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Lindridge J, Edwards T, Blackwood L. Advanced paramedics' restraint decision-making when managing acute behavioural disturbance (ABD) in the UK pre-hospital ambulance setting: A qualitative investigation. PLoS One 2024; 19:e0302524. [PMID: 38753728 PMCID: PMC11098407 DOI: 10.1371/journal.pone.0302524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
Acute behavioural disturbance (ABD), sometimes called 'excited delirium', is a medical emergency. In the UK, some patients presenting with ABD are managed by advanced paramedics (APs), however little is known about how APs make restraint decisions. The aim of this research is to explore the decisions made by APs when managing restraint in the context of ABD, in the UK pre-hospital ambulance setting. Seven semi-structured interviews were undertaken with APs. All participants were experienced APs with post-registration, post-graduate advanced practice education and qualifications. The resulting data were analysed using reflexive thematic analysis, informed by critical realism. We identified four interconnected themes from the interview data. Firstly, managing complexity and ambiguity in relation to identifying ABD patients and determining appropriate treatment plans. Secondly, feeling vulnerable to professional consequences from patients deteriorating whilst in the care of APs. Thirdly, negotiating with other professionals who have different roles and priorities. Finally, establishing primacy of care in relation to incidents which involve police officers and other professionals. A key influence was the need to characterise incidents as medical, as an enabler to establishing clinical leadership and decision-making control. APs focused on de-escalation techniques and sought to reduce physical restraint, intervening with pharmacological interventions if necessary to achieve this. The social relationships and interactions with patients and other professionals at the scene were key to success. Decisions are a source of anxiety, with fears of professional detriment accompanying poor patient outcomes. Our results indicate that APs would benefit from education and development specifically in relation to making ABD decisions, acknowledging the context of inter-professional relationships and the potential for competing and conflicting priorities. A focus on joint, high-fidelity training with the police may be a helpful intervention.
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Affiliation(s)
- Jaqualine Lindridge
- Department for Health, University of Bath, Bath, Somerset, England
- London Ambulance Service NHS Trust, London, England
| | | | - Leda Blackwood
- Department of Psychology, University of Bath, Bath, Somerset, England
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Cavanagh N, Blanchard IE, Weiss D, Tavares W. Looking back to inform the future: a review of published paramedicine research. BMC Health Serv Res 2023; 23:108. [PMID: 36732779 PMCID: PMC9893690 DOI: 10.1186/s12913-022-08893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Paramedicine has evolved in ways that may outpace the science informing these changes. Examining the scholarly pursuits of paramedicine may provide insights into the historical academic focus, which may inform future endeavors and evolution of paramedicine. The objective of this study was to explore the existing discourse in paramedicine research to reflect on the academic pursuits of this community. METHODS We searched Medline, Embase, CINAHL, Google Scholar and Web of Science from January, 2006 to April, 2019. We further refined the yield using a ranking formula that prioritized journals most relevant to paramedicine, then sampled randomly in two-year clusters for full text review. We extracted literature type, study topic and context, then used elements of qualitative content, thematic, and discourse analysis to further describe the sample. RESULTS The initial search yielded 99,124 citations, leaving 54,638 after removing duplicates and 7084 relevant articles from nine journals after ranking. Subsequently, 2058 articles were included for topic categorization, and 241 papers were included for full text analysis after random sampling. Overall, this literature reveals: 1) a relatively narrow topic focus, given the majority of research has concentrated on general operational activities and specific clinical conditions and interventions (e.g., resuscitation, airway management, etc.); 2) a limited methodological (and possibly philosophical) focus, given that most were observational studies (e.g., cohort, case control, and case series) or editorial/commentary; 3) a variety of observed trajectories of academic attention, indicating where the evolution of paramedicine is evident, areas where scope of practice is uncertain, and areas that aim to improve skills historically considered core to paramedic clinical practice. CONCLUSIONS Included articles suggest a relatively narrow topic focus, a limited methodological focus, and observed trajectories of academic attention indicating where research pursuits and priorities are shifting. We have highlighted that the academic focus may require an alignment with aspirational and direction setting documents aimed at developing paramedicine. This review may be a snapshot of scholarly activity that reflects a young medically directed profession and systems focusing on a few high acuity conditions, with aspirations of professional autonomy contributing to the health and social well-being of communities.
