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Kim SH, Lee H. Characteristics of consecutive versus non-consecutive frequent emergency medical services transport to a single emergency department. PLoS One 2024; 19:e0301337. [PMID: 38722985 PMCID: PMC11081241 DOI: 10.1371/journal.pone.0301337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/14/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE This study was to examine characteristics concerning frequent users of emergency medical services (EMS) transport by comparing patients who used EMS transport frequently for one year and those who used EMS transport for more than two years consecutively. METHODS A retrospective review for frequent use of EMS transport was conducted. The patients from the fire stations that transported more than 70% of all EMS transport to the study hospital emergency department (ED) were included. The study subjects were divided into consecutive group (frequent EMS transport for ≥ two years consecutively) and non-consecutive group (frequent EMS transport for only one year). Characteristics of patients who were frequent users of EMS transport and those of all cases with EMS transport were examined. RESULTS Of the total 205 patients and 1204 cases of frequent EMS transport, 85 (42%) patients and 755 (63%) cases were in the consecutive group. Patients in the consecutive group were more likely to have risky alcohol use, unemployed state, and medical aid type of payment for ED treatment than those in the non-consecutive group. More patients had previous experience of EMS transport to the study hospital ED in the consecutive group and the number of cases with alcohol ingestion was higher in the consecutive group. Elapsed time from EMS call to ED arrival was longer for the consecutive group. CONCLUSION Risky alcohol use, unemployed state, and previous experience of EMS transport were associated with consecutive and frequent use of EMS transport in frequent users of EMS transport.
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Affiliation(s)
- Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hyeji Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
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Malvestio MAA, Sousa RMCD. [Implementation of procedures by the Mobile Emergency Care Service (SAMU 192) in Brazil: performance, benchmarking, and challenges]. CIENCIA & SAUDE COLETIVA 2024; 29:e18482022. [PMID: 38198335 DOI: 10.1590/1413-81232024291.18482022] [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: 11/16/2022] [Accepted: 04/03/2023] [Indexed: 01/12/2024] Open
Abstract
The scope of this article is to describe and analyze the production of approved procedures carried out by regulation centers and mobile resources of SAMU 192 between 2015 and 2019, according to frequency, population-based indicators, and daily productivity, to establish a performance indicator. It consisted of an observational and descriptive census study, with production data drawn from the Outpatient Information System, and population data from the Brazilian Institute of Geography and Statistics and information from the Ministry of Health. The 116.8 million procedures analyzed resulted from a 28.5% increase in the period, while the population covered and mobile resources grew by 9.7% and 14.4%, respectively. Every 1,000 inhabitants covered generated 109.8 calls, resulting in 24.0 mobile resource dispatches per year. Basic support units performed 3.3 consultations, and 0.5 transfers daily, while advanced support performed 2.7 consultations and 0.9 transfers. The production of procedures exceeded the increase in the population covered, with variations between states, high incidence in populated areas, a strong presence of basic support and an increase in transfers, although national productivity was seen to be lower than international productivity.
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Affiliation(s)
- Marisa Aparecida Amaro Malvestio
- Programa de Pós-Doutorado da Escola de Enfermagem, Universidade de São Paulo (USP). Av. Dr. Enéas de Carvalho Aguiar 419, Cerqueira César. 05403-000 São Paulo SP Brasil.
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Kontunen P, Holstein R, Castrén M, Carter A. Optimal acute care for long-term care patients: from emergency department to home. CAN J EMERG MED 2023; 25:259-260. [PMID: 37036610 DOI: 10.1007/s43678-023-00488-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Perttu Kontunen
- Department of Public Health, Helsinki University, Yliopistonkatu 4, 00100, Helsinki, Finland.
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - Ria Holstein
- Department of Public Health, Helsinki University, Yliopistonkatu 4, 00100, Helsinki, Finland
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Alix Carter
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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Aged and Health Care Service Utilization by Older Australians Receiving Home Care Packages. J Am Med Dir Assoc 2023; 24:395-399.e2. [PMID: 36581309 DOI: 10.1016/j.jamda.2022.11.019] [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: 07/25/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To examine the (1) cohort of individuals living at home with Home Care Packages (HCPs) in 2016, (2) their access to other aged care services after HCP commencement, and (3) their hospital and ambulance service utilization. DESIGN A cross-sectional study was conducted using integrated aged care and health care data contained within the National Historical Cohort of the Registry of Senior Australians. SETTING AND PARTICIPANTS This study included people who accessed HCP between January 1, 2016 and December 31, 2016. METHODS The access to permanent residential aged care, transition care, respite care, hospital and ambulance services among Australian HCP recipients ≥65 years old in 2016 was evaluated. Descriptive statistics were employed. RESULTS In 2016, 84,681 individuals received HCPs, of which 68.4% (n = 57,942) accessed HCP levels 1‒2, 26.0% (n = 22,057) accessed HCP levels 3‒4, and 5.5% (n = 4682) accessed both care levels within the year. Of the individuals receiving HCP, 34.0% (n = 27,787) started services that year and 16.7% (n = 14,117) moved to permanent residential aged care, 18.4% (n = 15,592) used respite care and 5.8% (n = 4937) used transition care that year. Emergency department (ED) presentations [43.6%, 95% confidence interval (CI) 43.3‒44.0] were the most common hospital encounters, followed by inpatient hospitalizations for any reason (43.3%, 95% CI 42.9‒43.7), and unplanned hospitalizations (38%, 95% CI 37.6‒38.3). Forty-four percent (44.5%, 95% CI 43.9‒45.0) of individuals utilized ambulance services. ED presentations, hospitalization for any reason, and unplanned hospitalizations were more common in individuals receiving HCP levels 3‒4 compared with those accessing HCP levels 1‒2. CONCLUSIONS AND IMPLICATIONS HCP recipients in Australia have frequent hospitalizations, including ED presentations. In addition, almost 1 in 5 access respite care and 16.7% transition to permanent residential care each year. As the population accessing HCP is increasing, adequate support for these individuals to live well at home and avoid health events that lead to hospitalizations are necessary.
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Sinclair DR, Charlton K, Stow D, Burrow E, Hanratty B. Care Home Residency and Its Association with Ambulance Service Workload. J Am Med Dir Assoc 2023; 24:657-660. [PMID: 36822234 DOI: 10.1016/j.jamda.2023.01.021] [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: 09/26/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Care home residents comprise a significant minority of ambulance patients, but little is known about how care homes impact ambulance service workload. This study aims to quantify differences in the workload of ambulance paramedics associated with patient residence (care home vs private). DESIGN This was an observational study using routine ambulance service data and Clinical Frailty Scale scores from patients attended by 112 study paramedics between January 1, 2021, and June 30, 2021. SETTING AND PARTICIPANTS 3056 patients (459 in care homes) aged ≥50 attended by the North East Ambulance Service NHS Foundation Trust, England. METHODS This study used 2 outcome measures of treatment: time spent at scene and conveyance to hospital. Anonymized patient data and incident time logs were collected from ambulance electronic patient care records. The relationships between care home residency, conveyance to hospital, and time spent at scene were investigated using ordinal logistic regression and quantile regression. Models were weighted to address potential sampling imbalance using anonymised call logs containing all eligible ambulance callouts. RESULTS Care home residents were less likely to be conveyed to hospital [odds ratio: 0.75 (0.59-0.96)] and received shorter treatment time than community residents [median -7.0 (-12.0, -1.9) minutes for patients conveyed to hospital, -2.8 (-5.4, -0.3) minutes for patients discharged at scene]. CONCLUSIONS AND IMPLICATIONS Our results suggest that care homes provide support that reduces demand on the ambulance service and other "downstream" services in secondary care. This study also points to a need to enhance care for older people in private households to contain the demands on ambulance services. These findings have implications for countries like England, where ambulance services struggle to meet target response times, which may affect patient outcomes.
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Affiliation(s)
- David R Sinclair
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Karl Charlton
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Daniel Stow
- Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Emma Burrow
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Krammel M, Drahohs V, Hamp T, Lemoyne S, Grassmann D, Schreiber W, Sulzgruber P, Schnaubelt S. The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna-An Overview. J Clin Med 2023; 12:jcm12020643. [PMID: 36675572 PMCID: PMC9865411 DOI: 10.3390/jcm12020643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background: The city of Vienna, Austria, has a gradually aging population. Elderly people, over 65 years old and living at home or in nursing homes, frequently use Emergency Medical Services (EMS). However, there is no previous data comparing the EMS utilization of elderly- and non-elderly patients in Vienna. Methods: We retrospectively analyzed all EMS incidents in Vienna from 2012 to 2019. Transport- and emergency physician treatment rates, annual fluctuations, and the number of non-transports were compared between elderly (≥65 years) and non-elderly (18−64 years) patients. Results: Elderly people accounted for 42.6% of the total EMS responses in adult patients, representing an annual response rate of 223 per 1000 inhabitants ≥ 65 years. Compared to 76 per 1000 inhabitants in patients 18−64 years old, this results in an incidence rate ratio (IRR) of 2.93 [2.92−2.94]. Elderly people were more likely (OR 1.68 [1.65−1.70]) to need emergency physicians, compared to 18−64 year-olds. Nursing home residents were twice (OR 2.11 [2.06−2.17]) as likely to need emergency physicians than the rest of the study group. Non-transports were more likely to occur in patients over 65 years than in non-elderlies (14% vs. 12%, p < 0.001). Conclusions: The elderly population ≥ 65 years in Vienna shows higher EMS response rates than younger adults. They need emergency physicians more often, especially when residing in nursing homes. The economical and organizational strain this puts on the emergency response system should trigger further research and the development of solutions, such as specific response units dedicated to elderly people.
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Affiliation(s)
- Mario Krammel
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Emergency Medical Service, 1030 Vienna, Austria
| | - Valentin Drahohs
- Department of Anaesthesiology and Critical Care Medicine, Hospital St. Poelten, 3100 St. Poelten, Austria
| | - Thomas Hamp
- Emergency Medical Service, 1030 Vienna, Austria
- Department of Anaesthesiology, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabine Lemoyne
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Daniel Grassmann
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Emergency Medical Service, 1030 Vienna, Austria
| | - Wolfgang Schreiber
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrick Sulzgruber
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Sebastian Schnaubelt
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
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Lindskou TA, Andersen PJ, Christensen EF, Søvsø MB. More emergency patients presenting with chest pain. PLoS One 2023; 18:e0283454. [PMID: 36952460 PMCID: PMC10035919 DOI: 10.1371/journal.pone.0283454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Throughout recent years the demand for prehospital emergency care has increased significantly. Non-traumatic chest pain is one of the most frequent complaints. Our aim was to investigate the trend in frequency of the most urgent ambulance patients with chest pain, subsequent acute myocardial infarction (AMI) diagnoses, and 48-hour and 30-day mortality of both groups. METHODS Population-based historic cohort study in the North Denmark Region during 2012-2018 including chest pain patients transported to hospital by highest urgency level ambulance following a 1-1-2 emergency call. Primary diagnoses (ICD-10) were retrieved from the regional Patient Administrative System, and descriptive statistics (distribution, frequency) performed. We evaluated time trends using linear regression, and mortality (48 hours and 30 days) was assessed by the Kaplan Meier estimator. RESULTS We included 18,971 chest pain patients, 33.9% (n = 6,430) were diagnosed with"Diseases of the circulatory system" followed by the non-specific R- (n = 5,288, 27.8%) and Z-diagnoses (n = 3,634; 19.2%). AMI was diagnosed in 1,967 patients (10.4%), most were non-ST-elevation AMI (39.7%). Frequency of chest pain patients and AMI increased 255 and 22 patients per year respectively, whereas the AMI proportion remained statistically stable, with a tendency towards a decrease in the last years. Mortality at 48 hours and day 30 in chest pain patients was 0.7% (95% CI 0.5% to 0.8%) and 2.4% (95% CI 2.1% to 2.6%). CONCLUSIONS The frequency of chest pain patients brought to hospital during 2012-2018 increased. One-tenth were diagnosed with AMI, and the proportion of AMI patients was stable. Almost 1 in of 4 high urgency level ambulances was sent to chest pain patients. Only 1 of 10 patients with chest pain had AMI, and overall mortality was low. Thus, monitoring the number of chest pain patients and AMI diagnoses should be considered to evaluate ambulance utilisation and triage.
