Although hyperbolized in media, resuscitation is an infrequent requirement in Emergency Departments. More than 8 million patients presented to Australian public hospital emergency departments in 2017–18, yet only 60,000 needed immediate attention and resuscitation. This represents 0.75% of all ED presentations. Of these 8,500 were severely injured, indicating trauma resuscitation represents one in 1000 (0.10%) of all ED presentations and only one in seven (14%) of all ED resuscitations in Australia. Similarly, the United States reports 140,000,000 Emergency Department attendances per annum, with 4.5 million requiring immediate or emergent attendance and only 2.0 million requiring subsequent admission to a critical care unit (1.4%). Resuscitation is, therefore, an infrequent requirement for ED attendance and, as a result, emergency health practitioners are irregularly involved in resuscitation. Not only is resuscitation infrequent, is high risk. Not surprisingly, errors are common. The low resuscitation case incidence, the infrequent emergency health provider resuscitation exposure, the clinical and regional variability in outcomes and the related time pressures all increase the risk of error during resuscitation. We wish to leverage off the success of The Alfred's TRR trauma Computer-Assisted, Resuscitation Decision Support Systems (CARDSS) resuscitation system and assess the applicability and impact in other high-risk resuscitation settings. Cognitive aides have been shown by my group and others to mediate the deleterious effects of human factors. A single tool for decision-making that can adequately target resuscitation, a combination of physiological parameters, communication, cognitive aids and documentation is important for quality care. With the use of error prevention software, real-time information can be provided to the personnel at hand to provide the right level of advice to treat the patient. The project's primary objective, therefore, is to reduce preventable morbidity and mortality through the broader development and introduction of CARDSS. Standardization of clinical procedures will extend the existing research and teaching in trauma resuscitation against other domains of resuscitation care. The key resuscitation clinical domains to be included are Cardiac, Stroke, Sepsis, Trauma, Pediatrics, Toxidrome and Obstetric emergencies. The Proposed Research Objectives therefore are: 1) Standardization of clinical procedures required for resuscitation, 2) Develop CARDSS algorithms and reference data, 3) Improved clinical outcomes with less variability amongst the clinicians and facilities involved, 4) The development and collection of a corresponding multicenter dataset to research the impact of single and combined resuscitation interventions, 5) The use of the database/metadata for machine-learning modification of the underlying algorithms and 6) The trialing of the developed CARDSS across regional, remote, and international sites. This project will be specifically related to Cardiac Emergencies.
Resuscitation, Computerized Decisions Support, Cardiac Emergencies
Alfred Hospital Melbourne
Yesul Kim, Research and Development Manager, National Trauma Research Institute