(A77) Should Response Times continue to be used for Performance Measurement and Targets?

2011 ◽  
Vol 26 (S1) ◽  
pp. s21-s21
Author(s):  
J. Turner
Keyword(s):  
Response Time ◽  
Response Times ◽  
Vital Signs ◽  
Clinical Intervention ◽  
Evidence Base ◽  
Ambulance Service ◽  
Rapid Review ◽  
The Usa ◽  
Life Threatening

PurposeResponse time performance for emergency calls has been used as an indicator of ambulance service quality in England since 1974. It was revised in 1996 with targets set of eight minutes for life-threatening (category A) and 19 minutes for urgent (category B) calls. Internationally, response time has been used as the benchmark for emergency medical services (EMS) performance. The evidence to support use of response times as a quality measure has been examined.MethodsA rapid review was used to assess the evidence base for the eight minute response time target. Also, a descriptive observational study of the clinical characteristics of category B calls was performed using two months patient report form data from one English ambulance service.ResultsFive papers were identified that have examined the relationship between response time and mortality for 911/999 emergency call populations. Four papers were from the USA, and in all cases no survival benefit was found for response times > 5 minutes even after adjustment for variables including age, sex and illness severity. This finding was replicated in one UK study. The descriptive study examined call characteristics for 26,882 category B calls. Half of the patients received no intervention other than basic vital signs measurement and 75% had assessment only. Twenty-five percent required some clinical intervention with the majority only requiring oxygen. Less than 5% received significant intervention such as drugs, intravenous cannula, or airway management.ConclusionsWith the exception of cardiac arrest there is consistent evidence that response time has no impact on mortality for EMS calls. Alternative indicators of quality of care should be developed that allow less focus on time targets and more effort on innovation and development of services which could better meet the needs of the majority of patients who do not have a life-threatening problem.

scholarly journals Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Eamonn Byrne ◽  
Sasha Selby ◽  
Paul Gallen ◽  
Alan Watts
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Shared Decision Making ◽  
Vital Signs ◽  
Ambulance Service ◽  
Guidance Document ◽  
Shared Decision ◽  
Clinical Guidance ◽  
Decision Making Model

<p><strong>Introduction</strong></p><p>Every patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.</p><p><strong>Aim</strong></p><p>For patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.</p><p><strong>Methods</strong></p><p>All NAS incidents closed with a refusal of treatment or transport, from 1<sup>st</sup> Jan 2017 to 9<sup>th</sup> November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.</p><p><strong>Results</strong></p><p>31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.</p><p><strong>Conclusion</strong></p><p>Clinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel.</p>

History and experience of a volunteer ambulance first responder scheme in London

2021 ◽  
Vol 13 (8) ◽  
pp. 344-348
Author(s):  
Saman Al-Sahab ◽  
Aditi Nijhawan ◽  
Tim Kirkby ◽  
Shadman Aziz
Keyword(s):  
Cardiac Arrest ◽  
Blue Light ◽  
Response Times ◽  
Ambulance Service ◽  
First Responder ◽  
Emergency Responders ◽  
Life Saving ◽  
Wide Range ◽  
Life Threatening ◽  
Set Up

Emergency responders (ERs) are volunteers who attend category 1 (immediately life-threatening) and category 2 (emergency) 999 calls on behalf of the London Ambulance Service NHS Trust (LAS). ERs aim to arrive first on scene to these incidents to provide essential life-saving interventions prior to the arrival of further ambulance resources. ERs come from a wide range of backgrounds and undergo a thorough selection, training and mentorship process before advancing to working in a two-person ER crew. Compared to most traditional volunteer first responder schemes, the LAS ER scheme, which was set up in 2008, involves an enhanced skillset, dispatch to medical and traumatic emergencies in addition to cardiac arrest, and the use of blue-light vehicles to reduce response times. Over a period of 13 years, the scheme has grown in scope and size, and now operates with more than 120 volunteers based at seven ambulance stations across London.

scholarly journals Mental health and well-being of healthcare workers during the COVID-19 pandemic in the UK: contrasting guidelines with experiences in practice

BJPsych Open ◽  
2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Norha Vera San Juan ◽  
David Aceituno ◽  
Nehla Djellouli ◽  
Kirsi Sumray ◽  
Nina Regenold ◽  
...  
Keyword(s):  
Mental Health ◽  
Healthcare Workers ◽  
Well Being ◽  
Evidence Base ◽  
Rapid Review ◽  
Front Line ◽  
Contextual Characteristics ◽  
Definition Of ◽  
The Uk

