scholarly journals Decision-Making and Interventions During Interfacility Transport of High Acuity Patients with SARS-CoV-2 infection

2021 ◽  
Author(s):  
Ruben D. Troncoso ◽  
Eric M. Garfinkel ◽  
David Leon ◽  
Sandra M. Lopez ◽  
Andrew Lin ◽  
...  
Keyword(s):  
Decision Making ◽  
High Acuity ◽  
Interfacility Transport

Learning, Decisions and Transformation in Critical Care Nursing Practice

2008 ◽  
Vol 15 (3) ◽  
pp. 322-331 ◽  
Author(s):  
M Catherine Hough
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Role Model ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Critical Care Nurses ◽  
Care Practice ◽  
Theoretical Concepts ◽  
Education Levels ◽  
High Acuity

Critical care nurses are key providers in a high acuity environment. This qualitative research study explored ethical decision making in a critical care practice setting. Fifteen critical care nurses with varying experience and education levels were purposively sampled to assure the representativeness of the data. The theoretical concepts of experiential learning, perspective transformation, reflection-in-action and principle-based ethics were used as a framework for eliciting information from the participants. A new model of focused reflection in ethical decision making was developed. Findings showed that having a role model or mentor to help guide the ethical decision-making process was critical for focused ethical discourse and the decision making.

Obstetrics and gynaecology

2016 ◽  
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
High Risk ◽  
Perinatal Death ◽  
Careful Consideration ◽  
Risk Avoidance ◽  
Risk Transfer ◽  
Additional Pressure ◽  
Obstetrics And Gynaecology ◽  
High Acuity

High acuity and critical care presentations in obstetrics and gynaecology are not uncommon, and when seen in the retrieval setting they present pathophysiology and risk avoidance challenges for the retrieval physician, coordinator, and system. The particular risks in obstetric retrieval which are associated with the consideration of infant risk, and the emotive implications of perinatal death, create additional pressure. The wellbeing of the mother is in all circumstances the priority, and it is important that this drives decision-making and planning. Careful consideration and consultation with specialist retrieval coordinators with obstetric experience and qualifications is important to optimize plans. These plans often revolve around the wisdom of intervention or delivery pre, post, or instead of high-risk transfer. Experience, perspective, and understanding of practitioner and system capability will inform best decisions and outcomes.

Emergency Nursing Staff Dispatch: Sensitivity and Specificity in Detecting Prehospital Need for Physician Interventions During Ambulance Transport in Rovigo Emergency Ambulance Service, Italy

2013 ◽  
Vol 28 (5) ◽  
pp. 523-528 ◽  
Author(s):  
Marco Leopardi ◽  
Marco Sommacampagna
Keyword(s):  
Decision Making ◽  
Sensitivity And Specificity ◽  
Nursing Staff ◽  
Predictive Value ◽  
Ambulance Service ◽  
Decision Making Process ◽  
Emergency Nursing ◽  
Ambulance Transport ◽  
Emergency Ambulance ◽  
High Acuity

