scholarly journals Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Joanna M. Blodgett ◽  
Duncan J. Robertson ◽  
Elspeth Pennington ◽  
David Ratcliffe ◽  
Kenneth Rockwood
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Scoping Review ◽  
Positive Impact ◽  
Grey Literature ◽  
Secondary Contact ◽  
Supporting Evidence ◽  
Patient Centered ◽  
Centered Care ◽  
Alternate Routes

Abstract Background The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known. Methods This scoping review sought to identify all studies that examined alternate routes of care for the non-urgent “intermediate” patient, as triaged on scene. Search terms for the sample (ambulances, paramedics, etc.) and intervention (e.g. referrals, alternate care route, non-conveyance) were combined. Articles were systematically searched using four databases and grey literature sources (February 2020). Independent researchers screened title-abstract and full text stages. Results Of 16,037 records, 41 examined alternate routes of care after triage by the on-scene paramedic. Eighteen articles considered quantitative patient data, 12 studies provided qualitative perspectives while 11 were consensus or opinion-based articles. The benefits of alternative schemes are well-recognised by patients, paramedics and stakeholders and there is supporting evidence for a positive impact on patient-centered care and operational efficiency. Challenges to successful use of schemes included: patient safety resulting from incorrect triage decisions, inadequate training, lack of formal partnerships between ambulance and supporting services, and insufficient evidence to support safe implementation or continued use. Studies often inaccurately defined success using proxies for patient safety (e.g. decision comparisons, rates of secondary contact). Finally, patients expressed willingness for such schemes but their preference must be better understood. Conclusions This broad summary offers initial support for alternate routes of care for intermediate, non-urgent patients. Even so, most studies lacked methodologically rigorous evidence and failed to evaluate safe patient outcomes. Some remedies appear to be available such as formal triage pathways, targeted training and organisational support, however there is an urgent need for more research and dissemination in this area.

Usability evaluation of a mHealth application to support patient journey at pediatric emergency department (Preprint)

2020 ◽  
Author(s):  
Jessica Rochat ◽  
Frédéric Ehrler ◽  
Arnaud Ricci ◽  
Victor Garretas Ruiz ◽  
Christian Lovis
Keyword(s):  
Emergency Department ◽  
Interaction Design ◽  
Mobile Application ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Patient Centered ◽  
Patient Journey ◽  
Care Processes ◽  
System Usability Scale ◽  
Centered Care

BACKGROUND Patient experience at pediatric emergency department (PED) remain suboptimal. As an attempt to support the patients and their families before, during and after visit at PED, we have developed InfoKids, a mobile application guided by the patient centered care principle. OBJECTIVE The objective of this study is to assess the usability of the Infokids mobile application. METHODS The app was assessed through an in lab evaluation were participants had to execute 7 tasks of a scenario leading them from the installation of the app till the reception of a diagnostic sheet linked to the care episode. All interactions were recorded and usability flaws were analyzed in regards with usability criteria. A system usability scale questionnaire was also filled by the participant to compare our system with other. RESULTS A total of 17 parents, 15 women and 2 men (ages 26-53) participated in the study. Overall, they were mostly satisfied with the navigation, layout and interaction design of the app. Most of the problems encountered were related with navigation, especially difficulties for some participants to find the location of the action to perform. CONCLUSIONS empowering patient through mobile application supporting care processes has the potential to improve both care efficiency and to release pressure on healthcare system. The success of these applications is however linked to an optimal user experience that can be improved through usability testing.

scholarly journals Patient-Centered Care: An Examination of Provider–Patient Communication Over Time

2019 ◽  
Vol 6 ◽  
pp. 233339281988287
Author(s):  
Leslie Riggle Miller ◽  
B. Mitchell Peck
Keyword(s):  
Positive Impact ◽  
Patient Centered Care ◽  
Patient Communication ◽  
Self Report ◽  
Primary Data ◽  
Provider Communication ◽  
Patient Centered ◽  
Centered Care ◽  
Over Time

Objective: To examine the quality of provider communication over time considering the increasing emphasis on patient-centered care (PCC). Patient-centered care has been shown to have a positive impact on health outcomes, care experiences, quality-of-life, as well as decreased costs. Given this emphasis, we expect that provider–patient communication has improved over time. Data Source: We collected primary data by self-report surveys between summer 2017 and fall 2018. Study Design: We use a quantitative retrospective cohort study of a national sample of 353 patients who had an ostomy surgery. Data Extraction Method: We measure provider communication from open-ended self-reports from patients of the number of stated inadequacies in their care. Principal Findings: Results show that the time since patients had their surgery is related to higher quality provider communication. That is, patients who had their surgery further back in time reported higher quality provider communication compared with patients who had their surgery performed more recently. Conclusion: Results suggest that the quality of provider communication has not improved even with an emphasis on PCC.