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Affiliation(s)
- Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | | | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
- Clinic of Internal and Emergency Medicine, Department of Emergency and Trauma Care, Aalborg, Denmark
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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Charlton K, Sinclair DR, Hanratty B, Burrow E, Stow D. Measuring frailty and its association with key outcomes in the ambulance setting: a cross sectional observational study. BMC Geriatr 2022; 22:935. [PMID: 36471316 PMCID: PMC9721042 DOI: 10.1186/s12877-022-03633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Little is known about frailty in the ambulance setting, or its association with outcomes relevant to ambulance services. We sought to measure frailty in people aged ≥ 50 attended by an ambulance, and describe the relationship between frailty, odds of conveyance to hospital, and duration at scene. METHODS An observational study between 01/01/2021-30/06/2021 in North East Ambulance Service, England. Participants were aged ≥ 50 attended by an ambulance, excluding patients requiring immediate treatment for a life-threatening condition or with Glasgow Coma Scale < 15. Paramedics (n = 112) measured patient frailty using the Clinical Frailty Scale (CFS). Additional information was extracted from ambulance care records. Weighted regression models examined associations between frailty, hospital conveyance, and duration at scene. RESULTS Three thousand and fifty-six callouts were observed (mean patient age: 78.1 years, 57.2% female). Frailty prevalence (CFS ≥ 5) was 58.7%. Median duration at scene was 47.0 min (interquartile range 34.0-67.0 min). Ambulances spent a median of 8.2 (95%CI:5.4-11.0) minutes longer with frail patients than non-frail patients. Frail patients were less likely to be conveyed to hospital than non-frail patients (OR:0.75, 95%CI:0.60-0.94). CONCLUSION Frailty is common among people aged ≥ 50 attended by an ambulance and an important influence on workload. Ambulance services need a good understanding of frailty to meet patient needs. As populations age, community support should be prioritised to deliver appropriate frailty care and reduce demands on ambulance services.
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Affiliation(s)
- Karl Charlton
- grid.477636.70000 0001 0507 7689North East Ambulance Service NHS Foundation Trust, Ambulance HQ, Bernicia House, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne, NE15 8NY UK
| | - David R Sinclair
- grid.1006.70000 0001 0462 7212Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Barbara Hanratty
- grid.1006.70000 0001 0462 7212Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Emma Burrow
- grid.477636.70000 0001 0507 7689North East Ambulance Service NHS Foundation Trust, Ambulance HQ, Bernicia House, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne, NE15 8NY UK
| | - Daniel Stow
- grid.1006.70000 0001 0462 7212Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX UK ,grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, E1 4NS UK
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Ceklic E, Ball S, Finn J, Brown E, Brink D, Bailey P, Whiteside A, Brits R, Tohira H. Ambulance dispatch prioritisation for traffic crashes using machine learning: A natural language approach. Int J Med Inform 2022; 168:104886. [DOI: 10.1016/j.ijmedinf.2022.104886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
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Lewis ET, Williamson M, Lewis LP, Ní Chróinín D, Dent E, Ticehurst M, Peters R, Macniven R, Cardona M. The Feasibility of Deriving the Electronic Frailty Index from Australian General Practice Records. Clin Interv Aging 2022; 17:1589-1598. [PMID: 36353269 PMCID: PMC9639370 DOI: 10.2147/cia.s384691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Frailty is a prevalent condition in older adults. Identification of frailty using an electronic Frailty Index (eFI) has been successfully implemented across general practices in the United Kingdom. However, in Australia, the eFI remains understudied. Therefore, we aimed to (i) examine the feasibility of deriving an eFI from Australian general practice records and (ii) describe the prevalence of frailty as measured by the eFI and the prevalence with socioeconomic status and geographic remoteness. Participants and Methods This retrospective analysis included patients (≥70 years) attending any one of >700 general practices utilizing the Australian MedicineInsight data platform, 2017–2018. A 36-item eFI was derived using standard methodology, with frailty classified as mild (scores 0.13–0.24); moderate (0.25–0.36) or severe (≥0.37). Socioeconomic status (Socio-Economic Indexes for Areas (SEIFA) index)) and geographic remoteness (Australian Statistical Geography Standard (ASGC) remoteness areas) were also examined. Results In total, 79,251 patients (56% female) were included, mean age 80.0 years (SD 6.5); 37.4% (95% CI 37.0–37.7) were mildly frail, 16.7% (95% CI 16.4–16.9) moderately frail, 4.8% (95% CI 4.7–5.0) severely frail. Median eFI score was 0.14 (IQR 0.08 to 0.22); maximum eFI score was 0.69. Across all age groups, moderate and severe frailty was significantly more prevalent in females (P < 0.001). Frailty severity increased with increasing age (P < 0.001) and was strongly associated with socioeconomic disadvantage (P < 0.001) but not with geographic remoteness. Conclusion Frailty was identifiable from routinely collected general practice data. Frailty was more prevalent in socioeconomically disadvantaged groups, women and older patients and existed in all levels of remoteness. Routine implementation of an eFI could inform interventions to prevent or reduce frailty in all older adults, regardless of location.
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Affiliation(s)
- Ebony T Lewis
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- Correspondence: Ebony T Lewis, School of Population Health, Faculty of Medicine & Health, University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, Sydney, NSW, 2052, Australia, Tel +612 9065 2068, Email
| | - Margaret Williamson
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Lou P Lewis
- Matraville Medical Centre, Sydney, NSW, Australia
| | - Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Elsa Dent
- Torrens University Australia, Adelaide, SA, Australia
| | - Maree Ticehurst
- Matraville Medical Centre, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruth Peters
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Rona Macniven
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
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Samarkandi OA, Aljuaid M, Abdulrahman Alkohaiz M, Al-Wathinani AM, Alobaid AM, Alghamdi AA, Alhallaf MA, Albaqami NA. Societal vulnerability in the context of population aging-Perceptions of healthcare students' in Saudi Arabia. Front Public Health 2022; 10:955754. [PMID: 36238236 PMCID: PMC9552710 DOI: 10.3389/fpubh.2022.955754] [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: 05/29/2022] [Accepted: 08/09/2022] [Indexed: 01/24/2023] Open
Abstract
Background and objective Healthcare professionals have an important role in increasing awareness and protecting populations from natural disasters. This study aimed to assess the perception of healthcare students toward societal vulnerability in the context of population aging. Methods This is a cross-sectional questionnaire-based study conducted among students from two different health colleges over 4 months from February to May 2021. Descriptive analysis was used to assess the perception, and inferential testing was used to assess the various association of knowledge toward societal vulnerability using SPSS. Results The majority of respondents were male (69.2%), between 20 and 24 years of age (91.2%), and studying for a nursing degree (76.6%). Only 4.7% had previously completed a previous degree. The mean score of perceptions on the Aging and Disaster Vulnerability Scale among nursing students was 42.5 ± 10.3 (0-65) while for paramedicine 48.1 ± 9.7 (0-65). Similarly, the mean score among male students was 44.1 ±10.5. The mean PADVS total score for the cohort was 43.8 (SD = 10.5). The mean PADVS total score for nursing students was significantly lower than paramedic students (42.5 vs. 48.1; p < 0.001). There was no correlation between PADVS total score and gender, age, area of residence, or previous degree. Conclusion Our results indicate that Saudi healthcare students perceive older adults are somewhat vulnerable to disasters with significant differences between nursing and paramedic students. Furthermore, we suggest informing emergency services disaster response planning processes about educational intervention to overcome disasters in Saudi Arabia and other countries.
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Affiliation(s)
- Osama A. Samarkandi
- Nursing Informatics, Department of Basic Sciences, Vice Dean for Academic Affairs, Dean of Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia,*Correspondence: Osama A. Samarkandi
| | - Mohammed Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | | | - Ahmed M. Al-Wathinani
- Department of Emergency Medical Services (EMS), Prince Sultan College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Mohammed Alobaid
- Department of Trauma and Accident, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A. Alghamdi
- Department of Emergency Medical Services (EMS), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A. Alhallaf
- Department of Emergency Medical Services (EMS), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Nawaf A. Albaqami
- Department of Emergency Medical Services (EMS), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
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Hosseini H. Optimizing Falls-related Planning and Intervention for Nursing Facilities by Ownership Type. Hosp Top 2022:1-6. [PMID: 36066933 DOI: 10.1080/00185868.2022.2118094] [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: 10/14/2022]
Abstract
Falls among older adults are a major public health concern: They result in $30 billion in direct US healthcare costs annually and take an immense psychological and physical toll on older adults. Particularly concerning are falls in nursing home settings, which account for three times as many falls in adults over 65 than in any other setting. Objectives: We hypothesized that tailoring falls prevention and response plans to nursing home profit model (for- or nonprofit) and ownership type (public, private, franchise) would greatly improve effectiveness of general plans. Methods: To this end, we extracted data from existing government databases, collected qualitative data through structured interviews with home employees, and collected novel quantitative data through web surveys from a representative sample of 40 Pennsylvania nursing homes about prevention and mitigation protocols, population, and facility characteristics, and falls outcome metrics. We analyzed fall-related risk factors that we scored and used to build multivariate logistic regression models to predict falls rates, and subsequently used to build multilevel logistic regression multivariate models to pinpoint the influence of facility type. Results: We found a significant correlation between facility ownership and profit type and falls rates and outcomes. Conclusions: Armed with these analytical insights, we formulated improved falls prevention plans targeted to home types to achieve better falls outcomes as predicted by the models. Finally, we quantify the predicted impact of implementing these targeted plans on fall rates and outcomes in the homes in our study.
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Affiliation(s)
- Hengameh Hosseini
- Department of Health Administration and Human Resources, The University of Scranton, Scranton, PA, USA
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Comparison of the Agreement and Accuracy Between Paramedic and Hospital Diagnosis. Air Med J 2022; 41:228-232. [PMID: 35307148 DOI: 10.1016/j.amj.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/06/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Making an accurate clinical diagnosis in the field of prehospital is of great challenge in medical services. This study aimed to determine agreement between prehospital and in-hospital diagnoses. METHODS The diagnostic agreement was determined by a comparison of the discharge diagnosis with the prehospital emergency technicians in a period of 6 months at the emergency medical services in northwest Azerbaijan. The diagnostic agreement of discharge diagnoses was compared with the fist diagnosis by the paramedics. The results were analyzed using the kappa agreement coefficient and the chi-square test. RESULTS The overall agreement between the diagnosis made by the emergency medical technicians and the hospital's first diagnosis was 67% (95% confidence interval [CI], 61%-77%; k = 0.61; 95% CI, 0.56-0.67), whereas the agreement between the first diagnosis made by the emergency medical technicians and the hospital discharge diagnosis was 58% (95% CI, 49%-65%; k = 0.42; 95% CI, 0.37-0.48).There was a high proportion of diagnostic agreement for pregnancy (100%), poisoning by drugs (88%), essential (primary) hypertension (86%), and ischemic heart diseases (72%). There was a low proportion of diagnostic agreement for weakness (39%), mixed anxiety and depressive disorder (43%), and cerebellar stroke syndrome (59%). CONCLUSION Our attention in practice and emergency medical courses should be directed to diseases that have a subjective history, such as weakness and anxiety, due to the high proportion of incorrect diagnoses by the prehospital emergency technician. It should be noted that most of the incorrectly diagnosed cases were overestimated with another coronary syndrome.
