• Doctors, nurses, mental health clinicians, police, paramedics, schoolteachers, school counsellors, hospital security.

Recruitment Status

• Commenced 2^nd of May 2022 and will continue to the 30^th of June
• Sites pending governance approval can join in recruitment process and project until mid-June, 2022.

Current Status

• As of 30.05.2022 – Complete Survey 1 responses received from healthcare/community-based services members = 57 (out of 103 survey response records), and complete Survey 1 responses from patient/carers = 8 (out of 29 survey response records).
• The participants are from:
  • VIC – Austin Health, Monash Health, Royal Children’s Hospital, Eastern Health, University Hospital Geelong-Barwon Health, Ambulance Victoria, Vic Police
  • SA – Women’s and Children’s Hospital, South Australia Ambulance
  • QLD – Gold Coast University Hospital, Queensland Ambulance Service
  • TAS – Royal Hobart Hospital
  • WA – WA school psychologist, WA police

 We are very keen to recruit more patients and families – please make an effort to approach them over the next month.

 

 

 

 

 

 

 

 

 

Aim:

To improve discharge communication currently provided to children presenting to the ED with mild head injuries and concussion. Specifically, adolescents who have an increased risk of post-concussion symptoms.

Design:

A mixed method, stepped co-design method to engage parents, youths and clinicians in the development of head injury discharge communication strategies.

Recruitment:

Co-design team recruited: 2 doctors, 1 nurse, 1 nurse practitioner, 4 parents, 3 youths.

Current Status:

• Ethics received from RCH and Western Health.
• Co-design team recruited and training materials developed.
• First meeting to brainstorm what needs to improve in discharge communication held in March 2022.
• Meeting 2 (prioritisation process) and Meeting 3 to develop strategies to improve discharge communication will be held late May/early June.
• A prototype will be developed following this meeting along with usability testing.

The PREDICT members meeting will be held on October 20th 2022 at the Larwill Hotel, Melbourne (next to the RCH).  This will be a hybrid event with a Zoom link provided for those who are unable to attend in person.

DATE: Thursday 20/10/22

TIME: 10.00am – 4.30pm

VENUE: The Larwill Hotel, 48 Flemington Road, Parkville, Melbourne.

Further details including registration process will be available mid-May.  This meeting has previously been forwarded as a calendar invite.  Please check that it is in your diary.

See 2022 meeting schedule here.

Registration open early August.

Our “Getting to Know You” segment ensures PREDICT members are aware of new members, their interests and areas of expertise and where they are located.

This month we introduce Dylan Mordaunt from the Southern Adelaide Local Health Network.

“I work as the Executive Director of the Women’s and Children’s Division of the Southern Adelaide Local Health, clinically as a paediatrician and as an Associate Professor for Flinders University.

My research interests primarily relate to health services research, including implementation science as well as population health research, particularly clinical epidemiology, health economic and outcomes research.”

Welcome to PREDICT Dylan.

Acute Hypoxaemic Respiratory Failure aged 1-4 years
(Paediatric Acute Respiratory Intervention Studies)

Recruitment stats:

• Study commenced December 15th 2017 and study completed recruitment 27 March 2020 with recruitment of 1512 patients.
• Data analysis complete
• Manuscript complete (awaiting final Statistician elements) and will send to high ranked journal in April.

14 Centres participating include:

Australia

• GCUH, Southport, Qld
• PCH, WA
• QCH, Brisbane, Qld
• RCH, Melbourne, Victoria
• Monash Health, Victoria
• JHCH, Newcastle, NSW
• Townsville, Qld
• The Prince Charles Hospital, Qld
• Caboolture Hospital, Qld
• Ipswich Hospital, Qld
• Redcliffe Hospital, Qld

New Zealand

• KidzFirst, Middlemore, Auckland
• Starship Children’s Hospital, Auckland
• Waikato Hospital, Hamilton

Extension of the PARIS Trials continues….

1.     PARIS continues to evolve….

The PARIS trial named Remote PARIS has been underway since August 2020 and is a pilot study set in three remote and rural centres in Far North Qld: Cooktown, Weipa and Thursday Island.  The aim of this study is implementing what we have already learned with PARIS 1 and PARIS 2 pilot with the hypothesis that there will be reduced transfer rates out of these hospitals to Cairns and Townsville.

