Current projects - Southern Cross University

iSISTAQUIT

Lead Researcher: Professor Gillian Gould

Co-investigators: Professor Brian Oldenburg (La Trobe), Professor Tom Calma (USyd), Dr Marilyn Clarke (SCU), Dr Ratika Kumar (SCU), Professor Chris Doran (CQU), Associate Professor Michelle Kennedy (UON), Dr Chris Oldmeadow (HMRI), Professor Fay Mc Millian (UNSW)

Grant Scheme: Global Alliance for Chronic Disease and NHMRC

Project Summary: Tobacco smoking among Indigenous pregnant women (44% prevalence) is a significant risk factor for a range of cancers and noncommunicable diseases among women and children. Health providers lack confidence, seldom assist pregnant women quit or prescribe suitable pharmacotherapy. iSISTAQUIT (implementing Supporting Indigenous Smokers to Assist Quitting -iSQ) is an evidence-based intervention co-designed with Indigenous communities that provides free, online training in smoking cessation methods to health providers. The main objectives of the proposed study are to perform a comprehensive assessment of scalability and readiness for iSQ, and ultimately scale-up iSQ Australia-wide. An adaptive trial design will be used to test different implementation strategies for iSQ leading to roll-out of the optimal strategy nationally. The research will involve 6 stages. Stage 1 (Scale-up analysis) will use a qualitative approach to explore systemic factors such as organisational readiness, barriers and facilitators for successful iSQ scale up. In Stage 2 (Variation designing), context-relevant strategies for implementing iSQ will be designed and statistically modelled. Stages 3 (Optimisation) and 4 (Roll-out and evaluation) will run concurrently and use an adaptive trial design to identify the best way/s to implement iSQ into routine care, which will be then carried forward to full scale up. Interim analysis will be utilized to assess the best implementation strategy for iSQ using the RE-AIM framework to evaluate the implementation impact across professional groups. Stage 5 (Health Economic Assessment), Framework to Assess the Impact from Translational research (FAIT) will be used to comprehensively explore key economic, research translation and impact assessment questions. The research is completed with a Stage 6 (Contextual factor analysis) to explore the overall success of the SQ implementation, barriers and facilitators via interviews, surveys and focus groups with stakeholders.

Grant Amount: $1.8 million

iSISTAQUIT website

Improving the safety and quality of emergency nursing care

Lead researcher: Kate Curtis

Co-investigators: Fry M, Considine J, Shaban R, AlKhouri H, McPhail S, Dinh M, Aggar C, Hughes J, Murphy M

Grant Scheme: NHMRC partnership grant GNT2005403

Project Summary: Australia’s 287 emergency departments (EDs) see more than 8 million patients a year. Failure to assess, treat comprehensively and escalate appropriately can be catastrophic. Emergency nurses are the first clinicians with whom patients have contact, so patient safety is contingent on their accurate assessment, interpretation of clinical data, intervention and escalation. Particularly as across Australia in 2017-18, only 64% of urgent patients were seen by medical officers within 30mins of ED arrival and were solely in the care of emergency nurses during this time.

Patient assessment and management by Australia’s 29,000+ emergency nurses is hospital dependent and inconsistent resulting in avoidable patient deterioration, poor pain management, poor nursing documentation and patient dissatisfaction with emergency care. We propose a solution - HIRAID (History, Identify Red flags, Assessment, Interventions,

Diagnostics, communication and reassessment). HIRAID is the only validated framework designed to teach emergency nurses how to systematically assess and manage emergency patients. We have successfully piloted HIRAID across rural, regional EDs for usability. In the simulated environment HIRAID improved nurse assessment and communication. We now need a multi-centre RCT to generate the ultimate evidence for embedding of HIRAID into policy and practice.

Over 5 years, our team of Australia’s leading emergency clinician, nurse and health economic researchers will use an effectiveness-implementation hybrid design including a step–wedge cluster RCT across 31 NSW, Victoria and Qld hospitals. We hypothesise that when HIRAID is implemented there will be a 20% reduction in inpatient deterioration events related to emergency nursing care and an increase in patients who report their ED experience as very good. Our partners have been engaged with this proposal since inception and represent several of the key agencies that deliver or support emergency care in Australia.

