Peter Jones

Emergency departments across Australia and Aotearoa New Zealand provide care to nearly 11 million patients annually, yet only a small proportion of care is supported by high‐quality evidence. Identifying unanswered research questions that matter most to patients, consumers, whanau, carers and clinicians is essential to reducing research waste and duplication and improving emergency care. The Australasian College for Emergency Medicine, through its Clinical Trials Network, is undertaking a Priority Setting Partnership with the James Lind Alliance and supported by the College of Emergency Nursing Australasia and College of Emergency Nurses New Zealand to establish a prioritised research agenda for emergency care over the next five to 10 years. Using a transparent, evidence‐informed process, the partnership aims to ensure research reflects the diverse needs of communities across both countries, including groups historically under‐represented in research. Meaningful participation of consumers and clinicians will be essential to translate these priorities into research, funding and improvements in emergency care.

Objective: The primary aim of this project was to test the feasibility of collating valid and useful ED data to inform the future establishment of a binational (i.e., Australia and Aotearoa New Zealand) clinical registry for emergency care. A secondary aim of this project was to utilise multi‐site ED data to assess the crude impact of COVID‐19 restrictions on overall ED presentations. Methods: This was a retrospective observational study using data routinely collected by EDs. The inclusion criteria were all patients presenting to participating EDs between 2017 and 2020. The primary outcome was data completeness. The secondary outcome was the number of ED presentations. Variables for which there was at least 80% data completeness across all participating sites were eligible for simple demonstrations of multi‐jurisdictional analyses. Results: There were data for 11 ED networks and 4,405,762 ED presentations. There were just nine variables which met the 80% completeness cutoff: network and site identification, birthdate, gender, First Nations self‐identification, ED arrival date and time, ED arrival mode, triage category, ED triage date and time. Compared to the expected number of overall annual ED presentations, there was a reduction of 16% (95% CI 14% to 17%) in the actual number of overall ED presentations in 2020. Conclusions: Data completeness for routinely collected data collated from multiple sites was satisfactory for just a small number of variables. These findings inform the opportunities and challenges to establishing a binational clinical registry for emergency care.

Introduction: There is uncertainty around optimal haemodynamic management of community acquired septic shock presenting to the Emergency Department (ED), with current guidelines based on low quality evidence. Prior reviews have included mostly patients with hospital-acquired sepsis in the ICU who have received significant fluid resuscitation prior to randomisation. This review will assess whether restricted fluid administration with earlier vasopressor introduction, compared to liberal fluid administration with the potential for later vasopressor introduction, is associated with reduced mortality and improvements in other outcomes in ED patients with early septic shock. Methods: Systematic review and meta-analysis of randomised controlled trials, conducted according to the PRISMA guidelines. There will be no restriction on language, year of publication or publication status. The population will be adult patients predominantly presenting to ED with septic shock. The intervention will be early vasopressor / restricted fluid resuscitation compared to more liberal fluid resuscitation / later vasopressors. The primary outcome is all cause 90-day mortality, with secondary outcomes related to adverse events, ICU interventions, functional status and quality of life up to six months. We will conduct subgroup analyses by pre-randomisation fluid volume and whether timing of initial vasopressor use was pre-specified. We will search major medical databases using structured searches. Studies will be screened for inclusion by two reviewers independently. Data will be extracted onto standardised forms by two reviewers independently. Differences on inclusion and data extraction will be resolved by consensus. A Bayesian framework will be used as the primary statistical approach, and a frequentist framework as the secondary approach. A random-effect model will be used in the analyses and pooled estimates of effect sizes as risk ratios (RRs) for binary outcomes, and mean differences for continuous outcomes will be presented. We will assess risk of bias using the Cochrane Risk of Bias tool (RoB-2) and assess for publication and incomplete outcome reporting. Certainty of evidence will be assessed using the GRADE approach. Results: We will present the results of the review at national and international scientific meetings, and we will prepare a manuscript for submission for publication in a peer reviewed journal. Version (date): V 7.3 (8/8/25) Registration: The protocol was registered with the prospective register of systematic reviews (PROSPERO) and published online on the pre-print server MedRxiv.org on 27th August 2025. Contributions: PJ is the guarantor. PJ, AD, AH, SP and SM drafted the manuscript. All authors contributed to the development of the selection criteria, the risk of bias assessment strategy and data extraction criteria. LR, PJ, AH and AD developed the search strategy. AS provided statistical expertise. All authors read, provided feedback and approved the final version of the protocol. Support: No specific funding was received for this project. Alisa Higgins is supported by an NHMRC investigator grant.

