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Vianen NJ, Maissan IM, den Hartog D, Stolker RJ, Houmes RJ, Gommers DAMPJ, Van Meeteren NLU, Hoeks SE, Van Lieshout EMM, Verhofstad MHJ, Van Vledder MG. Opportunities and barriers for prehospital emergency medical services research in the Netherlands; results of a mixed-methods consensus study. Eur J Trauma Emerg Surg 2024; 50:221-232. [PMID: 36869883 PMCID: PMC10924026 DOI: 10.1007/s00068-023-02240-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Quality improvement in prehospital emergency medical services (EMS) can only be achieved by high-quality research and critical appraisal of current practices. This study examines current opportunities and barriers in EMS research in the Netherlands. METHODS This mixed-methods consensus study consisted of three phases. The first phase consisted of semi-structured interviews with relevant stakeholders. Thematic analysis of qualitative data derived from these interviews was used to identify main themes, which were subsequently discussed in several online focus groups in the second phase. Output from these discussions was used to shape statements for an online Delphi consensus study among relevant stakeholders in EMS research. Consensus was met if 80% of respondents agreed or disagreed on a particular statement. RESULTS Forty-nine stakeholders participated in the study; qualitative thematic analysis of the interviews and focus group discussions identified four main themes: (1) data registration and data sharing, (2) laws and regulations, (3) financial aspects and funding, and (4) organization and culture. Qualitative data from the first two phases of the study were used to construct 33 statements for an online Delphi study. Consensus was reached on 21 (64%) statements. Eleven (52%) of these statements pertained to the storage and use of EMS patient data. CONCLUSION Barriers for prehospital EMS research in the Netherlands include issues regarding the use of patient data, privacy and legislation, funding and research culture in EMS organizations. Opportunities to increase scientific productivity in EMS research include the development of a national strategy for EMS data and the incorporation of EMS topics in research agendas of national medical professional associations.
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Affiliation(s)
- Niek J Vianen
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Iscander M Maissan
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robert J Stolker
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J Houmes
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Nico L U Van Meeteren
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sanne E Hoeks
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - Mark G Van Vledder
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands.
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Becker J, Kurland L, Höglund E, Hugelius K. Dynamic ambulance relocation: a scoping review. BMJ Open 2023; 13:e073394. [PMID: 38101827 PMCID: PMC10729233 DOI: 10.1136/bmjopen-2023-073394] [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: 03/06/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Dynamic ambulance relocation means that the operators at a dispatch centre place an ambulance in a temporary location, with the goal of optimising coverage and response times in future medical emergencies. This study aimed to scope the current research on dynamic ambulance relocation. DESIGN A scoping review was conducted using a structured search in PubMed, Scopus and Web of Science. In total, 21 papers were included. RESULTS Most papers described research with experimental designs involving the use of mathematical models to calculate the optimal use and temporary relocations of ambulances. The models relied on several variables, including distances, locations of hospitals, demographic-geological data, estimation of new emergencies, emergency medical services (EMSs) working hours and other data. Some studies used historic ambulance dispatching data to develop models. Only one study reported a prospective, real-time evaluation of the models and the development of technical systems. No study reported on either positive or negative patient outcomes or real-life chain effects from the dynamic relocation of ambulances. CONCLUSIONS Current knowledge on dynamic relocation of ambulances is dominated by mathematical and technical support data that have calculated optimal locations of ambulance services based on response times and not patient outcomes. Conversely, knowledge of how patient outcomes and the working environment are affected by dynamic ambulance dispatching is lacking. This review has highlighted several gaps in the scientific coverage of the topic. The primary concern is the lack of studies reporting on patient outcomes, and the limited knowledge regarding several key factors, including the optimal use of ambulances in rural areas, turnaround times, domino effects and aspects of working environment for EMS personnel. Therefore, addressing these knowledge gaps is important in future studies.
