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Carter AJE, Jensen JL, Petrie DA, Greene J, Travers A, Goldstein JP, Cook J, Fidgen D, Swain J, Richardson L, Cain E. State of the Evidence for Emergency Medical Services (EMS) Care: The Evolution and Current Methodology of the Prehospital Evidence-Based Practice (PEP) Program. ACTA ACUST UNITED AC 2019; 14:57-70. [PMID: 30129435 PMCID: PMC6147365 DOI: 10.12927/hcpol.2018.25548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Emergency medical services (EMS) leaders and clinicians need to incorporate evidence into safe and effective clinical practice. Access to high-quality evidence, and the time to synthesize it, can be barriers to evidence-based practice. The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, repository of critically appraised evidence specific to EMS. This paper describes the evolution and current methodology of the PEP program. Methods/design: The purpose of PEP is to identify, catalog and critically appraise relevant studies. Following regular systematic searches, two trained appraisers critically appraise included studies and assign a score on three-point level of evidence (LOE) and direction of evidence (DOE) scales. Each clinical intervention is plotted on a 3 × 3 (LOE × DOE) evidence matrix, which provides a summary recommendation. Discussion: The PEP program is a unique knowledge translation tool, specific to EMS. End-users can easily identify which clinical interventions are, or are not, supported by evidence.
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Affiliation(s)
- Alix J E Carter
- Medical Director, Research, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Jan L Jensen
- Performance Manager, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - David A Petrie
- Medical Director, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Jennifer Greene
- Paramedic Knowledge Translation Coordinator, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Andrew Travers
- Provincial Medical Director, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Judah P Goldstein
- Research Coordinator, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Jolene Cook
- Medical Oversight Physician, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Dana Fidgen
- Manager, Emergency Health Services, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Janel Swain
- Provincial Ground Clinical Supervisor, Emergency Health Services, Halifax, NS
| | - Luke Richardson
- Medical Resident, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
| | - Ed Cain
- Emergency Medicine Physician, Emergency Medicine, Division of EMS, Dalhousie University, Halifax, NS
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Emergency Patients' and Family Members' Experiences of Nonconveyance Situations and Counseling Received From Care Providers. Adv Emerg Nurs J 2018; 40:312-323. [PMID: 30365446 DOI: 10.1097/tme.0000000000000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Making nonconveyance decisions can be demanding for care providers in prehospital emergency services. Studies have found homecare instructions and counseling of patients and family members partly insufficient. A descriptive cross-sectional design was applied for this pilot study to explore emergency patients' and family members' experiences of nonconveyance situations and counseling. Data were collected by questionnaires from acutely ill patients (n = 97) treated on-site and not transported to hospital and from their family members (n = 72) in 2015-2016. Responses to quantified statements were analyzed statistically, whereas responses to open questions were analyzed using qualitative inductive content analysis. Patients and family members had mostly received verbal home care instructions. Just more than 10% of patients found the instructions insufficient for their coping at home. Male patients were slightly more satisfied with counseling than female patients. One-fifth of female patients but only 6% of male patients were dissatisfied with nonconveyance decisions. In family members, the proportion of dissatisfied respondents was 14%. Older patients were more often dissatisfied than younger patients. Although the majority of the respondents were satisfied with the emergency medical services in general, patients suggested that home care instructions, staff competence, and availability of ambulances should be improved and resources and attention given to patients' opinions increased. Family members proposed more careful assessment of conveyance needs, increased resources, and attention given to the patient. The results highlight the importance of developing a more family-centered approach to emergency care.