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Affiliation(s)
- N. Cavanagh
- grid.413574.00000 0001 0693 8815Alberta Health Services, Emergency Medical Services, Edmonton, Alberta Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - I. E. Blanchard
- grid.413574.00000 0001 0693 8815Alberta Health Services, Emergency Medical Services, Edmonton, Alberta Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - D. Weiss
- grid.413574.00000 0001 0693 8815Alberta Health Services, Emergency Medical Services, Edmonton, Alberta Canada
| | - W. Tavares
- grid.512795.dThe Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Health and Society, University of Toronto, Toronto, Ontario Canada ,York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket, Ontario Canada
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Keene T, Pammer K, Lord B, Shipp C. Fluency and confidence predict paramedic diagnostic intuition: An experimental study of applied dual-process theory. Int Emerg Nurs 2022; 61:101126. [DOI: 10.1016/j.ienj.2021.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 11/25/2021] [Accepted: 12/10/2021] [Indexed: 11/05/2022]
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Mason R, Roodenburg J, Williams B. The relationship between resilience and psychological characteristics of paramedicine students. Australas Emerg Care 2021; 25:185-190. [PMID: 34740565 DOI: 10.1016/j.auec.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/23/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paramedics' continued exposure to occupational stressors can have a detrimental effect on their psychological well-being. Resilience can provide for better coping. Understanding individual differences provides explanations why some individuals thrive while others are more at risk. AIM To explore the effect of Personality according to the Big-Five, Ways of Thinking and Occupational Preference according to Holland's RIASEC Model, on resilience. METHOD Using a quantitative cross-sectional design, The Big-Five Inventory, Ways of Thinking, Brief RIASEC Marker Scales and Connor Davidson CD-RISC were administered. RESULTS Standard Multiple Regression showed that resilience is more likely to be seen in those who score high in Conscientiousness and low in Neuroticism. Modelling also showed that resilience is more likely to be seen in those who score high in Surgency (β = 0.364, p = .001) followed by the Freethinker (β = 0.312, p = .001), Scientific (β = 0.112, p = .027) and Controlled (β = 0.105, p = .040) ways of thinking. Although the RIASEC model was not a strong predictor of resilience, the Social (β = 0.252, p = .001) and Investigative (β = 0.153, p = .020) factors were highlighted as contributing towards a paramedic's resilience. CONCLUSION The paramedicine students that participated in this study report higher levels of some of the personality traits inherently protective in facilitating resilience.
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Affiliation(s)
- Rod Mason
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
| | - John Roodenburg
- Faculty of Education, Monash University, Victoria, Australia
| | - Brett Williams
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
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Jousi M, Mäkinen M, Kaartinen J, Meriläinen L, Castrén M. Pre-hospital suPAR, lactate and CRP measurements for decision-making: a prospective, observational study of patients presenting non-specific complaints. Scand J Trauma Resusc Emerg Med 2021; 29:150. [PMID: 34656150 PMCID: PMC8520226 DOI: 10.1186/s13049-021-00964-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background In the pre-hospital setting, non-urgent patients with non-specific chief complaints pose assessment challenges for the emergency medical systems (EMS). Severely ill patients should be identified among these patients, and unnecessary transport to the emergency department (ED) should be avoided. Unnecessary admissions burden EDs, deplete EMS resources and can even be harmful to patients, especially elderly patients. Therefore, tools for facilitating pre-hospital decision-making are needed. They could be based on vital signs or point-of-care laboratory biomarkers. In this study, we examined whether the biomarker soluble urokinase plasminogen activator receptor (suPAR), either alone or combined with C-reactive protein (CRP) and/or lactate, could predict discharge from the ED and act as a pre-hospital support tool for non-conveyance decision-making.
