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Winkler K, McKinney J, Reale C, Anders S, Rubenstein M, Cavagnini L, Crowe R, Ward MJ. A Qualitative Analysis of Barriers to Evidence-Based Care in the Prehospital Management of Patients with Suspected Acute Coronary Syndrome. PREHOSP EMERG CARE 2024:1-9. [PMID: 38981118 DOI: 10.1080/10903127.2024.2372817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/20/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES Prehospital electrocardiogram (ECG) and administration of aspirin are evidence-based strategies for patients with acute coronary syndrome (ACS). However, emergency medical services (EMS) compliance in patients with suspected ACS varies widely. We sought to understand the barriers to prehospital ECG acquisition and aspirin administration for patients with suspected ACS. METHODS In this qualitative study, we interviewed EMS clinicians at three geographically diverse United States (U.S.)-based EMS agencies. We interviewed practicing clinicians and quality and operations leaders at these agencies. Based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, interviews were recorded, transcribed, and analyzed using a grounded qualitative approach with open coding. The Systems Engineering Initiative for Patient Safety (SEIPS) framework and a constant comparison technique were used to identify and refine themes. RESULTS Twenty-five paramedics and 20 additional agency personnel participated. Median age was 41 (IQR: 34-51) years and 13 (29%) were female. Themes were organized using SEIPS and longitudinally through four phases of an EMS call. During the pre-arrival phase, staffing challenges, training quality, and dispatch may anchor EMS clinicians on a diagnosis. During the diagnosis and treatment phase, safety and communication barriers may take priority over care delivery. Additionally, EMS clinicians must allocate assets (e.g. whether to send an advanced life support unit) and financial resources; veteran EMS clinicians identified their experience whereas newer clinicians cited their recent education when making these decisions. Also, diagnostic uncertainty due to increasing patient complexity and atypical presentations contributed to diagnostic errors. During the response and transport phase, the scope of practice limits the use and interpretation of the ECG, with clinicians reporting that liberal use of ECG led to more rapid decision-making. Finally, in the after phase, personnel reported the "psychologically taxing" nature of the job contributing to biases, bad habits, and burnout. Performance feedback was desired for personal development, though currently perceived as infrequent and punitive. CONCLUSIONS Multiple, interrelated themes underscored the complexities of delivering evidence-based care to prehospital patients with ACS. Education in ECG interpretation, resource allocation, bias, and enhancing feedback may serve as strategies to address the identified barriers.
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Affiliation(s)
- Kailey Winkler
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jared McKinney
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carrie Reale
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shilo Anders
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa Rubenstein
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lauren Cavagnini
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee
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Ruhe MM, Veldhuis LI, Azijli-Abdelloui K, Schepers T, Ridderikhof ML. Prehospital analgesia in suspected hip fracture patients: adherence to national prehospital pain management guidelines. Eur J Trauma Emerg Surg 2024; 50:937-943. [PMID: 37957364 DOI: 10.1007/s00068-023-02385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Patients with hip fractures frequently present at the emergency department (ED). Despite high pain scores, prehospital pain management is often inadequate and insufficient. In the Netherlands, the emergency medical services (EMS) exhibit a high level of training, supported by a comprehensive pain treatment protocol. This study aimed to assess adherence to the protocol and hypothesized that prehospital pain management in hip fracture patients was both sufficient and adequate. METHODS This was a retrospective observational cohort study of patients with suspected hip fractures. The median differences in numerical rating scale (NRS) pain scores between the initial score in the ambulance and upon arrival at the ED were compared. Furthermore, adherence to the ambulance pain protocol was studied. RESULTS From September 2016 to March 2021, 436 ambulance-transported hip fracture patients were included, of whom 81% received analgesics by EMS. The median initial pain score measured by EMS was 8; this number decreased to 5 at ED presentation, a significant decrease (ρ < 0.001). In case a prehospital NRS pain score was assessed, 66.5% of the patients were treated according to the protocol. In 80% of patients, the protocol was not followed correctly, primarily due to missing NRS pain scores. CONCLUSION In suspected hip fracture patients, initial prehospital pain scores were high and most patients received analgesics from EMS. This resulted in a significant decrease in pain. In nearly 67% of patients in whom an NRS pain score was assessed in the prehospital phase, pain management was according to protocol. However, in 80% of the total population the pain protocol was not adhered to, mainly due to missing NRS pain scores.
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Affiliation(s)
- Michelle Manon Ruhe
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Lars I Veldhuis
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Kaoutar Azijli-Abdelloui
- Department of Emergency Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Milan L Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
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Khazaei A, Afshari A, Khatiban M, Borzou SR, Oshvandi K, Nabavian M, Maddineshat M. Perceptions of professional challenges by emergency medical services providers: a qualitative content analysis study. BMC Emerg Med 2024; 24:38. [PMID: 38448812 PMCID: PMC10916027 DOI: 10.1186/s12873-024-00955-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Emergency medical services (EMS) providers encounter a variety of challenges due to the unpredictable, uncontrollable, and dynamic conditions in the pre-hospital field. This study explored the perceived professional challenges among EMS providers. MATERIALS AND METHODS This study was conducted using a qualitative research approach and the method of content analysis. Eighteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. The collected data were then analyzed based on the Granheim and Lundman's method. RESULTS Based on data analysis, five categories and one theme were identified. The extracted theme was professional challenges. The five categories were as follows: Ineffective policies; multicultural and multidisciplinary factors; ambulance dispatch route problems; legal issues; and abuse against the emergency medical services CONCLUSION: In general, it has been found that EMS providers encounter numerous and complex professional challenges during their work. EMS managers can utilize the findings of the present study to develop strategies for reducing the professional challenges faced by EMS providers. By doing so, they can improve the quality of care in the prehospital field.
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Affiliation(s)
- Afshin Khazaei
- Department of Medical Emergencies, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Ali Afshari
- Chronic Diseases (Home Care) Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Mahnaz Khatiban
- Mother and Child Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Reza Borzou
- Chronic Diseases (Home Care) Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majedeh Nabavian
- Department of Nursing and Midwifery, Comprehensive Health Research Center, Babol Branch, Islamic Azad University, Babol, Iran
| | - Maryam Maddineshat
- Department of Nursing, School of Malayer Nursing, Chronic Disease (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Kuchenbuch M, Lo Barco T, Chemaly N, Chiron C, Nabbout R. Fifteen years of real-world data on the use of vigabatrin in individuals with infantile epileptic spasms syndrome. Epilepsia 2024; 65:430-444. [PMID: 37872396 DOI: 10.1111/epi.17808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate our treatment algorithm for infantile epileptic spasms syndrome (IESS) used between 2000 and 2018. We initiated vigabatrin (VGB), and steroids were added if the electroclinical response (spasms and electroencephalogram [EEG]) to VGB was not obtained or incomplete. METHODS Individuals with IESS treated with VGB were recruited from our hospital clinical data warehouse based on electronic health records (EHRs) generated since 2009 and containing relevant keywords. We confirmed the diagnosis of IESS. Clinical, EEG, imaging, and biological data were extracted from the EHRs. We analyzed factors associated with short-term response, time to response, relapse, time to relapse of spasms, and the presence of spasms at last follow-up. RESULTS We collected data from 198 individuals (female: 46.5%, IESS onset: 6 [4.5-10.3] months, follow-up: 4.6 [2.5-7.6] years, median [Q1-Q3]) including 129 (65.2%) with identifiable etiology. VGB was started 17 (5-57.5) days after IESS diagnosis. A total of 113 individuals were responders (57.1% of the cohort), 64 with VGB alone and 38 with VGB further combined with steroids (56.6% and 33.6% of responders, respectively). Among responders, 33 (29%) experienced relapses of spasms, mostly those with later onset of spasms (p = .002) and those who received VGB for <24 months after spasms cessation compared to a longer duration on VGB (45% vs. 12.8%, p = .003). At follow-up, 92 individuals were seizure-free (46.5% of the whole cohort), including 26 free of therapy (13.1%). One hundred twelve individuals (56.6%) were still receiving VGB, with a duration of 3.2 (1.75-5.7) years. SIGNIFICANCE Our sequential protocol introducing VGB then adding steroids is an effective alternative to a combined VGB-steroids approach in IESS. It avoids steroid-related adverse events, as well as those from VGB-steroid combination. According to our data, a period of 7 days seems sufficient to assess VGB response and enables the addition of steroids rapidly if needed. Continuing VGB for 2 years may balance the risk of relapse and treatment-induced adverse events.
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Affiliation(s)
- Mathieu Kuchenbuch
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Service de Pédiatrie, Reference Center for Rare Epilepsies, member of ERN EpiCARE, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Tommaso Lo Barco
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Nicole Chemaly
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
| | - Catherine Chiron
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Université de Paris Cité, Paris, France
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Hsiao YL, Bass EB, Wu AW, Kelly D, Sylvester C, Berkowitz SA, Bellantoni M. Preventing Avoidable Rehospitalizations through Standardizing Management of Chronic Conditions in Skilled Nursing Facilities. J Am Med Dir Assoc 2023; 24:1910-1917.e3. [PMID: 37690461 DOI: 10.1016/j.jamda.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES This study evaluated the impact of standardized care protocols, as a part of a quality improvement initiative (J10ohns Hopkins Community Health Partnership, J-CHiP), on hospital readmission rates for patients with a diagnosis of congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD) after being discharged to skilled nursing facilities (SNFs). DESIGN A retrospective study comparing 30-day hospital readmission rates the year before and 2 years following the implementation of the care protocol interventions. SETTINGS AND PARTICIPANTS Patients discharged from Johns Hopkins Hospital or Johns Hopkins Bayview Medical Center to the participating SNFs diagnosed with CHF and/or COPD. METHODS The standardized protocols included medical provider or nurse assessments on SNF admission, multidisciplinary care planning, and medication management to avoid unplanned readmissions to the hospital. Descriptive analyses were conducted to illustrate the 30-day readmission rates before and after protocol implementation. RESULTS There were 1128 patients in the pre-J-CHiP cohort and 2297 patients in the J-CHiP cohort. About half of the patients with a recorded diagnosis of CHF without COPD had the standardized protocol initiated, whereas 47% of the patients with a recorded diagnosis of COPD without CHF had the standardized protocol initiated. Of patients with recorded diagnoses of COPD and CHF, 49% had both protocols initiated. A reduction in the readmission rate was observed for patients with COPD protocols, from 23.5% in 2011 to 12.1% in 2015. However, fluctuations in the readmission rates were observed for patients who initiated the CHF protocols. CONCLUSIONS AND IMPLICATIONS There were improvements in the readmission rates in this study, especially for patients who had initiated standardized care protocols in the SNFs. Our findings demonstrate great value in standardizing care management and strengthening collaboration with chronic care settings to facilitate a smooth transition of medically complex patients discharged from large health care systems. Future interventions could consider assessing nonclinical factors that may impact preventable hospital readmissions.
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Affiliation(s)
- Ya Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Denise Kelly
- Division of Geriatric Medicine and Gerontology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Carol Sylvester
- Office of Population Health, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Scott A Berkowitz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michele Bellantoni
- Division of Geriatric Medicine and Gerontology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
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Wilkins-Caruana A, Bandara M, Musial K, Catchpoole D, Kennedy PJ. Inferring actual treatment pathways from patient records. J Biomed Inform 2023; 148:104554. [PMID: 38000767 DOI: 10.1016/j.jbi.2023.104554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Treatment pathways are step-by-step plans outlining the recommended medical care for specific diseases; they get revised when different treatments are found to improve patient outcomes. Examining health records is an important part of this revision process, but inferring patients' actual treatments from health data is challenging due to complex event-coding schemes and the absence of pathway-related annotations. The objective of this study is to develop a method for inferring actual treatment steps for a particular patient group from administrative health records - a common form of tabular healthcare data - and address several technique- and methodology-based gaps in treatment pathway-inference research. METHODS We introduce Defrag, a method for examining health records to infer the real-world treatment steps for a particular patient group. Defrag learns the semantic and temporal meaning of healthcare event sequences, allowing it to reliably infer treatment steps from complex healthcare data. To our knowledge, Defrag is the first pathway-inference method to utilise a neural network (NN), an approach made possible by a novel, self-supervised learning objective. We also developed a testing and validation framework for pathway inference, which we use to characterise and evaluate Defrag's pathway inference ability, establish benchmarks, and compare against baselines. RESULTS We demonstrate Defrag's effectiveness by identifying best-practice pathway fragments for breast cancer, lung cancer, and melanoma in public healthcare records. Additionally, we use synthetic data experiments to demonstrate the characteristics of the Defrag inference method, and to compare Defrag to several baselines, where it significantly outperforms non-NN-based methods. CONCLUSIONS Defrag offers an innovative and effective approach for inferring treatment pathways from complex health data. Defrag significantly outperforms several existing pathway-inference methods, but computationally-derived treatment pathways are still difficult to compare against clinical guidelines. Furthermore, the open-source code for Defrag and the testing framework are provided to encourage further research in this area.