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Travers AH. Evolution of a high-performance emergency health services system in Nova Scotia. Healthc Manage Forum 2018; 31:191-195. [PMID: 30071755 DOI: 10.1177/0840470418773416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since 1997, Emergency Health Services in Nova Scotia (NS) has evolved from a program providing prehospital care for patients in transport to a system providing integrated healthcare in both traditional (ie, ambulance) and non-traditional settings (eg, patient homes, hospital settings). This article highlights (1) the reorganization of the emergency medical service system design, (2) the strategies enabling efficient operation of this design, and (3) resultant innovations evolving from both system redesign and strategy application. Emergency Health Services has utilized a Public Utility Model (PUM) design providing prehospital healthcare, public safety, and public health responses to the population of NS. The success of the PUM has been complimented by three strategies: (1) co-leadership model operations, (2) common languages to translate evidence into practice, and (3) collaborative and integrated relationships with other regulated healthcare providers. This prehospital system design and application strategies could be applied in other sectors of community and hospital systems of care.
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Affiliation(s)
- Andrew H Travers
- 1 Emergency Health Services, Department of Health and Wellness, Halifax, Nova Scotia, Canada.,2 Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,3 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Holmberg M, Fagerberg I, Wahlberg AC. The knowledge desired by emergency medical service managers of their ambulance clinicians - A modified Delphi study. Int Emerg Nurs 2017; 34:23-28. [PMID: 28545930 DOI: 10.1016/j.ienj.2017.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/17/2017] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to identify the types of knowledge that Swedish Emergency Medical Service (EMS) managers considered desirable in their Ambulance Clinicians. BACKGROUND Emergency medical service managers are responsible for organisational tasking and in this are dependent on the knowledge possessed by their ambulance clinicians. It would therefore be of value to explore EMS managers' approach to this knowledge. DESIGN A modified Delphi method in three rounds. METHODS In total thirty-six EMS managers participated, and twenty-four finished all three rounds. They were encouraged to rate each sub-category, and the ten with the highest mean were interdependently ranked in the final round. RESULTS Five categories and twenty-six sub-categories emerged in the first round, covering knowledge related to; contextual aspects, medical and holistic assessments, formal education and organisational issues. Eventually, the sub-category 'Knowledge to assess the patient's situation from a holistic perspective' was the highest ranked, followed by 'Medical knowledge to assess and care for different diseases' and 'Knowledge to be able to care for critically ill patients'. CONCLUSIONS Taken together the knowledge areas address essentially medical care, contextual aspects and nursing. The boundaries between these can sometimes be seen as elusive, calling for ambulance clinicians to balance these areas of knowledge.
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Affiliation(s)
- Mats Holmberg
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Ingegerd Fagerberg
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
| | - Anna Carin Wahlberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Contemporary evidence-based practice in Canadian emergency medical services: a vision for integrating evidence into clinical and policy decision-making. CAN J EMERG MED 2016; 19:220-229. [PMID: 27658352 DOI: 10.1017/cem.2016.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and administrative decision-making remains a challenge. We propose a vision for EBP in EMS: Canadian EMS clinicians and leaders will understand and use the best available evidence for clinical and administrative decision-making, to improve patient health outcomes, the capability and quality of EMS systems of care, and safety of patients and EMS professionals. This vision can be implemented with the use of a structure, process, system, and outcome taxonomy to identify current barriers to true EBP, to recognize the opportunities that exist, and propose corresponding recommended strategies for local EMS agencies and at the national level. Framing local and national discussions with this approach will be useful for developing a cohesive and collaborative Canadian EBP strategy.
