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Omran LL, Andersson Hagiwara M, Puaca G, Maurin Söderholm H. The impact of video consultation on interprofessional collaboration and professional roles: a simulation-based study in prehospital stroke chain of care. J Interprof Care 2024; 38:664-674. [PMID: 38717805 DOI: 10.1080/13561820.2024.2344075] [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: 05/12/2023] [Accepted: 04/09/2024] [Indexed: 05/31/2024]
Abstract
Healthcare is often conducted by interprofessional teams. Research has shown that diverse groups with their own terminology and culture greatly influence collaboration and patient safety. Previous studies have focused on interhospital teams, and very little attention has been paid to team collaboration between intrahospital and prehospital care. Addressing this gap, the current study simulated a common and time-critical event for ambulance nurses (AN) that also required contact with a stroke specialist in a hospital. Today such consultations are usually conducted over the phone, this simulation added a video stream from the ambulance to the neurologist on call. The aim of this study was to explore interprofessional collaboration between AN's and neurologists when introducing video-support in the prehospital stroke chain of care. The study took place in Western Sweden. The simulated sessions were video recorded, and the participants were interviewed after the simulation. The results indicate that video has a significant impact on collaboration and can help to facilitate better understanding among different professional groups. The participants found the video to be a valuable complement to verbal information. The result also showed challenges in the form of a loss of patient focused care. Both ANs and neurologists saw the video as benefiting patient safety.
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Affiliation(s)
- Lise-Lotte Omran
- PreHospen Centre for Prehospital Research, University of Borås, Borås, Sweden
| | | | - Goran Puaca
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Nordquist H, Pappinen J, Torkki P, Nurmi J. Consultation Processes With Helicopter Emergency Medical Service Physicians in Finnish Prehospital Emergency Care: The Paramedics' Perspective. Air Med J 2023; 42:461-467. [PMID: 37996183 DOI: 10.1016/j.amj.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The Finnish emergency medical services operates mainly with highly educated paramedic-staffed units. Helicopter emergency medical services (HEMS) physicians alongside other physicians provide consultations to paramedics on the scene without the physician physically participating in the mission. We examined the Finnish paramedics' views regarding the consultation processes involving HEMS physicians. METHODS This was a cross-sectional survey study among paramedics (n = 200). Assessments of the performance of HEMS physicians and other physicians in the consultation process were analyzed descriptively. The effect of the physician being expressly part of the HEMS was analyzed with inductive content analysis. RESULTS Overall, consultations with the HEMS physician were well received among paramedics, and the HEMS physicians received higher assessments than other physicians. The familiarity with the prehospital environment, limitations, and local possibilities was valued. Expertise is particularly valuable in challenging emergency medical services missions but unnecessary in many nonurgent missions. There is scope for improvement in the attitudes and technical fluency of the consultation processes of HEMS physicians. CONCLUSION Using HEMS physicians in prehospital consultations could be recommended. Further studies are still needed to ensure the efficacy and efficiency of the consultation process and explore the integration of video connections into current consultation practices.
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Affiliation(s)
- Hilla Nordquist
- Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland.
| | - Jukka Pappinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Payne RE, Clarke A. How and why are video consultations used in urgent primary care settings in the UK? A focus group study. BJGP Open 2023; 7:BJGPO.2023.0025. [PMID: 37068795 PMCID: PMC10646199 DOI: 10.3399/bjgpo.2023.0025] [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: 02/07/2023] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Video consulting was widely rolled out across general practice at the start of the COVID-19 pandemic. In the in-hours setting there has been a marked shift away from using the technology, but many urgent care clinicians continue to use video consulting. Little is known about the reasons behind this discrepancy. AIM To understand how and why video is used in urgent care settings. DESIGN & SETTING Focus groups were held via Microsoft Teams with 11 GPs working in in- and out-of-hours settings across the UK. METHOD GPs were recruited through a convienience sampling strategy. Meetings were recorded, auto-transcribed, and checked for accuracy. A thematic analysis was performed. RESULTS Urgent care GPs used video as an adjunct to the telephone in the initial assessment of patients and felt it helped direct patients to the right service first time. They were confident using video for a broad range of presenting conditions. They felt it created additional trust and rapport with patients and was useful for bringing third parties into the consultation. They felt that it allowed them to maximise resources and use shielded colleagues effectively. They emphasised the importance of one-to-one training and this was seen as vital for effective implementation within an organisation. CONCLUSION Video consulting is useful in the urgent care setting as an adjunct to telephone consulting. It is particularly helpful in the initial triage of patients. One-to-one training is needed for effective implementation.
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Affiliation(s)
| | - Aileen Clarke
- Public Health and Applied Health Research, Warwick Medical School, University of Warwick, Coventry, UK
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Larribau R, Healey B, Chappuis VN, Boussard D, Guiche F, Herren T, Gartner BA, Suppan L. Contribution of Live Video to Physicians' Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3307. [PMID: 36834002 PMCID: PMC9959421 DOI: 10.3390/ijerph20043307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID-19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID-19 number) with suspected COVID-19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. A total of 8957 patients were included, and 2157 (48.0%) of the 4493 patients assessed on the official emergency number had dyspnoea, 4045 (90.6%) of 4464 patients assessed on the COVID-19 number had flu-like symptoms and 1798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n = 81) of cases and caught 7 (7.7%) patients in a life-threatening emergency. Medical triage decisions for suspected COVID-19 patients are strongly influenced by the use of live video.
