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Munot S, Bray JE, Redfern J, Bauman A, Marschner S, Semsarian C, Denniss AR, Coggins A, Middleton PM, Jennings G, Angell B, Kumar S, Kovoor P, Vukasovic M, Bendall JC, Evens T, Chow CK. Bystander cardiopulmonary resuscitation differences by sex - The role of arrest recognition. Resuscitation 2024; 199:110224. [PMID: 38685374 DOI: 10.1016/j.resuscitation.2024.110224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/03/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE To assess whether bystander cardiopulmonary resuscitation (CPR) differed by patient sex among bystander-witnessed out-of-hospital cardiac arrests (OHCA). METHODS This study is a retrospective analysis of paramedic-attended OHCA in New South Wales (NSW) between January 2017 to December 2019 (restricted to bystander-witnessed cases). Exclusions included OHCA in aged care, medical facilities, with advance care directives, from non-medical causes. Multivariate logistic regression examined the association of patient sex with bystander CPR. Secondary outcomes were OHCA recognition, bystander AED application, initial shockable rhythm, and survival outcomes. RESULTS Of 4,491cases, females were less likely to receive bystander CPR in private residential (Adjusted Odds ratio [AOR]: 0.82, 95%CI: 0.70-0.95) and public locations (AOR: 0.58, 95%CI:0.39-0.88). OHCA recognition during the emergency call was lower for females arresting in public locations (84.6% vs 91.6%, p = 0.002) and this partially explained the association of sex with bystander CPR (∼44%). This difference in recognition was not observed in private residential locations (p = 0.2). Bystander AED use was lower for females (4.8% vs 9.6%, p < 0.001); however, after adjustment for location and other covariates, this relationship was no longer significant (AOR: 0.83, 95%CI: 0.60-1.12). Females were less likely to be in an initial shockable rhythm (AOR: 0.52, 95%CI: 0.44-0.61), but more likely to survive the event (AOR: 1.34, 95%CI: 1.15-1.56). There was no sex difference in survival to hospital discharge (AOR: 0.96, 95%CI: 0.77-1.19). CONCLUSION OHCA recognition and bystander CPR differ by patient sex in NSW. Research is needed to understand why this difference occurs and to raise public awareness of this issue.
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Affiliation(s)
- Sonali Munot
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Janet E Bray
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Andrew Coggins
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Paul M Middleton
- South Western Emergency Research Institute, Ingham Institute, SWSLHD, Sydney, Australia
| | - Garry Jennings
- Sydney Health Partners, Charles Perkins Centre, The University of Sydney, Australia
| | - Blake Angell
- The George Institute for Global Health, University of New South Wales, Newtown, Australia
| | - Saurabh Kumar
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Pramesh Kovoor
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Matthew Vukasovic
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Jason C Bendall
- New South Wales Ambulance, Sydney, New South Wales, Australia; School of Medicine and Public Health (Anaesthesia and Intensive Care), The University of Newcastle, Australia
| | - T Evens
- New South Wales Ambulance, Sydney, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; The George Institute for Global Health, University of New South Wales, Newtown, Australia
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2
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Lin HM, Liu CK, Huang YC, Ho CW, Chen M. Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010428. [PMID: 35010693 PMCID: PMC8744657 DOI: 10.3390/ijerph19010428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 12/21/2022]
Abstract
Background: The decision to sign a do-not-resuscitate (DNR) consent is critical for patients concerned about their end-of-life medical care. Taiwan’s National Health Insurance Administration (NHIA) introduced a family palliative care consultation fee to encourage family palliative care consultations; since its implementation, identifying which families require such consultations has become more important. In this study, the Taiwanese version of the Palliative Care Screening Tool (TW–PCST) was used to determine each patient’s degree of need for a family palliative care consultation. Objective: This study analyzed factors associated with signing DNR consents. The results may inform family palliative care consultations for families in need, thereby achieving a higher DNR consent rate and promoting the effective use of medical resources, including time, labor, and funding. Method: In this retrospective study, logistic regression analysis was conducted to determine which factors affected the DNR decisions of 2144 deceased patients (aged ≥ 20 years), whose records were collected from the Taipei City Hospital health information system from 1 January to 31 December 2018. Results: Among the 1730 patients with a DNR consent, 1298 (75.03%) received family palliative care consultations. The correlation between DNR consent and family palliative care consultations was statistically significant (p < 0.001). Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR consent. Conclusions: This study determined that TW–PCST scores can be used as a measurement standard for the early identification of patients requiring family palliative care consultations. Family palliative care consultations provide opportunities for patients’ family members to participate in discussions about end-of-life care and DNR consent and provide patients and their families with accurate medical information regarding the end-of-life care decision-making process. The present results can serve as a reference to increase the proportion of patients willing to sign DNR consents and reduce the provision of ineffective life-prolonging medical treatment.