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Browne LR, Shah MI, Studnek JR, Ostermayer DG, Reynolds S, Guse CE, Brousseau DC, Lerner EB. Multicenter Evaluation of Prehospital Opioid Pain Management in Injured Children. PREHOSP EMERG CARE 2016; 20:759-767. [DOI: 10.1080/10903127.2016.1194931] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Muecke S, Curac N, Binks D. Informing clinical policy decision-making practices in ambulance services. INT J EVID-BASED HEA 2013; 11:299-304. [DOI: 10.1111/1744-1609.12039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lang ES, Spaite DW, Oliver ZJ, Gotschall CS, Swor RA, Dawson DE, Hunt RC. A national model for developing, implementing, and evaluating evidence-based guidelines for prehospital care. Acad Emerg Med 2012; 19:201-9. [PMID: 22320372 DOI: 10.1111/j.1553-2712.2011.01281.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In 2007, the Institute of Medicine's (IOM's) Committee on the Future of Emergency Care recommended that a multidisciplinary panel establish a model for developing evidence-based protocols for the treatment of emergency medical systems (EMS) patients. In response, the National EMS Advisory Council (NEMSAC) and the Federal Interagency Committee on EMS (FICEMS) convened a panel of multidisciplinary experts to review current strategies for developing evidence-based guidelines (EBGs) and to propose a model for developing such guidelines for the prehospital milieu. This paper describes the eight-step model endorsed by FICEMS, NEMSAC, and a panel of EMS and evidence-based medicine experts. According to the model, prehospital EBG development would begin with the input of evidence from various external sources. Potential EBG topics would be suggested following a preliminary evidentiary review; those topics with sufficient extant foundational evidence would be selected for development. Next, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology would be used to determine a quality-of-evidence rating and a strength of recommendation related to the patient care guidelines. More specific, contextualized patient care protocols would then be generated and disseminated to the EMS community. After educating EMS professionals using targeted teaching materials, the protocols would be implemented in local EMS systems. Finally, effectiveness and uptake would be measured with integrated quality improvement and outcomes monitoring systems. The constituencies and experts involved in the model development process concluded that the use of such transparent, objective, and scientifically rigorous guidelines could significantly increase the quality of EMS care in the future.
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Affiliation(s)
- Eddy S Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
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Cone DC, Brooke Lerner E, Band RA, Renjilian C, Bobrow BJ, Crawford Mechem C, Carter AJE, Kupas DF, Spaite DW. Prehospital care and new models of regionalization. Acad Emerg Med 2010; 17:1337-45. [PMID: 21122016 DOI: 10.1111/j.1553-2712.2010.00935.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article summarizes the discussions of the emergency medical services (EMS) breakout session at the June 2010 Academic Emergency Medicine consensus conference "Beyond Regionalization: Integrated Networks of Emergency Care." The group focused on prehospital issues such as the identification of patients by EMS personnel, protocol-driven destination selection, bypassing closer nondesignated centers to transport patients directly to more distant designated specialty centers, and the modes of transport to be used as they relate to the regionalization of emergency care. It is our hope that the proposed research agenda will be advanced in a way that begins to rigorously approach the unanswered research questions and that these answers, in turn, will lead to an evidence-based, cohesive, comprehensive, and more uniform set of guidelines that govern the delivery and practice of prehospital emergency care.
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Affiliation(s)
- David C Cone
- Yale University School of Medicine, New Haven, CT, USA.
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Jensen JL, Croskerry P, Travers AH. Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study. BMC Emerg Med 2009; 9:17. [PMID: 19772558 PMCID: PMC2754426 DOI: 10.1186/1471-227x-9-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 09/21/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The scope of practice of paramedics in Canada has steadily evolved to include increasingly complex interventions in the prehospital setting, which likely have repercussions on clinical outcome and patient safety. Clinical decision making has been evaluated in several health professions, but there is a paucity of work in this area on paramedics. This study will utilize the Delphi technique to establish consensus on the most important instances of paramedic clinical decision making during high acuity emergency calls, as they relate to clinical outcome and patient safety. METHODS AND DESIGN Participants in this multi-round survey study will be paramedic leaders and emergency medical services medical directors/physicians from across Canada. In the first round, participants will identify instances of clinical decision making they feel are important for patient outcome and safety. On the second round, the panel will rank each instance of clinical decision making in terms of its importance. On the third and potentially fourth round, participants will have the opportunity to revise the ranking they assigned to each instance of clinical decision making. Consensus will be considered achieved for the most important instances if 80% of the panel ranks it as important or extremely important. The most important instances of clinical decision making will be plotted on a process analysis map. DISCUSSION The process analysis map that results from this Delphi study will enable the gaps in research, knowledge and practice to be identified.
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Affiliation(s)
- Jan L Jensen
- Division of Emergency Medical Services, Department of Emergency Medicine, Dalhousie University, 1796 Summer Street, Room 3021, Halifax, Nova Scotia, Canada.
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