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14
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Shagerdi G, Ayatollahi H, Hemmat M. Emergency care for the elderly: A review of the application of health information technology. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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15
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Contreras WH, Sarquella E, Binefa E, Entrambasaguas M, Stjerne A, Booth P. The Impact on Ambulance Mobilisations of an Increasing Age Profile of Telecare Service Users Receiving Advanced Proactive, Personalised Telecare in Spain—a Longitudinal Study 2014–2018. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 6:153-173. [PMID: 35529538 PMCID: PMC9072606 DOI: 10.1007/s41666-021-00108-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
Advanced proactive personalised telecare services in Spain have helped service users to live independently in their own homes for longer. Concern was however noted regarding potential impacts on ambulance mobilisations as time in the service, and mean age at cessation, increased. The purpose of this study was to investigate these impacts. A longitudinal study of a telecare service user population in Spain (n = 202.1 k to 247.9 k) was undertaken using anonymised operational data collected in the delivery of proactive and personalised telecare services over the period 2014–2018. For the studied population, ambulance mobilisation on a per-person/per-annum (pp/pa) basis reduced despite the increasing age profile at cessation and with the characteristics of the population at registration remaining otherwise similar over the period. The study identified the positive correlation coefficient between ambulance mobilisations and service user’s dependency levels, and marginal negative correlation in older age bands. In conclusion, the increasing age at cessation has not correlated with an increased proportion of higher dependency service users. Indeed, the share of those over 85 years in the high dependency level decreased. This indicates that the changes in the telecare service which appear to have contributed to increased time living independently may also have helped ensure those continuing to live independently remain in lower risk bands.
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Affiliation(s)
| | | | - Eva Binefa
- Televida Servicio Sociosanitario, Barcelona, Spain
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16
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Prediction of hospitalization using artificial intelligence for urgent patients in the emergency department. Sci Rep 2021; 11:19472. [PMID: 34593930 PMCID: PMC8484275 DOI: 10.1038/s41598-021-98961-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Timely assessment to accurately prioritize patients is crucial for emergency department (ED) management. Urgent (i.e., level-3, on a 5-level emergency severity index system) patients have become a challenge since under-triage and over-triage often occur. This study was aimed to develop a computational model by artificial intelligence (AI) methodologies to accurately predict urgent patient outcomes using data that are readily available in most ED triage systems. We retrospectively collected data from the ED of a tertiary teaching hospital between January 1, 2015 and December 31, 2019. Eleven variables were used for data analysis and prediction model building, including 1 response, 2 demographic, and 8 clinical variables. A model to predict hospital admission was developed using neural networks and machine learning methodologies. A total of 282,971 samples of urgent (level-3) visits were included in the analysis. Our model achieved a validation area under the curve (AUC) of 0.8004 (95% CI 0.7963–0.8045). The optimal cutoff value identified by Youden's index for determining hospital admission was 0.5517. Using this cutoff value, the sensitivity was 0.6721 (95% CI 0.6624–0.6818), and the specificity was 0.7814 (95% CI 0.7777–0.7851), with a positive predictive value of 0.3660 (95% CI 0.3586–0.3733) and a negative predictive value of 0.9270 (95% CI 0.9244–0.9295). Subgroup analysis revealed that this model performed better in the nontraumatic adult subgroup and achieved a validation AUC of 0.8166 (95% CI 0.8199–0.8212). Our AI model accurately assessed the need for hospitalization for urgent patients, which constituted nearly 70% of ED visits. This model demonstrates the potential for streamlining ED operations using a very limited number of variables that are readily available in most ED triage systems. Subgroup analysis is an important topic for future investigation.
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17
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Zhu H, Pan L, Li Y, Jin H, Wang Q, Liu X, Wang C, Liao P, Jiang X, Li L. Spatial Accessibility Assessment of Prehospital EMS with a Focus on the Elderly Population: A Case Study in Ningbo, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199964. [PMID: 34639264 PMCID: PMC8508414 DOI: 10.3390/ijerph18199964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
The spatial accessibility of prehospital EMS is particularly important for the elderly population’s physiological functions. Due to the recent expansion of aging populations all over the globe, elderly people’s spatial accessibility to prehospital EMS presents a serious challenge. An efficient strategy to address this issue involves using geographic information systems (GIS)-based tools to evaluate the spatial accessibility in conjunction with the spatial distribution of aging people, available road networks, and prehospital EMS facilities. This study employed gravity model and empirical Bayesian Kriging (EBK) interpolation analysis to evaluate the elderly’s spatial access to prehospital EMS in Ningbo, China. In our study, we aimed to solve the following specific research questions: In the study area, “what are the characteristics of the prehospital EMS demand of the elderly?” “Do the elderly have equal and convenient spatial access to prehospital EMS?” and “How can we satisfy the prehospital EMS demand of an aging population, improve their spatial access to prehospital EMS, and then ensure their quality of life?” The results showed that 37.44% of patients admitted to prehospital EMS in 2020 were 65 years and older. The rate of utilization of ambulance services by the elderly was 27.39 per 1000 elderly residents. Ambulance use by the elderly was the highest in the winter months and the lowest in the spring months (25.90% vs. 22.38%). As for the disease spectrum, the main disease was found to be trauma and intoxication (23.70%). The mean accessibility score was only 1.43 and nearly 70% of demand points had scored lower than 1. The elderly’s spatial accessibility to prehospital EMS had a central-outward gradient decreasing trend from the central region to the southeast and southwest of the study area. Our proposed methodology and its spatial equilibrium results could be taken as a benchmark of prehospital care capacity and help inform authorities’ efforts to develop efficient, aging-focused spatial accessibility plans.
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Affiliation(s)
- Huanhuan Zhu
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Lin Pan
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yiji Li
- Ningbo Medical Emergency Center, Ningbo 315000, China; (Y.L.); (H.J.)
| | - Huiming Jin
- Ningbo Medical Emergency Center, Ningbo 315000, China; (Y.L.); (H.J.)
| | - Qian Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xin Liu
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Cong Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Peng Liao
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xinyang Jiang
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
| | - Luo Li
- School of Public Health, Fudan University, Shanghai 200032, China; (H.Z.); (L.P.); (Q.W.); (X.L.); (C.W.); (P.L.); (X.J.)
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
- Correspondence:
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Dwyer RA, Gabbe BJ, Tran T, Smith K, Lowthian JA. Residential aged care homes: Why do they call '000'? A study of the emergency prehospital care of older people living in residential aged care homes. Emerg Med Australas 2021; 33:447-456. [PMID: 33040460 DOI: 10.1111/1742-6723.13650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the clinical characteristics, medical interventions and patterns of ambulance service use related to the emergency, prehospital care of older people living in residential aged care (RAC) homes. METHODS Retrospective cohort study using secondary analyses of routinely collected clinical and administrative data from Ambulance Victoria and population data from the Australian Bureau of Statistics for the state of Victoria, Australia. Participants included people aged 65 years and over, attended by emergency ambulances from 2008 to 2013, with data captured in the Ambulance Victoria electronic record. RESULTS The mean (standard deviation) age of RAC residents attended by emergency ambulance was 85 (7.3) years and 63% were women. Common comorbidities included dementia (32.7%), ischaemic heart disease (27.7%) and osteoarthritis (24.6%). Polypharmacy was prevalent with 70% currently prescribed antibiotics, over 20% prescribed sedatives and a further 14.9% antipsychotics. Fifteen percent of attendances were for falls, which were more frequent among women than men. Other common reasons for ambulance call-out included uncontrolled pain, respiratory tract infection, non-specific febrile illness and altered conscious state. Almost 90% of people were transported to hospital from the RAC, with just over half of call-outs occurring out-of-hours. CONCLUSION This is the first study to describe emergency prehospital care, case-mix and intervention of frail, older people living in RAC. These results demonstrate a clinically complex group of people with high rates of comorbidity, cognitive impairment and polypharmacy. These valuable data will inform education and training of prehospital clinicians, assist in targeting preventative medicine and primary care programmes and further development of alternate, acute and emergency care pathways for this unique patient group.
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Affiliation(s)
- Rosamond A Dwyer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency Department, Peninsula Health, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Judy A Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia
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19
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Vuilleumier S, Fiorentino A, Dénéréaz S, Spichiger T. Identification of new demands regarding prehospital care based on 35,188 missions in 2018. BMC Emerg Med 2021; 21:63. [PMID: 34030660 PMCID: PMC8142491 DOI: 10.1186/s12873-021-00456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population ageing and increased prevalence of chronic diseases result in the emergence of new demands in prehospital care. The prehospital system is facing an increase of cases without acute threat to life (so-called "non-urgent"), which generates tension due to a higher number of admissions to emergency departments and a greater use of prehospital resources. Our aim is to understand this transition in prehospital activities and to delineate the primary missions performed by paramedics in 2018 with a focus on the population concerned, the severity of cases encountered and the typology of health issues. METHOD The study is retrospective, and descriptive, using a statistical description of 35,188 primary missions realized in 2018 in the State of Vaud (Switzerland). The characteristics taken into consideration are the age and gender of patients, as well as the health issue, the severity of cases based on National Advisory Committee for Aeronautics score (NACA score), and the time and place of intervention. RESULTS The results describe the primary missions in the State of Vaud in 2018 and show that 87% of missions concern "non-urgent" situations (without acute threat to life). Over half of patients are 65 or older, the highest proportion of health issues, 49%, are medical and only 23% of missions are for traumas. Mission related to mental health issues reach 7% and those for intoxication 6%. Most missions take place between 7:00 am and 6:00 pm (67%), and around 12% of missions lead to the non-transport of the patient. CONCLUSION The prehospital sector is confronted with a major transition in terms of patient care. An increase of non-urgent cases is observed, associated with the care of persons aged 65 or more. Our results question the adequacy between the needs in terms of prehospital care and the paramedic profession as it is currently defined, as well as the place of this profession within the health network. Reflecting upon the role of paramedics with respect to the socio-demographic evolution of populations appears necessary, to analyse the adequacy of the paramedics' skills to respond to the current needs.
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Affiliation(s)
- Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), CH-1004, Lausanne, Switzerland.
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), CH-1004, Lausanne, Switzerland
| | - Sandrine Dénéréaz
- Vocational Training College for Registered Paramedics and Emergency Care, ES ASUR, CH-1052, Le Mont-sur-Lausanne, Switzerland
| | - Thierry Spichiger
- Vocational Training College for Registered Paramedics and Emergency Care, ES ASUR, CH-1052, Le Mont-sur-Lausanne, Switzerland
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20
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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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21
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McManamny TE, Dwyer R, Cantwell K, Boyd L, Sheen J, Smith K, Lowthian JA. Emergency ambulance demand by older adults from rural and regional Victoria, Australia. Australas J Ageing 2021; 41:e74-e81. [PMID: 33955132 DOI: 10.1111/ajag.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the demographic profile and clinical case mix of older adults following calls for an emergency ambulance in rural Victoria, Australia. METHODS Retrospective cohort study using ambulance electronic patient care records from rural-dwelling older adults (≥65 years old) who requested emergency ambulance attendance during 2017. RESULTS A total of 84 785 older adults requested emergency ambulance attendance, representing a rate of 278 per 1000 population aged ≥65 years. More than 10% of calls were to residential aged care homes. Medical complaints and trauma accounted for 69% and 18% of attendances, respectively. The predominant cause of trauma was ground-level falls. Common reasons for call-outs were for pain (17.5%), respiratory problems (9.7%) and cardiovascular problems (8.5%). Increased demand was associated with increasing age and winter months. CONCLUSION Older adults from rural Victoria have high rates of emergency ambulance attendance and transportation to an emergency department, particularly with increasing age.