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Affiliation(s)
- Hui-Mei Lin
- Taipei City Hospital, RenAi Branch Nursing Supervisor, Taipei 106, Taiwan;
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
| | - Chih-Kuang Liu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Urology, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
| | - Yen-Chun Huang
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Chieh-Wen Ho
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Life Science, National Taiwan University, Taipei 106, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Correspondence:
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3
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Potenzi B, Lim AKH. Patient factors affecting the proper completion of a goals-of-care form in a general medicine hospital admission. Intern Med J 2021; 50:1232-1239. [PMID: 31760673 DOI: 10.1111/imj.14703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/16/2019] [Accepted: 11/09/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND The goals-of-care (GOC) form is a resuscitation planning tool used to document informed decisions tailored for individual patients admitted to hospital. Proper and timely completion of the GOC form is essential for its effective utility. AIMS To identify patient factors which may affect the timely discussion and documentation of GOC forms in patients admitted under a general medicine unit. METHODS We performed a cross-sectional study of 2589 patients during 3093 admissions under the general medicine unit from January 2017 to July 2017 at Dandenong Hospital in Melbourne, Australia. The main outcome was the proper completion of GOC forms, defined as GOC completion within 48 h of admission and adequate discussion with the patient or substitute decision maker. We used logistic regression to determine the association between the main outcome and several patient-related independent variables. RESULTS A GOC form was completed in 66% of all admissions but only 35% were considered properly completed (timely and adequately discussed). In the general multivariable logistic regression model, the variables associated with proper completion of GOC forms were age (OR = 1.58), English as the main spoken language (OR = 1.43) and readmissions (OR = 1.27). In patients 75 years and older, additional factors associated with proper GOC completion were confusion on admission (OR = 1.31) and number of comorbidities (OR = 1.27). CONCLUSIONS The proper GOC form completion rates were suboptimal in general medicine admissions, particularly in younger patients with fewer comorbidities. Additional effort is needed to improve GOC completion in these patients and those whose primary spoken language is not English.