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Affiliation(s)
- Adrian Wilkins-Caruana
- Australian Artificial Intelligence Institute, Faculty of Engineering and IT, University of Technology Sydney, Australia.
| | - Madhushi Bandara
- Australian Artificial Intelligence Institute, Faculty of Engineering and IT, University of Technology Sydney, Australia
| | - Katarzyna Musial
- Complex Adaptive Systems Lab, Data Science Institute, Faculty of Engineering and IT, University of Technology Sydney, Australia
| | - Daniel Catchpoole
- Australian Artificial Intelligence Institute, Faculty of Engineering and IT, University of Technology Sydney, Australia; Biospecimen Research Services, The Children's Cancer Research Unit, The Children's Hospital at Westmead, Australia
| | - Paul J Kennedy
- Australian Artificial Intelligence Institute, Faculty of Engineering and IT, University of Technology Sydney, Australia; Joint Research Centre in AI for Health and Wellness, University of Technology Sydney, Australia and Ontario Tech University, Canada
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Vu MT, Schwartz H, Straube S, Pondicherry N, Emanuels D, Dhanoa J, Bains J, Singh M, Stark N, Peabody C. Compass for antibiotic stewardship: using a digital tool to improve guideline adherence and drive clinician behaviour for appendicitis treatment in the emergency department. Emerg Med J 2023; 40:847-853. [PMID: 37907325 DOI: 10.1136/emermed-2022-213015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Antibiotic stewardship in the ED is important given the increasing prevalence of multidrug resistance associated with poorer patient outcomes. The use of broad-spectrum antibiotics in the ED for infections like appendicitis is common. At baseline, 75% of appendicitis cases at our institution received broad-spectrum ertapenem rather than the recommended narrower-spectrum ceftriaxone/metronidazole combination. We aimed to improve antibiotic stewardship by identifying barriers to guideline adherence and redesigning our appendicitis antibiotic guideline. METHODS Using the 'Fit between Individuals, Task and Technology (FITT)' framework, we identified barriers that preventclinicians from adhering to guidelines. We reformatted a clinical guideline and disseminated it using our ED's clinical decision support system (CDSS), E*Drive. Next, we examined E*Drive's user data and clinician surveys to assess utilisation and satisfaction. Finally, we conducted a retrospective chart review to measure clinician behaviour change in antibiotic prescription for appendicitis treatment. RESULTS Data demonstrated an upward trend in the number of monthly users of E*Drive from 1 April 2021 to 30 April 2022, with an average increase of 46 users per month. Our clinician survey results demonstrated that >95% of users strongly agree/agree that E*Drive improves access to clinical information, makes their job more efficient and that E*Drive is easy to access and navigate, with a Net Promoter Score increase from 26.0 to 78.3. 69.4% of patients treated for appendicitis in the post-intervention group received antibiotics concordant with our institutional guideline compared with 20.0% in the pre-intervention group (OR=9.07, 95% CI (3.84 to 21.41)). CONCLUSION Antibiotic stewardship can be improved by ensuring clinicians have access to convenient and up-to-date guidelines through clinical decision support systems. The FITT model can help guide projects by identifying individual, task and technology barriers. Sustained adherence to clinical guidelines through simplification of guideline content is a potentially powerful tool to influence clinician behaviour in the ED.
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Affiliation(s)
- Mai Trang Vu
- UCSF School of Medicine, San Francisco, California, USA
| | - Hope Schwartz
- UCSF School of Medicine, San Francisco, California, USA
| | - Steven Straube
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
| | | | | | - Jaskirat Dhanoa
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
| | - Jaskaran Bains
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
| | - Malini Singh
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
| | - Nicholas Stark
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
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Wennman I, Wijk H, Jood K, Carlström E, Fridlund B, Alsholm L, Herlitz J, Hansson PO. Fast track to stroke unit for patients not eligible for acute intervention, a case-control register study on 1066 patients. Sci Rep 2023; 13:20799. [PMID: 38012289 PMCID: PMC10682035 DOI: 10.1038/s41598-023-48007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
Stroke patients not eligible for acute intervention often have low priority and may spend long time at the emergency department (ED) waiting for admission. The aim of this retrospective case-control register study was to evaluate outcomes for such "low priority" stroke patients who were transported via Fast Track directly to the stroke unit, according to pre-specified criteria by emergency medical service (EMS). The outcomes of Fast Track patients, transported directly to stroke unit (cases) were compared with the outcomes of patients who fulfilled these critera for Fast Track, but instead were transported to the ED (controls). In all, 557 cases and 509 controls were identified. The latter spent a mean time of 237 min in the ED before admission. The 90-day mortality rate was 12.9% for cases and 14.7% for controls (n.s.). None of the secondary outcome events differed significantly between the groups: 28-day mortality rate; death rate during hospitalisation; proportion of pneumonias, falls or pressure ulcers; or health-related outcomes according to the EQ-5D-5L questionnaire. These findings indicates that the Fast Track to the stroke unit by an EMS is safe for selected stroke patients and could avoid non-valuable time in the ED.
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Affiliation(s)
- Ingela Wennman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 45, Gothenburg, Sweden.
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden.
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 45, Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, at the University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 45, Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Bengt Fridlund
- Centre for Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | - Linda Alsholm
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, at the University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Paliokaite I, Dambrauskas Z, Dobozinskas P, Pukenyte E, Mankute-Use A, Vaitkaitis D. Electronic field protocols for prehospital care quality improvement in Lithuania: a randomized simulation-based study. Scand J Trauma Resusc Emerg Med 2023; 31:83. [PMID: 37990261 PMCID: PMC10662541 DOI: 10.1186/s13049-023-01150-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Prehospital emergency care is complex and influenced by various factors, leading to the need for decision-support tools. Studies suggest that cognitive aids improve provider performance and patient outcomes in clinical emergencies. Electronic cognitive aids have rarely been investigated in prehospital care. Therefore, this study aimed to evaluate the effects of the electronic field protocol (eFP) module on performance, adherence to the standard of care, and satisfaction of prehospital care providers in a simulated environment. METHODS This randomised simulation-based study was conducted at the Lithuanian University of Health Sciences in Kaunas, Lithuania. The simulation scenarios were developed to test 12 eFPs: adult resuscitation, pediatric resuscitation, delivery and postpartum care, seizures in pregnancy, stroke, anaphylaxis, acute chest pain, acute abdominal pain, respiratory distress in children, severe trauma, severe infection and sepsis, and initial neonatal evaluation and resuscitation. Sixteen prehospital practitioners with at least 3 years of clinical experience were randomly assigned to either use the eFP module or perform without it in each of the 12 simulated scenarios. Participant scores and adherence to standardised checklists were compared between the two performance modes. Participant satisfaction was measured through a post-simulation survey. RESULTS A total of 190 simulation sessions were conducted. Compared to the use of memory alone, the use of the eFP module significantly improved participants' performance in 10 out of the 12 simulation scenarios. Adherence to the standardised checklist increased from 60 to 85% (p < 0.001). Post-simulation survey results indicate that participants found the eFP module easy to use and relevant to prehospital clinical practice. CONCLUSIONS The study findings suggest that the eFP module as a cognitive aid can enhance prehospital practitioners' performance and adherence to the standard of care in simulated scenarios. These results highlight the potential of standardised eFPs as a quality improvement step in prehospital care in Lithuania.
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Affiliation(s)
- Ieva Paliokaite
- Department of Emergency Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Zilvinas Dambrauskas
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Dobozinskas
- Department of Disaster Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Evelina Pukenyte
- Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aida Mankute-Use
- Department of Emergency Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dinas Vaitkaitis
- Department of Disaster Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Heuer C, Howard I, Stassen W. Trigger tool-based description of adverse events in helicopter emergency medical services in Qatar. BMJ Open Qual 2023; 12:e002263. [PMID: 37963672 PMCID: PMC10649605 DOI: 10.1136/bmjoq-2023-002263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 09/26/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Adverse events (AEs) in helicopter emergency medical services (HEMS) remain poorly reported, despite the potential for harm to occur. The trigger tool (TT) represents a novel approach to AE detection in healthcare. The aim of this study was to retrospectively describe the frequency of AEs and their proximal causes (PCs) in Qatar HEMS. METHODS Using the Pittsburgh Adverse Event Tool to identify AEs in HEMS, we retrospectively analysed 804 records within an existing AE TT database (21-month period). We calculated outcome measures for triggers, AEs and harm per 100 patient encounters, plotted measures on statistical process control charts, and conducted a multivariate analysis to report harm associations. RESULTS We identified 883 triggers in 536 patients, with a rate of 1.1 triggers per patient encounter, where 81.2% had documentation errors (n=436). An AE and harm rate of 27.7% and 3.5%, respectively, was realised. The leading PC was actions by HEMS Crew (81.6%; n=182). The majority of harm (57.1%) stemmed from the intervention and medication triggers (n=16), where deviation from standard of care was common (37.9%; n=11). Age and diagnosis-adjusted odds were significant in the patient condition (6.50; 95% CI 1.71 to 24.67; p=0.01) and interventional (11.85; 95% CI 1.36 to 102.92; p=0.03) trigger groupings, while age and diagnosis had no effect on harm. CONCLUSION The TT methodology is a robust, reliable and valid means of AE detection in the HEMS domain. While an AE rate of 27.7% is high, more research is required to understand prehospital clinical decision-making and reasons for guideline deviance. Furthermore, focused quality improvement initiatives to reduce AEs and documentation errors should also be addressed in future research.
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Affiliation(s)
- Calvin Heuer
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Ian Howard
- Clinical Services, Hamad Medical Corporation Ambulance Service, Doha, Qatar
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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van Veen LEJ, van der Weijden BM, van Bodegom-Vos L, Hol J, Visser DH, Achten NB, Plötz FB. Barriers and Facilitators to the Implementation of the Early-Onset Sepsis Calculator: A Multicenter Survey Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1682. [PMID: 37892345 PMCID: PMC10605684 DOI: 10.3390/children10101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Prior studies demonstrated the neonatal early-onset sepsis (EOS) calculator's potential in drastically reducing antibiotic prescriptions, and its international adoption is increasing rapidly. To optimize the EOS calculator's impact, successful implementation is crucial. This study aimed to identify key barriers and facilitators to inform an implementation strategy. A multicenter cross-sectional survey was carried out among physicians, residents, nurses and clinical obstetricians of thirteen Dutch hospitals. Survey development was prepared through a literature search and stakeholder interviews. Data collection and analysis were based on the Consolidated Framework for Implementation Research (CFIR). A total of 465 stakeholders completed the survey. The main barriers concerned the expectance of the department's capacity problems and the issues with maternal information transfer between departments. Facilitators concerned multiple relative advantages of the EOS calculator, including stakeholder education, EOS calculator integration in the electronic health record and existing positive expectations about the safety and effectivity of the calculator. Based on these findings, tailored implementation interventions can be developed, such as identifying early adopters and champions, conducting educational meetings tailored to the target group, creating ready-to-use educational materials, integrating the EOS calculator into electronic health records, creating a culture of collective responsibility among departments and collecting data to evaluate implementation success and innovation results.
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Affiliation(s)
- Liesanne E. J. van Veen
- Department of Paediatrics, Tergooi MC, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands; (L.E.J.v.V.); (B.M.v.d.W.)
- Department of Paediatrics, Franciscus Gasthuis en Vlietland, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
- Department of Paediatrics, Erasmus MC, Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands;
| | - Bo M. van der Weijden
- Department of Paediatrics, Tergooi MC, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands; (L.E.J.v.V.); (B.M.v.d.W.)