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Affiliation(s)
- Julia Becker
- Institute for Disaster and Emergency Management, Berlin, Germany
| | - Lisa Kurland
- Örebro Univeristy, Faculty of Medicine and Health, Orebro, Sweden
- Örebro University Hospital, Orebro, Sweden
| | - Erik Höglund
- Örebro Univeristy, Faculty of Medicine and Health, Orebro, Sweden
- Ambulance Department, Örebro Country Council, Örebro, Sweden
| | - Karin Hugelius
- Örebro Univeristy, Faculty of Medicine and Health, Orebro, Sweden
- Ambulance Department, Örebro Country Council, Örebro, Sweden
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Vazanic D, Kurtovic B, Balija S, Milosevic M, Brborovic O. Predictors, Prevalence, and Clinical Outcomes of Out-of-Hospital Cardiac Arrests in Croatia: A Nationwide Study. Healthcare (Basel) 2023; 11:2729. [PMID: 37893803 PMCID: PMC10606582 DOI: 10.3390/healthcare11202729] [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: 09/11/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains a pivotal health challenge globally. In Croatia, there has been a knowledge gap regarding the prevalence, predictors, and outcomes of OHCA patients. This study aims to determine the prevalence, prediction, and outcomes of OHCA patients in Croatia. METHODS An extensive one-year analysis was performed on all OHCA treated by the Emergency Medical Service in Croatia, based on the Utstein recommendations. Data were extracted from Croatian Institute of Emergency Medicine databases, focusing on adult individuals who experienced sudden cardiac arrest in out-of-hospital settings in Croatia. RESULTS From 7773 OHCA cases, 9.5% achieved spontaneous circulation pre-hospital. Optimal outcomes corresponded to EMS intervention within ≤13 min post-arrest onset AUC = 0.577 (95% CI: 0.56-0.59; p < 0.001) and female gender OR = 1.81 (95% CI: 1.49-2.19; p < 0.001). Northern Croatia witnessed lower success rates relative to the capital city Zagreb OR = 0.68 (95% CI: 0.50-0.93; p = 0.015). CONCLUSIONS Early intervention by EMS, specifically within a 13-min period following the onset of a cardiac arrest, significantly enhances the probability of achieving successful OHCA outcomes. Gender differences and specific initial heart rhythms further influenced the likelihood of successful outcomes. Regional disparities, with reduced success rates in northern Croatia compared to the City of Zagreb, were evident.
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Affiliation(s)
- Damir Vazanic
- Croatian Institute of Emergency Medicine, 10000 Zagreb, Croatia;
- Department of Nursing, Catholic University of Croatia, 10000 Zagreb, Croatia
- University of Applied Health Sciences, 10000 Zagreb, Croatia;
| | - Biljana Kurtovic
- University of Applied Health Sciences, 10000 Zagreb, Croatia;
- Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Sasa Balija
- Croatian Institute of Emergency Medicine, 10000 Zagreb, Croatia;
| | - Milan Milosevic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.M.); (O.B.)
| | - Ognjen Brborovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.M.); (O.B.)
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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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Ramage L, McLachlan S, Williams K. Determining the top research priorities in UK prehospital critical care: a modified Delphi study. Emerg Med J 2023; 40:271-276. [PMID: 36650041 PMCID: PMC10086275 DOI: 10.1136/emermed-2022-212622] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prehospital critical care is a rapidly evolving field. There is a paucity of evidence relating to its practice, with limited progress in answering those research questions identified over a decade ago. It is vital that evidence gaps are identified and addressed. This study aimed to define the current research priorities in UK prehospital critical care. METHODS This modified national Delphi study was coordinated by the Pre-HOspital Trainee Operated research Network and conducted in four rounds between October 2021 and April 2022. Rounds 1 and 2 were conducted online with clinicians involved in prehospital critical care delivery and non-clinical prehospital researchers. Rounds 3 and 4 were completed online by a subject matter expert (SME) panel. RESULTS In round 1, 78 participants submitted 394 research questions relating to prehospital critical care delivery in the UK. These were refined and categorised into 192 questions, which were scored for importance in round 2. Fifty questions were discussed and scored by the SME panel in round 3. Round 4 created a ranked top 20 list. The top research priority was 'Which cardiac arrest patients should critical care teams be dispatched to; how do we identify these patients during the emergency call?'. Other priorities included dispatch optimisation, out-of-hospital medical cardiac arrest management, optimising resuscitation in haemorrhagic shock, improving traumatic brain injury outcomes and optimising management of traumatic cardiac arrest. CONCLUSIONS This modified Delphi study identified 20 research priorities where efforts should be concentrated to develop collaborative prehospital critical care research within the UK over the next 5 years.