AbstractIntroductionIn Italy, administration of medications or advanced procedures dictates the prehospital presence of a physician to initiate treatment. Nursing staff is often used as dispatchers in Italian emergency medical ambulance services. There is little data about nursing dispatch performance in detecting high-acuity patients who need prehospital medications and procedures.ObjectiveTo determine the ability of a dispatch center staffed by emergency ambulance nurses to detect prehospital need for physician interventions in the context of a semi-rural area Emergency Medical Services system.MethodsA retrospective analysis of 53,606 calls from the Rovigo Emergency Ambulance Services’ database was undertaken. Physician prehospital interventions were defined as the administration of medications or procedures (advanced airway management and ventilation, pneumothorax decompression, fluid replacement therapy, external defibrillation, cardioversion and pacing). The dispatch codes (assigned by a subjective decision-making process as Red, Yellow, or Green) of all transported prehospital patient calls were matched with an out-of-hospital triage system staffed by clinicians to determine the number of correctly identified prehospital need of physician interventions. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.ResultsThe sensitivity of subjective experience-based nursing dispatch in detecting the need for physician interventions was 78.0% (95% CI, 76.9%-79.1%), with a PPV of 36.6% (95% CI, 35.8%-37.5%). Specificity was 83.8% (95% CI: 83.4%-84.1%), with an NPV of 96.9% (95% CI, 96.8%-97.1%).ConclusionA dispatch center staffed by nurses with six years of experience and three months of training correctly identified when not to send a doctor to the scene in the absence of need for physician interventions, using a subjective decision-making process. The nurses staffing the dispatch center also worked in the field. Dispatch center staff were not able to predict when there was no need for physician interventions in high-acuity dispatch code patients, resulting in an over-triage and use of emergency physicians on scene.LeopardiM, SommacampagnaM.Emergency nursing staff dispatch: sensitivity and specificity in detecting prehospital need for physician interventions during ambulance transport in Rovigo Emergency Ambulance Service, Italy. Prehosp Disaster Med. 2013;28(5):1-6.

scholarly journals Student paramedic anticipation, confidence and fears: Do undergraduate courses prepare student paramedics for the mental health challenges of the profession?

2017 ◽  
Vol 14 (4) ◽  
Author(s):  
Lisa Holmes ◽  
Russell Jones ◽  
Richard Brightwell ◽  
Lynne Cohen
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Skills ◽  
Significant Proportion ◽  
Clinical Decision ◽  
Mental Wellbeing ◽  
Making A Difference ◽  
High Acuity ◽  
Mental Health Challenges

IntroductionThis study explores the preparedness of undergraduate student paramedics for the mental health challenges of the paramedic profession from the perspective of course coordinators and their students. MethodsTwo surveys were developed and administered to course coordinators and students of the 16 undergraduate degree paramedicine courses across Australia and New Zealand. Sixteen course coordinators and 302 students responded. ResultsResults illustrate there was widespread recognition for the need to include preparation for the mental health challenges of the profession within undergraduate courses. Furthermore, most course coordinators and students had a preference for this topic to be taught using multiple teaching modes with particular preference for teaching the topic via discussion and activity based education. Teaching the topic as a standalone unit was supported by more than a third of course coordinators (43%) and a third of students (32%).ConclusionSix themes were identified as positive by anticipants: caring for people, high acuity work, diversity of work and patients, making a difference to patients and their families, using clinical skills and knowledge and engaging with the community. Students were most confident about communicating with patients and using clinical skills and knowledge. Students were least confident about clinical decision making and the most commonly cited fear was making a clinical mistake. A significant proportion of students (16%) feared for their personal mental wellbeing and 14% reported they were least confident about personal mental health within the profession.

scholarly journals P044: Factors influencing laboratory test ordering by physicians and nurses in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S92-S93
Author(s):  
L. Delaney ◽  
A. Gallant ◽  
S. Stewart ◽  
J. Curran ◽  
S.G. Campbell
Keyword(s):  
Decision Making ◽  
Laboratory Test ◽  
Laboratory Tests ◽  
Theoretical Domains Framework ◽  
Emergency Physicians ◽  
Factors Influencing ◽  
High Acuity ◽  
Chi Square Analysis ◽  
Test Ordering ◽  
Significant Factors

