Doctors and nurses spend years at university, ensuring they are equipped with all the knowledge to help and care for their patients. But like all professions, health care evolves, and changes, and new training and education is required.
A new research project based at Redland Hospital will aim to do just that for emergency clinicians and has the potential to not only help patients but also save the health system and in turn the taxpayer thousands of dollars each year.
Led by Redland Hospital emergency clinician Dr Henry Tsao, the project entitled: Laboratory stewardship of C-reactive protein in the emergency department, will audit data of emergency presentations to the Redland Hospital emergency department (ED) to assess incidence of whether C-reactive protein tests were ordered for patients unnecessarily.
“As you can imagine, we order a lot of tests, blood tests, imaging et cetera, some of which are indicated, some of which are not indicated,” Dr Tsao said.
“When it's indicated, it's great because it informs us in terms of the patient's diagnosis, their treatment, and also where they're going to go in the hospital.
“The problem is when it's not indicated and you get a positive test. Often what we found is that when a test is not indicated and it's ordered unnecessarily, and it ends up being positive, doctors and clinicians find it difficult to ignore. This often leads to inappropriate medical imaging including X-rays, CT scan, ultrasounds and MRI's which are associated with risks such as radiation risk.
“There's also the risk of finding incidental lumps and things that would not have caused any problems but now that you know you need to do something about, which may be associated with harm. For C-reactive protein, it is a non-specific inflammatory marker.
“We use it mainly for sepsis, but when it's elevated outside of sepsis, often doctors or clinicians will see that as a sign to prescribe antibiotics.”
The study of the data has the care of patients front of mind and came about as a result of the review of a patient who was cared for by the Redland ED. The study is also as much about reaffirming to doctors or making them more aware of what’s already outlined in existing guidelines but also updating the knowledge of and giving experience to doctors who have come from overseas.
“It's really hard because in emergency often there's a view that when we take bloods from a patient, we like to order all the tests straight away as this helps with flow.
“For most people that come through the ED, it's very rare that they don't get at least a blood test to look at their full blood count, electrolytes and renal function.
“We do educate doctors about what and when it is necessary to do certain tests but sometimes that slips through the gap.
Dr Tsao stressed that in many cases the tests are necessary and useful, but the research, which he hopes to eventually expand to eventually incorporate multiple Metro South Hospitals is about gathering the data to empower staff to make more measured decisions with regards to ordering tests.
“It's trying to just inform us about if there is harm as a result of the tests being ordered, hopefully that then provides further impetus to try and avoid or minimise some of this unnecessary testing in the future,” he said.
“The impact of this kind of research is really to try and educate doctors about the fact that for testst we do in the emergency department, , without the proper indications, can potentially lead to harm and obviously costs for the health system.
“I guess for a doctor, costs are not something we think of at the forefront of our brain while working, but certainly for the health system there is always a cost.
“As part of this study we also are doing a health economic analysis to show when a test is unnecessary, it's not just the cost of doing that test, but it's also the added cost of doing extra imaging and prescriptions medicines.
You can make important research like Dr Tsao’s study a reality by choosing the Redland Hospital Fund as your place to give here.