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Affiliation(s)
- Lisa Ramage
- Pre-Hospital Trainee Operated Research Network (PHOTON), London, UK
- Essex and Herts Air Ambulance, Earls Colne, Colchester, UK
| | - Sarah McLachlan
- Essex and Herts Air Ambulance, Earls Colne, Colchester, UK
- Anglia Ruskin University, Chelmsford, UK
| | - Kristian Williams
- Welsh Ambulance Services NHS Trust, Saint Asaph, UK
- Bangor University, Bangor, UK
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Kapadia M, Lehmann L, Auletta J, Beatty L, Bhatt N, Blacken R, Demmel K, Dodd T, Desmond C, Fitch T, Flesch L, Hartley D, Huber J, Ingraham H, Jakubowski R, Klunk A, Krupski C, Kusnier K, Liberio N, Maakaron J, Mueller M, Myers KC, Pai A, Parker L, Patel S, Phelan R, Polishchuk V, Sigmund A, Sper C, Tarquini S, Juckett M, Jaglowski S, Dandoy C, Rotz S. Quality Improvement in Hematopoietic Stem Cell Transplant and Cellular Therapy: Using the Model for Improvement to impact Outcomes. Transplant Cell Ther 2022; 28:233-241. [PMID: 35151937 DOI: 10.1016/j.jtct.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/18/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
Quality improvement and quality assurance form a complementary and independent relationship. Quality assurance measures compliance against industry standards utilizing audits, whereas quality improvement is a continuous process focused on processes and systems that can improve care. The Model for Improvement is a robust quality improvement tool that transplant and cellular therapy teams can employ to redesign healthcare processes. The Model for Improvement utilizes several components addressed in sequence to organize and critically evaluate improvement activities. Unlike other health sciences clinical research, quality improvement projects, and research are based on dynamic hypotheses that develop into observable, serial tests of change with continuous collection and feedback of performance data to stakeholders.
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Affiliation(s)
- Malika Kapadia
- Division of Pediatric Oncology, Dana Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard University Medical School Boston, MA, USA.
| | - Leslie Lehmann
- Division of Pediatric Oncology, Dana Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard University Medical School Boston, MA, USA.
| | - Jeffery Auletta
- National Marrow Donor Program/Be The Match and Hematology/Oncology/BMT & Infectious Diseases, Nationwide Children's Hospital.
| | - Lisa Beatty
- Division of Pediatric Oncology, Dana Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard University Medical School Boston, MA, USA.
| | - Neel Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Robyn Blacken
- Division of Pediatric Oncology, Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA.
| | - Kathy Demmel
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Therese Dodd
- Sarah Cannon Transplant & Cellular Therapy Network, Nashville, TN.
| | - Catherine Desmond
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Taylor Fitch
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Laura Flesch
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - David Hartley
- University of Cincinnati College of Medicine, Department of Pediatrics; James M Anderson Center, Cincinnati, OH.
| | - John Huber
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Hannah Ingraham
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Rita Jakubowski
- Department of Medical Oncology/ Hematopoietic and Cellular Therapy Service; Icahn School of Medicine/Mount Sinai Medical Center, New York, New York.
| | - Anna Klunk
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Christa Krupski
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Katilyn Kusnier
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Nicole Liberio
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI.
| | - Joseph Maakaron
- Division of Hematology, Oncology, and Transplantation; Department of Medicine; University of Minnesota.
| | - Mark Mueller
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Kasiani C Myers
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Ahna Pai
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH.
| | - Loretta Parker
- The University of Oklahoma College of Medicine, Department of Pediatrics; Division of Hematology/Oncology, Oklahoma City, OK.
| | - Sagar Patel
- Huntsman Cancer Institute, University of Utah.
| | - Rachel Phelan
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI.
| | - Veronika Polishchuk
- Division of Hematology, Oncology, and Bone and Marrow Transplant, Nationwide Children's Hospital, Department of Pediatrics, Ohio State University, OH, USA.
| | - Audrey Sigmund
- Divisions of Hematology and Medical Oncology, The Ohio State University, Columbus, OH.
| | - Christine Sper
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Sarah Tarquini
- Dana-Farber Boston Children's Cancer and Blood Disorders Center.
| | - Mark Juckett
- Division of Hematology, Oncology, and Transplantation; Department of Medicine; University of Minnesota.
| | - Samantha Jaglowski
- Division of Hematology-Oncology and transplantation; Department of Pediatrics. Ohio State University Medical Center.
| | - Christopher Dandoy
- University of Cincinnati College of Medicine, Department of Pediatrics; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH.