Donna Franklin is working with Weipa nurse and PhD candidate Sally West (James Cook University) on this study.  The PARIS study has grown many legs and we hope that the Remote PARIS study will be as successful as the other PARIS studies.

2.     PARIS has further evolved…..

It will now be extended to 18 centres across Northwest, Torres and Cape, Cairns and Hinterland and Townsville Hospital and Health Services in Queensland.  The hospitals are Level 2 and Level 3 sites with ~30 staff at each, and we will be putting in place a Respiratory Care Bundle with the knowledge gained from previous PARIS studies.

This study is called PARIS on Country and will commence July 2022 and run over 5 years.

This Respiratory Care Bundle is about respiratory support in various methods for infants and children presenting to emergency departments such that they can remain in the care of their local service and not require transfer out due to escalation of care that the local site cannot perform.  This study is not about nasal high flow specifically, but instead more about best care as per current new evidence for children presenting with a respiratory illness. For many of these centres the paediatric presentation and care can be a daunting experience and the Respiratory Care Bundle is aimed at assisting to relieve this concern and add knowledge and skill to the local teams. This in turn is aimed at keeping the child with their family and community on Country.

 

PREDICT would like to thank all those who attended the workshop “Implementation research in the PREDICT network – what is implementation research, what have we achieved and where are we heading?” on the Thursday 31st March. Attended by 33 participants, it was an engaging and informative workshop. We were very fortunate to hear presentations from Dr Lou Atkins on the use of implementation theories and frameworks and Prof Sandy Middleton on implementation research study designs; Prof Dominique Cadilhac provided informative examples of how clinical registries can drive improvement in care and Dr Dustin Ballard on optimising implementation research in the Electronic Health Record.

The afternoon session was dedicated to identifying priorities for implementation research in paediatric emergency medicine and identifying the research training needs for the PREDICT network.

We hope that this will be the first of several workshops to improve implementation research capacity within the network. For further information please contact Emma (emma.tavender@mcri.edu.au)

The PREDICT members meeting will be held on October 20th 2022 at the Larwill Hotel, Melbourne (next to the RCH).  This will be a hybrid event with a Zoom link provided for those who are unable to attend in person.

DATE: Thursday 20/10/22

TIME: 10.00am – 4.30pm

VENUE: The Larwill Hotel, 48 Flemington Road, Parkville, Melbourne.

Further details including registration process will be available mid-May.  This meeting has previously been forwarded as a calendar invite.  Please check that it is in your diary.

See 2022 meeting schedule here.

A face-to-face, two day Research Nurse/Assistant education session will be held on the 2nd & 3rd June 2022 at Queensland Children’s Hospital in Brisbane. Education and training for the following studies are included:

• PROMPT Bolus and SENTINEL
• SONIC
• PEACHY O & M
• CHOICE

Your manager/supervisor will advise you if you have been nominated to attend and you will be emailed further information by the organising team.

From past experience we have found these training sessions extremely beneficial for the research nurses recruiting for the studies. A range of study related topics will be covered, including meeting governance requirements, study oversight, in depth study-specific education about how to make the study operational at your site, data entry, recruitment of participants and troubleshooting problems that arise.

QUESTIONS:

Marian Chandler (re accommodation, travel, etc)

marian.chandler@mcri.edu.au or telephone (03) 9936 6049

or

Amanda Williams (study related or attendance questions)

Amanda.williams@rch.org.au or telephone (03) 9936 6635

Congratulations to the following PREDICT authors:

Furyk JS, George S, Phillips N, Emeto TI, Watt K, O’Brien S, Riney K, Wilson C, Hearps SJ, Borland ML, Dalziel SR, Babl FE; on behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT).
Status Epilepticus Australasian Registry for Children: A pilot prospective, observational, cohort study of paediatric status epilepticus. Emerg Med Australas. 2022 Apr 25. doi: 10.1111/1742-6723.13988. Epub ahead of print. PMID: 35466541.