scholarly journals The "unclear problem" category: An analysis of its implications and effects on the emergency medical dispatch process in Copenhagen, Denmark

2021 ◽  
Author(s):  
Helle Collatz Christensen ◽  
Sterre Otten ◽  
Cassandra Rehbock ◽  
Thomas Krafft ◽  
Martin Vang Haugaard ◽  
...  
Keyword(s):  
Patient Safety ◽  
Prehospital Care ◽  
Sustainable Use ◽  
The Elderly ◽  
Public Welfare ◽  
Emergency Call ◽  
Medical Emergency ◽  
Emergency Medical Dispatch ◽  
Emergency Medical ◽  
The Impact

Abstract ObjectiveAn effective emergency medical dispatch process is vital to provide appropriate prehospital care to patients. It increases patient safety and ensures the sustainable use of medical resources. Although Copenhagen has a sophisticated emergency medical services (EMS) system with a significant focus on public welfare, more than 10% of emergency calls are still being categorized as an "unclear problem" and are thus not categorized as "symptom-specific". Therefore, the objective of this research is to gain a better understanding of underlying implications that lead to the categorization of an emergency call as "unclear". This research investigates the effects of the "unclear problem" category (UPC) on the medical dispatching process at the emergency medical dispatch center in Copenhagen. Also, it explores the effectiveness of educating medical dispatchers about the use of the UPC to reduce its use. MethodsThis was a register-based study based on medical emergency call data. Descriptive analyses were conducted to investigate the effect of using the UPC on the medical dispatching process and determine the impact of alerting medical dispatchers to reduce its use. ResultsThe UPC accounted for 11.4% of the calls. Elderly patients were most often dispatched with the UPC. The UPC could impact the medical dispatching process in several potentially harmful, ways. Namely, it could lead to under or over triage and lead to inefficient use of EMS resources. Sensitizing medical dispatchers about the use of the UPC could have contributed to the decrease in the use of the UPC. ConclusionThe use of the UPC could have negative implications on patients' outcomes and the efficient use of EMS resources due to its possible impact on over-or under triage. The UPC is mainly used when dispatching the elderly. Nonetheless, the use of the UPC decreased throughout the study period after the medical dispatchers were alerted about the implications of its use.

Use of medical emergency call data as a marker of quality of emergency department care in the post-National Emergency Access Target era

2018 ◽  
Vol 42 (5) ◽  
pp. 607
Author(s):  
Lorraine Westacott ◽  
Judy Graves ◽  
Mohsina Khatun ◽  
John Burke
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Quality Of Care ◽  
Emergency Admission ◽  
Emergency Call ◽  
Medical Emergency ◽  
Negative Consequences ◽  
Model Of Care ◽  
Emergency Calls

Objectives Any new model of care should always be accompanied by rigorous monitoring to ensure that there are no negative consequences, especially any that impact upon patient safety. In 2013, ‘THERMoSTAT’ (Two- Hour Evaluation and Referral Model for Shorter Turnaround Times), an emergency department model of care developed by Royal Brisbane and Women’s Hospital staff was launched to gain efficiencies and improve hospital National Emergency Access Target (NEAT) compliance. The aim of this study was to trial the use of medical emergency call data as a novel marker of the quality of care delivered by our emergency department. Methods Incidence of medical emergency calls for hospital emergency admission patients for the 2 years pre- and 1 year post-THERMoSTAT were compared after standardising for overall hospital activity. Results During the study period, hospital activity increased 10%, and the emergency department experienced a total of 222 645 presentations, 68 000 (30.5%) of which converted into an admission. THERMoSTAT improved NEAT compliance by 17% (from 57.7% to 74.9%) with no change in any patient-safety indicators. A total of 8432 medical emergency calls were made on 5930 patients, 2831 of whom were emergency admissions. After adjusting for hospital activity, there was no change in the average number of patients per week who triggered a medical emergency call after the introduction of THERMoSTAT. These results were reproduced when data was analysed for: total number of inpatients triggering calls; emergency admission patients; and emergency admission patients within the first 24 h or first 4 h of admission. Conclusions This is the first report to investigate the correlation between inpatient medical emergency call incidence and emergency department model of care. Medical emergency call data showed significant promise as a measure of morbidity and as a more direct, objective, simple, quantitative and meaningful measure of patient safety. What is known about the topic? It is well established that extended emergency department lengths of stay are associated with poorer patient outcomes. The corollary of this is not always true however; shorter emergency department length of stay does not automatically translate into better care. Although the underlying philosophy of NEAT is to enhance patient care, there is a risk of negative consequences if NEAT is seen as an end in itself. Many of the commonly used emergency department key performance indicators focus on the timeliness of care and there is a scarcity of easily quantifiable markers that reliably reflect the quality of that care. What does this paper add? This study builds on the concept of medical emergency call incidence as a marker of safety and quality. It explores the utility of using the number of medical emergency calls made in the first few hours of an emergency admission as an indicator of the quality of care delivered by the emergency department. This is significant because it introduces a measure that has a focus that embraces more than the timeliness of care only. What are the implications for practitioners? If medical emergency call incidence in early emergency admissions can be proven to accurately reflect emergency department quality of care then it would provide an easily monitored, objective, quantitative and prompt measure that evaluates dimensions other than timeliness.