Background Substantial evidence has highlighted the importance of considering the mental health of healthcare workers during the COVID-19 pandemic, and several organisations have issued guidelines with recommendations. However, the definition of well-being and the evidence base behind such guidelines remain unclear. Aims The aims of the study are to assess the applicability of well-being guidelines in practice, identify unaddressed healthcare workers’ needs and provide recommendations for supporting front-line staff during the current and future pandemics. Method This paper discusses the findings of a qualitative study based on interviews with front-line healthcare workers in the UK (n = 33), and examines them in relation to a rapid review of well-being guidelines developed in response to the COVID-19 pandemic (n = 14). Results The guidelines placed greater emphasis on individual mental health and psychological support, whereas healthcare workers placed greater emphasis on structural conditions at work, responsibilities outside the hospital and the invaluable support of the community. The well-being support interventions proposed in the guidelines did not always respond to the lived experiences of staff, as some reported not being able to participate in these interventions because of understaffing, exhaustion or clashing schedules. Conclusions Healthcare workers expressed well-being needs that aligned with socio-ecological conceptualisations of well-being related to quality of life. This approach to well-being has been highlighted in literature on support of healthcare workers in previous health emergencies, but it has not been monitored during this pandemic. Well-being guidelines should explore the needs of healthcare workers, and contextual characteristics affecting the implementation of recommendations.

scholarly journals Thinking Takes Time: Children Use Agents’ Response Times to Infer the Source, Quality, and Complexity of Their Knowledge

2021 ◽  
Author(s):  
Emory Richardson ◽  
Frank Keil
Keyword(s):  
Social Cognition ◽  
Problem Solving ◽  
Response Time ◽  
Response Times ◽  
Task Complexity ◽  
Response Speed ◽  
Behavioral Sciences ◽  
Speed Accuracy ◽  
Fast Responses

Limits on mental speed entail speed-accuracy tradeoffs for problem-solving, but memory and perception are accurate on much faster timescales. While response times drive inference across the behavioral sciences, they may also help laypeople interpret each others’ everyday behavior. We examined children’s (ages 5 to 10) use of agents’ response time to infer the source and quality of their knowledge. In each trial, children saw a pathfinding puzzle presented to an agent, who claimed to have solved it after either 3s or 20s. In Experiment 1 (n=135), children used agents’ response speed to distinguish between memory, perception, and novel inference. In Experiment 2 (n=135), children predicted that fast responses would be inaccurate, but were less skeptical of slow agents. In Experiment 3 (n=128), children inferred task complexity from agents’ speed. Our findings suggest that the simple intuition that thinking takes time may scaffold everyday social cognition.

Does evidence support physiotherapy management of adult female chronic pelvic pain? A systematic review

2012 ◽  
Vol 3 (2) ◽  
pp. 70-81 ◽  
Author(s):  
S. Loving ◽  
J. Nordling ◽  
P. Jaszczak ◽  
T. Thomsen
Keyword(s):  
Clinical Trials ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Intervention Studies ◽  
Clinical Intervention ◽  
Evidence Base ◽  
Risk Of Bias ◽  
Randomised Clinical Trials ◽  
Multidisciplinary Intervention