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Affiliation(s)
- Tegwyn E McManamny
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Ambulance Victoria, Doncaster, VIC, Australia
| | - Rosamond Dwyer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Peninsula Health, Frankston, VIC, Australia
| | - Kate Cantwell
- Ambulance Victoria, Doncaster, VIC, Australia.,Department of Community Emergency Health and Paramedicine, Monash University, Frankston, VIC, Australia
| | | | - Jade Sheen
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Ambulance Victoria, Doncaster, VIC, Australia.,School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Judy A Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Bolton Clarke Research Institute, Bentleigh, VIC, Australia.,Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD, Australia.,Institute of Future Environments, Queensland University of Technology, Brisbane, QLD, Australia
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22
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Harris W, Stirling C, Williams AM, Lucas P. Care of frail and older adults: A content analysis of paramedic operational clinical practice guidelines. Int Emerg Nurs 2021; 56:101007. [PMID: 33872941 DOI: 10.1016/j.ienj.2021.101007] [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: 07/12/2020] [Revised: 02/25/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Frailty rates are increasing with population ageing. In paramedicine, Clinical Practice Guidelines (CPGs) are essential documents that support decision making, yet little evidence exists regarding the support CPGs provide paramedics in the care of frail and older adults. AIM To investigate how CPGs support paramedics' care of frail and older adults. METHODS CPGs from nine Australasian paramedic services were collected in 2019. Content analysis was used to explore two hundred and thirty-seven individual CPGs for decision support information regarding frail and older adults. RESULTS Evidence-based content relating to older adults was sparse compared to paediatric content. Two overarching decision support domains were identified, patient assessment and management. Inconsistent age descriptors were widespread, particularly in pharmacological guidelines. Five service providers' CPGs contained validated assessment instruments for use with older adults. CONCLUSION Decision support documentation regarding frail and older adults varies across Australasian paramedic services. Frailty and older adult specific CPGs, and validated assessment instruments suitable to the paramedicine environment could improve paramedic decision making and minimise patient risk. A collaborative approach encompassing service providers and educational institutions is crucial to develop consistent, evidence-based CPGs relevant to older adults.
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Affiliation(s)
- Wayne Harris
- Tasmanian School of Medicine, College of Health and Medicine, Division of Paramedicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia.
| | - Christine Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Private Bag 135, Hobart 7001, Tasmania, Australia.
| | - Anne-Marie Williams
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia.
| | - Peter Lucas
- Tasmanian School of Medicine, College of Health and Medicine, Division of Paramedicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia.
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23
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Duan Y. Construction of first-class university course based on artificial intelligence and neural network algorithm. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-189506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Curriculum is the basis of vocational training, its development level and teaching efficiency determine the realization of vocational training objectives, as well as the quality and level of major vocational academic training. Therefore, the development of curriculum is an important issue. And affect the school’s teaching capacity building. The analysis of the latest developments in the main courses shows that there are some deviations or irrationalities in the curriculum in some colleges and universities, and the general problems of understanding the latest courses, such as lack of solid foundation in curriculum setting, unclear direction of objectives, unclear reform ideas, inadequate and systematic construction measures, lack of attention to the quality of education. This paper explains the rules for the establishment of first-level courses, clarifies the ideas and priorities of architecture, and explores strategies for building university-level courses using knowledge of artificial intelligence and neural network algorithms in order to gain experience from them.
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Affiliation(s)
- Yingli Duan
- Yunnan Minzu University, Kunming, Yunnan, China
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24
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Eliakundu AL, Cadilhac DA, Kim J, Andrew NE, Bladin CF, Grimley R, Dewey HM, Donnan GA, Hill K, Levi CR, Middleton S, Anderson CS, Lannin NA, Kilkenny MF. Factors associated with arrival by ambulance for patients with stroke: a multicentre, national data linkage study. Australas Emerg Care 2021; 24:167-173. [PMID: 33642255 DOI: 10.1016/j.auec.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hospital arrival via ambulance influences treatment of acute stroke. We aimed to determine the factors associated with use of ambulance and access to evidence-based care among patients with stroke. METHODS Patients with first-ever strokes from the Australian Stroke Clinical Registry (2010-2013) were linked with administrative data (emergency, hospital admissions). Multilevel, multivariable regression models were used to determine patient, clinical and system factors associated with arrival by ambulance. RESULTS Among the 6,262 patients with first-ever stroke, 4,737 (76%) arrived by ambulance (52% male; 80% ischaemic). Patients who were older, frailer, with comorbidities or were unable to walk on admission (stroke severity) were more likely to arrive by ambulance to hospital. Compared to those using other means of transport, those who used ambulances arrived to hospital sooner after stroke onset (minutes, 124 vs 397) and were more likely to receive reperfusion therapy (adjusted odds ratio, 1.57, 95% CI: 1.09, 2.27). CONCLUSION Patients with stroke who use ambulances arrived faster and were more likely to receive reperfusion therapy compared to those using personal transport. Further public education about using ambulance services at all times, instead of personal transport when stroke is suspected is needed to optimise access to time critical care.
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Affiliation(s)
- Amminadab L Eliakundu
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Joosup Kim
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Christopher F Bladin
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia
| | - Rohan Grimley
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Sunshine Coast Clinical School, Griffith University, Birtinya, Queensland, Australia
| | - Helen M Dewey
- Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Kelvin Hill
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Stroke Foundation, Victoria, Australia
| | - Christopher R Levi
- Acute Stroke Services, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne &Australian Catholic University
| | - Craig S Anderson
- The George Institute for Global Health and Faculty of Medicine, University of New South Wales, New South Wales, Australia
| | - Natasha A Lannin
- Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
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Pinheiro TDCE, Alcântara CO, Pereira FM, Andrade MVMD, Moraes END, Bicalho MAC. Clinical Frailty Scale em idosos atendidos no Serviço Hospitalar de Emergência: a fragilidade basal é um bom preditor de mortalidade em 90 dias? REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.210122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Avaliar a capacidade da Clinical Frailty Scale (CFS) em predizer a mortalidade em até 90 dias e outros desfechos desfavoráveis em idosos admitidos em um Serviço Hospitalar de Emergência (SHE). Método Estudo de coorte prospectivo que incluiu idosos admitidos e que permaneceram por pelo menos uma noite no SHE de um hospital público terciário. O grau de fragilidade basal foi avaliado através da CFS e sua pontuação, o preditor estudado, por meio da curva Receiver Operator Characteristics (ROC). Analisou-se como desfecho primário a mortalidade em 90 dias. Considerou-se como desfechos secundários: mortalidade em 180 dias, declínio funcional, readmissão no SHE, reinternação e necessidade de atenção domiciliar. Resultados 206 participantes foram incluídos. Dos 127 idosos frágeis, 40 (31,5%) faleceram até o 90º dia comparado a 5 (6,3%) do grupo não frágil (p<0,001). Após ajuste para variáveis demográficas e clínicas, a fragilidade manteve-se no modelo como um preditor independente de mortalidade em 90 dias da admissão. A acurácia obtida pela curva ROC (AUROC) para predição de mortalidade em 90 dias foi de 0,81. Para mortalidade em 180 dias foi 0,80; para necessidade de atenção domiciliar, 0,77; e para reinternação, 0,65. Para os demais desfechos estudados, a acurácia não foi significativa. Conclusão A fragilidade basal medida pela CFS é um bom preditor de mortalidade em 90 e 180 dias e de necessidade de atenção domiciliar em idosos admitidos no SHE. Sua aplicação nesse cenário pode auxiliar na tomada de decisões clínicas.
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Affiliation(s)
| | | | - Fabiano Moraes Pereira
- Universidade Federal de Minas Gerais, Brasil; Universidade Federal de Minas Gerais, Brasil
| | - Marcus Vinícius Melo de Andrade
- Universidade Federal de Minas Gerais, Brasil; Universidade Federal de Minas Gerais, Brasil; Universidade Federal de Minas Gerais, Brasil
| | - Edgar Nunes de Moraes
- Universidade Federal de Minas Gerais, Brasil; Universidade Federal de Minas Gerais, Brasil
| | - Maria Aparecida Camargos Bicalho
- Universidade Federal de Minas Gerais, Brasil; Universidade Federal de Minas Gerais, Brasil; Universidade Federal de Minas Gerais, Brasil
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McManamny T, Jennings PA, Boyd L, Sheen J, Lowthian JA. Paramedic involvement in health education within metropolitan, rural and remote Australia: a narrative review of the literature. AUST HEALTH REV 2020; 44:114-120. [PMID: 30428973 DOI: 10.1071/ah17228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/21/2018] [Indexed: 11/23/2022]
Abstract
Objective A growing body of research indicates that paramedics may have a greater role to play in health care service provision, beyond the traditional models of emergency health care. The aim of this study was to identify and synthesise the literature pertaining to the role of paramedic-initiated health education within Australia, with specific consideration of metropolitan, rural and remote contexts. Methods A literature review was undertaken using the Ovid Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and Scopus databases. The search time frame was limited from January 2007 to November 2017. The search was performed using key paramedic search terms in combination with keywords such as health education, rural, metropolitan, remote and Australia. Reference lists from relevant papers were also reviewed. Results Fourteen articles met the inclusion criteria for synthesis. Health education in the Australian paramedic context relates largely to expanded-scope paramedics, health promotion and the role of paramedics as key members of local communities. There were no studies specifically related to the paramedic role in health education, although many papers referred to health education as one of many roles paramedics engage in today. Conclusion This review highlights a broadening of paramedicine's traditional scope of practice, and an indication of how vital paramedics could be to local communities, particularly in rural and remote areas. An expanded role may help address health workforce sustainability problems in areas where health care provision is challenged by geographical constraints and low workforce numbers. What is known about the topic? A broadening of paramedicine's traditional scope of practice has been linked to improvements in health workforce sustainability problems in areas where health care provision is challenged by geographical constraints and low workforce numbers, such as rural and remote Australia. Health education, as well as health promotion, primary health care and chronic disease management, have been proposed as potential activities that paramedics could be well placed to participate in, contributing to the health and well-being of local communities. What does this paper add? This paper identifies and synthesises literature focusing on paramedic-initiated health education in the Australian context, assessing the current health education role of paramedics in metropolitan, rural and remote areas. It provides an understanding of different geographical areas that may benefit from expanded-scope prehospital practice, indicating that the involvement of paramedics in health education in Australia is significantly determined by their geographical place of work, reflecting the influence of the availability of healthcare resources on individual communities. What are the implications for practitioners? Today's paramedics fill broader roles than those encompassed within traditional models of prehospital care. Rural and remote communities facing increasing difficulty in obtaining health service provision appear to benefit strongly from the presence of expanded-scope paramedics trained in health promotion, primary injury prevention, chronic disease management and health education: this should be a consideration for medical and allied health practitioners in these areas. Australian paramedics are uniquely placed to 'fill the gaps' left by shortages of healthcare professionals in rural and remote areas of the country.