Grant Amount: $1,498,877.45

HIRAID nursing framework website

A preliminary investigation on the effects of intermittent exposure to hypoxia on glucose homeostasis

Lead Researcher: Associate Professor Mike Climstein

Co-investigators: Adjunct Professor Shi Zhou, Dr Nela Rosic, Dr Rosemary Craig, Dr Kenneth Graham

Grant Scheme: Altitude Training Systems and AirLocker

Project Summary: Southern Cross University health researchers are conducting a research project entitled "A preliminary investigation on the effects of intermittent exposure to hypoxia on glucose homeostasis". There have been recent reports in the literature that intermittent exposure to hypoxia (i.e. breathing air with oxygen levels similar to being at a high altitude), with or without exercise, may have beneficial effects of lowering blood sugar in individuals with type 2 diabetes mellitus, as well as in weight control.

An estimated 1.2 million Australians are living with type 2 diabetes mellitus which is the 12^th leading contributor to Australia’s total disease burden. Type 2 diabetes is a metabolic disorder characterised by high levels of blood glucose (hyperglycaemia), with the mechanisms reported as impaired insulin secretion, insulin resistance, or both. Diabetes is a degenerative disorder, associated with micro- (retinopathy, nephropathy, neuropathy) and macrovascular (heart disease, cardiomyopathy, heart arrhythmias, peripheral arterial disease) complications and can be life-threatening. Pharmacological therapies are available, but often come with side effects. Furthermore, it is well known that current treatments also include healthy dietary habits and physical activity. However, it is hard to maintain this balance, especially for individuals with limited physical capabilities. Therefore, there is a need to find alternative therapies to target metabolic chronic diseases.

The proposed study will investigate the effects of intermittent exposure of mild hypoxia (F_iO₂15%) on blood glucose using an hypoxicator, this level of oxygen concentration is equivalent to the oxygen level at an altitude of 3000 meters.

Grant Amount: Altitude Training Systems $30,500 and AirLocker $50,853

Giving Patients an EPIC-START: An evidence-based, data-driven model of care to improve patient care and efficiency in emergency departments

Researchers: Curtis K, Dinh M, Fry M, Shetty A, Murphy M, Shaw T, Lung T, Alkhouri H, Considine J, Kourouche S, Hughes J, Shaban R, Koprinska I, Aggar C, Varndell W

Associate investigators: Berendsen Russell S, Smith K, Chan T, Hughes D, D’Amato A, Wand T, Ryan K, Mullan J, Murgho M.

Grant Scheme: MRFF Models of Care to Improve the Efficiency and Effectiveness of Acute Care Grant Opportunity Stream 2.

Project Summary: This $2,847,592 project will implement and evaluate EPIC-START with frontline clinicians at 30 EDs to give our patients better access to early evidence-based treatment pathways. EPIC-START seeks to improve patient outcomes through earlier decisions, delivery of care and detection of clinical deterioration by front line ED clinicians and is founded on a significant body of work undertaken by our team and partner organisations over the past 5 years.

The problem: The millions of Australians seeking care in our EDs each year are routinely confronted by overcrowded waiting rooms, ambulance ramping, stressed clinicians and long wait times. It is well known that ED overcrowding causes delays in treatment and diagnosis, leading to adverse events and poor patient outcomes. Current models of care in ED are neither equipped to deal with this reality nor designed to help patients move through ED efficiently in these situations. Access block, a major contributor to ED overcrowding, occurs when an ED patient needs hospital admission, but there are no in-patient ward beds available. Thus, the patient requiring admission is stranded in the ED, and ED capacity to care for incoming patients is compromised. ED overcrowding contributes to poorer quality of care and in some cases, preventable patient deaths. Publicly available hospital bed numbers in Australia have decreased, but ED presentations requiring admission has increased by 25%.

EPIC START will help this situation in 30 NSW EDs. The Early nurse Protocol Initiated Care- Sydney Triage to Admission Risk Tool (EPIC-START) model of care will implement data analytic tools and evidence-based clinical pathways specifically designed to improve patient flow in ED. The model focuses on the three D principles of patient flow: Earlier decision-making, delivery of care and detection of clinical deterioration. Validated decision support tools will be deployed at triage to stream patients to various parts of the hospital, with treatments commenced earlier using standardised nurse-initiated pathways across all common illnesses presenting to ED. Those who deteriorate despite early interventions will be flagged to senior doctors using electronic alerts based on data in the electronic medical record. This will improve efficiency and safety in ED.

“Our vision is to ensure all Australians have timely access to high quality and patient centred emergency care, by using sustainable, evidence-based and data-driven approaches to innovation in our EDs.”

