The Emergency Medicine Research Group
Areas of Research Interest of EMNRG
Group : Terms of Reference
Improvements in Patient Care Consequent to EMNRG Activities
The Emergency Care Foundation
The EMNRG was formally established in July of 2002, building on existing
systems and personnel.
- The need for a research group to co-ordinate and oversee departmental
research was evident in the number of projects already running and in the
expressions of interest from other areas wanting to conduct research in
- The members of the group represent various elements and interests within
the ED and include:
- Prof. Mike Ardagh,
as the Professor of Emergency Medicine at the
Christchurch School of Medicine and Health Sciences, based in Christchurch
Hospital, was responsible for developing the research group. He has
longstanding interests in research and an expertise in the areas of ethics
and resuscitation. Emergency Medicine is an emerging academic speciality
and his research output in this area is among the greatest in Australasia.
- An innovative step was the creation of a clinical Nurse Researcher
position, with a view to co-ordinating research opportunities and to
develop nursing research projects. Sandy Richardson was appointed
to this position in July 2002, and has been enthusiastic in the
development of the role and scope of practice associated with this. She
has a commitment to the integration of research and practice, and to
ensuring the expansion of a strong nursing knowledge base.
- Dr Martin Than,
Emergency Department Consultant, has a strong
interest in evidence-based practice, and in developing research based
around clinical care protocols and investigations. In addition to his
research interests, he has proved tireless in seeking funding and support
for the work of the research group.
- Dr Phil Hider, senior lecturer in clinical epidemiology in the
Christchurch School of Medicine and Health Sciences, has research and
undergraduate/postgraduate teaching expertise in evidence-based practice
and quality improvement. He brings a wealth of expertise and his work
within the Christchurch School of Medicine and Health Sciences (CSMHS)
brings new insights and approaches.
- Given the collaborative nature of Emergency Medicine, and the
developing focus on post-graduate education and research amongst nursing
practitioners, a strong nursing representation was sought.
Esson is the Nurse Manager for the Emergency Department, and
encourages the development of research-based practice, and further
education for nurses working in the area of emergency nursing.
- Kristi Calder joined the group in 2004, bringing with her
experience in recruitment and follow-up of study participants. She has
created and maintained databases for a number of current research
Areas of Research Interest of EMNRG
Areas of research interest can be grouped into four main
- ‘Access’ research explores issues related to ED attendance,
appropriateness, overcrowding and access block.
- ‘Accuracy’ research explores clinical predictors of disease,
and the development of clinical decision-making tools. Projects in this
regard include Acute Coronary Syndrome, Pulmonary Embolism (clots in the
lung), deep venous thrombosis (DVT) and abdominal pain.
‘Other’ research, including poisoning, and trauma imaging.
Research Group : Terms of Reference
In order to ensure that research resources and efforts are
used to their maximum effect, it is necessary to clearly formulate a purpose
statement encapsulating the aims and objectives of the Emergency Medicine and
Nursing Research Group (the Group) with regard to research to be carried out
in the Emergency Department of Christchurch Hospital. In association with
this, a number of research strands will be identified to help focus the use of
the available resources. It is envisaged that these strands will encompass the
existing interests of the department, but will be aligned to reflect
government priority health objectives and to relate to funding priority
objectives. This is not to imply that these guidelines will necessarily be
exclusive, as worthwhile research that falls outside these boundaries will
still be considered by the Group.
Research is recognised as both a formal requirement for
some staff and an anticipated academic and professional strategy for all. The
Christchurch Hospital Emergency Medicine and Nursing Research Group has been
- facilitate the ongoing research endeavours of individuals and groups,
which relate to the provision of emergency care
- promote and educate staff regarding Evidence Based Medicine (EBM) and
Evidence Based Nursing (EBN)
- guide and support staff in their research efforts
- co-ordinate research activities in the Emergency Department (ED)
- monitor and audit the progress of research in the ED
- maintain appropriate professional practice with regard to research
The aim of the group is to facilitate the recognition of
the Christchurch Hospital Emergency Department as a Centre of Excellence for
Improvements in Patient Care Consequent to EMNRG Activities
The research of the EMNRG was varied but mostly consistent
with three principal themes: access, accuracy and ethics.
research included work related to waiting
times in Emergency Departments, Emergency Department Overcrowding and
alternative forms of care.
Research does not, in itself, bring about
improvements in care, but it provides the knowledge so that improvements might
Specific improvements that have occurred as a result of this
research area include the following:
- The concept of ‘inappropriate’ Emergency Department (ED) attendance
– there is a perception that ED overcrowding is largely due to people
using the ED when they should have gone to a General Practitioner.
Research done in Christchurch suggests this is not the case, and that
there is no consensus among health care providers as to what constitutes
appropriate use of the ED. This research has prompted a PhD student to
embark on an extensive project to develop a consensus about who, ideally,
should go to the ED and who should go to a GP. A consequence of this will
be a more accurate assessment of ED utilisation, and more evidence based
development of services for emergency health care. A principle
underpinning this work is that lasting solutions to access to care involve
lowering barriers to appropriate care, rather than raising barriers to
care perceived to be inappropriate.
- The ‘Cardiac Failure Analogy’ of ED overcrowding (developed by members
of the Group, published in medical and nursing journals, and presented at
national conferences and meetings) has allowed the development of a template
for solutions to ED overcrowding. This template has been used in
Christchurch and is contributing to an improvement to ED patient waits,
privacy and comfort.
