Temperature--the forgotten vital sign

OBJECTIVE

To improve the measurement of core body temperature in the resuscitation room.

METHOD

This work was undertaken in the Emergency Department (ED) of a large District General Hospital. The clinical notes for all admissions to the resuscitation suite during a 2 month period were reviewed to establish the frequency of temperature measurement. Following a simple educational program, performance was re-audited using the same methodology.

RESULTS

Of the first cohort 13.4% had had their temperature recorded. This improved to 71.6%.

CONCLUSIONS

The measurement of body temperature in the resuscitation room is important as hypothermia has profound effects on the cardiovascular, pulmonary, neurological and haemostatic systems. Clinical audit highlights poor current performance and enables improvement of practice through simple education.

Remote trauma management--setting up a system

A telemedicine link to enable nurse practitioners at a remote minor injuries unit to obtain advice from an emergency physician at a main accident and emergency department is feasible and worthwhile. However, it is fraught with difficulties. These include technical difficulties, training problems, familiarization with the technology and provision of enough emergency physician time for the much longer duration of a full consultation. When choosing the equipment, attention has to be paid to the cameras, lighting, echo cancellation, layout of rooms, privacy and ambience. It is useful to obtain the system from suppliers who know what they are doing and have adequate backup of appropriate technical expertise, because each installation is different and difficult. Our experience suggests that anyone wishing to use similar technology should be prepared to be doggedly determined to learn the system, iron out kinks and motivate all concerned. The project will need to be driven. The technology is still at a stage where frustration and delay are significant. However, it is rewarding and very useful if the staff overcome its shortcomings and in due course all are pleased that they participated.

Teleradiology or teleconsultation for emergency nurse practitioners?

Twenty radiographs showing subtle orthopaedic findings were transmitted to three emergency physicians. Fifty-seven of the 60 attempted diagnoses were correct. We found the primary radiographic film had to be well centred, exposed, true and penetrated for successful transmission. There is a considerable element of familiarization with the technology. The software should permit simultaneous annotation from the two sites and additional cameras are necessary to enable emergency nurse practitioners (ENPs) to show the injured part. The 20 radiographs took 120 min to interpret with teleradiology rather than 10 min of viewing conventional films. The extra time for teleradiology is due to readers asking for multiple areas of the radiographic image to be enlarged before making a decision. We feel that ENPs should not engage in teleradiology but rather telemedical consultation.

The Minnesota Prenatal Care Coordination Project: successes and obstacles

The Minnesota Prenatal Care Coordination Project was a statewide effort to present systematically education and technical support to providers as they implemented the Minnesota Prenatal Care Initiative for expanded services to high-risk women. Educational methods included holding 12 regional workshops throughout the State, one-to-one contacts by nurse consultants, and newsletters and a guidebook (manual) were distributed to reach community providers. Analysis of the implementation was conducted using site visits, interviews with providers, and reviews of medical records, claims data, and other project documents. Successes in the first year were a twofold increase in the numbers of Medicaid-enrolled women who received risk assessment and enhanced services, more than one-third increase in provider participation, greater collaboration among multidisciplinary providers at the community level, and improved communication between State and local health care agencies. Obstacles included provider resistance to changes in practice, dissatisfaction with the enhanced services package and level of reimbursement, and problems with implementation protocols. The project demonstrated that prenatal care providers will change; they will improve practices and collaboration as a result of personalized education and support.

Barriers and motivators to prenatal care among low-income women

Substantial evidence exists which links prenatal care to improved birth outcomes. However, low-income and nonwhite women in the United States, who are at greatest risk for poor birth outcomes, continue to receive the poorest prenatal care. The purpose of this study was to identify and compare barriers and motivators to prenatal care among women who lived in low-income census tracts. The stratified sample included recently delivered white, black and American Indian women who received adequate, intermediate, and inadequate prenatal care. Interviews were conducted which focused primarily on the women's perceptions of problems in obtaining prenatal care and getting to appointments. Results indicated that women with inadequate care identified a greater number of barriers and perceived them as more severe. Psychosocial, structural, and socio-demographic factors were the major barriers, while the mother's beliefs and support from others were important motivators. The predictive power of selected barrier variables was examined by a regression analysis. These variables accounted for 50% of the variance in prenatal care use. The results affirm the complexity of prenatal care participation behavior among low-income women and the dominant influence of psychosocial factors. Comprehensive, coordinated and multidisciplinary outreach and services which address psychosocial and structural barriers are needed to improve prenatal care for low-income women.