- Amsterdam UMC, Department of Paediatrics and Amsterdam Reproduction & Development Research Institute, Location University of Amsterdam, Emma Children’s Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Jeroen Hol
- Department of Paediatrics, Noord West Ziekenhuis, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands;
| | - Douwe H. Visser
- Amsterdam UMC, Department of Paediatrics and Amsterdam Reproduction & Development Research Institute, Location University of Amsterdam, Emma Children’s Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam UMC, Department of Neonatology, Emma Children’s Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Niek B. Achten
- Department of Paediatrics, Erasmus MC, Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands;
| | - Frans B. Plötz
- Department of Paediatrics, Tergooi MC, Laan van Tergooi 2, 1212 VG Hilversum, The Netherlands; (L.E.J.v.V.); (B.M.v.d.W.)
- Amsterdam UMC, Department of Paediatrics and Amsterdam Reproduction & Development Research Institute, Location University of Amsterdam, Emma Children’s Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
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12
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Oliveira CB, Coombs D, Machado GC, McCaffery K, Richards B, Pinto RZ, O'Keeffe M, Maher CG, Christofaro DGD. Process evaluation of the implementation of an evidence-based model of care for low back pain in Australian emergency departments. Musculoskelet Sci Pract 2023; 66:102814. [PMID: 37421758 DOI: 10.1016/j.msksp.2023.102814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The Sydney Health Partners Emergency Department (SHaPED) trial targeted ED clinicians and evaluated a multifaceted strategy to implement a new model of care. The objective of this study was to investigate attitudes and experiences of ED clinicians as well as barriers and facilitators for implementation of the model of care. DESIGN A qualitative study. METHODS The EDs of three urban and one rural hospital in New South Wales, Australia participated in the trial between August and November 2018. A sample of clinicians was invited to participate in qualitative interviews via telephone and face-to-face. The data collected from the interviews were coded and grouped in themes using thematic analysis methods. RESULTS Non-opioid pain management strategies (i.e., patient education, simple analgesics, and heat wraps) were perceived to be the most helpful strategy for reducing opioid use by ED clinicians. However, time constraints and rotation of junior medical staff were seen as the main barriers for uptake of the model of care. Fear of missing a serious pathology and the clinicians' conviction of a need to provide something for the patient were seen as barriers to reducing lumbar imaging referrals. Other barriers to guideline endorsed care included patient's expectations and characteristics (e.g., older age and symptoms severity). CONCLUSIONS Improving knowledge of non-opioid pain management strategies was seen as a helpful strategy for reducing opioid use. However, clinicians also raised barriers related to the ED environment, clinicians' behaviour, and cultural aspects, which should be addressed in future implementation efforts.
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Affiliation(s)
- Crystian B Oliveira
- Faculty of Medicine, University of Western São Paulo (Unoeste), Presidente Prudente, Sao Paulo, Brazil; Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia.
| | - Danielle Coombs
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bethan Richards
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rafael Z Pinto
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Diego G D Christofaro
- Departamento de Educação Física, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
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Karmelić E, Lindlöf H, Luckhaus JL, Castillo MM, Vicente V, Härenstam KP, Savage C. Decision-making on the fly: a qualitative study of physicians in out-of-hospital emergency medical services. BMC Emerg Med 2023; 23:65. [PMID: 37286931 DOI: 10.1186/s12873-023-00830-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. METHODS Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. RESULTS Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. CONCLUSIONS The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians' journey from novice to expert.
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Affiliation(s)
- Ema Karmelić
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
| | - Henrik Lindlöf
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- The ambulance medical service of Region Västmanland, Västerås, Sweden
| | - Jamie Linnea Luckhaus
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
| | - Moa Malmqvist Castillo
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
| | - Veronica Vicente
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- The ambulance medical service in Stockholm (AISAB), Stockholm, Sweden
- Academic EMS, Stockholm, Sweden
| | - Karin Pukk Härenstam
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
- Department of Womens and Childrens Health, Karolinska Institutet, Stockholm, Sweden
| | - Carl Savage
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden.
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.
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Michaels JA, Maheswaran R. Conflicting perspectives during guidelines development are an important source of implementation failure. Health Policy 2023; 131:104801. [PMID: 36990043 DOI: 10.1016/j.healthpol.2023.104801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
In recent years many countries have created national bodies that provide evidence-based guidance and policy relating to the commissioning and provision of healthcare services. However, such guidance often fails to be consistently implemented. The differing perspectives from which guidance is developed is suggested as a significant contributor to these failures. A societal perspective is, necessarily, taken by policy makers, while patients and their healthcare professionals are primarily concerned with an individual perspective. This is particularly likely to impair implementation where national policy objectives, such as cost effectiveness, equity, or the promotion of innovation, are embodied in the guidance, while patients and healthcare professionals may consider it appropriate to over-ride these, based upon individual circumstances and preferences. This paper examines these conflicts with reference to guidance issued by the National Institute of Health and Care Excellence in England. Conflicts are identified between the objectives, values, and preferences of those who develop and those who implement such guidance, with consequent difficulties in providing helpful personalised recommendations. The implications of this for the development and implementation of guidance are discussed and recommendations are made regarding the ways in which such guidance is framed and disseminated.
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Ångerman S, Kirves H, Nurmi J. Multifaceted implementation and sustainability of a protocol for prehospital anaesthesia: a retrospective analysis of 2115 patients from helicopter emergency medical services. Scand J Trauma Resusc Emerg Med 2023; 31:21. [PMID: 37122004 PMCID: PMC10148755 DOI: 10.1186/s13049-023-01086-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Prehospital emergency anaesthesia (PHEA) is a high-risk procedure. We developed a prehospital anaesthesia protocol for helicopter emergency medical services (HEMS) that standardises the process and involves ambulance crews as active team members to increase efficiency and patient safety. The aim of the current study was to evaluate this change and its sustainability in (i) on-scene time, (ii) intubation first-pass success rate, and (iii) protocol compliance after a multifaceted implementation process. METHODS The protocol was implemented in 2015 in a HEMS unit and collaborating emergency medical service systems. The implementation comprised dissemination of information, lectures, simulations, skill stations, academic detailing, and cognitive aids. The methods were tailored based on implementation science frameworks. Data from missions were gathered from mission databases and patient records. RESULTS During the study period (2012-2020), 2381 adults underwent PHEA. The implementation year was excluded; 656 patients were analysed before and 1459 patients after implementation of the protocol. Baseline characteristics and patient categories were similar. On-scene time was significantly redused after the implementation (median 32 [IQR 25-42] vs. 29 [IQR 21-39] minutes, p < 0.001). First pass success rate increased constantly during the follow-up period from 74.4% (95% CI 70.7-77.8%) to 97.6% (95% CI 96.7-98.3%), p = 0.0001. Use of mechanical ventilation increased from 70.6% (95% CI 67.0-73.9%) to 93.4% (95% CI 92.3-94.8%), p = 0.0001, and use of rocuronium increased from 86.4% (95% CI 83.6-88.9%) to 98.5% (95% CI 97.7-99.0%), respectively. Deterioration in compliance indicators was not observed. CONCLUSIONS We concluded that clinical performance in PHEA can be significantly improved through multifaceted implementation strategies.
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Affiliation(s)
- Susanne Ångerman
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, 01530 Vantaa, Finland
| | - Hetti Kirves
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, 01530 Vantaa, Finland
| | - Jouni Nurmi
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, 01530 Vantaa, Finland
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Benhamed A, Mercier E, Freyssenge J, Heidet M, Gauss T, Canon V, Claustre C, Tazarourte K. Impact of the 2015 European guidelines for resuscitation on traumatic cardiac arrest outcomes and prehospital management: A French nationwide interrupted time-series analysis. Resuscitation 2023; 186:109763. [PMID: 36924821 DOI: 10.1016/j.resuscitation.2023.109763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/19/2023] [Accepted: 03/03/2023] [Indexed: 03/17/2023]
Abstract
AIM To evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines on patient outcomes following traumatic cardiac arrest (TCA) and on advanced life support interventions carried out by physician-staffed ambulances. METHODS Data of TCA patients aged ≥18 years were extracted from the French nationwide cardiac arrest registry. A pre- (2011-2015) and a post-publication period (2016-2020) were defined. In the guidelines, a specific TCA management algorithm was introduced to prioritise the treatment of reversible causes. Its impact was evaluated using adjusted interrupted time series analysis. RESULTS 4,980 patients were treated (2,145 during the pre-publication period and 2,739 during the post-publication period). There was no significant change in the rates of prehospital ROSC (22.4% vs. 20.2%, p = 0.07 in the pre- and post- intervention respectively), survival (1.4% vs. 1.4%, p = 0.87) or good neurological outcome (71.4% vs. 66.7%, p = 0.93) or in the incidence of organ donation (1.6% vs. 1.3%, p = 0.50). There were nonsignificant changes in the adjusted temporal trend for ROSC (aOR 0.88; 95% CI [0.77; 1.00]), survival (aOR 1.34; 95% CI [0.83;2.17]), good neurological outcome (aOR 1.57; 95% CI [0.82;3.05]), and organ donation (aOR 1.06; 95% CI [0.71;1.60]). The use of intraosseous catheters (13.0% vs. 19.2%, p < 0.001), external haemorrhage control measures (23.9% vs. 64.8%, p < 0.001), bilateral chest decompression (13.7% vs. 16.5%, p = 0.009), and packed red cell transfusion (2.7% vs. 6.5%, p < 0.001) increased in the post-publication period. CONCLUSIONS Despite the increased frequency of trauma rescue interventions performed by on-scene physicians, no change in patient-centred outcomes was associated with the publication of the 2015 ERC guidelines in France.
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Affiliation(s)
- Axel Benhamed
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Recherche, CHU de Québec-Université Laval, Québec, Québec, Canada.
| | - Eric Mercier
- Centre de Recherche, CHU de Québec-Université Laval, Québec, Québec, Canada.
| | - Julie Freyssenge
- Réseau Urg'ARA, Lyon, France; INSERM U1290 (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France.
| | - Mathieu Heidet
- SAMU 94, Hôpitaux Universitaires Henri Mondor, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
| | - Tobias Gauss
- Anaesthesia Critical Care, Grenoble Alpes University Hospital, Grenoble, France.
| | - Valentine Canon
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et Des Pratiques Médicales, F-59000 Lille, France.
| | | | - Karim Tazarourte
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France; INSERM U1290 (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France.
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Ulrich Hansen M, Vejzovic V, Zdravkovic S, Axelsson M. Ambulance nurses' experiences of using prehospital guidelines for patients with acute chest pain - A qualitative study. Int Emerg Nurs 2022; 63:101195. [PMID: 35802956 DOI: 10.1016/j.ienj.2022.101195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/29/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ambulance nurses have an important role in early recognition and treatment often being the first medical contact for patients with acute chest pain. However, there is sparse knowledge on the experiences of ambulance nurses with regard to use of Prehospital Guidelines for patients with Acute Chest Pain. AIM To explore ambulance nurses' experiences of using prehospital guidelines for patients with acute coronary syndrome. METHOD A qualitative descriptive study design. Semi-structured interviews with 22 ambulance nurses recruited through purposive sampling strategy. The material was transcribed and analysed using content analysis. RESULTS Two main categories emerged from the results. The first category Sense of professional obligation included experiences of having an important role in caring for patients with acute chest pain. Understanding this role and the collaboration in the chain of care prompted ambulance nurses to adhere to the guidelines. However, not receiving enough feedback on the provided care made them uncertain whether to use guidelines. The second category Clinical difficulties using guidelines consisted of experiences of being surrounded by practical challenges while using guidelines. Ambulance nurses meet these challenges by relying on their clinical experience, which sometimes led to them deviating from the guidelines. CONCLUSIONS The ambulance nurses experienced a mixture of feeling secure and insecure when using the guidelines. Foremost, when encountering patients with unspecific chest pain, they felt a lack of feedback and an insufficient collaboration within the chain of care, which made them deviate from guidelines. To increase adherence in guidelines, post-registration education to update the knowledge and skills about guidelines for acute chest pain is needed followed by formal inter-disciplinary feedback on the care provided.