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Affiliation(s)
- Tegwyn McManamny
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Paul A Jennings
- Department of Community Emergency Health and Paramedic Practice, Monash University, Moorooduc Hwy, Frankston, Vic. 3199, Australia. Email
| | - Leanne Boyd
- Cabrini Health, 154 Wattletree Road, Malvern, Vic. 3144, Australia. Email
| | - Jade Sheen
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email
| | - Judy A Lowthian
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
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Campagna S, Conti A, Dimonte V, Dalmasso M, Starnini M, Gianino MM, Borraccino A. Trends and Characteristics of Emergency Medical Services in Italy: A 5-Years Population-Based Registry Analysis. Healthcare (Basel) 2020; 8:healthcare8040551. [PMID: 33322302 PMCID: PMC7763006 DOI: 10.3390/healthcare8040551] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Emergency Medical Services (EMS) plays a fundamental role in providing good quality healthcare services to citizens, as they are the first responders in distressing situations. Few studies have used available EMS data to investigate EMS call characteristics and subsequent responses. Methods: Data were extracted from the emergency registry for the period 2013–2017. This included call and rescue vehicle dispatch information. All relationships in analyses and differences in events proportion between 2013 and 2017 were tested against the Pearson’s Chi-Square with a 99% level of confidence. Results: Among the 2,120,838 emergency calls, operators dispatched at least one rescue vehicle for 1,494,855. There was an estimated overall incidence of 96 emergency calls and 75 rescue vehicles dispatched per 1000 inhabitants per year. Most calls were made by private citizens, during the daytime, and were made from home (63.8%); 31% of rescue vehicle dispatches were advanced emergency medical vehicles. The highest number of rescue vehicle dispatches ended at the emergency department (74.7%). Conclusions: Our data showed that, with some exception due to environmental differences, the highest proportion of incoming emergency calls is not acute or urgent and could be more effectively managed in other settings than in an Emergency Departments (ED). Better management of dispatch can reduce crowding and save hospital emergency departments time, personnel, and health system costs.
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Affiliation(s)
- Sara Campagna
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
| | - Alessio Conti
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
| | - Valerio Dimonte
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
| | - Marco Dalmasso
- Epidemiology Unit, Local Health Unit TO3, Piedmont Region, 10195 Grugliasco, Italy;
| | - Michele Starnini
- Institute of Scientific Interchange (ISI) Foundation, 10126 Torino, Italy;
| | - Maria Michela Gianino
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
- Correspondence:
| | - Alberto Borraccino
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
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Amare AT, Caughey GE, Whitehead C, Lang CE, Bray SC, Corlis M, Visvanathan R, Wesselingh S, Inacio MC. The prevalence, trends and determinants of mental health disorders in older Australians living in permanent residential aged care: Implications for policy and quality of aged care services. Aust N Z J Psychiatry 2020; 54:1200-1211. [PMID: 32746615 DOI: 10.1177/0004867420945367] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health disorders are a major health concern in older people and are associated with a higher risk of disability, frailty and early mortality. This study aimed to conduct a contemporary population-based assessment of the prevalence, trends and factors associated with mental health disorders in individuals who are living in permanent residential aged care (PRAC) in Australia. METHODS A retrospective cross-sectional study was conducted using national data from the Registry of Senior Australians, a national cohort of older Australians who had aged care eligibility assessment and entered PRAC between 2008 and 2016. Stepwise multivariate logistic regression modeling was applied to identify factors associated with mental health disorders. RESULTS Of 430,862 individuals included in this study, 57.8% had at least one mental health disorder. The prevalence of depression, phobia/anxiety and psychosis were as follows: 46.2% (95% confidence interval = [46.0%, 46.3%]), 14.9% (95% confidence interval = [14.8%, 15.0%]) and 9.7% (95% confidence interval = [9.6%, 9.8%]), respectively. The likelihood of having a mental health disorder was higher for those who were (adjusted odds ratio [95% confidence interval]) relatively younger, specifically for every 10-year increment in age, the odds of having mental health disorders was 44.0% lower (0.56, [0.55, 0.56]); female (1.33 [1.32, 1.35]); having increasing numbers of physical health comorbidities, 6-10 (1.26 [1.24, 1.29]) or 11-15 (1.48 [1.45, 1.51]) or more than 15 (1.64 [1.58, 1.71]) compared to people having less than five comorbidities; having limitations related to health care tasks (1.05 [1.04, 1.07]), meals (1.04 [1.02, 1.05]) or social and community participation (1.10 [1.08, 1.12]). CONCLUSION The burden of mental health disorders in older Australians living in PRAC was high and individuals with these conditions tend to be younger, with several physical comorbidities and/or functional limitations. Understanding the profile of individuals with mental health disorders at entry into PRAC can be used as evidence for baseline resource allocation for this population and evaluation of future needs of mental health services.
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Affiliation(s)
- Azmeraw T Amare
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre and National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Gillian E Caughey
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Craig Whitehead
- Department of Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Sarah Ce Bray
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre and National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Chakroun-Walha O, Walha A, Bradai H, Nasri A, Karray R, Jerbi M, Trabelsi R, Rekik N. Frailty screening of Tunisian older adults: feasibility and usefulness in the Emergency Department. Afr J Emerg Med 2020; 10:229-233. [PMID: 33299754 PMCID: PMC7700987 DOI: 10.1016/j.afjem.2020.07.014] [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: 02/10/2020] [Revised: 07/03/2020] [Accepted: 07/29/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Frail older adults are at an increased risk for adverse outcomes after an Emergency Department (ED) visit. Several tools exist for the screening of frailty among these patients. However, no tool has been validated in Tunisia. This study aims to evaluate the usefulness of frailty screening in predicting the outcome of older adults presenting to the ED. Methods This is a prospective, monocentric study. We evaluated the eligible patients at the ED and after their discharge. Follow-up phone calls were scheduled at 1, 2, 3, and 6 months after the ED visit. All patients aged 65 years or older; and visiting the ED during the inclusion period were involved. We used the ADL index and ISAR scale for assessing frailty. Results We enrolled 184 patients; they were living alone in 25% of cases. Half of them had medical care insurance. The ADL index was maximum (6 = total dependency) in 20% of cases. The ISAR score was above 1 point in 38%. Unplanned hospitalizations have accounted for 34%. In univariate analysis, the ADL index and ISAR score were statistically higher in the group of “unplanned hospitalization”. In multivariate analysis, the ISAR score and ADL index have not been associated with unplanned hospitalization. Conclusion Our results did not demonstrate the relevance of the ISAR or ADL scales in predicting the mortality or the need for unplanned hospitalization in multivariate analysis. This study did indicate an increased mortality in the “frail” patients in the univariate analysis. Further studies with larger samples and different tools are necessary.
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Eastwood K, Nambiar D, Dwyer R, Lowthian JA, Cameron P, Smith K. Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study. BMJ Open 2020; 10:e042351. [PMID: 33158837 PMCID: PMC7651717 DOI: 10.1136/bmjopen-2020-042351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches. OBJECTIVES To examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch. DESIGN A retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted. SETTING The secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period. PARTICIPANTS There were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses. MAIN OUTCOME MEASURES Descriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients. RESULTS The dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005). CONCLUSION Secondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.
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Affiliation(s)
- Kathryn Eastwood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Dhanya Nambiar
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosamond Dwyer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Judy A Lowthian
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Bolton Clarke Research Institute, Bolton Clarke, Bentleigh, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
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Navarro Moya P, Villar Hoz E, González Carrasco M. How medical transport service professionals perceive risk/protective factors with regard to occupational burnout syndrome: Differences and similarities between an Anglo-American and Franco-German model. Work 2020; 67:295-312. [PMID: 33044211 DOI: 10.3233/wor-203280] [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: 11/15/2022] Open
Abstract
BACKGROUND Several studies show that professionals in the two main models of pre-hospital care (Franco-German (FG) and Anglo-American (AA)) are exposed to different psychosocial risk factors, with consequences such as burnout syndrome. Few studies provide information on protective factors, nor are there any results on risk/protective factors from the perspective of professionals and comparing both models (FG and AA). OBJECTIVE From the perspective of medical transport (MT) professionals, we aimed to identify the risk/protective factors that may be involved in occupational burnout syndrome (OBS), comparing Franco-German (FG) and Anglo-American (AA) pre-hospital care models, as well as emergency (EMT) and non-emergency (non-EMT) services. METHOD This was a qualitative research, through 12 semi-structured, in-depth interviews with participants chosen through intentional and snowball sampling. Content analysis and coding was carried out based on Bronfenbrenner's ecological model and supported by the N-VIVO computer program. RESULTS Our results illustrate the multi-causal nature of OBS, with risk/protective factors interacting at different levels of the ecological model. Among the data found at the different levels, some of the risk factors provoking OBS most commonly cited by professionals from both models are: work overload, work schedules, the coordinating centre, relationships with managers, the lack of work-life balance, the institutional model, the privatization of companies and the bureaucratization of management. The most cited factors acting as protectors include the stress involved in the emergency services, relationships with colleagues, relationships with other professionals or users, and social recognition. DISCUSSION In general, we conclude that there are more similarities than differences in terms of how the workers in each model perceive the risk/protective factors.
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Affiliation(s)
| | - E Villar Hoz
- Departament de Psicologia, Universitat de Girona, Girona, Spain
| | - M González Carrasco
- Institut de Recerca sobre Qualitat de Vida, Universitat de Girona, Girona, Spain
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Myall M, Rowsell A, Lund S, Turnbull J, Arber M, Crouch R, Pocock H, Deakin C, Richardson A. Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review. BMJ Open 2020; 10:e036925. [PMID: 32948555 PMCID: PMC7511644 DOI: 10.1136/bmjopen-2020-036925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond. DESIGN A scoping review using Arksey and O'Malley's five-stage framework. Papers were analysed using thematic analysis. DATA SOURCES MEDLINE; Embase; CINAHL; Scopus; Social Sciences Citation Index (Web of Science), ProQuest Dissertations & Theses A&I (Proquest), Health Technology Assessment database; PsycINFO; Grey Literature Report and PapersFirst were searched from January 2000 to May 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative and mixed methods studies reporting the experiences of PHPs, families and bystanders of death and dying in prehospital settings as a result of natural causes, trauma, suicide and homicide, >18 years of age, in Europe, USA, Canada, Australia and New Zealand. RESULTS Searches identified 15 352 papers of which 51 met the inclusion criteria. The review found substantial evidence of PHP experiences, except call handlers, and papers reporting family and bystander experiences were limited. PHP work was varied and complex, while confident in clinical work, they felt less equipped to deal with the emotion work, especially with an increasing role in palliative and end-of-life care. Families and bystanders reported generally positive experiences but their support needs were rarely explored. CONCLUSIONS To the best of our knowledge this is the first review that explores the experiences of PHPs, families and bystanders. An important outcome is identifying current gaps in knowledge where further empirical research is needed. The paucity of evidence suggested by this review on call handlers, families and bystanders presents opportunities to investigate their experiences in greater depth. Further research to address the current knowledge gaps will be important to inform future policy and practice.