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Affiliation(s)
- Bradley Potenzi
- Department of General Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Andy K H Lim
- Department of General Medicine, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
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4
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Bryant J, Waller A, Pickles R, Hullick C, Price E, White B, Willmott L, Bowman MA, Knight A, Ryall MA, Sanson-Fisher R. Knowledge and confidence of junior medical doctors in discussing and documenting resuscitation plans: A cross-sectional survey. Intern Med J 2020; 51:2055-2060. [PMID: 32687240 DOI: 10.1111/imj.14994] [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: 04/30/2020] [Revised: 07/06/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND A Resuscitation Plan is a medically authorised order to use or withhold resuscitation interventions. Absence of appropriate resuscitation orders exposes patients to the risk of invasive medical interventions that may be of questionable benefit depending on individual circumstances. AIMS To describe among junior doctors: (1) self-reported confidence discussing and completing resuscitation plans; (2) knowledge of resuscitation policy including whether resuscitation plans are legally enforceable and key triggers for completion; and (3) the factors associated with higher knowledge of triggers for completing resuscitation plans. METHODS A cross-sectional survey was conducted at five hospitals. Junior doctors on clinical rotation were approached at scheduled training sessions, before or after ward rounds, or at change of rotation orientation days and provided with a pen-and-paper survey. RESULTS A total of 118 junior doctors participated. Most felt confident discussing (79%, n = 92) and documenting (87%, n = 102) resuscitation plans with patients. However, only 45% of doctors (n = 52) correctly identified that resuscitation plans are legally enforceable medical orders. On average, doctors correctly identified 6.8 (SD = 1.8) out of 10 triggers for completing a resuscitation plan. Doctors aged >30 years were four times more likely to have high knowledge of triggers for completing resuscitation plans (OR 4.28 (95% CI 1.54 to 11.89), p = 0.0053). CONCLUSION Most junior doctors feel confident discussing and documenting resuscitation plans. There is a need to improve knowledge about legal obligations to follow completed resuscitation plans, and about when resuscitation plans should be completed to ensure they are completed with patients who are most at risk. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Amy Waller
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Rob Pickles
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,John Hunter Hospital Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Carolyn Hullick
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,John Hunter Hospital Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Emma Price
- John Hunter Hospital Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Ben White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ms Alison Bowman
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Anne Knight
- Manning Education Centre University of Newcastle Department of Rural Health 69a High St Taree, New South Wales, Australia
| | - Mary-Ann Ryall
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Central Coast Clinical School, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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5
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Levinson M, Mills A, Barrett J, Sritharan G, Gellie A. 'Why didn't you write a not-for-cardiopulmonary resuscitation order?' Unexpected death or failure of process? AUST HEALTH REV 2019; 42:53-58. [PMID: 27978419 DOI: 10.1071/ah16140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to understand the reasons for the delivery of non-beneficial cardiopulmonary resuscitation (CPR) attempts in a tertiary private hospital over 12 months. We determined doctors' expectations of survival after CPR for their patient, whether they had considered a not-for-resuscitation (NFR) order and the barriers to completion of NFR orders. Methods Anonymous questionnaires were sent to the doctors primarily responsible for a given patient's care in the hospital within 2 weeks of the unsuccessful CPR attempt. The data were analysed quantitatively where appropriate and qualitatively for themes for open-text responses Results Most doctors surveyed in the present study understood the poor outcome after CPR in the older person. Most doctors had an expectation that their own patient had a poor prognosis and a poor likely predicted outcome after CPR. This implied that the patient's death was neither unexpected nor likely to be reversible. Some doctors considered NFR orders, but multiple barriers to completion were cited, including the family's wishes, being time poor and diffusion or deferral of responsibility. Conclusions It is likely that futile CPR is provided contrary to policy and legal documents relating to end-of-life care, with the potential for harms relating to both patient and family, and members of resuscitation teams. The failure appears to relate to process rather than recognition of poor patient outcome. What is known about the topic? Mandatory CPR has been established in Australian hospitals on the premise that it will save lives. The outcome from in-hospital cardiac arrest has not improved despite significant training and resources. The outcome for those acutely hospitalised patients aged over 80 years has been repeatedly demonstrated to be poor with significant morbidity in the survivors. There is emerging literature on the extent of the delivery of non-beneficial treatments at the end of life, including futile CPR, the recognition of harms incurred by patients, families and members of the resuscitation teams and on the opportunity cost of the inappropriate use of resources. What does this paper add? This is the first study, to our knowledge, that has demonstrated that doctors understood the outcomes for CPR, particularly in those aged 80 years and older, and that failure to recognise poor outcome and prognosis in their own patients is not a barrier to writing NFR orders. What are the implications for practitioners? Recognition of the poor outcomes from CPR for the elderly patient for whom the doctor has a duty of care should result in a discussion with the patients, allowing an exploration of values and expectations of treatment. This would promote shared decision making, which includes the use of CPR. Facilitation of these discussions should be the focus of health service review.