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Affiliation(s)
- Michael Ulrich Hansen
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden.
| | - Vedrana Vejzovic
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Slobodan Zdravkovic
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
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Larsson G, Hansson P, Olsson E, Herlitz J, Hagiwara MA. Prehospital assessment of patients with abdominal pain triaged to self-care at home: an observation study. BMC Emerg Med 2022; 22:92. [PMID: 35659247 PMCID: PMC9164890 DOI: 10.1186/s12873-022-00649-x] [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: 01/28/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients who call for emergency medical services (EMS) due to abdominal pain suffer from a broad spectrum of diseases, some of which are time sensitive. As a result of the introduction of the concept of 'optimal level of care', some patients with abdominal pain are triaged to other levels of care than in an emergency department (ED). We hypothesised that it could be challenging in a patient safety perspective. AIM This study aims to describe consecutive patients who call for EMS due to abdominal pain and are triaged to self-care by EMS clinicians. METHODS This was an observational study performed in an EMS organisation in Western Sweden during 2020. The triage tool Rapid Emergency Triage and Treatment System (RETTS), which included Emergency Signs and Symptom (ESS) codes, was used to find medical records where patients with abdominal pain have been triaged to self-care and 194 patients was included in the study. RESULTS Of total 48,311 ambulance missions, A total of 1747 patients were labelled with ESS code six (abdominal pain), including 223 (12.8%) who were given the code for self-care and 194 who were further assessed by the research group. Of these patients, 32 (16.3%) had a return visit within 96 hours due to the same symptoms and 11 (5.6%) were hospitalised. In six of these patients, the EMS triage was evaluated retrospectively and assessed as inappropriate. These patients had a final diagnosis of ruptured abdominal aneurysm (n = 1), acute appendicitis with peritonitis (n = 2) and acute pancreatitis (n = 3). All these patients required extensive evaluation and different treatments, including acute surgery, antibiotics and fluid therapy. CONCLUSION Amongst the 1747 patients assessed by EMS due to abdominal pain, 223 (12.8%) were triaged to self-care. Of the 194 patients who were further assessed, 16.3% required a return visit to the ED within 96 hours and 5.6% were hospitalised. Six patients had obvious time-sensitive conditions. Our study highlights the difficulties in the early assessment of abdominal pain and the requirement for an accurate decision support tool.
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Affiliation(s)
- Glenn Larsson
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Hansson
- NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, Sweden
| | - Emelie Olsson
- NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, 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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Johansson H, Lundgren K, Hagiwara MA. Reasons for bias in ambulance clinicians' assessments of non-conveyed patients: a mixed-methods study. BMC Emerg Med 2022; 22:79. [PMID: 35524195 PMCID: PMC9074185 DOI: 10.1186/s12873-022-00630-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background The number of ambulance assignments and the influx of patients to the emergency departments (EDs) in Sweden have increased in recent years. This is one reason the protocol for prehospital emergency care was developed around referring patients for non-conveyance, either through the see-and-convey elsewhere approach or through the see-and-treat approach. However, this protocol has led to challenges in patient assessments. This study aimed to investigate the underlying causes of patient harm among those referred for the see-and-treat approach by the emergency medical services. Methods This three-phase study involved a mixed-methods design. Cases of injuries, internal investigations and incident analyses of referrals for the see-and-treat approach in two regions in south eastern Sweden from 2015 to 2020 were examined using qualitative content analysis. This qualitative analysis was the basis for the quantitative analysis of the ambulance records. After the qualitative analysis was completed, a review protocol was developed; 34 variables were used to review 240 randomly selected ambulance records logged in 2020, wherein patients were referred for the see-and-treat approach. Finally, the review results were synthesised. Results The qualitative analysis revealed three common themes: ‘assessment of patients’, ‘guidelines’ and ‘environment and organisation’. These results were confirmed by a medical journal review. Shortcomings were found in the anamnesis and in the number of targeted examinations performed. The checklist for referring patients for the see-and-treat approach and the information sheet to be provided to the patients were not used. In 34% of the ambulance records examined, the EMS clinicians deviated from the current guidelines for a see-and-treat referral. Conclusions The results indicated that the low adherence to guidelines and the patient assessment deviating from the protocol put patients at risk of being harmed during a see-and-treat referral. Measures are needed to guarantee a safe assessment of an increasing number of patients who are referred for the see-and-treat approach, especially the multi-sick elderly patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00630-8.
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Affiliation(s)
- Helena Johansson
- Falck Ambulans Östergötland, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Kristin Lundgren
- Ambulanssjukvården Region Jönköpings län, 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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20
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Mastenbrook J, Emrick D, Bauler LD, Markman J, Koedam T, Fales W. Evaluation of Basic Life Support First Responder Naloxone Administration Protocol Adherence. Cureus 2021; 13:e18932. [PMID: 34812316 PMCID: PMC8604552 DOI: 10.7759/cureus.18932] [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] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: Opioid overdoses have become a significant problem across the United States resulting in respiratory depression and risk of death. Basic Life Support (BLS) first responders have had the option to treat respiratory depression using a bag-valve-mask device, however naloxone, an opioid antagonist, has been shown to quickly restore normal respiration. Since the introduction of naloxone and recent mandates across many states for BLS personnel to carry and administer naloxone, investigation into the adherence of naloxone use standing protocols is warranted. Methods: This preliminary study examined 100 initial cases of BLS first responder administration of naloxone for appropriate indications and protocol adherence. Results: This study found that n=22/100 naloxone administrations were inappropriate, often given to patients who were not suffering from respiratory depression (n=11/22). Positive pressure ventilation (PPV) was not administered prior to naloxone in n=56/100 cases, of which n=42/100 had an inadequate respiratory effort documented. For patients with a known history of substance use disorder, there was a significant increase in administration of naloxone prior to PPV (60%; n=33/55) compared to patients without a known history (30%; n=9/30). Conclusion: Overall these preliminary data suggest that during BLS naloxone administration, the majority of cases did not follow at least one component of the standard protocol for patients with respiratory depression. This study suggests that further education and more research are needed to better understand the decision-making processes of prehospital providers to ensure adherence to standard protocols.
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Affiliation(s)
- Joshua Mastenbrook
- Emergency Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - Daniel Emrick
- Student Affairs, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - Laura D Bauler
- Biomedical Sciences, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - James Markman
- General Surgery, Mount Carmel Graduate Medical Education, Grove City, USA
| | - Tyler Koedam
- Emergency Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
| | - William Fales
- Emergency Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA
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21
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Mosca CG, Stein C, Lawrence H. South African pre-hospital emergency care personnel's lived experiences of managing paediatric emergencies: A qualitative research design utilising one-on-one interviews. Health SA 2021; 26:1558. [PMID: 34394964 PMCID: PMC8335770 DOI: 10.4102/hsag.v26i0.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/21/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The phenomenon of managing paediatric emergencies in the pre-hospital environment within the South African setting is poorly understood with specific regard to what emergency care personnel are experiencing when managing paediatric emergencies. AIM The aim of this study was to explore and describe the lived experiences of emergency care personnel in managing paediatric patients in the pre-hospital environment and to understand the meaning and the significance of these experiences. SETTING All participants were purposively sampled from emergency medical services agencies operating within the Johannesburg metropolitan city area. METHODS This study followed a qualitative, exploratory, descriptive, phenomenological design, whereby participants purposively sampled within the Johannesburg metropolitan city voluntarily consented to one-on-one interviews (n = 10). RESULTS Three main themes, with 11 contributing categories, were identified and contextualised with available literature. Emerging from the main themes was an overall sense that managing paediatric emergencies is a negative experience, coloured with feelings of inadequacy, stress, anxiety and even fear. CONCLUSIONS The findings of this study provided new insights into what South African EMS are experiencing when managing paediatric emergencies, which enables future research efforts to identify research and practice gaps that are relevant to paediatric pre-hospital emergency care, and that are specific to the South African environment. CONTRIBUTION This research provides preliminary insight into the lived experiences of prehospital personnel managing paediatric emergencies as well as emerging recommendations for the improvement of the prehospital care of paediatric patients.
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Affiliation(s)
- Colin G Mosca
- Department of Emergency Medical Care, Faculty of Health Science, University of Johannesburg, Johannesburg, South Africa
| | - Christopher Stein
- Department of Emergency Medical Care, Faculty of Health Science, University of Johannesburg, Johannesburg, South Africa
| | - Heather Lawrence
- Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
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22
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Dmitriew C, Ohle R. Barriers and facilitators affecting implementation of the Canadian clinical practice guidelines for the diagnosis of acute aortic syndrome. Implement Sci Commun 2021; 2:60. [PMID: 34088362 PMCID: PMC8178923 DOI: 10.1186/s43058-021-00160-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The 2020 Canadian clinical practice guidelines for the diagnosis of AAS incorporate all available evidence into four key recommendations. In order to facilitate the implementation of these recommendations, a clinical decision aid was created. The objective of this study was to identify barriers and facilitators among physicians prior to implementation of the guideline recommendations in a multicentre step wedge cluster randomized control trial. METHODS We conducted semi-structured interviews with nine emergency room physicians working at five sites distributed between urban academic and rural settings. We used purposive sampling, contacting physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators to guideline recommendation uptake and use. Responses were analysed according to the Theoretical Domains Framework, and overarching themes describing these barriers and facilitators were identified. RESULTS Two themes and six subthemes encompassing 13 theoretical domains were identified. These included clinical decision-making support, awareness of the evidence, social factors, expected consequences, ability of physicians to acquire the necessary data and ease of use. A majority of interviewees anticipated that the guideline recommendations would support clinical decision making and more effectively risk-stratify patients. Other facilitators included endorsement of the guidelines by professional organizations and peers. Barriers to implementation include the fact that laboratory testing and knowledge of the rationale for its use in the investigation of AAS were not widespread. The complexity of the clinical decision aid and concerns about test specificity were also identified as potential barriers to use. CONCLUSION Physicians were amenable to using the AAS guideline recommendations to support clinical decision-making and to reduce resource use. A structured intervention should be developed to address the identified barriers and leverage the facilitators in order to ensure successful implementation. Our findings may have implications for the implementation of other guidelines used in emergency departments.
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Affiliation(s)
- Caitlin Dmitriew
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Robert Ohle
- The Department of Emergency Medicine, Health Science North Research Institute, Northern Ontario School of Medicine, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5 J1, Canada.
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23
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Zhang X, Wu Z, Zhao B, Zhang Q, Li Z. Implementing a Pressure Injury Care Bundle in Chinese Intensive Care Units. Risk Manag Healthc Policy 2021; 14:2435-2442. [PMID: 34113197 PMCID: PMC8187104 DOI: 10.2147/rmhp.s292579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of pressure injury (PI) in intensive care units (ICUs) is high with a low compliance rate for PI prevention standard care. Although studies have confirmed that PIs are largely preventable, a PI care bundle based on the best evidence in Chinese ICUs is lacking. Aim The aims of this study are to assess the effectiveness of our PI care bundle-which is based on the best evidence and designed to prevent the development of ICU PIs-and to identify the changes in nurse compliance rates during the implementation process. Methods A quasi-experimental, pre- and post-intervention design was used. Implementation strategies included training, auditing during the use of the care bundle, and measuring outcome indicators in the ICU. The key elements of the care bundle were risk identification, skin assessment, patient repositioning, skin care, use of a pressure-reducing device, and nutrition. The number and stage of PIs were collected at three time points by unit staff. The implementation compliance rate was measured at two time points using a compliance checklist. Results Pressure injury rates were reduced significantly from 13.86% to 10.41%. The incidence of new hospital-acquired pressure injuries (HAPI) decreased by 29.5% within 6 months. The compliance rate of nurses increased significantly from 55.15% to 60.15% before and after the implementation of the care bundle (χ2=16.72, P=0.00); This result may be attributable to the implementation of care bundle training for nurses and the audit. Conclusion A standardized care bundle based on the best evidence is indicated to effectively reduce the incidence of PIs. The increase in compliance rate after the intervention may benefit from nurses training in the care bundle and the audit during the intervention.