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Affiliation(s)
- Michelle Myall
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Alison Rowsell
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Susi Lund
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Mick Arber
- York Health Economics Consortium, University of York, York, North Yorkshire, UK
| | - Robert Crouch
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Helen Pocock
- South Central Ambulance Service NHS Foundation Trust Southern Headquarters, Otterbourne, Hampshire, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Charles Deakin
- South Central Ambulance Service NHS Foundation Trust Southern Headquarters, Otterbourne, Hampshire, UK
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, Hampshire, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Ocular trauma associated with falls in older people: A 10-year review from a state trauma service. Injury 2020; 51:2009-2015. [PMID: 32690213 DOI: 10.1016/j.injury.2020.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/23/2020] [Accepted: 07/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls are the leading cause of injury-related emergency presentations, hospital admissions and deaths in Victorians over the age of 65. While there is extensive literature analysing traumatic injuries resulting from falls in older patients, there is little data on ocular injuries in this patient group. METHODOLOGY A retrospective audit of all patients over 65 years referred to the Ophthalmology Department of a tertiary hospital following fall from standing height between January 2009 and December 2018 to determine the demographics, injury setting, ophthalmic injuries, interventions and outcomes of ocular trauma secondary to falls. RESULTS Two hundred and seventy patients (F = 155, M = 115) were included, with a mean age of 81 years. 180 falls (66.7%) occurred in a residential environment. The most common reason for referral was orbital fracture (n = 155). Severe ocular injuries included globe rupture (n = 23), retro-bulbar haematoma (n = 22), retinal detachment (n = 6) and traumatic optic neuropathy (n = 6). Forty patients (14.8%) presented with a visual acuity (VA) below 6/60 while 34 patients (12.5%) had a non-assessable VA secondary to delirium or intubation. Of these 34, 9 had a significant ocular injury. A total of 28 patients (10.4%) were permanently blinded by their injuries. Twenty-three patients (8.5%) required admission to ICU and 16 patients (5.93%) died during their in-hospital stay. Thirty-six injuries were referred beyond the 24-hour mark, including a globe rupture and a case of traumatic optic neuropathy. With the exception of the missed globe rupture, all other injuries requiring emergency surgery were operated on within 24 h. CONCLUSION Falls in older people may be associated with sight-threatening ocular injuries which are common and easy to miss in this population demographic. The presence of ocular injuries in this patient group is associated with significant rates of in-hospital mortality and poor functional outcomes. It is therefore essential for trauma practitioners to perform a detailed and systematic assessment in order to identify sight-threatening ocular injuries and allow for expedient sight-saving intervention to be performed.
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Yamamoto A, Kuriyama A, Ikegami T. Validity of a five-level prehospital triage system in Japan: A cohort study. Am J Emerg Med 2020; 45:329-334. [PMID: 33041143 DOI: 10.1016/j.ajem.2020.08.079] [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: 05/09/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The increasing worldwide demand for ambulance transport may worsen patient prognosis due to a prolonged response time and overcrowding in the emergency department. Triage in the prehospital setting may reduce the demand for ambulance transport by advising low-acuity patients seek non-emergency medical care. In Japan, a five-level triage system that allows emergency medical services (EMS) to triage patients has been implemented since 2014. This study aimed to validate the five-level triage system. METHODS We conducted a retrospective cohort study in patients aged ≥16 years who were transported by EMS to a tertiary-care hospital in Japan from April 2018 to June 2018. We used admission to the intensive care unit (ICU) as the primary outcome. Our secondary outcome was overall admission. We conducted multivariable logistic regression analysis to determine the strength of association between triage acuity and admission (ICU and overall). RESULTS A total of 1261 patients were included in the analysis. The odds ratios of ICU admission were 9.62 (95% confidence interval: 5.66-16.3) in Level 1 and 2.93 (95% confidence interval: 1.60-5.38) in Level 2 compared with reference groups composed of Levels 4 and 5. Similar associations were found for triage acuity and overall admission. CONCLUSIONS Our study validates the five-level prehospital triage system for patients transported by EMS and demonstrates an association between the triage acuity and ICU admissions.
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Affiliation(s)
- Atsushi Yamamoto
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.
| | - Tetsunori Ikegami
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
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Bloemhoff A, Schoon Y, Smulders K, Akkermans R, Vloet LCM, van den Berg K, Berben SAA. Older persons are frailer after an emergency care visit to the out-of-hours general practitioner cooperative in the Netherlands: a cross-sectional descriptive TOPICS-MDS study. BMC FAMILY PRACTICE 2020; 21:171. [PMID: 32819281 PMCID: PMC7441648 DOI: 10.1186/s12875-020-01220-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/14/2020] [Indexed: 12/02/2022]
Abstract
Background In the Netherlands, community-dwelling older people with primary care emergency problems contact the General Practitioner Cooperative (GPC) after hours. However, frailty remains an often unobserved hazard with adverse health outcomes. The aim of this study was to provide insight into differences between older persons with or without GPC emergency care visits (reference group) regarding frailty and healthcare use. Methods A cross-sectional descriptive study design was based on data from the public data repository of The Older Persons and Informal Caregivers Survey Minimum Dataset (TOPICS-MDS). Frailty in older persons (65+ years, n = 32,149) was measured by comorbidity, functional and psychosocial aspects, quality of life and a frailty index. Furthermore, home care use and hospital admissions of older persons were identified. We performed multilevel logistic and linear regression analyses. A random intercept model was utilised to test differences between groups, and adjustment factors (confounders) were used in the multilevel analysis. Results Compared to the reference group, older persons with GPC contact were frailer in the domain of comorbidity (mean difference 0.52; 95% CI 0.47–0.57, p < 0.0001) and functional limitations (mean difference 0.53; 95% CI 0.46–0.60, p < 0.0001), and they reported less emotional wellbeing (mean difference − 4.10; 95% CI -4.59- -3.60, p < 0.0001) and experienced a lower quality of life (mean difference − 0.057; 95% CI -0.064- -0.050, p < 0.0001). Moreover, older persons more often reported limited social functioning (OR = 1.50; 95% CI 1.39–1.62, p < 0.0001) and limited perceived health (OR = 1.50, 95% CI 1.39–1.62, p < 0.0001). Finally, older persons with GPC contact more often used home care (OR = 1.37; 95% CI 1.28–1.47, p < 0.0001) or were more often admitted to the hospital (OR = 2.88; 95% CI 2.71–3.06, p < 0.0001). Conclusions Older persons with out-of-hours GPC contact for an emergency care visit were significantly frailer in all domains and more likely to use home care or to be admitted to the hospital compared to the reference group. Potentially frail older persons seemed to require adequate identification of frailty and support (e.g., advanced care planning) both before and after a contact with the out-of-hours GPC.
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Affiliation(s)
- Anneke Bloemhoff
- Eastern Regional Emergency Healthcare Network, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Yvonne Schoon
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kien Smulders
- General Practitioners Cooperative Gelderse Vallei, Ede, The Netherlands
| | - Reinier Akkermans
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lilian C M Vloet
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Karin van den Berg
- Eastern Regional Emergency Healthcare Network, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sivera A A Berben
- Eastern Regional Emergency Healthcare Network, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.,Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Koivulahti O, Tommila M, Haavisto E. The accuracy of preliminary diagnoses made by paramedics - a cross-sectional comparative study. Scand J Trauma Resusc Emerg Med 2020; 28:70. [PMID: 32703267 PMCID: PMC7376915 DOI: 10.1186/s13049-020-00761-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient’s outcome. The research in this area is relatively scarce and there are no previous studies in Finland describing the accuracy of preliminary diagnoses made by paramedics. The aim of this study was to evaluate whether paramedics are making accurate preliminary diagnoses for the patients they are transporting to hospital. In addition, the aim was to describe the variables related to an accurate preliminary diagnosis. Methods A cross-sectional comparative approach was used and conducted through a questionnaire to gather data from the paramedics. A total of 71 paramedics participated in the study and 378 patient cases were included. The paramedics were asked to describe the basic information of a case, to state their preliminary diagnosis, and give their own educational background. The accuracy of the paramedic’s preliminary diagnosis was compared with the discharge diagnosis of the ED physicians retrieved from hospital’s patient records. Logistic regression analysis and a binomial test were used to test the statistical significance. Results The agreement between the paramedics’ preliminary diagnosis vs. hospital diagnosis was 70% (n = 261). Diagnostic accuracy varied according to the medical condition from mental diseases and intoxication (86%, p = 0,000), cerebral strokes (81%, p = 0,007) to infections (31% p = 0,029). The educational background of a bachelor-degree-level paramedic (p = 0,016, 95% Cl 1,7-139,6) and a good self-assessment value (p = 0,003, 95% Cl 1,2-2,7) were related to making a correct diagnosis. Conclusions Paramedics are able to determine preliminary diagnoses at satisfactory level. The relationship between educational background and diagnostic accuracy suggests that there is a definitive need for a specific pre-hospital nursing education.
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Affiliation(s)
- Outi Koivulahti
- Department of Nursing Science, University of Turku, Department of Nursing Science 20014 University of Turku, Turku Finland and Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland.
| | - Miretta Tommila
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, University of Turku and Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Department of Nursing Science 20014 University of Turku, Turku Finland and Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland
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Ming Ng W, De Souza CR, Pek PP, Shahidah N, Ng YY, Arulanandam S, White AE, Leong BSH, Ong MEH. myResponder Smartphone Application to Crowdsource Basic Life Support for Out-of-Hospital Cardiac Arrest: The Singapore Experience. PREHOSP EMERG CARE 2020; 25:388-396. [PMID: 32497484 DOI: 10.1080/10903127.2020.1777233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The Singapore myResponder is a novel smartphone application developed by the Singapore Civil Defence Force (SCDF) that notifies volunteer first responders of a suspected out-of-hospital cardiac arrest (OHCA) case and locations of Automated External Defibrillators (AED) in the vicinity so that they can assist with resuscitation. We aimed to examine the performance of this application, challenges encountered, and future directions. Methods: We analyzed data from the myResponder app since its launch from April 2015 to July 2019. The number of installations, registered community first responders, suspected OHCA cases, notifications sent by the app, percentage of responders who accepted activation and arrived at scene were reviewed. A subgroup of taxi driving responders (within a 1.5-kilometer response radius) carrying an AED under a subsequent pilot program was also analyzed. Results: By July 2019, 46,689 responders were registered in the myResponder app. There were a total of 19,189 cases created for suspected OHCA, with a median of 358 cases per month (IQR 330-430), in which 10,073 responders accepted activation from myResponder and 4,955 arrived on-scene. A total of 135,599 notifications were sent for these cases, with a median of 7.1 notifications per case (IQR 4.3-8.7). In 2019, the percentages of responders who accepted notification and arrived on scene were 45.8% and 24.1%, respectively. 43% (1110/2581) of responders arrived before EMS crew. Conclusion: The myResponder mobile application is a feasible smart technology solution to improve community response to OHCA, and to increase bystander CPR and AED use. Future directions include increasing the number of active responders, improving response rates, app performance, and better data capture for quality improvement.
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Al-Azzani MAK, Davari S, England TJ. An empirical investigation of forecasting methods for ambulance calls - a case study. Health Syst (Basingstoke) 2020; 10:268-285. [PMID: 34745589 DOI: 10.1080/20476965.2020.1783190] [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: 10/24/2022] Open
Abstract
A primary goal of emergency services is to minimise the response times to emergencies whilst managing operational costs. This paper is motivated by real data from the Welsh Ambulance Service which in recent years has been criticised for not meeting its eight-minute response target. In this study, four forecasting approaches (ARIMA, Holt Winters, Multiple Regression and Singular Spectrum Analysis (SSA)) are considered to investigate whether they can provide more accurate predictions to the call volume demand (total and by category) than the current approach on a selection of planning horizons (weekly, monthly and 3-monthly). Each method is applied to a training and test set and root mean square error (RMSE) and mean absolute percentage error (MAPE) error statistics are determined. Results showed that ARIMA is the best forecasting method for weekly and monthly prediction of demand and the long-term demand is best predicted using the SSA method.