Grant Amount: $2,847,592.26

Announcement Publication EPIC-START to patient care flow

Health student preparation for interprofessional practice

Lead Researcher: Dr Andrew Woods

Co-investigators: Naumann F, Aggar C, Newman D, Bowen K, Sorwar G, Clark D

Grant Scheme: SCU Faculty of Health Collaborative Research Grant

Project Summary: The recognition of patient deterioration and escalation processes are multifaceted and relevant to all health clinicians involved in patient care. Delays in activating emergency response systems or escalation of care are associated with adverse health outcomes and longer hospital stay. Failure to activate response systems or escalate care has also been associated with social-cultural factors and health workforce inter-professional hierarchies. In the Australian rural health context there are limited opportunities to communicate with staff across health disciplines beyond the everyday practice environment. In 2021, research conducted by the Northern NSW Local Health District identified staff confidence increased through interprofessional teamwork and experience in recognising and responding to deteriorating patients. Supported by the NSW Health Rural Research Capacity Building Program, nursing clinician and Masters of Research student Deborah Newman led a collaborative IPE-based research project named In Sync. A collaboration between NNSW LHD, SCU FoH staff, SCU Faculty of Science and Engineering staff and honours student, David Clark, the In Sync pilot explored the implementation of IPE learning for healthcare professionals using online and mixed reality (MR) technologies (Newman et al 2023). These technologies included Microsoft Hololens 2 and GigXR’s software Holopatient. Being a new mode of simulation learning, David’s IT-focused research explored the MR user experience and acceptance (Clark et al., 2023). Associated with the project, industry discussions with software developers have explored potential implementation of AI technology and applications to rehabilitative and community-based contexts.

The aim of this project is to extend the use of immersive mixed-reality learning to SCU Faculty of Health (FoH) and Bond University (BU) students (medical, nursing, midwifery, speech pathology and occupational therapy) through interprofessional learning (IPE) contexts using GigXR’s Holoscenarios.

Grant Amount: $10,000.

Rainbow-Inclusive Aged Care

Co-creating rainbow inclusive care for gender and sexually diverse people in residential aged care

Chief Investigators: Prof Mark Hughes (SCU), Dr Andrea Waling (La Trobe), Prof Limin Mao (UNSW), Prof Ruth Hubbard (UQ), Dr Lukasz Krzyowski (ECU), Dr Craig Sinclair (UNSW), Dr Kristiana Ludlow (UQ), Dr Benignus Logan (UQ), Prof Adam Bourne (La Trobe).

Associate Investigators: Samantha Edmonds (Older Persons Advocacy Network), Dr Maria Pallotta-Chiarolli (GSE Tapestry Consulting), Dr Amber Mills (Australian Association of Gerontology), Jami Jones (Rainbow Health Australia), Pauline Crameri (Val's LGBTI Ageing and Aged Care).

Industry/community partners: Wesley Mission Queensland, Amana Living (WA), Older Persons Advocacy Network, Australian Association of Gerontology, Aged and Community Care Providers Association, LGBTIQ+ Health Australia, GLBTI Rights In Ageing Inc.

Grant Scheme: Medical Research Future Fund (MRFF) - 2023 MRFF Models of Care for Sexuality and Gender Diverse People & People with Innate Variations of Sex Characteristics - Stream 2.

Project Summary: This project will explore inclusive care for gender and sexually diverse people in residential aged care. It will follow an Appreciative Inquiry approach and utilise practice theory to identify what enables and constrains inclusive care. Co-creation, co-design, and co-research methods with LGBTQ+ individuals as active participants will shape the project and its outcomes. It will involve a national survey of residential aged care workers and field research in two project sites (Queensland and Western Australia), involving two aged care providers and up to 19 residential care homes.

Communities of practice will be established in both states to bring together stakeholders, people with lived experience expertise, and researchers. A national survey, observations in residential homes, and interviews with residents, staff, and other stakeholders will be conducted to investigate the constraints on and enablers of inclusive care. These findings will be interpreted in the communities of practice and a shared vision for a rainbow-inclusive model of care will be created through focus groups and organisational summits. A series of co-design workshops will develop resources and guidelines to support implementation. The model will then be implemented and evaluated in partner residential homes, with the learning and resources refined and disseminated to the aged care sector.

The study aims to provide evidence-based recommendations and resources to promote the inclusion of gender and sexually diverse people in residential aged care and provide a foundation for improving their health outcomes. By involving LGBTQ+ people as co-researchers and utilising a collaborative approach, the project will ensure the rainbow-inclusive model will be effective in achieving the goal of inclusive care. Incorporation of implementation science will facilitate translation of research findings into practice and minimise the lag between generating knowledge and its application in the aged care sector.

Grant Amount: $999,533 over 5 years (2024 to 2028).

Rainbow Inclusive Aged Care Website