The Rural Acute Hospital Data Register (RAHDaR)

Timeline: June 2017 to April 2018

Lead Investigator: Associate Professor Tim Baker

Associate Professor Tim Baker is an Emergency Physician at one regional, one small rural, and one remote emergency department. He is Director of Deakin University’s Centre for Rural Emergency Medicine. With his team, he publishes research on rural emergency care and contributes to ACEM, government, and non-government committees. He teaches medical students, junior doctors, fellowship trainees, and other rural clinician groups. He is interested in the knowledge, skills, and attitudes required for excellent rural emergency practice.

Study investigators and primary affiliations

Associate Professor Tim Baker, Centre for Rural Emergency Medicine, Deakin University

Kate Kloot, Centre for Rural Emergency Medicine, Deakin University

Description of study

Large Victorian Hospitals are required to report detailed demographic, clinical and patient flow data on every emergency patient they treat. Smaller hospitals are not. This missing data leaves a gap in our understanding of rural and regional emergency care. The RAHDaR database aims to collect, collate, and compare detailed data from every emergency care facility in South West Victoria, big or small (approximately 60,000 presentations across 12 facilities each year). This data can be used to understand how small facilities function, and how all facilities combine to function as a region. It can assess patient outcomes and assess interventions.

Study completion

RAHDaR is now a live database with full ongoing ethical approval from South West Healthcare Ethics Committee (SWHC 2017-23) and Deakin University Human Research Ethics Committee (DUHREC 2018-032). All emergency presentation data from each of the above hospitals is being collated into the database. This VEMD-equivalent data is mainly from Trakcare, however data in other formats is also being field-matched (where available) and collated.

The first two research projects using the data register have received full ethical approval from both committees and have commenced with data collection:

An observational study of the carbon footprint of rural health services interhospital patient transfers (SWHC LNR/18/SWH/1; DUHREC 2018-065), and
Workload at Rural Emergency Care Facilities – Workload Variability (SWHC LNR/18/SWH/2; DUHREC 2018-066.

Discussions have commenced with the Department of Health and Human Services regarding having the database recognised within the Centre for Victorian Data Linkage. Discussions have also taken place with Ambulance Victoria on the use of RAHDaR data to monitor the impact of pilot interventions, such as new clinical practice guidelines, prior to implementation of these interventions statewide.

Lessons from this study

Extensive consultation was undertaken with South West Healthcare Ethics Committee and Deakin University Human Research Ethics Committee regarding processes to ensure ethics approval was appropriate for the initial database approval, and then minimal effort would be required for future projects using RAHDaR data. Development of standardised data request forms and CEO letters have resulted in a more streamlined system of ethical review as each project is more easily understood – a system appreciated by the South West Healthcare Ethics Committee. Investigation of other large database procedures, such as VSTORM, were undertaken, and this led to development of processes and procedures from early in the project. These have assisted in standardising systems for determining the information available and methods for extraction for future research studies.

Future plans

Discussions have commenced with the Department of Health and Human Services to have RAHDaR recognised within the Centre for Victorian Data Linkage (CDVL). The CVDL provides linkable data to researchers and policymakers to support evidence-based improvements in planning and service delivery, develops new data linkage capacity in Victoria, and facilitates researchers to undertake innovative research using linkable data drawn from existing datasets.

Expansion of the project to encompass all Western region hospitals is planned. This would include to recruitment of all 16 Grampians region hospitals, two of which (Ballarat and Horsham) are currently mandated to collect VEMD data. There are potential problems to overcome, including significant distance between hospitals, a lack of a common software system, and less familiarity with VEMD collection that may result in poorer data quality.

Translational impact

In this initial 12-month project, benchmarked reports have been completed and sent to health services at 6 and 12 months. These reports highlight areas such as timing and urgency of presentations, common conditions and transport to and from the facility. This information can then be used as a basis for change aimed at improving in patient care. Subsequent reports from the database will allow monitoring of improvements and a solid foundation for workforce planning.

The research projects based on RAHDaR database will allow a deeper understanding of how rural emergency care functions, and how it may function better. The initial research project on workload and overcrowding may lead to flexible staffing that can better meet patient need while preventing clinician burnout.

Data from RAHDaR will also allow for evaluation of changes to Ambulance Victoria clinical practice, particularly the introduction of new skills and practice in rural areas, as the patient journey from pre-hospital setting through to hospital management can be tracked.

Publication and dissemination

Conference presentation:

Baker, T. (2017) ‘Rural Acute Hospital Data Register (RAHDaR): Preliminary results’. Paper presented to Western Alliance Fourth Annual Symposium – Building Research Capacity in Regional and Rural Health Care: Victories and valedictories, values and virtues, Geelong, 6-8 September, 2017.

Reports:

Rural Acute Hospital Data Register Report: February – June data, and July- December data. Individual hospital reports for each timeframe submitted to: South West Healthcare Camperdown, Colac Area Health, Western District Health Service, Lorne Community Hospital, Moyne Health Service, Otway Health, Portland District Health, Terang and Mortlake Health Service, Timboon and District Health Service, and South West Healthcare Warrnambool.

Manuscripts in preparation:

Kloot, K and Baker, T. The development of RAHDaR (Rural Acute Hospital Data Register) in South West Victoria.

Intended journal submissions:

An observational study of the carbon footprint of rural health services interhospital patient transfers
Workload variability in small rural hospitals in South West Victoria
Overcrowding and access block in rural Victorian hospital
Seasonal variability: a comparison of Urgent Care Centre and Emergency Department presentations in rural Victoria.