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Affiliation(s)
- Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva, Switzerland
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Isakov A, Carr M, Munjal KG, Kumar L, Gausche-Hill M. EMS Agenda 2050 Meets the COVID-19 Pandemic. Health Secur 2022; 20:S97-S106. [PMID: 35475661 DOI: 10.1089/hs.2021.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alexander Isakov
- Alexander Isakov, MD, MPH, FACEP, FAEMS, is a Professor of Emergency Medicine, Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Carr
- Michael Carr, MD, FACEP, is an Assistant Professor of Emergency Medicine, Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kevin G Munjal
- Kevin G. Munjal, MD, MPH, MSCR, is an Associate Professor of Emergency Medicine and Population Health Science and Policy, Departments of Emergency Medicine, Population Health Science and Policy, and Prehospital Care, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lekshmi Kumar
- Lekshmi Kumar, MD, MPH, FACEP, FAEMS, is an Associate Professor of Emergency Medicine, Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Marianne Gausche-Hill
- Marianne Gausche-Hill MD, FACEP, FAAP, FAEMS, is a Professor of Clinical Emergency Medicine and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Exploring the Feelings of Nurses during Resuscitation—A Cross-Sectional Study. Healthcare (Basel) 2021; 10:healthcare10010005. [PMID: 35052169 PMCID: PMC8774964 DOI: 10.3390/healthcare10010005] [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] [Received: 11/29/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) is one of the most stressful situations in emergency medicine. Nurses involved in performing basic and advanced resuscitation procedures are therefore exposed to a certain amount of stress. The purpose of this study was to determine the stressors and the level of stress experienced by nurses during resuscitation. A cross-sectional quantitative study was done. The sample consisted of 457 nurses who worked in emergency units. First demographic data were collected, followed by a questionnaire regarding the effect of different situations that occur during and after resuscitation on nurses including Post-Code Stress Scale questionnaire. The most disturbing situations for respondents were resuscitation of young person (MV = 3.7, SD = 1.4), when they fail to establish an intravenous pathway (MV = 3.5, SD = 1.4), chaotic situation during resuscitation (MV = 3.4, SD = 1.4) and making decision about termination of resuscitation (MV = 3.1, SD = 1.5). Research has shown that nurses are exposed to a certain amount of stress during resuscitation, but most of them manage to compensate for stress effectively.
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Vicente V, Johansson A, Selling M, Johansson J, Möller S, Todorova L. Experience of using video support by prehospital emergency care physician in ambulance care - an interview study with prehospital emergency nurses in Sweden. BMC Emerg Med 2021; 21:44. [PMID: 33827436 PMCID: PMC8028766 DOI: 10.1186/s12873-021-00435-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction When in need of emergency care and ambulance services, the ambulance nurse is often the first point of contact for the patient with healthcare. This role requires comprehensive knowledge of the ambulance nurse to be able to assign the right level of care and, if necessary, to provide self-care advice for patients with no further conveyance to hospital. Recently, an application was developed for transmitting real-time video to facilitate consultation between ambulance nurses and prehospital physicians in the role of regional medical support (RMS) for ambulance care. The use of video communication as a complement of medical support when referring to self-care is still an unexplored method in a prehospital setting. Our study aimed to elucidate ambulance nurses’ experience of video consultation with RMS physician during the assessment of patients considered to be triaged to self-care. Method We conducted a qualitative design study using semi-structured interviews with open questions. Twelve ambulance nurses were included in the study. To explore the ambulance nurses’ experience of performing video consultation with RMS physician, in cases when a patient was assessed and triaged to self-care, a content analysis was performed. Results A main category emerged from the results: “ Video consultation as decision support in the ambulance care promotes increased patient participation and for the ambulance nurses, it creates a feeling of increased patient safety “. The main category was based and formed on the following categories: “ Simultaneous presence of ambulance nurse and a physician increases patient participation during the assessment resulting in a confident care decision “. “Interprofessional collaboration strengthens the medical assessment”. “Video technology promotes accessibility for patients needs in the ambulance care regardless of emergency level”. Conclusions Ambulance nurses experienced that the use of video consultation increases patient involvement and confidence in healthcare when both the ambulance nurse and the physician were present when deciding on self-care advice. The live imaging allowed the ambulance nurse and prehospital physician to reach a consensus on the patient’s current medical care needs, which in turn led to a feeling of increased patient safety for the ambulance nurses.
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Affiliation(s)
- Veronica Vicente
- The Ambulance Medical Service in Stockholm (AISAB), Lindetorpsvägen 11, SE-121 18 Johanneshov, Stockholm, Sweden. .,Academic EMS, Stockholm, Sweden. .,Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Stockholm, Sweden.
| | - Anders Johansson
- Office of Medical Services, Region Skåne, Malmö, Sweden.,Department of Clinical Science, Lund University, Region Skåne, Lund, Sweden
| | - Magnus Selling
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Stockholm, Sweden
| | - Johnny Johansson
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset in Stockholm, Stockholm, Sweden
| | - Sebastian Möller
- Office of Medical Services, Region Skåne, Malmö, Sweden.,Department of Clinical Science, Lund University, Region Skåne, Lund, Sweden
| | - Lizbet Todorova
- Office of Medical Services, Region Skåne, Malmö, Sweden.,Department of Clinical Science, Lund University, Region Skåne, Lund, Sweden
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