scholarly journals Data-driven approach to Early Warning Score-based alert management

2018 ◽  
Vol 7 (3) ◽  
pp. e000088 ◽  
Author(s):  
Muge Capan ◽  
Stephen Hoover ◽  
Kristen E Miller ◽  
Carmen Pal ◽  
Justin M Glasgow ◽  
...  
Keyword(s):  
Patient Safety ◽  
Early Warning ◽  
Early Recognition ◽  
Clinical Information ◽  
Patient Characteristics ◽  
The Elderly ◽  
Early Warning Score ◽  
The Right ◽  
The Impact ◽  
Alerting Systems

BackgroundIncreasing adoption of electronic health records (EHRs) with integrated alerting systems is a key initiative for improving patient safety. Considering the variety of dynamically changing clinical information, it remains a challenge to design EHR-driven alerting systems that notify the right providers for the right patient at the right time while managing alert burden. The objective of this study is to proactively develop and evaluate a systematic alert-generating approach as part of the implementation of an Early Warning Score (EWS) at the study hospitals.MethodsWe quantified the impact of an EWS-based clinical alert system on quantity and frequency of alerts using three different alert algorithms consisting of a set of criteria for triggering and muting alerts when certain criteria are satisfied. We used retrospectively collected EHRs data from December 2015 to July 2016 in three units at the study hospitals including general medical, acute care for the elderly and patients with heart failure.ResultsWe compared the alert-generating algorithms by opportunity of early recognition of clinical deterioration while proactively estimating alert burden at a unit and patient level. Results highlighted the dependency of the number and frequency of alerts generated on the care location severity and patient characteristics.ConclusionEWS-based alert algorithms have the potential to facilitate appropriate alert management prior to integration into clinical practice. By comparing different algorithms with regard to the alert frequency and potential early detection of physiological deterioration as key patient safety opportunities, findings from this study highlight the need for alert systems tailored to patient and care location needs, and inform alternative EWS-based alert deployment strategies to enhance patient safety.

scholarly journals Emergency medical dispatch recognition, clinical intervention and outcome of patients in traumatic cardiac arrest from major trauma: an observational study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022464
Author(s):  
Craig Prentice ◽  
Jeyasankar Jeyanathan ◽  
Richard De Coverly ◽  
Julia Williams ◽  
Richard Lyon
Keyword(s):  
Cardiac Arrest ◽  
Significant Proportion ◽  
Helicopter Emergency Medical Service ◽  
Medical Intervention ◽  
Emergency Call ◽  
Blood Product Transfusion ◽  
Emergency Medical Dispatch ◽  
Resuscitative Thoracotomy ◽  
Traumatic Cardiac Arrest ◽  
Emergency Medical

ObjectivesThe aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate.SettingHelicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5 million and a transient population of up to 8 million people.ParticipantsPatients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust’s geographical region were identified. The inclusion criteria were all cases of reported TCA on receipt of the initial emergency call. Patients were subsequently excluded if a medical cause of cardiac arrest was suspected.Outcome measuresPatient records were analysed for actual presence of cardiac arrest, prehospital resuscitation procedures undertaken and for survival to hospital rates.Results112 patients were reported to be in TCA on receipt of the 999/112 call. 51 (46%) were found not to be in TCA on arrival of emergency medical services. Of the ‘not in TCA cohort’, 34 (67%) received at least one advanced prehospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved return-of-spontaneous circulation. In 45 (88%) patients, the HEMS team escorted the patient to hospital.ConclusionA significant proportion of patients reported to be in TCA on receipt of the emergency call are not in actual cardiac arrest but are critically unwell requiring advanced prehospital medical intervention. Early activation of an enhanced care team to a reported TCA call allows appropriate advanced resuscitation. Further research is warranted to determine which interventions contribute to improved TCA survival.