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Affiliation(s)
- Xiaoman Zhang
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, People's Republic of China
| | - Zhijun Wu
- ZhongWei Institute of Nursing Information, Beijing, Beijing 518031, People's Republic of China
| | - Baosheng Zhao
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, People's Republic of China
| | - Qi Zhang
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, People's Republic of China
| | - Zhenxiang Li
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, People's Republic of China
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24
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Spicher N, Barakat R, Wang J, Haghi M, Jagieniak J, Öktem GS, Hackel S, Deserno TM. Proposing an International Standard Accident Number for Interconnecting Information and Communication Technology Systems of the Rescue Chain. Methods Inf Med 2021; 60:e20-e31. [PMID: 33979848 PMCID: PMC8294938 DOI: 10.1055/s-0041-1728676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The rapid dissemination of smart devices within the internet of things (IoT) is developing toward automatic emergency alerts which are transmitted from machine to machine without human interaction. However, apart from individual projects concentrating on single types of accidents, there is no general methodology of connecting the standalone information and communication technology (ICT) systems involved in an accident: systems for alerting (e.g., smart home/car/wearable), systems in the responding stage (e.g., ambulance), and in the curing stage (e.g., hospital). OBJECTIVES We define the International Standard Accident Number (ISAN) as a unique token for interconnecting these ICT systems and to provide embedded data describing the circumstances of an accident (time, position, and identifier of the alerting system). MATERIALS AND METHODS Based on the characteristics of processes and ICT systems in emergency care, we derive technological, syntactic, and semantic requirements for the ISAN, and we analyze existing standards to be incorporated in the ISAN specification. RESULTS We choose a set of formats for describing the embedded data and give rules for their combination to generate an ISAN. It is a compact alphanumeric representation that is generated easily by the alerting system. We demonstrate generation, conversion, analysis, and visualization via representational state transfer (REST) services. Although ISAN targets machine-to-machine communication, we give examples of graphical user interfaces. CONCLUSION Created either locally by the alerting IoT system or remotely using our RESTful service, the ISAN is a simple and flexible token that enables technological, syntactic, and semantic interoperability between all ICT systems in emergency care.
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Affiliation(s)
- Nicolai Spicher
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Ramon Barakat
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Ju Wang
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Mostafa Haghi
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Justin Jagieniak
- Physikalisch-Technische Bundesanstalt PTB, National Metrology Institute of Germany, Braunschweig, Germany
| | - Gamze Söylev Öktem
- Physikalisch-Technische Bundesanstalt PTB, National Metrology Institute of Germany, Braunschweig, Germany
| | - Siegfried Hackel
- Physikalisch-Technische Bundesanstalt PTB, National Metrology Institute of Germany, Braunschweig, Germany
| | - Thomas Martin Deserno
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
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25
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Jansson J, Larsson M, Nilsson J. Advanced paramedics and nurses can deliver safe and effective pre-hospital and in-hospital emergency care: An integrative review. Nurs Open 2021; 8:2385-2405. [PMID: 33955702 PMCID: PMC8363369 DOI: 10.1002/nop2.866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/05/2022] Open
Abstract
AIM To explore and present an overview of scope of practice among registered nurses and paramedics with an advanced level of education in pre-hospital and in-hospital emergency care. DESIGN An integrative literature review. METHOD Studies published between 2006 and 2018 were retrieved by searching the databases CINAHL, PubMed, Scopus and Web of Science. Studies were selected by three independent researchers, and data were synthesized using thematic analysis. RESULTS The 25 studies identified focused on in-hospital (n = 15) and pre-hospital emergency care (n = 10) and included 13 professional titles originated from seven countries. The thematic analysis disclosed four themes; "Versatile care," "Safe care based on precision and accuracy," "Autonomous performance within boundaries" and "Beneficial towards patients and society." Advanced paramedics' and advanced nurses' services are characterized as safe, of high quality and of public benefit. Their services are being used in everyday practice as well as directed to certain categories of patients.
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Affiliation(s)
- Jörgen Jansson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Maria Larsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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26
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Wiercigroch D, Hoyeck P, Sheikh H, Hulme J. A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department. BMC Emerg Med 2021; 21:48. [PMID: 33858328 PMCID: PMC8051038 DOI: 10.1186/s12873-021-00443-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Emergency departments (EDs) across Canada are increasingly prescribing buprenorphine for opioid use disorder (OUD). The objective of this study was to identify the current knowledge, attitudes, and behaviours of ED physicians on the management of OUD in the ED, including barriers and facilitators to prescribing buprenorphine. Methods We purposefully selected emergency physicians from one ED in Toronto which had recently received education on OUD management and had a new addiction medicine follow-up clinic, to participate in semi-structured interviews. We used semi-structured interviews to explore experiences with patients with OUD, conceptions of role of the ED in addressing OUD, and specifically ask about perceptions and experience on using buprenorphine for opioid withdrawal. Our analysis was informed by constructivist grounded theory to help uncover contextualized social processes and focus on what people do and why they do it. Two researchers independently coded transcripts using an iterative constant comparative and interpretative approach. Results Results fell broadly into facilitators and barriers. Generally, management of OUD in the ED varied significantly. Physician-level facilitators to treating opioid withdrawal with buprenorphine included: knowledge about OUD an7d buprenorphine, positive experiences with substitution therapy in the past, and the presence of physician champions. Systems-level facilitators included timely access to follow-up care and pre-printed order sets. Barriers included provider inexperience, lack of feedback on treatment effectiveness, limited time to counsel patients, and pressure to discharge patients quickly. Additional barriers included concerns about precipitating withdrawal, prescribing a chronic medication in acute care, and patient attitudes. Conclusion This study describes barriers and facilitators to addressing OUD and prescribing buprenorphine in a Canadian ED. These findings suggest a role for additional provider education, involvement of allied health professionals in counseling, and mentorship by physician champions in the department. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00443-1.
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Affiliation(s)
- David Wiercigroch
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Canada.
| | - Patricia Hoyeck
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Canada
| | - Hasan Sheikh
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,University Health Network Emergency Department, Toronto, Canada
| | - Jennifer Hulme
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,University Health Network Emergency Department, Toronto, Canada
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27
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Cnossen MC, Scholten AC, Lingsma HF, Synnot A, Tavender E, Gantner D, Lecky F, Steyerberg EW, Polinder S. Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review. J Neurotrauma 2021; 38:1072-1085. [PMID: 26431625 PMCID: PMC8054518 DOI: 10.1089/neu.2015.4121] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Guidelines aim to improve the quality of medical care and reduce treatment variation. The extent to which guidelines are adhered to in the field of traumatic brain injury (TBI) is unknown. The objectives of this systematic review were to (1) quantify adherence to guidelines in adult patients with TBI, (2) examine factors influencing adherence, and (3) study associations of adherence to clinical guidelines and outcome. We searched EMBASE, MEDLINE, Cochrane Central, PubMed, Web of Science, PsycINFO, SCOPUS, CINAHL, and grey literature in October 2014. We included studies of evidence-based (inter)national guidelines that examined the acute treatment of adult patients with TBI. Methodological quality was assessed using the Research Triangle Institute item bank and Quality in Prognostic Studies Risk of Bias Assessment Instrument. Twenty-two retrospective and prospective observational cohort studies, reported in 25 publications, were included, describing adherence to 13 guideline recommendations. Guideline adherence varied considerably between studies (range 18-100%) and was higher in guideline recommendations based on strong evidence compared with those based on lower evidence, and lower in recommendations of relatively more invasive procedures such as craniotomy. A number of patient-related factors, including age, Glasgow Coma Scale, and intracranial pathology, were associated with greater guideline adherence. Guideline adherence to Brain Trauma Foundation guidelines seemed to be associated with lower mortality. Guideline adherence in TBI is suboptimal, and wide variation exists between studies. Guideline adherence may be improved through the development of strong evidence for guidelines. Further research specifying hospital and management characteristics that explain variation in guideline adherence is warranted.
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Affiliation(s)
- Maryse C. Cnossen
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Hester F. Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anneliese Synnot
- Center for Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emma Tavender
- Australian Satellite of Cochrane EPOC group, Melbourne, Australia
| | - Dashiell Gantner
- Center for Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Australia
| | - Fiona Lecky
- Department of Emergency Medicine, University of Sheffield, University of Manchester and Salford Royal Hospital NHS Foundation Trust, and 2012 NICE Head Injury Guideline Development Group, United Kingdom
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
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28
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Schwartz HEM, Stark NR, Sowa CS, Singh MK, Peabody CR. Building Back Better: Applying Lessons from the COVID-19 Pandemic to Expand Critical Information Access. J Emerg Med 2021; 61:607-614. [PMID: 34108121 PMCID: PMC7997598 DOI: 10.1016/j.jemermed.2021.03.014] [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: 12/30/2020] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
Background The Coronavirus disease 2019 (COVID-19) pandemic generated an unprecedented volume of evolving clinical guidelines that strained existing clinical information systems and necessitated rapid innovation in emergency departments (EDs). Objectives Our team aimed to harness new COVID-19-related reliance on digital clinical support tools to re-envision how all clinical guidelines are stored and accessed in our ED. Methods We used a design-thinking approach including empathizing, defining the problem, ideating, prototyping, and testing to develop a low-cost, homegrown clinical information hub: E*Drive. To measure impact, we compared web traffic on E*Drive to our legacy cloud-based folder system and conducted a survey of end-users using a validated health technology utilization instrument. Results Our final product, E*Drive, is a centralized clinical information hub storing everything from clinical guidelines to discharge resources. Clinical guidelines are standardized and housed within the high-traffic E*Drive platform to increase accessibility. Since launch, E*Drive has averaged 84 unique weekly users, compared with less than one weekly user on the legacy system. We surveyed 52 clinicians for a total response rate of 47%. Prior to the E*Drive rollout, 12.5% of ED clinicians felt confident accessing clinical information on the legacy system, whereas 76.6% of ED clinicians felt they could more easily access clinical information using E*Drive. Conclusion The COVID pandemic revealed vulnerabilities within our information dissemination system and presented an opportunity to improve clinical information delivery. Centralized web-based clinical information hubs designed around the clinician end-user experience can increase clinical guideline access in the ED.
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Affiliation(s)
- Hope E M Schwartz
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Nicholas R Stark
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Cathleen S Sowa
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Malini K Singh
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Christopher R Peabody
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
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29
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Jones AR, Tay CT, Melder A, Vincent AJ, Teede H. What Are Models of Care? A Systematic Search and Narrative Review to Guide Development of Care Models for Premature Ovarian Insufficiency. Semin Reprod Med 2021; 38:323-330. [PMID: 33684948 DOI: 10.1055/s-0041-1726131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
No specific model of care (MoC) is recommended for premature ovarian insufficiency (POI), despite awareness that POI is associated with comorbidities requiring multidisciplinary care. This article aims to explore the definitions and central components of MoC in health settings, so that care models for POI can be developed. A systematic search was performed on Ovid Medline and Embase, and including gray literature. Unique definitions of MoC were identified, and thematic analysis was used to summarize the key component of MoC. Of 2,477 articles identified, 8 provided unique definitions of MoC, and 11 described components of MoC. Definitions differ in scope, focusing on disease, service, or system level, but a key feature is that MoC is operational, describing how care is delivered, as well as what that care is. Thematic analysis identified 42 components of MoC, summarized into 6 themes-stakeholder engagement, supporting integrated care, evidence-based care, defined outcomes and evaluation, behavior change methodology, and adaptability. Stakeholder engagement was central to all other themes. MoCs operationalize how best practice care can be delivered at a disease, service, or systems level. Specific MoC should be developed for POI, to improve clinical and process outcomes, translate evidence into practice, and use resources more efficiently.
