Background
Healthcare disparities for Indigenous Australians are well documented. However, there is no information on how Indigenous Australians presenting to the emergency department (ED) with pain are treated and if this differs from other populations.

Aim
To identify the prevalence, treatment and outcomes of pain care for Indigenous Australians in the ED compared to Non-Indigenous Australians.

Method
This study combines data linkage with applying a clinical text deep learning model to identify patients presenting in pain over three years at an inner-city ED. Descriptive statistics and bivariate analysis were utilised to determine if there was an association between patients’ Indigenous background, the provision of analgesia and time to the first analgesic medication (TTA). Multivariate modelling was then used to control for confounding factors based on previous applications of Symptom Management Theory to pain care in the ED.

Results
Indigenous Australians were more likely to receive analgesia (OR1.09, 95%CI 1.03-1.15, p=0.002) and opioids (OR1.10, 95%CI 1.04-1.17, p<0.001) than non-Indigenous Australians. Indigenous Australians also had a quicker TTA than non-Indigenous Australians (HR 1.04, 95%CI 1.00–1.08, p=0.077). However, when controlling for age, gender, socioeconomic status and emergency department workload, these associations are no longer seen.

Conclusion
There is no relationship between a patient’s Indigenous status and the pain care they receive in ED. The factors that impacted their pain care represent social determinants of health (SDH), and the EDs workload. SDH are more prevalent in the Indigenous population and impacts the care they receive upon arrival to ED in pain.

Introduction: Blunt chest injuries result in up to 10% of major trauma admissions. Comorbidities, such as chronic pulmonary disease, can complicate recovery and increase the mortality rate in this patient cohort. A better understanding of the association between comorbidities and patient outcomes will facilitate enhanced models of care for particularly vulnerable groups of patients, including older adults and patients with lung disease.
Aim: To describe the association of comorbidities with the health outcomes of major trauma patients with blunt chest injuries in New South Wales (NSW), Australia.
Methods: A retrospective cohort study using linked data from the NSW Trauma Registry and NSW mortality and hospitalisation records between 1st of January 2012 and 31st of December 2019.
Results: Blunt chest injuries were present in 42.2% of the 22,755 patients. Severely injured patients with blunt chest injury and a higher number of comorbidities, a higher length of stay (LOS), a higher prolonged LOS rate, longer intensive care unit (ICU) stay, and a higher rehabilitation admission rate when compared to patients with blunt chest injury with no or lower comorbidities. Patients with chronic pulmonary disease had a higher LOS (OR 0.41 95% CI 0.26-0.57) and ICU stay (OR 0.36, 95%CI 0.15-0.58) when compared with patients without chronic pulmonary disease.
Conclusion: Patients with blunt chest injury and comorbidities, particularly chronic pulmonary disease, are at risk of poorer outcomes including extended intubation times and increased hospital LOS. Multidisciplinary management of chest injury patients with comorbidities should be considered in any trauma care pathways.

Background/Introduction: Hip fracture is the most serious fall-related injury suffered by older people. The human cost is high; 25% of patients are dead at one year, 50% do not regain their previous level of function. Compliance with the Australian Commission on Safety and Quality in Health Care Hip Fracture Standard, which consolidates the best available evidence for managing this patient group is inconsistent and hospital-dependent. So, we developed eHIP. eHIP activates a rapid, multidisciplinary response to the ED, actions evidence-based treatment and streamlines admission.

Aim: To implement and evaluate the impact of Early activation HIP Fracture Care Bundle (eHIP) on patient and health service outcomes.

Methods: eHIP was embedded in routine care using implementation science. We addressed 83 barriers using 41 behaviour change techniques assessed using Affordable, Practical, Effective, Acceptable, Side-effects (APEASE) criteria. The predominant mechanisms were: 1) formal policy outlining eHIP responder roles 24/7; 2) video promotion https://youtu.be/oAwJXpDTd7A 3) pager group; 4) fascia iliaca block; 5) eMR modifications; 6) face to face reinforcement and modelling; 7) communication and prompts. The uptake and impact of eHIP was measured pre- and post.

Results: 87.6% of eligible patients received eHIP. The number of Fascia Iliaca blocks increased by 24%. Patients mobilised post operatively within 24h doubled. Pressure injuries reduced. Charting of appropriate pain relief improved by a factor of 11. These improvements have been sustained for 2 years.

Conclusion/Recommendations: The use of behaviour change theory to implement evidence in the ED results in sustained, improved patient care.