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Affiliation(s)
- Michele Levinson
- Cabrini-Monash Department of Medicine, Cabrini Institute for Research and Education, 154 Wattletree Road, Malvern, Vic. 3144, Australia.
| | - Amber Mills
- Cabrini-Monash Department of Medicine, Cabrini Institute for Research and Education, 154 Wattletree Road, Malvern, Vic. 3144, Australia.
| | - Jonathan Barrett
- Intensive Care Unit, Epworth Healthcare, 89 Bridge Road, Richmond, Vic. 3121, Australia. Email
| | - Gaya Sritharan
- Cabrini-Monash Department of Medicine, Cabrini Institute for Research and Education, 154 Wattletree Road, Malvern, Vic. 3144, Australia.
| | - Anthea Gellie
- Cabrini-Monash Department of Medicine, Cabrini Institute for Research and Education, 154 Wattletree Road, Malvern, Vic. 3144, Australia.
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6
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Sritharan G, Mills AC, Levinson MR, Gellie AL. Doctors' attitudes regarding not for resuscitation orders. AUST HEALTH REV 2019; 41:680-687. [PMID: 27883873 DOI: 10.1071/ah16161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/14/2016] [Indexed: 11/23/2022]
Abstract
Objectives The aims of the present study were to investigate doctors' attitudes regarding the discussion and writing of not for resuscitation (NFR) orders and to identify potential barriers to the completion of these orders. Methods A questionnaire-based convenience study was undertaken at a tertiary hospital. Likert scales and open-ended questions were directed to issues surrounding the discussion, timing, understanding and writing of NFR orders, including legal and personal considerations. Results Doctors thought the presence of an NFR order both should and does alter care delivered by nursing staff, particularly delivery of pain relief, nursing observations and contacting the medical emergency team. Eighty-five per cent of doctors believed they needed somebody else's consent to write an NFR order (seeking of consent is not a requirement in most Australian jurisdictions). Conclusion There are complex barriers to the writing and implementation of NFR orders, including doctors' knowledge around the need for consent when cardiopulmonary resuscitation is likely to be futile or excessively burdensome. Doctors also believed that NFR orders result in changes to goals-of-care, suggesting a confounding of NFR orders with palliative care. Furthermore, doctors are willing to write NFR orders where there is clear medical indication and the patient is imminently dying, but are otherwise reliant on patients and family to initiate discussion. What is known about the topic? Hospitalised elderly patients, in the absence of an NFR order, are known to have poor survival and outcomes following resuscitation. Further, Australian data on the prevalence of NFR forms show that only a minority of older in-patients have a written NFR order in their history. In Australian hospitals, NFR orders are completed by doctors. What does this paper add? To our knowledge, the present study is the first in Australia to qualitatively analyse doctors' reasons to writing NFR orders. The open-text nature of this questioning has been important in eliciting doctors' responses without hypothesis guessing bias. Further, we add to the literature on the breadth of considerations doctors may encounter with regard to NFR orders. What are the implications for practitioners? The findings indicate the issues impeding decision making around cardiopulmonary resuscitation relate to poor knowledge of the law, particularly around the issue of consent and confounding NFR orders with provision of palliative care. Such barriers to the completion of NFR orders expose elderly in-patients to futile and burdensome resuscitation events. The findings suggest consideration be given to education and training materials to inform doctors about jurisdictional law regarding resuscitation documentation, support decision making around cardiopulmonary resuscitation and promote goals-of-care discussions on admission.
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Affiliation(s)
- Gaya Sritharan
- Cabrini-Monash University Department of Medicine, Cabrini Institute, 183 Wattletree Road, Malvern, Vic. 3144, Australia.
| | - Amber C Mills
- Cabrini-Monash University Department of Medicine, Cabrini Institute, 183 Wattletree Road, Malvern, Vic. 3144, Australia.
| | - Michele R Levinson
- Cabrini-Monash University Department of Medicine, Cabrini Institute, 183 Wattletree Road, Malvern, Vic. 3144, Australia.
| | - Anthea L Gellie
- Cabrini-Monash University Department of Medicine, Cabrini Institute, 183 Wattletree Road, Malvern, Vic. 3144, Australia.