| | - Seth Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
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Heino A, Raatiniemi L, Iirola T, Meriläinen M, Liisanantti J, Tommila M. The development of emergency medical services benefit score: a European Delphi study. Scand J Trauma Resusc Emerg Med 2021; 29:151. [PMID: 34656149 PMCID: PMC8520267 DOI: 10.1186/s13049-021-00966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background The helicopter emergency services (HEMS) Benefit Score (HBS) is a nine-level scoring system developed to evaluate the benefits of HEMS missions. The HBS has been in clinical use for two decades in its original form. Advances in prehospital care, however, have produced demand for a revision of the HBS. Therefore, we developed the emergency medical services (EMS) Benefit Score (EBS) based on the former HBS. As reflected by its name, the aim of the EBS is to measure the benefits produced by the whole EMS systems to patients. Methods This is a four-round, web-based, international Delphi consensus study with a consensus definition made by experts from seven countries. Participants reviewed items of the revised HBS on a 5-point Likert scale. A content validity index (CVI) was calculated, and agreement was defined as a 70% CVI. Study included experts from seven European countries. Of these, 18 were prehospital expert panellists and 11 were in-hospital commentary board members. Results The first Delphi round resulted in 1248 intervention examples divided into ten diagnostic categories. After removing overlapping examples, 413 interventions were included in the second Delphi round, which resulted in 38 examples divided into HBS categories 3–8. In the third Delphi round, these resulted in 37 prehospital interventions, examples of which were given revised version of the score. In the fourth and final Delphi round, the expert panel was given an opportunity to accept or comment on the revised scoring system. Conclusions The former HBS was revised by a Delphi methodology and EBS developed to represent its structural purpose better. The EBS includes 37 exemplar prehospital interventions to guide its clinical use. Trial registration The study permission was requested and granted by Turku University Hospital (decision number TP2/010/18). Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00966-3.
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Affiliation(s)
- Anssi Heino
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland. .,University of Turku, Turku, Finland.
| | - Lasse Raatiniemi
- Centre for Prehospital Emergency Care, Oulu University Hospital, Oulu, Finland
| | - Timo Iirola
- University of Turku, Turku, Finland.,Emergency Medical Services, Turku University Hospital, Turku, Finland
| | - Merja Meriläinen
- Medical Research Centre, Oulu University Hospital, Oulu, Finland
| | - Janne Liisanantti
- Department of Anaesthesiology, Medical Research Centre and Research Group of Anaesthesia and Intensive Care, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Miretta Tommila
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.,University of Turku, Turku, Finland
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Haugland H, Olkinuora A, Rognås L, Ohlen D, Krüger A. Testing quality indicators and proposing benchmarks for physician-staffed emergency medical services: a prospective Nordic multicentre study. BMJ Open 2019; 9:e030626. [PMID: 31685504 PMCID: PMC6858216 DOI: 10.1136/bmjopen-2019-030626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES A consensus study from 2017 developed 15 response-specific quality indicators (QIs) for physician-staffed emergency medical services (P-EMS). The aim of this study was to test these QIs for important characteristics in a real clinical setting. These characteristics were feasibility, rankability, variability, actionability and documentation. We further aimed to propose benchmarks for future quality measurements in P-EMS. DESIGN In this prospective observational study, physician-staffed helicopter emergency services registered data for the 15 QIs. The feasibility of the QIs was assessed based on the comments of the recording physicians. The other four QI characteristics were assessed by the authors. Benchmarks were proposed based on the quartiles in the dataset. SETTING Nordic physician-staffed helicopter emergency medical services. PARTICIPANTS 16 physician-staffed helicopter emergency services in Finland, Sweden, Denmark and Norway. RESULTS The dataset consists of 5638 requests to the participating P-EMSs. There were 2814 requests resulting in completed responses with patient contact. All QIs were feasible to obtain. The variability of 14 out of 15 QIs was adequate. Rankability was adequate for all QIs. Actionability was assessed as being adequate for 10 QIs. Documentation was adequate for 14 QIs. Benchmarks for all QIs were proposed. CONCLUSIONS All 15 QIs seem possible to use in everyday quality measurement and improvement. However, it seems reasonable to not analyse the QI 'Adverse Events' with a strictly quantitative approach because of a low rate of adverse events. Rather, this QI should be used to identify adverse events so that they can be analysed as sentinel events. The actionability of the QIs 'Able to respond immediately when alarmed', 'Time to arrival of P-EMS', 'Time to preferred destination', 'Provision of advanced treatment' and 'Significant logistical contribution' was assessed as being poor. Benchmarks for the QIs and a total quality score are proposed for future quality measurements.