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Affiliation(s)
- Alicia R Jones
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia
| | - Chau T Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia
| | - Angela Melder
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Monash Partner's Academic Health Science Centre, Victoria, Australia
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia.,Department of Endocrinology, Monash Health, Victoria, Australia.,Monash Partner's Academic Health Science Centre, Victoria, Australia
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30
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Eismann L, Kretschmer A, Bader MJ, Kess S, Stief CG, Strittmatter F. Adherence to guidelines in the management of urolithiasis: are there differences among distinct patient care settings? World J Urol 2021; 39:3079-3087. [PMID: 33388879 DOI: 10.1007/s00345-020-03562-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Urolithiasis is a common diagnosis in urology. New technologies offer a variety of diagnostic and therapy and consequently display a financial burden on healthcare systems. Hence, clinical practice guidelines (CPG) are essential to implement evidence-based medicine and assure a standard of care considering limited resources. To date, there is no evidence of the use and adherence to CPG on urolithiasis. MATERIAL AND METHODS Therefore, we performed a cross-sectional study to analyze the use of CPG on urolithiasis. Data collection was carried out by a questionnaire given to 400 German urologists. The survey included use and adherence to guidelines, evaluation of the clinical situation, therapy spectrum, and workplace. In total, 150 (37%) questionnaires were received and included in our survey. Statistics were performed by SPSS using Chi-quadrat test/Fisher's exact test. RESULTS In our study, urologists were office based, hospital affiliated, non-academic, or academic centers in 53%, 32%, 16% and 5%, respectively. In 74% and 70%, urologists adhere to CPG in diagnostic and therapy. Interestingly, workplace and therapy spectrum determines the use of different CPG (p = 0.01; p = 0.022). Academic urologists were more likely to use international CPG of EAU (40%), while outpatient urologists significantly orientated on national CPG (46%). 86% of urologists with high volume of urolithiasis practice interventions in contrast to 53% in low volume (p = 0.001). More than 80% of urologists use short versions and app version of CPG. CONCLUSION We firstly describe compliance and the use of CPG on urolithiasis. EAU and DGU present the most commonly used CPG. Short version and app version of CPG find frequent clinical utilization.
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Affiliation(s)
- Lennert Eismann
- Department of Urology, University Hospital of Munich, LMU, Marchioninistr. 15, 81377, Munich, Germany.
| | - Alexander Kretschmer
- Department of Urology, University Hospital of Munich, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | | | - Sabine Kess
- Department of Gynecology and Obstetrics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christian G Stief
- Department of Urology, University Hospital of Munich, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - Frank Strittmatter
- Department of Urology, University Hospital of Munich, LMU, Marchioninistr. 15, 81377, Munich, Germany
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Riyami HA, Riyami AA, Nadar SK. Comparison between two protocols for deflation of the TR band following coronary procedures via the radial route. J Saudi Heart Assoc 2020; 32:52-56. [PMID: 33154892 PMCID: PMC7640594 DOI: 10.37616/2212-5043.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/16/2019] [Accepted: 11/10/2019] [Indexed: 11/26/2022] Open
Abstract
Aim Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction. Methods All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the study. The TR band was applied using the patent hemostasis method (2 ml air pushed in after the radial pulse appears on pulse oximetry after full occlusion with 16 ml air). Patients were randomly assigned to either protocol. Protocol 1 involved removal of 2 ml of air starting 1 hour after the sheath removal and then removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved removal of 4 ml of air 2 hours after the sheath removal and then further 4 ml of air every 15 minutes until the band came off. Patient and staff satisfaction was measured with a visual analogue scale. Results A total of 174 patients were recruited (mean age, 60 ± 11 years; 127 male, 47 female). The baseline characteristics including total heparin dose and type of procedure, in the two arms were the same. Protocol 2 (n = 84) was associated with a significantly lower time to TR band removal as compared to protocol 1 (n = 90; 201 ± 43 min vs. 274 ± 54 min; p < 0.001). There was no difference in complications such as bleeding or hematoma formation between the two groups. Patient satisfaction was the same between the two groups. However, the staff preferred protocol 1 (p = 0.01). Conclusion A protocol of delayed initiation of TR band deflation followed by quick deflations is associated with a lower time to band removal with no increase in bleeding complications or patient satisfaction. However, the staff preferred longer intervals between deflations.
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Affiliation(s)
- Hassan Al Riyami
- Department of Cardiology, Sultan Qaboos University Hospital, Alkhod, Muscat, Oman
| | - Adil Al Riyami
- Department of Cardiology, Sultan Qaboos University Hospital, Alkhod, Muscat, Oman
| | - Sunil K Nadar
- Department of Cardiology, Sultan Qaboos University Hospital, Alkhod, Muscat, Oman
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Gravesteijn BY, Sewalt CA, Stocchetti N, Citerio G, Ercole A, Lingsma HF, von Steinbüchel N, Steyerberg EW, Wilson L, Maas AIR, Menon DK, Lecky FE. Prehospital Management of Traumatic Brain Injury across Europe: A CENTER-TBI Study. PREHOSP EMERG CARE 2020; 25:629-643. [PMID: 32877267 DOI: 10.1080/10903127.2020.1817210] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Prehospital care for traumatic brain injury (TBI) is important to prevent secondary brain injury. We aim to compare prehospital care systems within Europe and investigate the association of system characteristics with the stability of patients at hospital arrival. METHODS We studied TBI patients who were transported to CENTER-TBI centers, a pan-European, prospective TBI cohort study, by emergency medical services between 2014 and 2017. The association of demographic factors, injury severity, situational factors, and interventions associated with on-scene time was assessed using linear regression. We used mixed effects models to investigate the case mix adjusted variation between countries in prehospital times and interventions. The case mix adjusted impact of on-scene time and interventions on hypoxia (oxygen saturation <90%) and hypotension (systolic blood pressure <100mmHg) at hospital arrival was analyzed with logistic regression. RESULTS Among 3878 patients, the greatest driver of longer on-scene time was intubation (+8.3 min, 95% CI: 5.6-11.1). Secondary referral was associated with shorter on-scene time (-5.0 min 95% CI: -6.2- -3.8). Between countries, there was a large variation in response (range: 12-25 min), on-scene (range: 16-36 min) and travel time (range: 15-32 min) and in prehospital interventions. These variations were not explained by patient factors such as conscious level or severity of injury (expected OR between countries: 1.8 for intubation, 1.8 for IV fluids, 2.0 for helicopter). On-scene time was not associated with the regional EMS policy (p= 0.58). Hypotension and/or hypoxia were seen in 180 (6%) and 97 (3%) patients in the overall cohort and in 13% and 7% of patients with severe TBI (GCS <8). The largest association with secondary insults at hospital arrival was with major extracranial injury: the OR was 3.6 (95% CI: 2.6-5.0) for hypotension and 4.4 (95% CI: 2.9-6.7) for hypoxia. DISCUSSION Hypoxia and hypotension continue to occur in patients who suffer a TBI, and remain relatively common in severe TBI. Substantial variation in prehospital care exists for patients after TBI in Europe, which is only partially explained by patient factors.
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Affiliation(s)
- Benjamin Yaël Gravesteijn
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Charlie Aletta Sewalt
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Nino Stocchetti
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Giuseppe Citerio
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Ari Ercole
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Hester Floor Lingsma
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Nicole von Steinbüchel
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Ewout Willem Steyerberg
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Lindsay Wilson
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Andrew I R Maas
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - David K Menon
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
| | - Fiona Elizabeth Lecky
- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
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- Received May 5, 2020 from Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (BYG, CAS, HFL, EWS); Department of Pathophysiology and Transplantation, Milan University, Milan, Italy (NS); School of Medicine and Surgery, University Milano - Bicocca, Milan, Italy (GC); Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium (AIRM); Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (AE, DKM); Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen (NVS); Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (EWS); Division of Physiology, University of Stirling, Stirling, UK (LW); Center for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK (FEL); Emergency Department, Salford Royal Hospital, Salford, UK (FEL). Revision received August 23, 2020; accepted for publication August 24, 2020
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Höglund E, Andersson-Hagiwara M, Schröder A, Möller M, Ohlsson-Nevo E. Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden. BMC Emerg Med 2020; 20:61. [PMID: 32778074 PMCID: PMC7418316 DOI: 10.1186/s12873-020-00353-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/21/2020] [Indexed: 01/10/2023] Open
Abstract
Background There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data. Methods A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test. Results Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women. Conclusions Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.
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Affiliation(s)
- Erik Höglund
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Box 1613, 701 16, Örebro, Sweden.
| | - Magnus Andersson-Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Agneta Schröder
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Box 1613, 701 16, Örebro, Sweden.,Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway
| | - Margareta Möller
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Box 1613, 701 16, Örebro, Sweden
| | - Emma Ohlsson-Nevo
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Box 1613, 701 16, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Sjölin H, Lindström V, Vicente V, Hult H, Ringsted C, Kurland L. Prehospital emergency nurses' experiences of care in critical incidents. Int Emerg Nurs 2020; 51:100890. [PMID: 32502944 DOI: 10.1016/j.ienj.2020.100890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The ambulance care setting is complex and unpredictable and the personnel must prepare for upcoming assignments. Prehospital emergency care nurses (PENs), are frequently exposed to critical incidents (CIs). There are, to our knowledge, no prior studies describing experiences of requirements for management of caring for a patient during a CI in the ambulance care context. Therefore, the aim of the study was to explore PENs' experiences of care in CIs. METHOD A qualitative research design with content analysis has been used, based on semi-structured interviews with eleven PENs in Sweden. RESULTS PENs' experiences can be described as: "In a critical incident, personal ability based on experiential knowledge is central to patient care". Three generic categories underpinned the main category: "Clinical expertise", "Professional approach" and "Broad knowledge base". CONCLUSIONS The care given during a CI in the ambulance care setting depends on PENs' personal ability based on experiential knowledge. Employers need to build an organization providing prerequisites and support during an CI. Suggested activities are to create forums for PENs to share experiences with each other, possibility to get feedback on completed assignments and continued training to develop new knowledge and be prepared for the unpredictable environment that characterizes CI.
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Affiliation(s)
- Helena Sjölin
- Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Orebro, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Sweden.
| | - Veronica Lindström
- Academic EMS in Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
| | - Veronica Vicente
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Sweden; Academic EMS in Stockholm, Sweden.
| | - Håkan Hult
- Department of CLINTEC, Karolinska Institute, Stockholm, Sweden.
| | - Charlotte Ringsted
- Centre for Health Science Education, Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Lisa Kurland
- Örebro University, Dept. of Medical Sciences, Örebro University Hospital, Dept. of Emergency Medicine, Sweden.
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Optimizing Routine and Disaster Prehospital Care Through Improved Emergency Medical Services Oversight. Disaster Med Public Health Prep 2020; 15:595-607. [PMID: 32476635 DOI: 10.1017/dmp.2020.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify modifiers of emergency medical services (EMS) oversight quality, including facilitators and barriers, and inform best practices and policy related to EMS oversight and system performance. METHODS We used a qualitative design, including 4 focus groups and 10 in-depth, 1-on-1 interviews. Primary data were collected from EMS stakeholders in Michigan from June to July 2016. Qualitative data were analyzed using the rapid assessment technique. RESULTS Emergent themes included organizational structure, oversight and stakeholder leadership, interorganizational communication and relationships, competition or collaboration among MCA stakeholders, quality improvement practices, resources, and needs specific to rural communities. CONCLUSIONS EMS is a critical component of disaster response. This study revealed salient themes and modifiers, including facilitators and barriers, of EMS oversight quality. These findings were evaluated in the context of current evidence and informed state policy to improve the quality of EMS oversight and prehospital care for both routine and disaster settings. Some were particular to geographic regions and communities, whereas others were generalizable.
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Fleet R. A Canadian Rural Living Lab Hospital: Implementing solutions for improving rural emergency care. Future Healthc J 2020; 7:15-21. [PMID: 32104760 PMCID: PMC7032583 DOI: 10.7861/fhj.2019-0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION More than 6 million Canadians live in rural areas (approximately 20% of the population) and emergency services are a critical safety net for them. OBJECTIVES We want to create, in Baie-Saint-Paul (rural emergency department, Québec, Canada), an experimental milieu where all stakeholders develop, implement and evaluate solutions to address the problems that beset their environment. METHOD The Living Lab will rely on the quadruple aim approach to improve health system performance and will use a multimethod approach based on the philosophy of open and user-driven innovation. Three pilot projects will be implemented (quality of work life programme, computed tomography implementation study and telemedicine in ambulances). Other possible solutions will be evaluated and prioritised (in situ simulation, care protocol, telemedicine, point-of-care ultrasound, helicopters and drones). CONCLUSION We are confident that this Living Lab will contribute to saving lives, will improve the quality of work life for rural healthcare professionals, and will inspire similar innovation internationally.
