Annual expenditure on health care in Australia amounts to $130 billion – that's more than 9 per cent of gross domestic product. Yet the research that underpins both policy and practice doesn't always stand up to scrutiny.
One area where a huge knowledge gap exists is emergency care.
"Public hospital emergency departments see about seven million patients a year," says Clinical Associate Professor Paul Middleton, who is Chair of the NSW branch of the Australian Resuscitation Council. "Most hospitals collect data on major life-threatening trauma but not anything outside that, such as data on people with chest pains or gastro problems, or on sick children. So we have a large chunk of the Australian population presenting each year at EDs and nobody has any idea of who they are, what was wrong with them, what made them get better, or what made them get worse.
"In NSW there are more than 180 institutions that take emergency patients. Yet it was only last year that the NSW Ministry of Health Emergency Department Data Collection (EDDC) system finally managed to cover more than 50 per cent of these places, and almost none of them were in country areas.
"What's more, NSW and Tasmania do not even have a cardiac arrest register."
Colleague Suzanne Davies, Senior Lecturer in Paramedic Practice at the UTAS School of Medicine's Rozelle campus, chimes in: "... and these EDDCs often come with a rider that warns: 'Please understand that this information is often entered by clerical staff who have no training in data collection'. So whatever clinical data you do have is so flawed that no one will use it.
"It is quite shocking when you look into it – health is the single biggest budget item in the states and Commonwealth yet there is little clinical data to guide our spending."
Assoc Prof Middleton and Ms Davies are developing the innovative Distributed Research in Emergency and Acute Medicine (DREAM) network, which seeks to address this almost total lack of data collection and epidemiology in hospital emergency departments around the country.
"Emergency departments do routinely collect electronic data that is reported nationally but it is very limited and administrative in nature – what time you turned up, which of the five triage categories you were assigned, and what time you left," Ms Davies said.
"So if you're writing health policy and you wanted to know what interventions worked and what didn't, what made patients survive or not, then you have no clinical data on a national level to work with. You would have to approach individual hospitals and attempt to extract data from the medical notes of each person presenting at their EDs."
Assoc Prof Middleton adds: "The clinicians themselves are overburdened. On many occasions large and small studies are designed which depend on either electronic data only, or on the people working in our EDs to collect the data and upload it to a database. But everyone in EDs is under the pump all the time – they don't have the time to do it, and they are not being paid to do it, and as a result many people are really not motivated to take part."
Yet the solution does lie within the EDs, Assoc Prof Middleton suggests.
"In my 20 years of emergency medicine I have found that in every ED there are people who are really taken with the idea of doing research – some are nurses, some are allied health professionals, some are paramedics, some are doctors. But they need to be taught how to do it. It needs to be an incremental teaching process because it is not easy – you must know how to recognise the right data, how to read a published paper, how even to search for evidence, etc.
"The point of the DREAM collaboration is to identify, recruit and find funding for people in every single ED in NSW and Tasmania – initially – that will allow them to devote a fractional amount of their time to collect data. So they will be paid to do that and not just be a clinician. They would be taught research skills through sophisticated e-learning and mentored throughout it all.
"We would create a big permanent network of trained clinical-data collectors, so anything you wanted to know you could ask the network – cardiac, trauma, paediatrics..."
A website is being built which will be the core resource for the collaboration, providing the education and a repository for the data reporting.
Ms Davies is being supported by the University of Tasmania, which has provided funding so she can play her part in making DREAM a reality.