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Affiliation(s)
- Helge Haugland
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav University Hospital, Trondheim, Norway
| | - Anna Olkinuora
- Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland
| | - Leif Rognås
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus N, Denmark
- Danish Air Ambulance, Aarhus, Denmark
| | - David Ohlen
- Airborne Intensive Care Unit, Department of Anaesthesia, Perioperative Management and Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Krüger
- Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav University Hospital, Trondheim, Norway
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Alstrup K, Petersen JAK, Barfod C, Knudsen L, Rognås L, Møller TP. The Danish helicopter emergency medical service database: high quality data with great potential. Scand J Trauma Resusc Emerg Med 2019; 27:38. [PMID: 30953564 PMCID: PMC6451291 DOI: 10.1186/s13049-019-0615-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background The Danish Helicopter Emergency Medical Service (HEMS) is part of the Danish pre-hospital response offering advanced patient care on scene and during rapid transport to definitive care. Monitoring HEMS performance and the quality of critical care has high national as well as international priority underlining the need for research in this field. The data quality of the Danish HEMS database is unknown. Furthermore, a set of quality indicators (QI) developed by an international collaboration group (EQUIPE) potentially for use in physician-staffed EMS, has recently been presented. The aim of the current study was to present the design and data quality of the Danish helicopter database, and to evaluate the coverage of available variables in the database according to the QIs proposed. Method The study included all helicopter dispatches between October 1st 2014 and April 30th 2018. The database layout and data entering procedure, as well as the key variables and data completeness were described. Furthermore, missing data and misclassifications were addressed. Lastly, the 26 QIs proposed by the EQUIPE-collaboration were evaluated for coverage in the HEMS database. Results A total of 13,392 missions were included in the study. The database includes a broad spectrum of mission- and patient-specific data related to the pre-hospital pathway of acutely ill or injured patients in a national coverage. Missing data for the majority of variables is less than 6.5%. The percentage of completed report forms has increased over time and reached 99.9% in 2018. Misclassification were observed for 294 patients in the study period corresponding to 3,7%. Less than half of the QIs proposed by the EQUIPE-collaboration group were directly available from the database. Conclusions Helicopter Emergency Medical Services in Denmark are a new and sparsely investigated health care provider. The database contains nearly all missions dispatched by the five regional Emergency Medical Dispatch Centres. Generally, the data quality is considered high with great potential for future research. Potential quality indicators as proposed by the EQUIPE-collaboration group could inspire the configuration and design of the next version of Hemsfile creating an even more solid basis for research and quality improvement. Electronic supplementary material The online version of this article (10.1186/s13049-019-0615-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Alstrup
- Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark.
| | - Jens Aage Kølsen Petersen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | - Charlotte Barfod
- The Danish Air Ambulance, Aarhus, Denmark.,Emergency Medical Services, Copenhagen, Denmark
| | - Lars Knudsen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | - Leif Rognås
- Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark.,Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
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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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Haugland H, Rehn M, Klepstad P, Krüger A. Developing quality indicators for physician-staffed emergency medical services: a consensus process. Scand J Trauma Resusc Emerg Med 2017; 25:14. [PMID: 28202076 PMCID: PMC5311851 DOI: 10.1186/s13049-017-0362-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/10/2017] [Indexed: 12/24/2022] Open
Abstract
Background There is increasing interest for quality measurement in health care services; pre-hospital emergency medical services (EMS) included. However, attempts of measuring the quality of physician-staffed EMS (P-EMS) are scarce. The aim of this study was to develop a set of quality indicators for international P-EMS to allow quality improvement initiatives. Methods A four-step modified nominal group technique process (expert panel method) was used. Results The expert panel reached consensus on 26 quality indicators for P-EMS. Fifteen quality indicators measure quality of P-EMS responses (response-specific quality indicators), whereas eleven quality indicators measure quality of P-EMS system structures (system-specific quality indicators). Discussion When measuring quality, the six quality dimensions defined by The Institute of Medicine should be appraised. We argue that this multidimensional approach to quality measurement seems particularly reasonable for services with a highly heterogenic patient population and complex operational contexts, like P-EMS. The quality indicators in this study were developed to represent a broad and comprehensive approach to quality measurement of P-EMS. Conclusions The expert panel successfully developed a set of quality indicators for international P-EMS. The quality indicators should be prospectively tested for feasibility, validity and reliability in clinical datasets. The quality indicators should then allow for adjusted quality measurement across different P-EMS systems. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0362-4) contains supplementary material, which is available to authorized users.
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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.
| | - 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
| | - 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
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