AbstractBackground and purposeChronic pelvic pain (CPP) is a debilitating condition among women with a major impact on health-related quality of life, work productivity and health care utilisation. The exact prevalence of chronic pelvic pain is not known, but 3.8% is commonly suggested. Musculoskeletal dysfunction is frequently cited as a possible aetiology. Physiotherapy is therefore recommended as one treatment modality. The aim of this systematic review was to source and critically evaluate the evidence for an effect of physiotherapy on pain, physical activity and quality of life in the treatment of female CPP.MethodsElectronic databases, conference proceedings, text books and clinical guidelines were searched for quantitative, observational, and prospective clinical intervention studies of female chronic pelvic pain where physiotherapy was a sole or significant component of the intervention. Trial inclusion, data extraction according to predefined criteria and risk of bias assessment were performed by two independent authors. Methodological quality of the included clinical intervention studies was assessed using The Cochrane Collaboration’s tool for assessing risk of bias. Review Manager (RevMan) version 5.0 was used for data analysis. Effect estimates (relative risk, mean difference and mean change) with 95% confidence intervals were calculated for the above outcomes. For significant outcomes the numbers needed to treat were calculated.ResultsThe search strategy identified 3469 potential articles. Of these, 11 articles, representing 10 studies, met the inclusion criteria. There were 6 randomised clinical trials, 1 cohort study and 3 case series. Methodological quality was dependent on study type. Accordingly, level of evidence was judged higher in randomised clinical trials than in the other study types. Physiotherapy treatments varied between studies and were provided in combination with psychotherapeutic modalities and medical management. This did not allow for the ‘stand-alone’ value of physiotherapy to be determined. Heterogeneity across the studies, with respect to participants, interventions, outcome measures and times of follow-up, prevented meta-analysis. Narrative synthesis of the results, based on effect estimates and clinically relevant pain improvement, disclosed some evidence to support an effect of multidisciplinary intervention and Mensendieck somatocognitive therapy on female chronic pelvic pain.ConclusionChronic pelvic pain in women is a major health care problem with no specific therapies and poor prognosis. There seems to be some evidence to support the use of a multidisciplinary intervention in the management of female chronic pelvic pain. Somatocognitive therapy is a new approach that appears to be promising and randomised clinical trials are underway in order to establish its evidence base.ImplicationsBased on the findings of this review, recommendations for physiotherapy in chronic pelvic pain clinical guidelines, textbooks and narrative reviews should be interpreted with caution due to the lack of a sufficient evidence base. Only small and largely non-randomised studies have been undertaken of physiotherapeutic interventions and this greatly limits the available evidence on which to base clinical practice. High quality randomised clinical trials are therefore urgently needed.

scholarly journals Tele-EMS physicians improve life-threatening conditions during prehospital emergency missions

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hanna Schröder ◽  
Stefan K. Beckers ◽  
Klaudia Ogrodzki ◽  
Christina Borgs ◽  
Sebastian Ziemann ◽  
...  
Keyword(s):  
Vital Signs ◽  
Improve Patient Care ◽  
Secondary Outcome ◽  
Telemedicine System ◽  
Threatening Condition ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Drug Doses ◽  
The City

AbstractAlmost seven years ago, a telemedicine system was established as an additional component of the city of Aachen’s emergency medical service (EMS). It allows paramedics to engage in an immediate consultation with an EMS physician at any time. The system is not meant to replace the EMS physician on the scene during life-threatening emergencies. The aim of this study was to analyze teleconsultations during life-threatening missions and evaluate whether they improve patient care. Telemedical EMS (tele-EMS) physician consultations that occurred over the course of four years were evaluated. Missions were classified as involving potentially life-threatening conditions based on at least one of the following criteria: documented patient severity score, life-threatening vital signs, the judgement of the onsite EMS physician involved in the mission, or definite life-threatening diagnoses. The proportion of vital signs indicating that the patient was in a life-threatening condition was analyzed as the primary outcome at the start and end of the tele-EMS consultation. The secondary outcome parameters were the administered drug doses, tracer diagnoses made by the onsite EMS physicians during the missions, and quality of the documentation of the missions. From January 2015 to December 2018, a total of 10,362 tele-EMS consultations occurred; in 4,293 (41.4%) of the missions, the patient was initially in a potentially life-threatening condition. Out of those, a total of 3,441 (80.2%) missions were performed without an EMS physician at the scene. Records of 2,007 patients revealed 2,234 life-threatening vital signs of which 1,465 (65.6%) were remedied during the teleconsultation. Significant improvement was detected for oxygen saturation, hypotonia, tachy- and bradycardia, vigilance states, and hypoglycemia. Teleconsultation during missions involving patients with life-threatening conditions can significantly improve those patients' vital signs. Many potentially life-threatening cases could be handled by a tele-EMS physician as they did not require any invasive interventions that needed to be performed by an onsite EMS physician. Diagnoses of myocardial infarction, cardiac pulmonary edema, or malignant dysrhythmias necessitate the presence of onsite EMS physicians. Even during missions involving patients with life-threatening conditions, teleconsultation was feasible and often accessed by the paramedics.

scholarly journals Slow response times undermine trust in algorithmic (but not human) predictions

2019 ◽  
Author(s):  
Emir Efendic ◽  
Philippe van de Calseyde ◽  
Anthony M Evans
Keyword(s):  
Response Time ◽  
Response Times ◽  
Perceived Quality ◽  
Slow Response ◽  
Total N ◽  
Perceived Effort ◽  
Prediction Quality ◽  
Complex Processes ◽  
The Relationship