Patient-centered care for chronic pain in the emergency department: A qualitative study

2016 ◽  
Vol 24 ◽  
pp. 22-27 ◽  
Author(s):  
Jayalakshmi Jambunathan ◽  
Sharon Chappy ◽  
Jack (John) Siebers ◽  
Alishia Deda
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Qualitative Study ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Centered Care

scholarly journals Instruments for Measuring Incidents Related to Patient Safety in the Context of Paediatric Intensive Care - Protocol for a Scoping Review

2021 ◽  
Author(s):  
Helga Oliveira ◽  
Ricardo Rafael Marques ◽  
Maria Alice Santos Curado ◽  
Maria Filomena Gaspar ◽  
Paulo Sousa
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Scoping Review ◽  
Selection Process ◽  
Grey Literature ◽  
Public Health Problem ◽  
Paediatric Intensive Care ◽  
Sources Of Information ◽  
Measurement Instruments ◽  
Care Protocol

Abstract Background: Patient safety is a fundamental principle of health care, but one of the biggest challenges currently faced and a serious public health problem, since the occurrence of adverse events is probably one of the main causes of morbidity and mortality worldwide. The vulnerability of the paediatric population, combined with the potentially dangerous context of intensive care, makes Paediatric Intensive Care Units services of particular complexity in matters of safety, where there is a greater likelihood of incidents with serious consequences. It is agreed that research on the topic of PS should start with the measuring of different types of harm that exist in the contexts, to identify high-risk areas and define priorities. For this, it is necessary to resort to a multiplicity of valid, reliable and specific measurement instruments and to learn their advantages and limitations. Objectives: Identify and map in scientific literature the instruments for measuring incidents related to patient safety applicable in the context of paediatric intensive care.Methods: This review will cover studies and documents that refer to all measurement instruments used in the field of ​​patient safety in a context of paediatric intensive care. Published studies of a quantitative, qualitative or mixed nature and grey literature relevant to the topic will be included, in Portuguese, English or Spanish and produced since 2015. The sources of information include several databases and sources relevant to grey literature. The two authors will independently conduct the entire data selection process. The results of the research strategy will be presented in a PRISMA flowchart. The extracted data, after being organised in the extraction table, will be mapped in a descriptive and logical way, taking into account the defined review questions.Discussion: The mapping of the tools in these protocol will allow to summarize the most widely used instruments, to know their specificities and to guide researchers to use the most appropriate measurement tools for their context, specifically, in paediatric intensive care.Scoping Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/dashboard, DOI https://doi.org/10.17605/OSF.IO/V435E.

scholarly journals How the use of a patient-accessible health record contributes to patient-centered care: Scoping review. (Preprint)

10.2196/17655 ◽  
2020 ◽  
Author(s):  
Janine Benjamins ◽  
Annemien Haveman ◽  
Marian Gunnink ◽  
Annemieke Goudkuil ◽  
Emely de Vet
Keyword(s):  
Scoping Review ◽  
Patient Centered Care ◽  
Health Record ◽  
Patient Centered ◽  
Centered Care

scholarly journals OP120 Rapid Qualitative Reviews: A Scoping Review Of Guidance And Examples

2018 ◽  
Vol 34 (S1) ◽  
pp. 45-45
Author(s):  
Fiona Campbell ◽  
Laura Weeks ◽  
Andrew Booth ◽  
David Kaunelis ◽  
Andrea Smith
Keyword(s):  
Qualitative Research ◽  
Scoping Review ◽  
Literature Search ◽  
De Novo ◽  
Evidence Synthesis ◽  
Grey Literature ◽  
Decision Makers ◽  
Medical Subject Headings ◽  
Patient Centered ◽  
Guidance Documents

Introduction:Decision-makers are increasingly recognizing the usefulness of qualitative research to inform patient-centered policy decisions, and are accordingly increasingly demanding qualitative evidence as part of health technology assessment (HTA). In the context of tight HTA timelines, a new form of evidence synthesis has emerged—rapid qualitative reviews. The need for rapidity requires either an increase in resources or, more commonly, a compromise in rigor, yet guidance on appropriate compromises for qualitative reviews is lacking.Methods:In order to inform de novo guidance, we conducted a systematic scoping review to identify existing guidance and published examples of rapid qualitative reviews. We searched Medline and CINAHL using medical subject headings and keywords related to “rapid reviews” and “qualitative” research, and screened the 1,771 resultant citations independently in duplicate. Additionally, we searched the grey literature and solicited examples from our contacts and other evidence-synthesis organizations. We summarized included guidance and reviews using the Search, AppraisaL, Synthesis, Analysis (SALSA) framework to identify abbreviations in the review process.Results:We found no guidance documents specific to rapid qualitative reviews. We found one published peer-reviewed rapid qualitative review, and several more (>10; grey literature search in process) through our organizational contacts. While methods to abbreviate the process are poorly reported, an abbreviated literature search (years and databases searched) and the use of a single reviewer appear common.Conclusions:A number of agencies are producing rapid qualitative reviews, however our review identifies the urgent need to develop and explore methods for the synthesis of qualitative research that balance rapidity and rigor.