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Affiliation(s)
| | - Soheil Davari
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Tracey Jane England
- School of Mathematics, Cardiff University, Aneurin Bevan University Health Board, Newport, UK
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Dwyer RA, Gabbe BJ, Tran T, Smith K, Lowthian JA. Predictors of transport to hospital after emergency ambulance call-out for older people living in residential aged care. Australas J Ageing 2020; 39:350-358. [PMID: 32558049 DOI: 10.1111/ajag.12803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/20/2020] [Accepted: 04/10/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES People living in residential aged care (RAC) frequently experience ambulance call-out. These episodes may have unintended consequences, yet remain under-investigated. Our aim was to examine clinical and sociodemographic features associated with transfer to hospital for this population. METHODS Retrospective cohort study using 6 years of clinical data from Ambulance Victoria (AV). Data analysis included multilevel multivariable logistic regression analysis of factors associated with transport to hospital. RESULTS Odds of transfer were greater for people in rural areas, those with a history of depression, cardiovascular disease and osteoporosis, and residents prescribed antipsychotic and antidepressant medication. Ambulance call-out for trauma (commonly low-level fall) was less frequently transferred to hospital than that for a medical complaint. CONCLUSION These results will improve prediction of call-outs likely to require transfer. Findings include identification of clinical features to be targeted by community and preventative health programs to reduce risk of acute health deterioration and requirement for emergency hospital transfer.
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Affiliation(s)
- Rosamond A Dwyer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Peninsula Health, Frankston, Vic., Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Ambulance Victoria, Blackburn North, Vic., Australia
| | - Judy A Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Bolton Clarke Research Institute, Bentleigh, Vic., Australia
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Søvsø MB, Huibers L, Bech BH, Christensen HC, Christensen MB, Christensen EF. Acute care pathways for patients calling the out-of-hours services. BMC Health Serv Res 2020; 20:146. [PMID: 32106846 PMCID: PMC7045402 DOI: 10.1186/s12913-020-4994-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Western countries, patients with acute illness or injury out-of-hours (OOH) can call either emergency medical services (EMS) for emergencies or primary care services (OOH-PC) in less urgent situations. Callers initially choose which service to contact; whether this choice reflect the intended differences in urgency and severity is unknown. Hospital diagnoses and admission rates following an OOH service contact could elucidate this. We aimed to investigate and compare the prevalence of patient contacts, subsequent hospital contacts, and the age-related pattern of hospital diagnoses following an out-of-hours contact to EMS or OOH-PC services in Denmark. METHODS Population-based observational cohort study including patients from two Danish regions with contact to EMS or OOH-PC in 2016. Hospital contacts were defined as short (< 24 h) or admissions (≥24 h) on the date of OOH service contact. Both regions have EMS, whereas the North Denmark Region has a general practitioner cooperative (GPC) as OOH-PC service and the Capital Region of Copenhagen the Medical Helpline 1813 (MH-1813), together representing all Danish OOH service types. Calling an OOH service is mandatory prior to a hospital contact outside office hours. RESULTS OOH-PC handled 91% (1,107,297) of all contacts (1,219,963). Subsequent hospital contacts were most frequent for EMS contacts (46-54%) followed by MH-1813 (41%) and GPC contacts (9%). EMS had more admissions (52-56%) than OOH-PC. For both EMS and OOH-PC, short hospital contacts often concerned injuries (32-63%) and non-specific diagnoses (20-45%). The proportion of circulatory disease was almost twice as large following EMS (13-17%) compared to OOH-PC (7-9%) in admitted patients, whereas respiratory diseases (11-14%), injuries (15-22%) and non-specific symptoms (22-29%) were more equally distributed. Generally, admitted patients were older. CONCLUSIONS EMS contacts were fewer, but with a higher percentage of hospital contacts, admissions and prevalence of circulatory diseases compared to OOH-PC, perhaps indicating that patients more often contact EMS in case of severe disease. However, hospital diagnoses only elucidate severity of diseases to some extent, and other measures of severity could be considered in future studies. Moreover, the socio-demographic pattern of patients calling OOH needs exploration as this may play an important role in choice of entrance.
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Affiliation(s)
- Morten Breinholt Søvsø
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | | | | | - Erika Frischknecht Christensen
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
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Spangler D, Hermansson T, Smekal D, Blomberg H. A validation of machine learning-based risk scores in the prehospital setting. PLoS One 2019; 14:e0226518. [PMID: 31834920 PMCID: PMC6910679 DOI: 10.1371/journal.pone.0226518] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/26/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The triage of patients in prehospital care is a difficult task, and improved risk assessment tools are needed both at the dispatch center and on the ambulance to differentiate between low- and high-risk patients. This study validates a machine learning-based approach to generating risk scores based on hospital outcomes using routinely collected prehospital data. METHODS Dispatch, ambulance, and hospital data were collected in one Swedish region from 2016-2017. Dispatch center and ambulance records were used to develop gradient boosting models predicting hospital admission, critical care (defined as admission to an intensive care unit or in-hospital mortality), and two-day mortality. Composite risk scores were generated based on the models and compared to National Early Warning Scores (NEWS) and actual dispatched priorities in a prospectively gathered dataset from 2018. RESULTS A total of 38203 patients were included from 2016-2018. Concordance indexes (or areas under the receiver operating characteristics curve) for dispatched priorities ranged from 0.51-0.66, while those for NEWS ranged from 0.66-0.85. Concordance ranged from 0.70-0.79 for risk scores based only on dispatch data, and 0.79-0.89 for risk scores including ambulance data. Dispatch data-based risk scores consistently outperformed dispatched priorities in predicting hospital outcomes, while models including ambulance data also consistently outperformed NEWS. Model performance in the prospective test dataset was similar to that found using cross-validation, and calibration was comparable to that of NEWS. CONCLUSIONS Machine learning-based risk scores outperformed a widely-used rule-based triage algorithm and human prioritization decisions in predicting hospital outcomes. Performance was robust in a prospectively gathered dataset, and scores demonstrated adequate calibration. Future research should explore the robustness of these methods when applied to other settings, establish appropriate outcome measures for use in determining the need for prehospital care, and investigate the clinical impact of interventions based on these methods.
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Affiliation(s)
- Douglas Spangler
- Uppsala Center for Prehospital Research, Department of Surgical Sciences—Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Thomas Hermansson
- Uppsala Ambulance Service, Uppsala University Hospital, Uppsala, Sweden
| | - David Smekal
- Uppsala Center for Prehospital Research, Department of Surgical Sciences—Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Ambulance Service, Uppsala University Hospital, Uppsala, Sweden
| | - Hans Blomberg
- Uppsala Center for Prehospital Research, Department of Surgical Sciences—Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Ambulance Service, Uppsala University Hospital, Uppsala, Sweden
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Lindskou TA, Mikkelsen S, Christensen EF, Hansen PA, Jørgensen G, Hendriksen OM, Kirkegaard H, Berlac PA, Søvsø MB. The Danish prehospital emergency healthcare system and research possibilities. Scand J Trauma Resusc Emerg Med 2019; 27:100. [PMID: 31684982 PMCID: PMC6829955 DOI: 10.1186/s13049-019-0676-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/02/2019] [Indexed: 11/10/2022] Open
Abstract
The emergency medical healthcare system outside hospital varies greatly across the globe - even within the western world. Within the last ten years, the demand for emergency medical service systems has increased, and the Danish emergency medical service system has undergone major changes.Therefore, we aimed to provide an updated description of the current Danish prehospital medical healthcare system.Since 2007, Denmark has been divided into five regions each responsible for health services, including the prehospital services. Each region may contract their own ambulance service providers. The Danish emergency medical services in general include ambulances, rapid response vehicles, mobile emergency care units and helicopter emergency medical services. All calls to the national emergency number, 1-1-2, are answered by the police, or the Copenhagen fire brigade, and since 2011 forwarded to an Emergency Medical Coordination Centre when the call relates to medical issues. At the Emergency Medical Coordination Centre, healthcare personnel assess the situation guided by the Danish Index for Emergency Care and determine the level of urgency of the situation, while technical personnel dispatch the appropriate medical emergency vehicles. In Denmark, all healthcare services, including emergency medical services are publicly funded and free of charge. In addition to emergency calls, other medical services are available for less urgent health problems around the clock. Prehospital personnel have since 2015 utilized a nationwide electronic prehospital medical record. The use of this prehospital medical record combined with Denmark's extensive registries, linkable by the unique civil registration number, enables new and unique possibilities to do high quality prehospital research, with complete patient follow-up.
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Affiliation(s)
- Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
| | - Søren Mikkelsen
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000, Odense, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Poul Anders Hansen
- Emergency Medical Services, North Denmark Region, Hjulmagervej 20, 9000, Aalborg, Denmark
| | - Gitte Jørgensen
- The Prehospital Organisation, The Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark
| | - Ole Mazur Hendriksen
- Prehospital Emergency Medical Services, Region Zealand, Fælledvej 1, 4200, Slagelse, Denmark
| | - Hans Kirkegaard
- Department of Research and Development, Emergency Medical Services, Olof Palmes Alle 34, 8200, Aarhus N, Central Denmark Region, Denmark
| | - Peter Anthony Berlac
- Copenhagen Emergency Medical Services, Telegrafvej 5, 2. stairway, 3. floor, 2750, Ballerup, Denmark
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
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Inacio MC, Bray SCE, Whitehead C, Corlis M, Visvanathan R, Evans K, Griffith EC, Wesselingh SL. Registry of Older South Australians (ROSA): framework and plan. BMJ Open 2019; 9:e026319. [PMID: 31221875 PMCID: PMC6588952 DOI: 10.1136/bmjopen-2018-026319] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Australia's ageing population puts significant demands on the aged care and healthcare sectors. To monitor the provision of aged care and healthcare services to older people, each government body has an individual data collection system. Together these systems can be the basis for creating the evidence necessary to support future allocation of resources for our ageing community. The Registry of Older South Australians (ROSA) is a cross-sector multidisciplinary (ie, aged care and healthcare) platform built to address the challenges of monitoring people in aged care settings. This protocol describes the ROSA's framework and plans. METHODS AND ANALYSIS A registry to capture 16 000 South Australians/year undergoing an aged care eligibility assessment was designed. ROSA will contain information captured by the Commonwealth and South Australian state Health Authority, linked by two data integrating authorities, and housed on a secured data platform. ROSA will contain information on the sociodemographic, health, function, psychological, social, home and safety assessment and concerns characteristics, aged care services, general health services, and mortality of people receiving aged care services. Registered participants will be prospectively monitored until their death and yearly updates of their aged care and healthcare services information will be added to the registry. ETHICS AND DISSEMINATION ROSA will longitudinally monitor the services provided to a population that puts costly demands on the state healthcare and aged care systems, identify unwanted variation, and underpin future research. ROSA's expected outputs include an annual report, a research agenda that focuses on high burden conditions and potentially economically impactful questions, educational materials, and risk profiling tools. ROSA was approved by the South Australian Department for Health and Ageing HREC (HREC/17/SAH/125) and the Australian Institute of Health and Welfare HREC (EO2018/2/429).