Algorithms consistently perform well on various prediction tasks, but people often mistrust their advice. Here, we demonstrate one component that affects people’s trust in algorithmic predictions: response time. In seven studies (total N = 1928 with 14,184 observations), we find that people judge slowly generated predictions from algorithms as less accurate and they are less willing to rely on them. This effect reverses for human predictions, where slowly generated predictions are judged to be more accurate. In explaining this asymmetry, we find that slower response times signal the exertion of effort for both humans and algorithms. However, the relationship between perceived effort and prediction quality differs for humans and algorithms. For humans, prediction tasks are seen as difficult and effort is therefore positively correlated with the perceived quality of predictions. For algorithms, however, prediction tasks are seen as easy and effort is therefore uncorrelated to the quality of algorithmic predictions. These results underscore the complex processes and dynamics underlying people’s trust in algorithmic (and human) predictions and the cues that people use to evaluate their quality.

Psychological influences on wound healing

2019 ◽  
Vol 98 (8) ◽  
pp. 312-314
Keyword(s):  
Wound Healing ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Wound Complications ◽  
State Of Mind ◽  
Life Threatening ◽  
Psychological Influences ◽  
Fear And Anxiety ◽  
Care Costs

Surgical wound complications remain a major cause of morbidity; although usually not life threatening, they reduce the quality of life. They are also associated with excessive health care costs. Wound healing is affected by many factors – wound characteristics, infection, comorbidities and nutritional status of the patient. In addition, though, psychological stress and depression may decrease the inflammatory response required for bacterial clearance and so delay wound healing, as well. Although the patient´s state of mind can be influenced only to a certain extent, we should nevertheless stick to ERAS (Enhanced Recovery After Surgery) guidelines and try to diminish fear and anxiety by providing enough information preoperatively, pay due attention to postoperative analgesia and seek to provide an agreeable environment.

Effect of new dietary supplement on sperm quality

2012 ◽  
Vol 153 (45) ◽  
pp. 1787-1792 ◽  
Author(s):  
Mária Horváth ◽  
Endre Czeizel
Keyword(s):  
Adverse Effect ◽  
Clinical Trial ◽  
Dietary Supplement ◽  
Male Fertility ◽  
Sperm Quality ◽  
Sperm Count ◽  
Before And After ◽  
The Usa ◽  
New Treatments

Introduction: There is a decline in male fertility thus new treatments are needed. Aims: To test the efficacy of a new dietary supplement developed in the USA and registered as a curing drug in Hungary (OGYI). Methods: In a clinical trial 100 men with low sperm quality (spermium count 5–20 M/ml, good motility 10–40%, and adverse shape 30–50%) were examined. Results: Sperm parameters were measured before and after a 3-month treatment and after another 3-month without treatment. This dietary supplement statistically and clinically significantly improved sperm count and motility. In 74 cases this dietary supplement demonstrated a beneficial effect on sperm quality (more than 10% increase in sperm count, or quality of motility, or shape); in 16 cases the improvement exceeded 30%. No adverse effect could be accounted for this treatment. Conclusions: This new dietary supplement may contribute to the treatment of male infertility. Orv. Hetil., 2012, 153, 1787–1792.

Time after time: support for memory accounts of temporal preparation.

2019 ◽  
Author(s):  
Joe Butler ◽  
Samuel Ngabo ◽  
Marcus Missal
Keyword(s):  
Response Times ◽  
Reaction Times ◽  
Evidence Base ◽  
Higher Order ◽  
Order Effects ◽  
Previous Trial ◽  
Adaptive Responses ◽  
Temporal Preparation ◽  
Subsequent Trial ◽  
Higher Order Effects

Complex biological systems build up temporal expectations to facilitate adaptive responses to environmental events, in order to minimise costs associated with incorrect responses, and maximise the benefits of correct responses. In the lab, this is clearly demonstrated in tasks which show faster response times when the period between warning (S1) and target stimulus (S2) on the previous trial was short and slower when the previous trial foreperiod was long. The mechanisms driving such higher order effects in temporal preparation paradigms are still under debate, with key theories proposing that either i) the foreperiod leads to automatic modulation of the arousal system which influences responses on the subsequent trial, or ii) that exposure to a foreperiod results in the creation of a memory trace which is used to guide responses on the subsequent trial. Here we provide data which extends the evidence base for the memory accounts, by showing that previous foreperiod exposures are cumulative with reaction times shortening after repeated exposures; whilst also demonstrate that the higher order effects associated with a foreperiod remain active for several trials.

Sign in / Sign up

Export Citation Format

Share Document