Dispatchers impression plus Medical Priority Dispatch System reduced dispatch centre times in cases of out of hospital cardiac arrest. Pre-alert--a prospective, cluster randomized trial

Streamlining Telecommunications Center and Interfacility Patient Throughput to a Pediatric Emergency Department by Utilizing an Electronic Handoff: A Quality Improvement Initiative

OBJECTIVE

Effective handoffs are critical for patient safety and high-quality care. The pediatric emergency department serves as the initial reception for patients where optimal communication is crucial. The complexities of interfacility handoffs can result in information loss due to lack of standardization. The aim of our project was a 50% reduction in monthly calls routed through the communication center from 157 to 78, for interfacility transfers to the emergency department from outpatient sites within our organization over a 1-year period, through utilization of an electronic handoff activity.

METHODS

We designed a quality improvement project in a tertiary care pediatric hospital to improve the process of interfacility transfer. The initiative aimed to streamline the transfer of patients from ambulatory, urgent care, and nurse triage encounters to the pediatric emergency department by using the electronic health record. The primary outcome measure was number of monthly calls received by the telecommunications center for these transfers.Our process measure was tracked by measuring the utilization of the electronic handoff. In addition, the number of safety events reported because of information lost through using the electronic handoff served as a balancing measure.

RESULTS

One year after the enterprise-wide rollout of the handoff, the telecommunications center was receiving an average of 29 calls per month versus 157 at time of study initiation, a decrease of 81.5%. Monthly usage increased from zero to an average of 544 during the same period. The project was continued after the initial 12-month data collection and demonstrated stability.

CONCLUSIONS

Our initiative facilitated the safe and efficient transfer of patients and streamlined workflows without sacrificing quality of patient care. Our telecommunications center has been freed up for other tasks with fewer interruptions during patient throughput. Next steps will analyze the encounters of transferred patients to further optimize patient flow at our organization.

Impact of an emergency medical dispatch system on survival from out-of-hospital cardiac arrest: a population-based study

Background

In countries where a single public emergency telephone number is not in operation, different emergency telephone numbers corresponding to multiple dispatch centres (police, fire, emergency medical service) may create confusion for the population about the most appropriate service to call. In particular, out-of-hospital cardiac arrest (OHCA) requires a prompt and effective response. We compare two different dispatch systems on OHCA patient survival at 30 days in a national system with multiple emergency telephone numbers.

Methods

We conducted an observational retrospective study of 6871 patients aged 18 years or older with presumed OHCA of cardiac origin between 2005 and 2013 in three counties of the Northern French Alps region. One county had a single dispatch centre combining medical and fire emergencies, and two had multiple dispatch centres. Propensity score matching analyses were performed to compare patient survival at 30 days.

Results

A total of 2257 emergency calls for OHCA were managed by a single dispatch centre and 4614 by a multiple dispatch centre. A single dispatch centre was associated with an increase in survival (adjusted odds ratio [OR] for all patients: 1.7; 95 % confidence interval [CI] = 1.3–2.2; p <0.001; adjusted OR for propensity-matched patients: 2.0; 95 % CI = 1.2–3.4; p = 0.012).

Conclusions

A single dispatch centre was associated with a markedly improved increase of survival among OHCA patients at 30 days in a system with several emergency telephone numbers.

Electronic supplementary material

The online version of this article (doi:10.1186/s13049-016-0247-y) contains supplementary material, which is available to authorized users.

Emergency dispatch process and patient outcome in bystander-witnessed out-of-hospital cardiac arrest with a shockable rhythm

Objective

To describe the dispatch process for out-of-hospital cardiac arrest (OHCA) in bystander-witnessed patients with initial shockable rhythm, and to evaluate whether recognition of OHCA by the emergency medical dispatcher (EMD) has an effect on the outcome.

Methods

This study was part of the FINNRESUSCI study focusing on the epidemiology and outcome of OHCA in Finland. Witnessed [not by Emergency Medical Service (EMS)] OHCA patients with initial shockable rhythm in the southern and the eastern parts of Finland during a 6-month period from March 1 to August 31 2010, were electronically collected from eight dispatch centres and from paper case reports filled out by EMS crews.

Results

Of the 164 patients, 82.3% (n=135) were correctly recognized by the EMD as cardiac arrests. The majority of all calls (90.7%) were dispatched within 2 min. Patients were more likely to survive and be discharged from the hospital if the EMS response time was within 8 min (P<0.001). Telephone-guided cardiopulmonary resuscitation (T-CPR) was given in 53 cases (32.3%). Overall survival to hospital discharge was 43.4% (n=71). Survival to hospital discharge was 44.4% (n=60) when the EMD recognized OHCA and 37.9% (n=11) when OHCA was not recognized. The difference was not statistically significant (P=0.521).

Conclusion

The rate of recognition of cardiac arrest by EMD was high, but EMD recognition did not affect the outcome. The survival rate was high in both groups. Recognized cardiac arrest patients received bystander CPR more frequently than those for whom OHCA remained unrecognized.

Part 3: Adult Basic Life Support and Automated External Defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

This review comprises the most extensive literature search and evidence evaluation to date on the most important international BLS interventions, diagnostics, and prognostic factors for cardiac arrest victims. It reemphasizes that the critical lifesaving steps of BLS are (1) prevention, (2) immediate recognition and activation of the emergency response system, (3) early high-quality CPR, and (4) rapid defibrillation for shockable rhythms. Highlights in prevention indicate the rational and judicious deployment of search-and-rescue operations in drowning victims and the importance of education on opioid-associated emergencies. Other 2015 highlights in recognition and activation include the critical role of dispatcher recognition and dispatch-assisted chest compressions, which has been demonstrated in multiple international jurisdictions with consistent improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS treatment recommendations, the importance of high quality was reemphasized across all measures of CPR quality: rate, depth, recoil, and minimal chest compression pauses, with a universal understanding that we all should be providing chest compressions to all victims of cardiac arrest. This review continued to focus on the interface of BLS sequencing and ensuring high-quality CPR with other important BLS interventions, such as ventilation and defibrillation. In addition, this consensus statement highlights the importance of EMS systems, which employ bundles of care focusing on providing high-quality chest compressions while extricating the patient from the scene to the next level of care. Highlights in defibrillation indicate the global importance of increasing the number of sites with public-access defibrillation programs. Whereas the 2010 ILCOR Consensus on Science provided important direction for the “what” in resuscitation (ie, what to do), the 2015 consensus has begun with the GRADE methodology to provide direction for the quality of resuscitation. We hope that resuscitation councils and other stakeholders will be able to translate this body of knowledge of international consensus statements to build their own effective resuscitation guidelines.

Pre-hospital emergency medicine

Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care.