Methods This was a prospective, observational study of adult patients with normal or near-normal vital signs transported by an EMS to an ED with a code referring to deteriorated general condition. The levels of suPAR, CRP and lactate in the patients’ pre-hospital blood samples were analysed. The values of hospitalized patients were compared to those of discharged patients to determine whether these biomarkers could predict direct discharge from the ED. Results A total of 109 patients (median age: 81 years) were included in the study. Of those, 52% were hospitalized and 48% were discharged from the ED. No statistically significant association was found between suPAR and the ED discharge vs hospitalization outcome (OR: 1.04, 95% CI 0.97–1.13, AUROC: 0.58, 95% CI 0.47–0.69). Adding CRP (AUROC: 0.64, 95% CI 0.54–0.75) or lactate (AUROC: 0.60, 95% CI 0.49–0.71) to the regression models did not improve their diagnostic accuracy. None of the patients with a suPAR value of less than 2 ng/ml were admitted to hospital, while 64% of the patients with a suPAR value of more than 6 ng/ml were hospitalized. Conclusion Pre-hospital suPAR measurements alone or combined with CRP and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints and normal or near-normal vital signs.
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Affiliation(s)
- Milla Jousi
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HYKS Akuutti, PL 340, 00029, HUS, Helsinki, Finland.
| | - Marja Mäkinen
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HYKS Akuutti, PL 340, 00029, HUS, Helsinki, Finland
| | - Johanna Kaartinen
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HYKS Akuutti, PL 340, 00029, HUS, Helsinki, Finland
| | - Leena Meriläinen
- Aidian Oy (Previously Orion Diagnostica), PL 83, 02101, Espoo, Finland
| | - Maaret Castrén
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HYKS Akuutti, PL 340, 00029, HUS, Helsinki, Finland
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Frazão TDC, Santos AFAD, Camilo DGG, da Costa Júnior JF, de Souza RP. Priority setting in the Brazilian emergency medical service: a multi-criteria decision analysis (MCDA). BMC Med Inform Decis Mak 2021; 21:151. [PMID: 33957933 PMCID: PMC8100937 DOI: 10.1186/s12911-021-01503-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the proven value of multicriteria decision analysis in the health field, there is a lack of studies focused on prioritising victims in the Emergency Medical Service, EMS. With this, and knowing that the decision maker needs a direction on which choice may be the most appropriate, based on different and often conflicting criteria. The current work developed a new model for prioritizing victims of SAMU/192, based on the multicriteria decision methodology, taking into account the scarcity of resources. METHODS An expert panel and a discussion group were formed, which defined the limits of the problem, and identified the evaluation criteria for choosing a victim, amongst four alternatives illustrated from hypothetical scenarios of emergency situations-clinical and traumatic diseases of absolute priority. For prioritization, an additive mathematical method was used that aggregates criteria in a flexible and interactive version, FITradeoff. RESULTS The structuring of the problem led the researchers to identify twenty-five evaluation criteria, amongst which ten were essential to guide decisions. As a result, in the simulation of prioritization of four requesting victims in view of the availability of only one ambulance, the proposed model supported the decision by suggesting the prioritization of one of the victims. CONCLUSIONS This work contributed to the prioritization of victims using multicriteria decision support methodology. Selecting and weighing the criteria in this study indicated that the protocols that guide regulatory physicians do not consider all the criteria for prioritizing victims in an environment of scarcity of resources. Finally, the proposed model can support crucial decision based on a rational and transparent decision-making process that can be applied in other EMS.