Introduction: Understanding factors that influence laboratory test ordering in emergency departments (EDs) can help to improve current laboratory test ordering practices. The aim of this study is to compare patterns and influences in laboratory test ordering between emergency physicians and nurses at two ED sites, Halifax Infirmary (HI) and Dartmouth General (DG). Methods: A mixed-methods approach involving administrative data and telephone interviews was employed. Data from 211,279 patients at HI and DG EDs were analyzed. Chi-square analysis and binary logistic regression were used to determine significant factors influencing whether a test was ordered, as well as significant factors predicting likelihood of a nurse or a physician ordering a test. All significant associations had a p-value of <0.0001. Interviews were conducted (n=25) with doctors and nurses in order to explore areas of potential influence in a clinician’s decision-making process, and discuss what makes decision making difficult or inconsistent in the ED. These interviews were analyzed according to the Theoretical Domains Framework. The interviews were coded by two individuals using a consensus methodology in order to ensure accuracy of coding. Results: Overall, laboratory tests were more likely to be ordered at DG than at HI (OR=1.52, 95% CI: [1.48, 1.55]). Laboratory tests were more likely to be ordered by nurses at DG than at HI (OR=1.58, 95% CI: [1.54, 1.62]). Laboratory tests were more likely to be ordered if the ED was not busy, if the patient was over 65, had a high acuity, had a long stay in the ED, required consults, or was admitted to hospital. Doctors were more likely to order a laboratory test in patients over 65, requiring consults or hospital admission, whereas nurses were more likely to order laboratory tests in patients with high acuity or long stays in the ED. Data from the interviews suggested differing influences on decision making between nurses and doctors, especially in the areas of social influence and knowledge. Conclusion: Currently, there is limited research that investigates behaviour of both emergency physicians and nurses. By determining barriers that are most amenable to behaviour change in emergency physicians and nurses, findings from this work may be used to update practice guidelines, ensuring more consistency and efficiency in laboratory test ordering in the ED.

Health Economic Implications of Complications Associated With Pancreaticoduodenectomy

2019 ◽  
pp. 144-167
Author(s):  
Jason Wang ◽  
Laurence Weinberg
Keyword(s):  
Decision Making ◽  
Health Economic ◽  
Clinical Decision Making ◽  
Clinical Information ◽  
Clinical Decision ◽  
Tertiary Hospital ◽  
Hospital Environment ◽  
Activity Based Costing ◽  
Economic Implications ◽  
High Acuity

Clinical costing is a powerful tool to bridge the disconnect between financial and clinical information, and is an ideal platform to conduct research aimed at informing value-based clinical decision making. This chapter will provide an example of the utility of activity-based costing to elucidate the costs of complications following pancreaticoduodenectomy, a high acuity procedure with high costs. It will show the significance of clear clinical costing in targeting cost containment in a tertiary hospital environment.

Discarding optimality: Throwing out the baby with the bathwater?

2018 ◽  
Vol 41 ◽  
Author(s):  
Patrick Simen ◽  
Fuat Balcı
Keyword(s):  
Decision Making ◽  
Perceptual Decision Making ◽  
Reward Rate ◽  
Perceptual Decision ◽  
Standard Observer ◽  
Rate Maximization ◽  
Reward Rate Maximization ◽  
Descriptive Standard ◽  
Observer Model

AbstractRahnev & Denison (R&D) argue against normative theories and in favor of a more descriptive “standard observer model” of perceptual decision making. We agree with the authors in many respects, but we argue that optimality (specifically, reward-rate maximization) has proved demonstrably useful as a hypothesis, contrary to the authors’ claims.

LPCD framework: Analytical tool or psychological model?

2018 ◽  
Vol 41 ◽  
Author(s):  
David Danks
Keyword(s):  
Decision Making ◽  
Analytical Tool ◽  
Mathematical Framework ◽  
Bayesian Decision ◽  
Perceptual Decision Making ◽  
Psychological Model ◽  
Psychological Reality ◽  
Psychological Theories ◽  
Target Article ◽  
Bayesian Decision Making

AbstractThe target article uses a mathematical framework derived from Bayesian decision making to demonstrate suboptimal decision making but then attributes psychological reality to the framework components. Rahnev & Denison's (R&D) positive proposal thus risks ignoring plausible psychological theories that could implement complex perceptual decision making. We must be careful not to slide from success with an analytical tool to the reality of the tool components.

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