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Affiliation(s)
- Richard Fleet
- psychologist and associate professor, Laval University, Québec, Canada, endowed research chair of emergency medicine, Centre de recherche du CISSS Chaudière-Appalaches, Lévis, Canada and Centre de recherche sur les soins et services de première ligne de l’Université Laval, Québec, Canada
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Physician Prehospital Care in Mexico City: Retrospective Analysis of Endotracheal Intubation in Patients with Severe Head Trauma. Prehosp Disaster Med 2020; 35:128-132. [PMID: 31973785 DOI: 10.1017/s1049023x20000035] [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: 11/07/2022]
Abstract
INTRODUCTION In Mexico, physicians have become part of public service prehospital care. Head injured patients are a sensitive group that can benefit from early advanced measures to protect the airway, with the objective to reduce hypoxia and maintain normocapnia. PROBLEM The occurrence of endotracheal intubation to patients with severe head injuries by prehospital physicians working at Mexico City's Service of Emergency Medical Care (SAMU) is unknown. METHODS A retrospective analysis of five-year data (2012-2016) from Mexico City's Medical Emergencies Regulation Center was performed. Only SAMU ambulance services were analyzed. Adult patients with a prehospital diagnosis of head injury based on mechanism of injury and physical examination with a Glasgow Coma Scale (GCS) <nine were included. RESULTS A total of 293 cases met the inclusion criteria; the mean GCS was five points. Of those, 150 (51.1%) patients were intubated. There was no difference in the occurrence of intubation among the different GCS scales, or if the patient was considered to have isolated head trauma versus polytrauma. Fifteen patients were intubated using sedation and neuromuscular blockage. Four patients were intubated with sedation alone and six patients with neuromuscular blockage alone. One patient was intubated using opioid analgesia, sedation, and neuromuscular blockage. CONCLUSIONS Patients with severe head injuries cared by prehospital physicians in Mexico City were intubated 51.1% of the time and were more likely to be intubated without the assistance of anesthetics.
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Zwinkels RLJ, Endeman H, Hoeks SE, de Maat MPM, den Hartog D, Stolker RJ. The clinical effect of hemostatic resuscitation in traumatic hemorrhage; a before-after study. J Crit Care 2020; 56:288-293. [PMID: 31917070 DOI: 10.1016/j.jcrc.2019.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Rob L J Zwinkels
- Department of Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Henrik Endeman
- Department of Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Sanne E Hoeks
- Department of Anesthesia, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Moniek P M de Maat
- Department of Hematology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Dennis den Hartog
- Trauma Research Unit Department of Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Robert Jan Stolker
- Department of Anesthesia, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
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Binkhorst M, van de Wiel I, Draaisma JMT, van Heijst AFJ, Antonius T, Hogeveen M. Neonatal resuscitation guideline adherence: simulation study and framework for improvement. Eur J Pediatr 2020; 179:1813-1822. [PMID: 32472265 PMCID: PMC7547969 DOI: 10.1007/s00431-020-03693-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/17/2020] [Accepted: 05/16/2020] [Indexed: 11/25/2022]
Abstract
We wanted to assess newborn life support (NLS) knowledge and guideline adherence, and provide strategies to improve (neonatal) resuscitation guideline adherence. Pediatricians completed 17 multiple-choice questions (MCQ). They performed a simulated NLS scenario, using a high-fidelity manikin. The literature was systematically searched for publications regarding guideline adherence. Forty-six pediatricians participated: 45 completed the MCQ, 34 performed the scenario. Seventy-one percent (median, IQR 56-82) of the MCQ were answered correctly. Fifty-six percent performed inflation breaths ≤ 60 s, 24% delivered inflation breaths of 2-3 s, and 85% used adequate inspiratory pressures. Airway patency was ensured 83% (IQR 76-92) of the time. Median events/min, compression rate, and percentage of effective compressions were 138/min (IQR 130-145), 120/min (IQR 114-120), and 38% (IQR 24-48), respectively. Other adherence percentages were temperature management 50%, auscultation of initial heart rate 100%, pulse oximeter use 94%, oxygen increase 74%, and correct epinephrine dose 82%. Ten publications were identified and used for our framework. The framework may inspire clinicians, educators, researchers, and guideline developers in their attempt to improve resuscitation guideline adherence. It contains many feasible strategies to enhance professionals' knowledge, skills, self-efficacy, and team performance, as well as recommendations regarding equipment, environment, and guideline development/dissemination.Conclusion: NLS guideline adherence among pediatricians needs improvement. Our framework is meant to promote resuscitation guideline adherence. What is Known: • Inadequate newborn life support (NLS) may contribute to (long-term) pulmonary and cerebral damage. • Video-based assessment of neonatal resuscitations has shown that deviations from the NLS guideline occur frequently; this assessment method has its audiovisual shortcomings. What is New: • The resuscitation quality metrics provided by our high-fidelity manikin suggest that the adherence of Dutch general pediatricians to the NLS guideline is suboptimal. • We constructed a comprehensive framework, containing multiple strategies to improve (neonatal) resuscitation guideline adherence.
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Affiliation(s)
- Mathijs Binkhorst
- Department of Neonatology, Amalia Children's Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Irene van de Wiel
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jos M. T. Draaisma
- Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arno F. J. van Heijst
- Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Tim Antonius
- Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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Schweitzer G, Nascimento ERPD, Malfussi LBHD, Hermida PMV, Nascimento KCD, Moreira AR. Implementation of the protocol of nursing care in trauma in aeromedical service. Rev Bras Enferm 2020; 73:e20180516. [DOI: 10.1590/0034-7167-2018-0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 05/11/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyze the implementation of a nursing care protocol for trauma patients before, during and after the flight. Method: A cross-sectional quantitative study carried out in an aeromedical service, using a checklist with 106 care: 79 before flight, 25 during, and 2 after flight. 97 patients were included in the study. Results: Most care (n = 59; 55.7%) was implemented, totaling 4,435, 1,480 and 192 cares performed before, during and after the flight, respectively. They stood out as unrealized care: protect ears with ear muffler (n = 55) and avoid leaving the pulse oximeter exposed to the sun’s rays (n = 22). The main reason for the non-performance was lack of appeal (n = 94). Conclusion: Although most protocol care has been implemented, unrealized care compromises the quality of care, which requires the management of the service to provide more incentive to nurses and adequate resources for its implementation.
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Moafa HN, van Kuijk SMJ, Franssen GHLM, Moukhyer ME, Haak HR. What is known about the quality of out-of-hospital emergency medical services in the Arabian Gulf States? A systematic review. PLoS One 2019; 14:e0226230. [PMID: 31856219 PMCID: PMC6922377 DOI: 10.1371/journal.pone.0226230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Emergency Medical Services (EMS) have been developed in the Arabian Gulf States (AGS) in the last three decades. The EMS needs continuous quality assessment of their performance to improve and provide the best out-of-hospital care. This study aims to assess the quality of EMS in the AGS according to the six quality domains of the Institute of Medicine. METHODS We searched four databases (i.e., PubMed, EMBASE, Web of Science, and CINAHL) for studies that reported on the quality of EMS in any of the AGS using clinical or non-clinical performance indicators. To quantify study quality and risk of bias, the adapted Newcastle Ottawa Scale was used. We focused on structural and functional indicators, clinical and non-clinical. RESULTS Twenty-five studies were eligible for inclusion. One study contained result of safety, fifteen time-centeredness, twenty effectiveness, five patient-centeredness, and thirteen studies reported on equity of EMS. None of the studies reported on efficiency of EMS. A significant proportion of studies showed high scores on the Newcastle-Ottawa scale. Limited studies on EMS quality were available, not covering all relevant quality domains and not covering the whole AGS region. The equity domain showed the best outcome performance finding, whereas finding of the patient-centeredness domain showed room for improvement in the foreseeable future. CONCLUSION This review highlights the need for more and better studies of sufficient quality about all domains of quality in EMS in all the AGS. EMS research in Kuwait and Bahrain is warranted, as currently studies of EMS quality are unavailable for these States. Moreover, efficiency researches exploring this discipline should be conducted specially no studies were found has been searching this domain. TRIAL REGISTRATION PROSPERO registration number: CRD42019123896.
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Affiliation(s)
- H. N. Moafa
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - S. M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - M. E. Moukhyer
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - H. R. Haak
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maxima Medisch Centre, Eindhoven, The Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Magnusson C, Herlitz J, Karlsson T, Jiménez-Herrera M, Axelsson C. The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years. BMC Pediatr 2019; 19:500. [PMID: 31842832 PMCID: PMC6912993 DOI: 10.1186/s12887-019-1857-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 11/26/2019] [Indexed: 12/04/2022] Open
Abstract
Background The rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse’s field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis. Methods A prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse’s field assessment and the hospital diagnosis. Results Among all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital with a potentially life-threatening condition. Of the children triaged with RETTS-p (85.9%), 149 of 390 children (38.2%) were triaged to RETTS-p red or orange (life-threatening, potentially life-threatening), of which 40 (26.8%) children were classified as emergent. The hospitalised children were triaged with the highest frequency to level yellow (can wait; 41.5%). In children with RETTS-p red or orange, the sensitivity for a defined emergent patient was 66.7%, with a corresponding specificity of 67.0%. The EMS field assessment was in agreement with the final hospital diagnosis in 80% of the cases. Conclusions The RETTS-p sensitivity in this study is considered moderate. Two thirds of the children triaged to life threatening or potentially life threatening were later identified as non-emergent. Of those, one in six was discharged from the PED without any intervention. Further, one third of the children were under triaged, the majority were found in the yellow triage level (can wait). The highest proportion of hospitalised patients was found in the yellow triage level. Our result is in agreement with previous studies using other triage instruments. A computerised decision support system might help the EMS triage to increase sensitivity and specificity.
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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pre Hospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Thomas Karlsson
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Christer Axelsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pre Hospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Sharma S, Breckons M, Brönnimann Lambelet B, Chung J, List T, Lobbezoo F, Nixdorf DR, Oyarzo JF, Peck C, Tsukiyama Y, Ohrbach R. Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain. J Oral Rehabil 2019; 47:87-100. [DOI: 10.1111/joor.12871] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Sonia Sharma
- Department of Oral Diagnostic Sciences, School of Dental Medicine University at Buffalo Buffalo NY USA
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology Malmö University Malmö Sweden
| | | | - Ben Brönnimann Lambelet
- Psychiatric Services of District Aargau Ambulatory Center for Psychiatry and Psychotherapy Aarau Switzerland
| | - Jin‐Woo Chung
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry Seoul National University Seoul Korea
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology Malmö University Malmö Sweden
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Donald R. Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry University of Minnesota Minneapolis MN USA
| | - Juan Fernando Oyarzo
- TMD and Orofacial Pain, Faculty of Odontology Universidad Andres Bello Santiago Chile
| | - Christopher Peck
- Faculty of Dentistry The University of Sydney Surry Hills NSW Australia
| | - Yoshihiro Tsukiyama
- Section of Dental Education, Faculty of Dental Science Kyushu University Fukuoka Japan
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, School of Dental Medicine University at Buffalo Buffalo NY USA
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Niele N, Houten MA, Boersma B, Biezeveld MH, Douma M, Heitink K, ten Tusscher GW, Tromp E, van Goudoever JB, Plötz FB. Multi-centre study found that strict adherence to guidelines led to computed tomography scans being overused in children with minor head injuries. Acta Paediatr 2019; 108:1695-1703. [PMID: 30721540 DOI: 10.1111/apa.14742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/01/2022]
Abstract
AIM Our primary aim was to calculate the head computed tomography (CT) scan rate in children with a minor head injury (MHI) when the Dutch National guidelines were followed in clinical practice. The secondary aim was to determine the incidence of CT abnormalities and the guideline predictors associated with traumatic abnormalities. METHODS We performed a multi-centre, prospective observational cross-sectional study in the emergency departments of six hospitals in The Netherlands between 1 April 2015 and 31 December 2016. RESULTS Data on 1002 patients were studied and 69% of cases complied with the guidelines. The overall CT rate was 44% and the incidence of traumatic abnormal CT findings was 13%. CT scans were performed in 19% of children under two years of age, 48% of children between two and five years and 63% of children aged six years or more. Multivariate regression analysis for all age categories showed that CT abnormalities were predicted by a Glasgow Coma Scale of less than 15, suspicion of a basal skull fracture, vomiting and scalp haematomas or external lesions of the skull. CONCLUSION Strict adherence to the Dutch national guidelines resulted in CT overuse. New guidelines are needed to safely reduce CT scan indications.