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Lord B, Andrew E, Henderson A, Anderson DJ, Smith K, Bernard S. Palliative care in paramedic practice: A retrospective cohort study. Palliat Med 2019; 33:445-451. [PMID: 30720392 DOI: 10.1177/0269216319828278] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic's role in the care of these patients. AIM To describe the incidence and nature of cases attended by paramedics and the care provided where the reason for attendance was associated with a history of palliative care. DESIGN This is a retrospective cohort study. SETTING/PARTICIPANTS Adult patients (aged >17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care or end of life were recorded in the patient care record. Secondary transfers including inter-hospital transport cases were excluded. RESULTS A total of 4348 cases met inclusion criteria. Median age was 74 years (interquartile range 64-83). The most common paramedic assessments were 'respiratory' (20.1%), 'pain' (15.8%) and 'deceased' (7.9%); 74.4% ( n = 3237) were transported, with the most common destination being a hospital (99.5%, n = 3221). Of those with pain as the primary impression, 359 (53.9%) received an analgesic, morphine, fentanyl or methoxyflurane, and 356 (99.2%) were transported following analgesic administration. Resuscitation was attempted in 98 (29.1%) of the 337 cases coded as cardiac arrest. Among non-transported cases, there were 105 (9.6%) cases where paramedics re-attended the patient within 24 h of the previous attendance. CONCLUSION Paramedics have a significant role in caring for patients receiving palliative care. These results should inform the design of integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.
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Affiliation(s)
- Bill Lord
- 1 School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Emily Andrew
- 2 Centre for Research and Evaluation, Ambulance Victoria, Doncaster, VIC, Australia.,3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Amanda Henderson
- 1 School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - David J Anderson
- 4 Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,5 School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Karen Smith
- 2 Centre for Research and Evaluation, Ambulance Victoria, Doncaster, VIC, Australia.,3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,7 Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, VIC, Australia
| | - Stephen Bernard
- 2 Centre for Research and Evaluation, Ambulance Victoria, Doncaster, VIC, Australia.,3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,6 The Alfred Hospital, Melbourne, VIC, Australia
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8
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Johnson CE, Chong JC, Wilkinson A, Hayes B, Tait S, Waldron N. Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients. Intern Med J 2018; 47:798-806. [PMID: 28401688 DOI: 10.1111/imj.13454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/23/2017] [Accepted: 04/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Advance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR. AIM To assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients. METHODS A pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with 'Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer. RESULTS When compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03). CONCLUSION An increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care.
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Affiliation(s)
- Claire E Johnson
- School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Jeffrey C Chong
- Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia
| | - Anne Wilkinson
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Barbara Hayes
- Advance Care Planning Program, Northern Health, Melbourne, Victoria, Australia.,Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sonia Tait
- Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia
| | - Nicholas Waldron
- Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia.,Health Strategy and Networks, System Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia.,School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
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9
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Bossaert L, Perkins G, Askitopoulou H, Raffay V, Greif R, Haywood K, Mentzelopoulos S, Nolan J, Van de Voorde P, Xanthos T. Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Mills A, Walker A, Levinson M, Hutchinson AM, Stephenson G, Gellie A, Heriot G, Newnham H, Robertson M. Resuscitation orders in acute hospitals: A point prevalence study. Australas J Ageing 2016; 36:32-37. [DOI: 10.1111/ajag.12354] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Amber Mills
- Cabrini-Monash University Department of Medicine; Cabrini Institute; Melbourne Victoria Australia
| | - Anne Walker
- The Alfred Hospital; Melbourne Victoria Australia
| | - Michele Levinson
- Cabrini-Monash University Department of Medicine; Cabrini Institute; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - Alison M Hutchinson
- Centre for Nursing Research; Deakin University and Monash Health Partnership; Melbourne Victoria Australia
| | - Gemma Stephenson
- Cabrini-Monash University Department of Medicine; Cabrini Institute; Melbourne Victoria Australia
| | - Anthea Gellie
- Cabrini-Monash University Department of Medicine; Cabrini Institute; Melbourne Victoria Australia
| | - George Heriot
- Royal Melbourne Hospital; Melbourne Victoria Australia
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11
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Waldron N, Johnson CE, Saul P, Waldron H, Chong JC, Hill AM, Hayes B. Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making. BMC Health Serv Res 2016; 16:555. [PMID: 27716183 PMCID: PMC5053041 DOI: 10.1186/s12913-016-1803-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 09/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. METHODS Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. RESULTS Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. CONCLUSION Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.