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Affiliation(s)
- Talita D. C. Frazão
- Departamento de Engenharia de Produção, Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Natal, 59072-970 Brazil
| | - Ana F. A. dos Santos
- Departamento de Engenharia de Produção, Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Natal, 59072-970 Brazil
| | - Deyse G. G. Camilo
- Departamento de Engenharia de Produção, Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Natal, 59072-970 Brazil
| | - João Florêncio da Costa Júnior
- Departamento de Engenharia de Produção, Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Natal, 59072-970 Brazil
| | - Ricardo P. de Souza
- Departamento de Engenharia de Produção, Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Natal, 59072-970 Brazil
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Bennett R, Mehmed N, Williams B. Non-technical skills in paramedicine: A scoping review. Nurs Health Sci 2020; 23:40-52. [PMID: 32734658 DOI: 10.1111/nhs.12765] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Abstract
This scoping review aims to identify which non-technical skills have been empirically identified in the literature, to create the first list of empirically identified non-technical skills for paramedics and allied health personnel. A five-stage scoping literature was undertaken in March 2020. The search retrieved a total of 4756 citations. A total of 93 studies met the inclusion criteria and were analyzed for data charting. A total of 26 non-technical skills were identified in the literature. The top five non-technical skills included decision-making (33%, n = 31), communication (24%, n = 23), empathy (17%, n = 16), leadership (12%, n = 12), and ethics (10%, n = 10). Furthermore, only five studies investigated the assessment or measurement of non-technical skills. This scoping review identified 26 non-technical skills that had been investigated in the paramedic literature to create the first list of empirically based desirable non-technical skills for a paramedic. Subsequently, research can then begin to focus on identifying the link that these have to paramedic practice and patient safety.
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Affiliation(s)
- Ryan Bennett
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Niall Mehmed
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Brett Williams
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
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Andersson U, Maurin Söderholm H, Wireklint Sundström B, Andersson Hagiwara M, Andersson H. Clinical reasoning in the emergency medical services: an integrative review. Scand J Trauma Resusc Emerg Med 2019; 27:76. [PMID: 31426839 PMCID: PMC6700770 DOI: 10.1186/s13049-019-0646-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022] Open
Abstract
Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted. AIM The aim was to investigate the nature, deployment, and factors influencing EMS clinicians' clinical reasoning by means of a review. METHOD Data was collected through searches in electronic databases, networking among research teams, colleagues and friends, "grey literature," and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding - namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians' clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes. RESULTS This review showed that EMS clinicians' clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use "workarounds" to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives. CONCLUSION Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.
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Affiliation(s)
- Ulf Andersson
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden
- PreHospen—Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Hanna Maurin Söderholm
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden
- PreHospen—Centre for Prehospital Research, University of Borås, Borås, Sweden
- Swedish School of Library and Information Science, University of Borås, Borås, Sweden
| | - Birgitta Wireklint Sundström
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden
- PreHospen—Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden
- PreHospen—Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Henrik Andersson
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden
- PreHospen—Centre for Prehospital Research, University of Borås, Borås, Sweden
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Aldamiri KT, Alhusain FA, Almoamary A, Alshehri K, Al Jerian N. Clinical Decision-making among Emergency Physicians: Experiential or Rational? J Epidemiol Glob Health 2019; 8:65-68. [PMID: 30859790 PMCID: PMC7325819 DOI: 10.2991/j.jegh.2018.04.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/18/2018] [Indexed: 12/01/2022] Open
Abstract
It has been postulated that everyone has an affinity for one of two cognitive approaches: experiential (intuitive) or rational (conscious). The aim of this study was to analyze the thinking processes of Saudi emergency physicians at nine hospitals in Riyadh. This was a cross-sectional study, which was undertaken in Riyadh using a psychometric tool called the Rational–Experiential Inventory-40. The survey, sent by e-mail to 202 emergency physicians, had a 53% response rate. Most respondents were male (86%). The total surveyed participants included consultants (36%), associate consultants (19%), registrars, fellow or staff physicians (7%), and residents (38%). The results found a mean (standard deviation) score of 3.73 (0.51) for rational approaches to decision-making and 3.09 (0.45) for experiential approaches among the emergency physicians surveyed. The difference of 0.46 between the two scores was not statistically significant (p = 0.23). Female emergency physicians tended toward slower logical thinking (rational). Consultant emergency physicians had a higher score for fast intuitive automatic thinking (experiential) than nonconsultant physicians. This was statistically significant, t105 = 2.1, p = 0.4. Our results suggest that although both thinking styles are used in clinical decision-making, consultant emergency physicians prefer rational approaches to decision-making.