- The Group is contributing to the development of an innovation in emergency
health care called the ‘Emergency Practitioner Project’. This is based
on research conducted in England and involves ‘up-skilling’ ambulance
paramedics to perform more advanced patient assessments at the patient’s
home. More patient specific interventions can then be instituted, including
alternative community care options.
‘Accuracy’ research is about improving the
diagnostic accuracy of health care professionals involved in Emergency Care.
Meningitis is a well-publicised condition which is misdiagnosed from time to
time. There are many conditions which masquerade under the guise of a more
benign condition - meningitis looking like the ‘flu’, myocardial
infarction (heart attack) looking like indigestion, pulmonary embolism (clots
in the lung) looking like a chest infection or a muscle strain, are a few
The Group has projects in the areas of acute abdominal pain, acute
myocardial infarction and pulmonary embolism and intends to study meningitis
when resources allow. The pulmonary embolism research is ongoing but already
has an international reputation. Much of the Emergency Care Foundation’s
funding has been put towards this research project. Specific improvements in
patient care as a result of this research theme include:
- A specific risk assessment tool has been incorporated into blood test
request forms for patients with possible pulmonary embolism presenting to
Christchurch Hospital Emergency Department. This tool assists doctors
determining which patients can go home and which need further
investigations. The further investigations in question are a form of
scanning of the patient’s chest. These investigations are costly,
involve a wait for the patient, and sometimes cause harm due to radiation,
reaction to injected drugs or incorrect interpretation of the result.
Consequently, the use of these tests should be restricted to those who
really need them. This tool improves the accuracy of test ordering.
- The Pulmonary Embolism research has revealed that a blood test result
helps to exclude the diagnosis of Pulmonary Embolism with a very high
level of accuracy. This result is of considerable international
significance and has resulted in a number of presentations at conferences.
In Christchurch this has allowed the reassurance and discharge of patients
with greater confidence.
- Research into abdominal pain and syncope (collapse) has led to
preliminary plans for acute abdominal pain and syncope clinics. The
research has indicated a potential benefit of these clinics for the prompt
follow-up and investigation of patients with these presentations.
Ethics’ research concerns the process of ethical
decision-making in the Emergency Department and Emergency Care. Professor
Ardagh has a PhD in Bioethics and has continued work in this area, with the
assistance of the Group.
Specific improvements in patient care as a result of
this research theme include:
- The ‘Ethics Toolkit’ for Emergency Care has been constructed and
shared with audiences at conferences and meetings throughout New Zealand,
and in Australia and the United Kingdom. It is regularly used to teach
staff in Christchurch, and to assist with decision-making in individual
cases. It is the subject of interest from an international publishing
house as a potential book to guide Emergency Health Care providers
- Guidelines for the handling of material (clothing etc), the performance
of examinations and procedures, when these things might be the subject of
police investigation, have been produced as an outcome of the research
regarding the Forensic Nurse Practitioner in the Emergency Department.
A further research theme relates to management of the
poisoned patient and, in particular, the use of interventions to prevent the
poison being absorbed into the blood stream (eg. gastric lavage, or stomach
Specific improvements in patient care as a result of this
research theme include:
- This research revealed that gastric lavage (stomach washout/pump) had
limited utility in the management of poisoned patients. Consequently, (and
the publications and presentations of the group made this a consequence
for all New Zealand Emergency Departments), this invasive and unpleasant
procedure is done infrequently now.
- Further research revealed that, although the use of ‘activated
charcoal’ is much better than gastric lavage, supportive care is of
greatest benefit for the poisoned patient.
- A consequence of the poisoning research is that admissions to hospital
are greatly reduced, with most patients having short-term observation
under the care of Emergency Department staff instead. This allows the
patient home much earlier, as well as reducing the use of a limited
In summary, consequences of the research of the EMNRG include many
improvements in patient care and greater efficiencies in resource utilisation.
The Emergency Care Foundation
Our Mission Statement:
To help ensure that Emergency Care is the best it can possibly be.
To date there has been limited research undertaken into the many facets
of emergency care, leaving many important question unanswered of both a
medical and administrative nature. Unfortunately neither hospitals nor
health boards fund this. The Emergency Care Foundation was set up in
December 2003 by Professor Mike Ardagh and Dr Martin Than. Its primary
focus is ‘leadership’ in Emergency Care and answering unsolved question
to benefit all practitioners.
While the term Emergency Care covers the
practice of Emergency Medicine it also includes other aspects of the
management of unwell or injured persons such as first aid, rescue and
pre-hospital care and covers Emergency Care Foundation’s future research
into all aspects of emergency care.
Currently the foundation is
involved in research at the Christchurch Hospital.
Emergency Research - Emergency Department -
Christchurch HospitalThe research is focused upon five important goals.
- Establish solutions
to the problems of people accessing appropriate Emergency Care.
This research will specifically examine methods of reducing waiting
times and overcrowding in Emergency Departments.
- Undertake research leading to improvements in diagnostic accuracy and
decision making in emergency care, particularly in relation to conditions
which can be difficult to diagnose (heart disease, blood clots in the legs
and lungs and infections like meningitis).
- Improve knowledge about the best way to manage a variety of emergency
- Initiate research leading to advancements in relation to ethical
decision-making in emergency care.
- Improve access to emergency care for all those who might need it and
improve the diagnostic and decision-making accuracy of doctors and nurses
working in emergency care.
For more information about the Emergency Care Foundation, please visit
their website www.emergencycare.org.nz