Resident and RN perceptions of the impact of a medical emergency team on education and patient safety in an academic medical center*

2009 ◽  
Vol 37 (12) ◽  
pp. 3091-3096 ◽  
Author(s):  
Babak Sarani ◽  
Seema Sonnad ◽  
Meredith R. Bergey ◽  
Joanne Phillips ◽  
Mary Kate Fitzpatrick ◽  
...  
Keyword(s):  
Patient Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Emergency Team ◽  
Academic Medical ◽  
The Impact

Knowledge and Attitudes of the Out-Of-Hospital Emergency Care Consumers in Santo Domingo, Dominican Republic

2008 ◽  
Vol 23 (4) ◽  
pp. 373-376 ◽  
Author(s):  
Amado Alejandro Báez ◽  
Ediza Giraldez ◽  
Peter L. Lane ◽  
Charles Pozner ◽  
Juan Rodriguez ◽  
...  
Keyword(s):  
Dominican Republic ◽  
Medical Care ◽  
Prehospital Care ◽  
Statistical Significance ◽  
Medical Emergency ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Emergency Medical Care ◽  
Santo Domingo ◽  
Emergency Medical

AbstractIntroduction:Prehospital emergency services are a vital public service, and consumer access to the system is an important factor in their use. The Dominican Republic recently experienced “the epidemiological transition” leading to increased morbidity and mortality secondary to traumatic and cardiac conditions—thus, increasing the need for prompt and adequate delivery of emergency medical care.Methods:A survey was administered to 90 subjects from diverse backgrounds, all living in Santo Domingo. Survey items included questions on emergency medical services (EMS) systems knowledge (i.e., access numbers), confidence in the system, first-aid education and prior experience with the EMS system. Chi-square was used to measure statistical significance for categorical variables and Student's t-test for continuous variables (JMP 2.0 software was used for statistical processing).Results:A total of 90 subjects were surveyed. The average age of respondents was 36 ± 12 years SD. More than one-fifth (22.2%) of respondents did not know the established universal emergency number (9-1-1), and 37.8% responded that they would access a different telephone number in case of a medical emergency.Conclusions:Important deficiencies and access-to-care concerns were interpreted from the results. An adequate understanding of the current state of prehospital care could lead to creation of policies by system administrators to further improve the delivery of emergency medical care. This study will assist system administrators in future design and policy issues.

scholarly journals Impact of a visual indicator on the noise level in an emergency medical dispatch center - a pilot study

2020 ◽  
Author(s):  
Justin Outrey ◽  
Jean-Baptiste Pretalli ◽  
Sophie Pujol ◽  
Alice Brembilla ◽  
Thibaut Desmettre ◽  
...  
Keyword(s):  
Noise Level ◽  
Ambient Noise ◽  
Well Being ◽  
University Hospital ◽  
Emergency Medical Dispatch ◽  
Baseline Phase ◽  
Effective Prevention ◽  
Ambient Noise Level ◽  
Emergency Medical ◽  
The Impact

Abstract Background A maximum of 52 to 55 dB(A) is recommended in order to prevent adverse events in call centres. We aimed at assessing the noise level and the impact of a visual noise indicator on the ambient noise level in a French Regional Emergency Medical Dispatch Centre (EMDC). Methods We conducted an observational study in the EMDC of the SAMU25 (University Hospital of Besancon). We measured the noise level using a SoundEarII® noise indicator (Dräger Medical SAS, France). The measurement took place in two phases on three consecutive days from 00:00 to 11:59 PM. At baseline, phase 1, the device recorded the average ambient noise for each minute without visual indication. Secondly, phase 2 included a sensor mounted with a light that would turn on if noise ever exceeded 65 and 75 dB(A). Results The sound level was greater than 52 dB(A) in 97.2% and 66.8% of the time in phases 1 and 2 respectively; this level was greater than 55 dB(A) in 84.9% and 43.9% of the time in phases 1 and 2 respectively.Conclusions The noise levels were higher than recommended and sometimes close to legal limits, requiring preventive measures. The noise indicator had a positive effect on the ambient noise level. This work will allow the implementation of effective prevention solutions and, based on future assessments, could improve operators’ well-being and better care for patient.