Background: Quality improvement activities targeting low‐value care are important to ensure that scarce healthcare resources are used responsibly. However, there has been little systematic research into what diagnostic testing is considered by emergency department (ED) clinicians to be at risk of unwarranted variation or potentially low value.Objectives: This study aimed to determine the views of ED clinicians on which diagnostic tests are highest risk for variation and/or low‐value care.Methods: A voluntary electronic survey was distributed to emergency clinicians across Australia and Aotearoa New Zealand. Respondents were asked to identify which investigations were high risk for unwarranted variation and/or low value.Results: There were 184 responses (75 doctors, 82 nurses, and 27 other) analysed. Investigations identified included D‐dimer (42%), venous blood gas (VBG) (39%), C‐reactive protein (CRP) (35%), and plain x‐rays of the abdomen (35%). Compared to nursing staff, medical staff perceived CRP (51% vs. 24%), urine drug screening (55% vs. 21%), clotting profile (48% vs. 24%), salicylate level (29% vs. 7%), erythrocyte sedimentation rate (41% vs. 10%), and abdominal x‐ray (67% vs. 16%) at higher risk. D‐dimer and VBG were seen to be high risk by both groups. Routinely ordered tests (e.g., full blood examination) were considered relatively low risk.Conclusions: Several commonly used investigations are perceived to be at high risk of unwarranted variation or low‐value care. These risks are perceived differently by different groups of emergency clinicians. Potential future directions include understanding the reasons for variation and efforts to reduce variation, including audit and feedback.

Introduction International consensus guidelines support the initial administration of 30 mL/kg of intravenous fluids for haemodynamic resuscitation of newly diagnosed septic shock. Practice variation exists between the volume of fluids administered and timing of vasopressor commencement. The optimal approach in patients with septic shock is uncertain. Methods and analysis Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In emergency Department Sepsis is a 1000-participant multicentre, randomised, open-label, parallel group clinical trial conducted in patients with septic shock presenting to the emergency department in participating sites in Australia, New Zealand and Ireland. Participants are randomised (1:1) to either restricted fluids and early vasopressors or a larger initial intravenous fluid volume and later vasopressors. The primary outcome is days alive and out of hospital at day 90 postrandomisation. Secondary outcomes are all-cause mortality at day 90, time from randomisation until death (to day 90), days alive and at home at day 90 and ventilator-free, vasopressor-free and renal replacement-free days to day 28 postrandomisation and death or disability at 6-month and 12-month postrandomisation. Health-related quality of life will be assessed at day 180 and 12 months following randomisation. Ethics and dissemination The study was approved by Northern Sydney Local Health District Human Research Ethics Committee (HREC2020/ETH02874) on 21 January 2021. Patients will be enrolled under a waiver of prior consent. The patient or next-of-kin (or equivalent according to local jurisdiction) is approached at the first available opportunity and given a trial information sheet. According to local approvals, the patient or next-of-kin chooses to either continue in the trial or opt-out/decline continued participation. Results will be disseminated in peer-reviewed journals and presented at academic conferences. Trial registration number NCT04569942

Objectives: To evaluate the impact of persistent opioid use (POU) following surgery or trauma on health outcomes using linked data. Background: Surgery and trauma can lead to POU, characterized by continuous opioid consumption following hospital discharge. Outside the United States, there is a lack of population-based studies on POU outcomes in opioid-naive patients following these events. Methods: We included opioid-naïve patients who have dispensed opioids after being discharged following admission for surgery or trauma to any New Zealand (NZ) hospital from 2007 to 2019. Differences in outcomes between individuals with and without POU were assessed between 180 and 360 days after discharge. The primary outcome was all-cause mortality, the secondary outcomes were all-cause and opioid-related hospitalization, and Days Alive and Out of Hospital (DAOH). Cox and quantile multivariable regression models were used to examine the association between POU and outcomes. Results: Overall, 298,928 surgical and 206,663 trauma patients were included in the final analyses, and 17,779 (5.9%) surgical and 17,867 (8.6%) trauma patients developed POU. POU was significantly associated with increased risk of all-cause mortality (surgical, aHR=6.59; 95% CI: 5.82–7.46; trauma, aHR=2.77; 95% CI: 2.47–3.11), all-cause hospitalization (surgical, aHR=2.02; 95% CI: 1.95–2.08; trauma, aHR=1.57; 95% CI: 1.52–1.62), opioid-related hospitalization (surgical, aHR=2.49; 95% CI: 2.24–2.76; trauma, aHR=1.89; 95% CI: 1.73–2.05) and reduced DAOH. Conclusions: Among opioid-naive patients who received opioids after surgery or trauma, POU was associated with worse outcomes, including increased mortality. Further investigation is warranted to understand the reasons for continued opioid use beyond 90 days and mechanisms associated with harm.

Over 10 million ED visits occur each year across Australia and Aotearoa New Zealand. Outside basic administrative data focused on time‐based targets, there is minimal information about clinical performance, quality of care, patient outcomes, or equity in emergency care. The lack of a timely, accurate or clinically useful data collection represents a missed opportunity to improve the care we deliver each day. The present paper outlines a proposal for a National Acute Care Secure Health Data Environment, including design, possible applications, and the steps taken to date by the Australasian College for Emergency Medicine ED Epidemiology Network in collaboration with the College of Emergency Nursing Australasia. Optimal use of the existing information collected routinely during clinical care of emergency patients has the potential to enable data‐driven quality improvement and research, leading to better care and better outcomes for millions of patients and families each year.