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Affiliation(s)
- Nicholas Waldron
- Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, 3056 Albany Highway, Armadale, 6112, Western Australia, Australia.,Health Strategy and Networks, System Policy and Planning, Department of Health, Government of Western Australia, 189 Royal Street, East Perth, 6004, Western Australia, Australia.,School of Medicine, University of Notre Dame, 32 Mouat St, Fremantle, 6959, Western Australia, Australia
| | - Claire E Johnson
- Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, 35 Stirling Hwy, Nedlands, 6009, Western Australia, Australia.
| | - Peter Saul
- John Hunter Hospital, Lookout Rd, New Lambton Heights, Newcastle, NSW, 2305, Australia.,Intensive Care, Newcastle Private Hospital, 14 Lookout Rd, New Lambton Heights, Newcastle, NSW, 2305, Australia
| | - Heidi Waldron
- Clinical Teaching - Public Hospitals and Curriculum Development Communication and Clinical Practice Domain, School of Medicine, University of Notre Dame, 32 Mouat St, Fremantle, 6959, Western Australia, Australia
| | - Jeffrey C Chong
- Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, 3056 Albany Highway, Armadale, 6112, Western Australia, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Kent St, Bentley, 6102, Western Australia, Australia
| | - Barbara Hayes
- Advance Care Planning Program, Northern Health, 85 Cooper St., Epping, VIC, 3076, Australia.,Medical School, University of Melbourne, Parkville, VIC, 3010, Australia
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12
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Arendts G, Carpenter CR, Hullick C, Burkett E, Nagaraj G, Rogers IR. Approach to death in the older emergency department patient. Emerg Med Australas 2016; 28:730-734. [DOI: 10.1111/1742-6723.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Glenn Arendts
- Emergency Medicine; The University of Western Australia; Perth Western Australia Australia
- Harry Perkins Institute for Medical Research; Perth Western Australia Australia
| | | | - Carolyn Hullick
- Emergency Department; John Hunter Hospital; Newcastle New South Wales Australia
| | - Ellen Burkett
- Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Guruprasad Nagaraj
- Hornsby and Royal North Shore Hospitals; Sydney New South Wales Australia
- School of Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Ian R Rogers
- The University of Notre Dame; Fremantle Western Australia Australia
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13
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Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0083-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, Mentzelopoulos SD, Nolan JP, Van de Voorde P, Xanthos TT, Georgiou M, Lippert FK, Steen PA. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:302-11. [DOI: 10.1016/j.resuscitation.2015.07.033] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Egerton-Warburton D. Cardiopulmonary resuscitation--time for a change in the paradigm? Med J Aust 2015; 202:78. [PMID: 25627733 DOI: 10.5694/mja14.01508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022]
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16
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Levinson M, Mills A. Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion. Med J Aust 2015; 202:19. [DOI: 10.5694/mja14.01123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/18/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Michele Levinson
- Cabrini‐Monash University Department of Medicine, Monash University, Melbourne, VIC
| | - Amber Mills
- Cabrini‐Monash University Department of Medicine, Monash University, Melbourne, VIC
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