scholarly journals 2183 Balancing patient-centeredness and patient safety in the hospitals: The case of pain care and patient satisfaction

2018 ◽  
Vol 2 (S1) ◽  
pp. 79-79
Author(s):  
Olena Mazurenko ◽  
Basia Andraka-Christou ◽  
Matthew Bair ◽  
Areeba Kara ◽  
Christopher A. Harle
Keyword(s):  
Patient Safety ◽  
Patient Satisfaction ◽  
Hospitalized Patients ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Bargaining Process ◽  
Pain Medications ◽  
Centered Care ◽  
Complex Decision Making ◽  
Pain Care

OBJECTIVES/SPECIFIC AIMS: This study seeks to understand the relationship between opioid prescribing and patient satisfaction among non-surgical, hospitalized patients. As part of this study, we qualitatively examined challenges in delivering safe and patient-centered care through voices of physicians’, and nurses.’ METHODS/STUDY POPULATION: We collected data through in-person interviews using semi-structured guides tailored to the informant roles. Study participants came from 1 healthcare system located in a mid-Western state. Each interview lasted 30–45 minutes, was audio-recorded with consent, and transcribed for analysis. Two researchers each coded 17 transcripts for discussions around patient-centeredness (including patient satisfaction, patient experiences), and patient safety for hospitalized patients experiencing pain. Analysis followed a general inductive approach, where researchers identified themes related to the research questions using an open coding technique. They discussed and reached consensus on all codes, and extracted several preliminary themes. The analysis was supported by NVivo software. RESULTS/ANTICIPATED RESULTS: The following themes emerged: (1) complex decision-making process to prescribe opioids for hospitalized patients; (2) the role of objective findings in prescribing decisions; (3) bargaining process in prescribing opioids; (4) balancing patient-centeredness and patient safety for selected populations; (5) opioids are the predominant medications for pain care. DISCUSSION/SIGNIFICANCE OF IMPACT: Clinicians’ decision to prescribe opioids for nonsurgical hospitalized patients is based on multiple factors, including patient’s condition, patient’s preference for pain medications, or standard hospital’s pain care regimen. Interventions that improve clinicians’ ability to prescribe opioids may be needed to improve delivery of patient-centered and safe pain care.

scholarly journals Models of care for frail older persons who present to the emergency department: a scoping review protocol

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Ya-Ling Huang ◽  
Megan McGonagle ◽  
Rebecca Shaw ◽  
Julie Eastham ◽  
Nemat Alsaba ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Scoping Review ◽  
Older Persons ◽  
Grey Literature ◽  
Models Of Care ◽  
The Body ◽  
Model Of Care ◽  
Frail Older People ◽  
Frail Older Persons

Abstract Background People aged ≥ 65 years comprise around 1 in 5 emergency department (ED) presentations. Many of these presentations occur due to complications associated with chronic diseases and frailty. This review aims to provide a comprehensive understanding of available research regarding models of care for frail older people presenting to the ED. Methods The Joanna Briggs Institute scoping review framework will be used to guide this review. Literature searches will be conducted in the following electronic databases (from January 2009 onwards): CINAHL via EBSCOhost, Ovid MEDLINE, Embase, SocINDEX. Grey literature will be identified through searching Google Scholar. This review will consider primary research studies (including observational and interventional studies) published in English on models of care for frail older people (aged ≥ 65) presenting to the ED. Two researchers will independently screen all citations, full-text articles, and abstract data. Potential disagreements will be resolved through discussion with a third researcher. Data extracted from included studies will include the following: author(s), year of publication, country, research design and aim, time frame of the study, study population and sample size, data collection methods, definition of frailty, model of care, and key findings that pertain to the ability to inform this review. The strength of the body of evidence will be assessed using the National Health and Medical Research Council level of evidence hierarchy body of evidence matrix. Data will be presented in a tabular format and accompanied by a narrative that describes the characteristics of the body of literature. Discussion Despite the increased number of ED presentations for frail older people, there has been no synthesis of the sources of evidence of model of care for frail older people in the setting of emergency care. The results of this scoping review will provide an overview of different models of care and help inform future research in the development of models of care for frail older persons, tailored to the healthcare system in the emergency context. Systematic review registration This scoping review has been registered in the Open Science Framework (osf.io/h2t94).

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