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Affiliation(s)
- Maria C Inacio
- Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah Catherine Elizabeth Bray
- Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
- Division of Rehabilitation, Aged Care and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Megan Corlis
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
- Aged and Extended Care Services, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Keith Evans
- Silver Chain Group, Keswick, South Australia, Australia
| | - Elizabeth C Griffith
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Social factors in frequent callers: a description of isolation, poverty and quality of life in those calling emergency medical services frequently. BMC Public Health 2019; 19:684. [PMID: 31159766 PMCID: PMC6547509 DOI: 10.1186/s12889-019-6964-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background Frequent users of emergency medical services (EMS) comprise a disproportionate percentage of emergency department (ED) visits. EDs are becoming increasingly overwhelmed and a portion of use by frequent callers of EMS is potentially avoidable. Social factors contribute to frequent use however few studies have examined their prevalence. This study aims to describe social isolation/loneliness, poverty, and quality of life in a sample of frequent callers of EMS in the Hamilton region, a southern Ontario mid-sized Canadian city. Study design Cross-sectional quantitative study. Methods We surveyed people who called EMS five or more times within 12 months. A mailed self-administered survey with validated tools, and focused on four major measures: demographic information, social isolation, poverty, and quality of life. Results Sixty-seven frequent EMS callers revealed that 37–49% were lonely, 14% had gone hungry in the preceding month, and 43% had difficulties making ends meet at the end of the month. For quality of life, 78% had mobility problems, 55% had difficulty with self-care, 78% had difficulty with usual activities, 87% experienced pain/discomfort, and 67% had anxiety/depression. Overall quality adjusted life years value was 0.53 on a scale of 0 to 1. The response rate was 41.1%. Conclusions Loneliness in our participants was more common than Hamilton and Canadian rates. Frequent EMS callers had higher rates of poverty and food insecurity than average Ontario citizens, which may also act as a barrier to accessing preventative health services. Lower quality of life may indicate chronic illness, and users who cannot access ambulatory care services consistently may call EMS more frequently. Frequent callers of EMS had high rates of social loneliness and poverty, and low quality of life, indicating a need for health service optimization for this vulnerable population.
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Higashi H, Takaku R, Yamaoka A, Lefor AK, Shiga T. The Dedicated Emergency Physician Model of emergency care is associated with reduced pre-hospital transportation time: A retrospective study with a nationwide database in Japan. PLoS One 2019; 14:e0215231. [PMID: 30990824 PMCID: PMC6467406 DOI: 10.1371/journal.pone.0215231] [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: 01/07/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022] Open
Abstract
In Japan, the increasing number of patients needing emergency medical care due to population aging is a major public health problem. Recently, emergency medicine in Japan has seen a growth in the number of Dedicated Emergency Physician Model style departments. We aimed to determine whether there is an association between Dedicated Emergency Physician Model emergency care and pre-hospital transportation time. We conducted a secondary analysis of a Japanese national pre-hospital database from 2010 to 2014. Three regions (group 1: Urayasu city and Ichikawa city in Chiba prefecture, group 2: Kamakura city, Chigasaki city, Fujisawa city and Zushi city in Kanagawa prefecture, and group 3: Fukui city in Fukui prefecture) were evaluated as Dedicated Emergency Physician Model emergency medicine areas. We compared transportation times in these areas with all municipalities in the same prefectures, and with a nearby area using multivariate linear regression with cluster adjustment. The variables used for adjustment are the time from Emergency Medical Services activation to the scene, month, day of the month, day of the week, time of day, age, gender, type of injury, severity, and location of call. Compared with all municipalities in each prefecture there were significant reductions in pre-hospital transportation time: 4.2 minutes (95% confidence interval, 0.9 to 7.5, p<0.05) in Group 1, 6.2 minutes (95%CI, 2.9 to 9.6, p<0.01) fin Group 2 and 7.5 minutes (95%CI, 6.0 to 9.0, p<0.01) in Group 3. Compared with nearby areas, there were statistically significant reductions in transportation time in Group 1, 6.8 minutes (95%CI, 0.7 to 12.8, p<0.05) and in Group 2, 6.8 minutes (95%CI, 3.7 to 9.9, p<0.05). There was a trend for reduced transportation time in Group 3, 2.3 minutes, (5.3 to -0.6, p<0.1). Areas with a Dedicated Emergency Physician Model are associated with reduced pre-hospital transportation time.
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Affiliation(s)
- Hidenori Higashi
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama City, Wakayama, Japan
- * E-mail:
| | - Reo Takaku
- Institute for Health Economics and Policy, Minato-ku, Tokyo, Japan
| | - Atsushi Yamaoka
- Faculty of Economics of Kobe University, Nada-ku Kobe City, Hyogo, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takashi Shiga
- Department of Emergency Medicine, International University of Health and Welfare, Minato-ku, Tokyo, Japan
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Cardona M, Lewis E, Shanmugam S, Nicholson M, Williamson M, Hanly L, Hillman K. Dissonance on perceptions of end-of-life needs between health-care providers and members of the public: Quantitative cross-sectional surveys. Australas J Ageing 2019; 38:e75-e84. [PMID: 30868725 DOI: 10.1111/ajag.12630] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/30/2018] [Accepted: 01/24/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate views, determinants and barriers to end-of-life discussions for doctors, nurses and members of the public (MoP) and their acceptability of risk prediction tools. METHODS Concurrent surveys of 360 doctors and nurses and 497 MoP. RESULTS Sixty per cent of clinicians reported high confidence in initiating end-of-life discussions, and 55.8% regularly engaged in them. Barriers to end-of-life communication reported by clinicians were uncertainty on the likely time to death (44.7%) and family requests to withhold information from patients (44.2%). By contrast, most (92.8%) MoP wanted information about life expectancy; 89.9% wanted involvement in treatment decisions if the likelihood of death was high; and 23.8% already had an advance care directive. CONCLUSIONS A dissonance exists between doctor/nurses perception of older peoples' preference for receiving prognostic information and the public desire for involvement in decision-making at the end of life. As public attitudes change, strategies for greater involvement of patients in shared end-of-life planning are warranted.
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Affiliation(s)
- Magnolia Cardona
- Centre for Research in Evidence Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ebony Lewis
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | | | - Margaret Nicholson
- Intensive Care Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Margaret Williamson
- South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Laura Hanly
- South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ken Hillman
- Intensive Care Unit, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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Athari F, Hillman KM, Frost SA. The concept of frailty in intensive care. Aust Crit Care 2019; 32:175-178. [DOI: 10.1016/j.aucc.2017.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/25/2017] [Accepted: 11/28/2017] [Indexed: 01/19/2023] Open
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O'Hara R, Bishop-Edwards L, Knowles E, O'Cathain A. Variation in the delivery of telephone advice by emergency medical services: a qualitative study in three services. BMJ Qual Saf 2019; 28:556-563. [PMID: 30636202 PMCID: PMC6593649 DOI: 10.1136/bmjqs-2018-008330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/15/2018] [Accepted: 11/03/2018] [Indexed: 12/02/2022]
Abstract
Background An emergency ambulance is not always the appropriate response for emergency medical service patients. Telephone advice aims to resolve low acuity calls over the phone, without sending an ambulance. In England, variation in rates of telephone advice and patient recontact between services raises concerns about inequities in care. To understand this variation, this study aimed to explore operational factors influencing the provision of telephone advice. Methods This is a multimethod qualitative study in three emergency medical services in England with different rates of telephone advice and recontact. Non-participant observation (120 hours) involved 20 call handlers and 27 clinicians (eg, paramedics). Interviews were conducted with call handlers, clinicians and clinician managers (n=20). Results Services varied in their views of the role of telephone advice, selection of their workforce, tasks clinicians were expected and permitted to do, and access to non-ambulance responses. Telephone advice was viewed either as an acceptable approach to managing demand or a way of managing risk. The workforce could be selected for their expertise or their inability to work ‘on-the-road’. Some services permitted proactive identification of calls for a lower priority response and provided access to a wider range of response options. The findings aligned with telephone advice rates for each service, particularly explaining why one service had lower rates. Conclusion Some of the variation observed can be explained by operational differences between services and some of it by access to alternative response options in the wider urgent and emergency care system. The findings indicate scope for greater consistency in the delivery of telephone advice to ensure the widest range of options to meet the needs of different populations, regardless of geographical location.
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Affiliation(s)
- Rachel O'Hara
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Emma Knowles
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Mahmuda S, Wade-Vallance A, Stosic A, Guenter D, Howard M, Agarwal G, McLeod B, Angeles R. Understanding Why Frequent Users of EMS Call 9-1-1: A Grounded Theory Study. Health Promot Pract 2018; 21:440-447. [PMID: 30222003 DOI: 10.1177/1524839918799504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Frequent users of emergency medical services (EMS) have disproportionately high 9-1-1 call frequency. Evidence suggests that this small group burdens the health care system, leading to misallocation of already-limited health resources. AIM To understand frequent users' perceptions and experiences regarding EMS, as well as the driving factors underlying their frequent use. METHOD A grounded theory approach guided our qualitative research process. Participants older than 17 years who called EMS five or more times in the past year were consecutively sampled where each participant was contacted in the order they appeared on our list of potential participants for interviews until data saturation was achieved. Transcripts were analyzed to derive common themes among frequent EMS callers. RESULTS Frequent EMS calls often resulted from chronic medical conditions creating recurrent crisis situations, mental health issues as well as mobility issues, frequent noninjurious falls, and social isolation. Combined with these factors, perceptions of the purpose of EMS and social circumstances also contributed to the creation of complex health issues that influenced frequent EMS use. These findings can advise the development of future paramedicine programs and health promotion interventions.
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Affiliation(s)
| | | | - Alix Stosic
- McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
| | | | | | | | - Brent McLeod
- Hamilton Paramedic Services, Hamilton, Ontario, Canada
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Cox S, Roggenkamp R, Bernard S, Smith K. The epidemiology of elderly falls attended by emergency medical services in Victoria, Australia. Injury 2018; 49:1712-1719. [PMID: 30126534 DOI: 10.1016/j.injury.2018.06.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/06/2018] [Accepted: 06/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND With an increase in the proportion of older people in the community comes an increase in the demand on emergency medical services (EMS) by elderly patients who have fallen. OBJECTIVE To describe the epidemiology of elderly falls patients attended by EMS in Victoria, Australia and identify predictors of transport and repeat falls. METHODS A retrospective review included all elderly (age ≥ 65 years) falls patients attended by EMS between 2010 and 2017. Patient characteristics are described using descriptive statistics. Predictors of transport to hospital and repeat falls were identified using multivariable logistic regression analyses. RESULTS Between 2010 and 2017 EMS attended 324,060 elderly falls patients, which represents 9.7% of EMS attended workload in Victoria. The median age of patients was 83 years (IQR: 76-88) and 60.2% were female. Comorbidities and medication use were common, while private residence (64.3%) and nursing home (20.0%) were common scene locations. Overall, 78.8% of falls events resulted in transport to hospital by EMS. Predictors of transport to hospital included female gender, one or more pre-existing medical conditions or current medications and meeting the pre-hospital trauma triage criteria or hospital major trauma criteria. To investigate predictors of repeat falls, the follow-up period was restricted to 12-months post initial fall, which resulted in 30,997 patients and 42,873 (13.2%) repeat fall incidents. The median number of days between the initial fall and a second fall was 98 (IQR: 27-206). Predictors of repeat falls included living at a nursing home, one or more pre-existing medical conditions and one or more current medications. CONCLUSIONS Older falls patients place significant demand on EMS resources in Victoria, Australia, accounting for 9.7% of EMS attendances. Despite high demand, just 3.8% of elderly falls patients received a 'lights and sirens' emergency transport response to hospital. Furthermore, a large number of falls incidents recorded during the study period were repeat falls. Access to alternative pathways of care like GP referral, allied and community health services may benefit this patient group. Development and enrolment into such programs may improve patient outcomes by minimising falls risk and decrease demand on EMS and hospital resources.
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Affiliation(s)
- Shelley Cox
- Centre for Research & Evaluation, Medical Directorate, Ambulance Victoria, Victoria, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Victoria, Australia.
| | - Renee Roggenkamp
- Centre for Research & Evaluation, Medical Directorate, Ambulance Victoria, Victoria, Australia
| | - Stephen Bernard
- Centre for Research & Evaluation, Medical Directorate, Ambulance Victoria, Victoria, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Victoria, Australia; Intensive Care Unit, The Alfred Hospital, Victoria, Australia
| | - Karen Smith
- Centre for Research & Evaluation, Medical Directorate, Ambulance Victoria, Victoria, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Western Australia, Australia
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