Improving emergency medical care for psychiatric inpatients

2011 ◽  
Vol 26 (S2) ◽  
pp. 1722-1722
Author(s):  
C. Gordon ◽  
F. Cheema ◽  
J. Graham
Keyword(s):  
Medical Care ◽  
Qualitative Interviews ◽  
Primary Objective ◽  
Medical Emergency ◽  
Psychiatric Ward ◽  
Emergency Medical Care ◽  
Modest Improvement ◽  
Emergency Medical ◽  
Psychiatric Staff ◽  
The Impact

IntroductionAt the European Psychiatric Association's International Congress 2010, we reported on psychiatric staff confidence regarding emergency medical care in our poster: “How Well Prepared is a Psychiatric Ward for Dealing with a Medical Emergency?”. This work highlighted areas for improvement, including staff confidence and familiarity with equipment. Consequently, several aspects of practice were enhanced, including addressing training shortfalls alongside adopting a uniform layout for emergency trolleys. In order to identify improvement, the process was re-audited with a new qualitative component to gather staff opinion.ObjectivesOur primary objective was to examine whether our interventions had improved staff confidence with regard emergency medical care. Our secondary objectives included exploring staff attitudes toward delivery of such care and to identify further areas for improvement.AimsOur primary aim was to evaluate the impact of our interventions on delivery of emergency medical careMethodsOur original questionnaire survey was repeated and the results compared with those obtained previously. Additionally, a series of semi-structured qualitative interviews will be performed with staff to compliment the questionnaires.ResultsResults will be available in February 2011.ConclusionsGiven that psychiatric patients often suffer from significant physical health problems, it is imperative that staff are comfortable in delivering initial emergency medical care. We anticipate our results will demonstrate modest improvement. Clinical governance is an ongoing process, therefore the most important conclusions to be drawn will be our recommendations for future work, which will encompass the next step in our efforts to improve delivery of emergency medical care.

TREAT MENT OF PAIN DURING EMERGENCY MEDICA L SERVICES

2020 ◽  
Vol 7 (2) ◽  
pp. 135-145
Author(s):  
Dawid Surowicz ◽  
Dominik Gałuszka ◽  
Agnieszka Martyka ◽  
Karolina Penar ◽  
Krystian Wolanin ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Emergency Services ◽  
Opioid Analgesics ◽  
Multimodal Analgesia ◽  
Medical Emergency ◽  
Emergency Medical ◽  
Treat Ment ◽  
Medical Teams ◽  
Medical Emergency Services ◽  
The Impact

Introduction: Pain, while undertaking medical rescue operations, is a common complication of injuries or a symptom of disease entities of internal medicine. Equipping emergency medical teams with painkillers from various groups, gives broad opportunities to fight pain at the pre-hospital stage. The manner of using medicines is regulated by law in the form of an executive regulation to the Act on State Emergency Medical Services, which specifies the type and route of their administration. When undertaking analgesic treatment, one should be aware of the contraindications to the use of individual medications, possible complications of their use, and methods of combining analgesics and co-analgesics as part of multimodal analgesia. The consequence of using medicines may be their impact on the work of the circulatory and respiratory systems, hence it is necessary to observe the patient’s cardiopulmonary stability during medical emergency operations at the call site, during transport and in the Hospital Emergency Department. The aim: This article aims to systematize the knowledge of painkillers available to the paramedic and methods of assessing pain intensity according to the following scales: numerical, verbal, visual-analog and picture for pediatric patients with whom it is possible to make logical contact. Conclusions: 1. Basic emergency teams are equipped with drugs from the following groups: nonsteroidal anti-inflammatory drugs, non-opioid analgesics and opioid analgesics. Thanks to them, it is possible to effectively and noticeably reduce pain at the stage of providing medical emergency services. 2. Despite properly undertaken pain therapy with available means and methods, it may not be possible to completely eliminate pain and clearly determine its etiology at the pre-hospital stage. 3. Available scales allow proper assessment of pain intensity in both pediatric and adult patients. 4. In complex cases, pain should not go away, it is necessary to use multimodal analgesia by combining analgesics of different groups, or to include in analgesic therapy co-analgesics, which, due to the weakening of the impact of a potential cause of pain, may determine the effectiveness of therapy. 5. Establishing the etiology of pain due to the numerous potential pathologies that cause it requires careful assessment of the patient at the stage of providing medical emergency services and the implementation of a full and properly conducted physical examination.

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