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Affiliation(s)
- Khalid Talal Aldamiri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Faisal Ahmed Alhusain
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amal Almoamary
- Department of Emergency Medicine, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Khalid Alshehri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nawfal Al Jerian
- Department of Emergency Medicine, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Alshaalan AA, Alharbi MK, Alattas KA. Preference of cognitive approaches for decision making among anesthesiologists' in Saudi Arabia. Saudi J Anaesth 2019; 13:191-196. [PMID: 31333362 PMCID: PMC6625279 DOI: 10.4103/sja.sja_792_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims: The aim of this study was to analyze the thinking processes of anesthesia physicians at in Riyadh, Jeddah, and Dammam cities in Saudi Arabia. Subjects and Methods: This cross-sectional study was undertaken in the cities of Riyadh, Jeddah, and Dammam in Saudi Arabia. Using a previously published psychometric tool (the Rational and Experiential Inventory, REI-40), the survey was sent through email and social networks to anesthesia physicians working in the targeted hospitals. An initial survey was sent out, followed by a reminder and a second survey to nonrespondents. Analysis included descriptive statistics and Student's t-tests. Results: Most of the participants (69.2%) were males. At the time of the study, 35% of participants were consultants; 9.6% were associate consultants; 19.2% were registrars, fellows, or staff physicians; and 35.8% were senior residents. Anesthesia physicians’ mean “rational” score was 3.22 [standard deviation (SD) =0.49)] and their mean “experiential” score was 3.01 (SD = 0.31). According to Pearson's correlation, the difference of 0.21 between these two scores was not statistically significant (P = 0.35). Male anesthesia physicians tended more toward faster, logical thinking. Consultant anesthesia physicians had faster rational thinking than nonconsultant physicians (P = 0.01). Anesthesia physicians with more than 10 years in practice had faster rational thinking than physicians who had worked for fewer than 10 years (P = 0.001). Conclusions: This study evaluated anesthesia physicians’ general decision-making approaches. Despite the fact that both rational and experiential techniques are used in clinical decision-making, male consultants and physicians with more than 10 years’ experience and certified non-Saudi board anesthesiologists prefer rational decision-making style.
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Affiliation(s)
- Anas Alshaalan Alshaalan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed K Alharbi
- Anaesthesia Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Khaled A Alattas
- Anaesthesia Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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Magnusson C, Axelsson C, Nilsson L, Strömsöe A, Munters M, Herlitz J, Hagiwara MA. The final assessment and its association with field assessment in patients who were transported by the emergency medical service. Scand J Trauma Resusc Emerg Med 2018; 26:111. [PMID: 30587210 PMCID: PMC6307253 DOI: 10.1186/s13049-018-0579-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background In patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment. Aim In a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge. Methods Thirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were age < 18 years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment. Results In all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%. Conclusion Among patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored. Electronic supplementary material The online version of this article (10.1186/s13049-018-0579-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30, Gothenburg, Sweden
| | - Christer Axelsson
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Anneli Strömsöe
- School of Education, Health and Social Studies, Dalarna University Falun, SE-791 88, Falun, Sweden.,Department of Prehospital Care, County Council of Dalarna, S-79129, Falun, Sweden
| | - Monica Munters
- Department of Ambulance Care, Region of Dalarna, SE-791 29, Falun, Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
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