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Affiliation(s)
- Nicky Niele
- Department of Paediatrics Tergooi Hospital Blaricum The Netherlands
- Department of Paediatrics Emma Children's Hospital Amsterdam UMC Amsterdam The Netherlands
| | - Marlies A. Houten
- Department of Paediatrics Spaarne Gasthuis Hospital Hoofddorp The Netherlands
| | - Bart Boersma
- Department of Paediatrics Noordwest Ziekenhuisgroep Alkmaar The Netherlands
| | | | - Matthijs Douma
- Department of Emergency Medicine Dijklander Hospital Hoorn The Netherlands
| | - Katja Heitink
- Department of Paediatrics Flevo Hospital Almere The Netherlands
| | | | - Ellen Tromp
- Department of Epidemiology and Statistics St Antonius Hospital Nieuwegein The Netherlands
| | | | - Frans B. Plötz
- Department of Paediatrics Tergooi Hospital Blaricum The Netherlands
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Thorvaldsen NØ, Flingtorp LD, Wisborg T, Jeppesen E. Implementation of new guidelines in the prehospital services: a nationwide survey of Norway. Scand J Trauma Resusc Emerg Med 2019; 27:83. [PMID: 31464620 PMCID: PMC6716817 DOI: 10.1186/s13049-019-0660-0] [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] [Received: 05/07/2019] [Accepted: 08/20/2019] [Indexed: 12/01/2022] Open
Abstract
Background A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. “The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury” was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process. Method An electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline. Results In all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents. Conclusion Although the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline. Electronic supplementary material The online version of this article (10.1186/s13049-019-0660-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nina Øye Thorvaldsen
- Emergency Medical Services, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway. .,Faculty of Health Science, University of Stavanger, Stavanger, Norway.
| | - Lars Didrik Flingtorp
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo, Norway
| | - Torben Wisborg
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Anesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
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Theodoridis X, Grammatikopoulou MG, Petalidou A, Kontonika SM, Potamianos SP, Bogdanos DP. A Systematic Review of Medical Nutrition Therapy Guidelines for Liver Cirrhosis: Do We Agree? Nutr Clin Pract 2019; 35:98-107. [DOI: 10.1002/ncp.10393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Xenophon Theodoridis
- Department of Rheumatology and Clinical Immunology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
- School of Medicine; Faculty of Health Sciences; Aristotle University of Thessaloniki; Thessaloniki Greece
- Department of Nutritional Sciences & Dietetics; International Hellenic University; Thessaloniki Greece
| | - Maria G. Grammatikopoulou
- Department of Rheumatology and Clinical Immunology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
- School of Medicine; Faculty of Health Sciences; Aristotle University of Thessaloniki; Thessaloniki Greece
- Department of Nutritional Sciences & Dietetics; International Hellenic University; Thessaloniki Greece
| | - Arianna Petalidou
- Department of Rheumatology and Clinical Immunology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
| | - Stamatia-Maria Kontonika
- Department of Rheumatology and Clinical Immunology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
- Department of Nutritional Sciences & Dietetics; International Hellenic University; Thessaloniki Greece
| | - Spyros P. Potamianos
- Department of Gastroenterology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology; Faculty of Medicine; School of Health Sciences; University of Thessaly; Larissa Greece
- Division of Transplantation Immunology and Mucosal Biology; MRC Centre for Transplantation; King's College London Medical School; London United Kingdom
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Wooldridge A, Carayon P, Hoonakker P, Hose BZ, Ross J, Kohler JE, Brazelton T, Eithun B, Kelly MM, Dean SM, Rusy D, Durojaiye A, Gurses AP. Complexity of the pediatric trauma care process: Implications for multi-level awareness. COGNITION, TECHNOLOGY & WORK (ONLINE) 2019; 21:397-416. [PMID: 31485191 PMCID: PMC6724740 DOI: 10.1007/s10111-018-0520-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/23/2018] [Indexed: 06/02/2023]
Abstract
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, we combine interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity. Specifically, we identify the 53 roles directly involved in patient care in each hospital unit and describe the 3324 total transitions between hospital units and the 69 unique pathways, from arrival to discharge, experienced by pediatric trauma patients. We continue the argument to shift from eliminating complexity to coping with it and propose supporting three levels of awareness to enhance the resilience and adaptation necessary for patient safety in health care, i.e. safety in complex systems. We discuss three levels of awareness (individual, team and organizational) and describe challenges and potential sociotechnical solutions for each. For example, one challenge to individual awareness is high time pressure. A potential solution is clinical decision support of information perception, integration and decision making. A challenge to team awareness is inadequate "non-technical" skills, e.g., leadership, communication, role clarity; simulation or another form of training could improve these. The complex, distributed nature of this process is a challenge to organizational awareness; a potential solution is to develop awareness of the process and the roles and interdependencies within it, by using process modeling or simulation.
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Affiliation(s)
- Abigail Wooldridge
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, 3135 Engineering Centers Building, Madison WI 53706, USA
| | - Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Joshua Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, MC 9123, Madison WI 53705, USA
| | - Jonathan E Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Department of Surgery Administration MC: 7375, Madison WI 53792, USA
| | - Thomas Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 600 Highland Avenue, Madison WI 53793, USA
| | - Benjamin Eithun
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, 1675 Highland Avenue, Madison WI 53792, USA
| | - Michelle M Kelly
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, 3135 Engineering Centers Building, Madison WI 53706, USA
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 600 Highland Avenue, Madison WI 53793, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ashimiyu Durojaiye
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15 Floor, Baltimore MD 21202, USA, Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, 2024 East Monument Street, S1-200, Baltimore MD 21205, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15 Floor, Baltimore MD 21202, USA, Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, 2024 East Monument Street, S1-200, Baltimore MD 21205, USA
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Eftekhari A, DehghaniTafti A, Nasiriani K, Hajimaghsoudi M, Fallahzadeh H, Khorasani-Zavareh D. Management of Preventable Deaths due to Road Traffic Injuries in Prehospital Phase; a Qualitative Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:32. [PMID: 31555762 PMCID: PMC6732201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Prehospital care plays an important role in decreasing the number of deaths due to road traffic injuries (RTIs). This study aimed to identify the challenges of preventable deaths due to RTIs in the prehospital phase based on the attitudes of stakeholders. METHODS Conventional content analysis of qualitative study was used to analyze the data. The participants were 24 RTI prevention experts from fire-fighting organization, traffic police, the Red Crescent, Emergency Medical Services staff, emergency medicine specialists, and hospital emergency nurses who were selected by means of purposive sampling. Data were collected using unstructured interviews and analyzed by means of data coding, followed by extracting sub-categories, and main categories. RESULTS Six main categories were extracted as the major challenges of preventable deaths in RTIs in the prehospital phase including "poor management of the crash scene" with two subcategories of lack of rapid access to the patient and lack of scene safety, "lack of adequate rules and regulations" with two subcategories of lack of protocols and guidelines and lack of clear duties checklists, "poor management of time" with two subcategories of elongated response time at the crash scene and elongated time of victim transport, "low quality of training" with two subcategories of insufficient training of Emergency Medical Services (EMS) staff and inadequate public training, "poor communication and coordination" with two subcategories of poor communication of EMS staff and lack of uniform commandership at the crash scene, and "low quality of victim management" with two subcategories of low quality of clinical care and lack of accurate clinical assessment. CONCLUSION The following measures are necessary to reduce preventable deaths due to RTIs in the prehospital phase: accurate clinical assessment of the victim on the scene, provision of high quality and accurate clinical care, enforcement of legal obligations and using protocols in the field of victim management, coordination of the involved organizations through identifying the duties and responsibilities of each organization, and full management of the crash scene by assigning a unique commander to each unit and creation of the highest level of safety on crash scene.
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Affiliation(s)
- Adel Eftekhari
- Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Abbasali DehghaniTafti
- Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Khadijeh Nasiriani
- Department of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Majid Hajimaghsoudi
- Trauma Research Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Davoud Khorasani-Zavareh
- Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding author: Davoud Khorasani-Zavareh, Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98 21 22 43 99 82, Fax: +98 21 22 43 97 84, E-mail:
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Haugland H, Uleberg O, Klepstad P, Krüger A, Rehn M. Quality measurement in physician-staffed emergency medical services: a systematic literature review. Int J Qual Health Care 2019; 31:2-10. [PMID: 29767795 PMCID: PMC6387994 DOI: 10.1093/intqhc/mzy106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/14/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Quality measurement of physician-staffed emergency medical services (P-EMS) is necessary to improve service quality. Knowledge and consensus on this topic are scarce, making quality measurement of P-EMS a high-priority research area. The aim of this review was to identify, describe and evaluate studies of quality measurement in P-EMS. DATA SOURCES The databases of MEDLINE and Embase were searched initially, followed by a search for included article citations in Scopus. STUDY SELECTION The study eligibility criteria were: (1) articles describing the use of one quality indicator (QI) or more in P-EMS, (2) original manuscripts, (3) articles published from 1 January 1968 until 5 October 2016. The literature search identified 4699 records. 4543 were excluded after reviewing title and abstract. An additional 129 were excluded based on a full-text review. The remaining 27 papers were included in the analysis. Methodological quality was assessed using an adapted critical appraisal tool. DATA EXTRACTION The description of used QIs and methods of quality measurement was extracted. Variables describing the involved P-EMSs were extracted as well. RESULTS OF DATA SYNTHESIS In the included papers, a common understanding of which QIs to use in P-EMS did not exist. Fifteen papers used only a single QI. The most widely used QIs were 'Adherence to medical protocols', 'Provision of advanced interventions', 'Response time' and 'Adverse events'. CONCLUSION The review demonstrated a lack of shared understanding of which QIs to use in P-EMS. Moreover, papers using only one QI dominated the literature, thus increasing the risk of a narrow perspective in quality measurement. Future quality measurement in P-EMS should rely on a set of consensus-based QIs, ensuring a comprehensive approach to quality measurement.
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Affiliation(s)
- Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - Andreas Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesia, Oslo University Hospital, Oslo, Norway
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Hagiwara MA, Magnusson C, Herlitz J, Seffel E, Axelsson C, Munters M, Strömsöe A, Nilsson L. Adverse events in prehospital emergency care: a trigger tool study. BMC Emerg Med 2019; 19:14. [PMID: 30678636 PMCID: PMC6345067 DOI: 10.1186/s12873-019-0228-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care. Methods We used a retrospective study design where 30 randomly selected prehospital medical records were screened for AEs each month in three prehospital organizations in Sweden during a period of one year. A total of 1080 prehospital medical records were included. The record review was based on the use of 11 screening criteria. Results The reviewers identified 46 AEs in 46 of 1080 (4.3%) prehospital medical records. Of the 46 AEs, 43 were classified as potential for harm (AE1) (4.0, 95% CI = 2.9–5.4) and three as harm identified (AE2) (0.3, 95% CI = 0.1–0.9). However, among patients with a life-threatening condition (priority 1), the risk of AE was higher (16.5%). The most common factors contributing to AEs were deviations from standard of care and missing, incomplete, or unclear documentation. The most common cause of AEs was the result of action(s) or inaction(s) by the emergency medical service (EMS) crew. Conclusions There were 4.3 AEs per 100 ambulance missions in Swedish prehospital care. The majority of AEs originated from deviations from standard of care and incomplete documentation. There was an increase in the risk of AE among patients who the EMS team assessed as having a life-threatening condition. Most AEs were possible to avoid. Electronic supplementary material The online version of this article (10.1186/s12873-019-0228-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
| | - Carl Magnusson
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30, Gothenburg, Sweden
| | - Johan Herlitz
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Elin Seffel
- Department of Ambulance Care, Södra Älvsborg Hospital (SÄS), SE-501 82, Borås, Sweden
| | - Christer Axelsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Monica Munters
- Department of Ambulance Care, Region of Dalarna, SE-791 29, Falun, Sweden
| | - Anneli Strömsöe
- School of Health, Care and Social Welfare, Mälardalens högskola, SE-721 23, Västerås, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
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