Exploring the Feelings of Nurses during Resuscitation—A Cross-Sectional Study

Cardiopulmonary resuscitation (CPR) is one of the most stressful situations in emergency medicine. Nurses involved in performing basic and advanced resuscitation procedures are therefore exposed to a certain amount of stress. The purpose of this study was to determine the stressors and the level of stress experienced by nurses during resuscitation. A cross-sectional quantitative study was done. The sample consisted of 457 nurses who worked in emergency units. First demographic data were collected, followed by a questionnaire regarding the effect of different situations that occur during and after resuscitation on nurses including Post-Code Stress Scale questionnaire. The most disturbing situations for respondents were resuscitation of young person (MV = 3.7, SD = 1.4), when they fail to establish an intravenous pathway (MV = 3.5, SD = 1.4), chaotic situation during resuscitation (MV = 3.4, SD = 1.4) and making decision about termination of resuscitation (MV = 3.1, SD = 1.5). Research has shown that nurses are exposed to a certain amount of stress during resuscitation, but most of them manage to compensate for stress effectively.

Implementation of a Multidisciplinary “Code Hip” Protocol is Associated with Decreased Time to Surgery and Improved Patient Outcomes

Background: The purpose of this study is to report outcomes data based on the implementation of a “Code Hip” protocol, a multidisciplinary approach to the care of fragility hip fracture patients focussing on medical optimization and early operative intervention. We hypothesized that implementation of this protocol would decrease time from presentation to surgical intervention and improve outcomes based on short term post-operative data. Methods: A retrospective chart review was performed on all patients aged greater than 65 years old with a fragility hip fracture from October 2015 through June 2018. In addition to demographic and patient factors, we recorded time to surgery, type of surgical interventions performed, ability to ambulate in the post-operative period, 90-day post-operative complications and overall hospital cost. Results: There were 114 patients in the pre-Code Hip cohort and 132 patients in the post-Code Hip cohort. Demographic factors were not different between the 2 cohorts. Time from presentation to surgery in the post-Code Hip cohort was shorter at 23.1 ± 16.4 hours versus 33.2 ± 27.2 hours (p < 0.001). 30.3% of patients in the post-Code Hip cohort had at least one post-operative complication compared to 42.1% in the pre-Code Hip cohort (RR = 0.72, CI = 0.51 -1.01, p = 0.05). The post-Code Hip cohort had a significantly lower rate of hospital readmission (p = 0.04), unplanned reoperation (p = 0.02), surgical site infection (p = 0.03), and sepsis (p = 0.05). Total hospital cost per patient decreased from an average of $14,079 +/- $10,305 pre-Code Hip cohort to $11,744 +/- $4,174 per patient in the post-Code Hip cohort (p = 0.02). Conclusions: Implementation of our Code Hip protocol, which invokes a multidisciplinary approach to the elderly patient with a fragility hip fracture, is associated with shorter times from presentation to surgery, increased ability to ambulate post-operatively, decreased short term post-operative complication, and decreased hospital costs. Level of Evidence: Therapeutic Level III

The organisational adoption of soft law encouraging joint consultative committees in Mauritius

PurposeJoint consultative committees (JCCs) involving employee representatives exist to stimulate positive employee relations and unlock employee involvement to build organisational performance. They are rare in Africa. Mauritius is a successful, beacon economy for Africa. We therefore investigate which categories of an organisation implemented the 2008 Mauritian government Code of Practice on JCCs, to discover how effective this “soft law” for of institutional change had been three years after its inception, when post-Code JCCs were formed.Design/methodology/approachWe test propositions derived from institutional theory broadly conceived, through analysis of data from 120 organizations in Mauritius responding to a comprehensive HR survey covering a wide range of organisational level policies and practices conducted during the JCC formation period 2011–2012.FindingsBy 2012, nearly 30% of our sample had JCCs. Three quite distinct categories of an organisation created them, as follows: those with substantial union influence, those where strategic HRM was practiced and recently formed organisations. Remarkably, no interaction effects existed between the three categories.Originality/valueSeveral contributions are made to shed light on a previously unstudied institution. First, we empirically establish that over a limited period in response to institutional change in the form of the code of practice, JCCs increased from 10% of organizations to almost 30%. Our second central contribution is to show three principal, quite separate organisational antecedents of JCCs, which do not interact statistically.

Abstract TMP72: Auto-Launching of Interfacility Transport for Presumed Emergent Large Vessel Occlusion Strokes Decreases Door-In-Door-Out (DIDO) Times and May Improve Outcomes

Introduction: Mechanical thrombectomy (MT) is effective for select acute ischemic strokes due to large vessel occlusion (LVO-AIS). Systems of care need to expeditiously identify, transfer, and treat qualifying LVO-AIS. Data are needed to define which ingredients are most effective when engineering LVO-AIS regional systems of care. Methods: Strong Memorial Hospital (SMH) is a Comprehensive Stroke Center in Rochester, NY serving twenty-two New York State designed stroke centers (NYS-DSC). Arnot Ogden Medical Center (AOMC), Cayuga Medical Center (CMC), and Geneva General Hospital (GGH) are NYS-DSCs located 115, 91, and 50 miles from SMH, respectively. Clinical leaders at each site collaborated to implement an integrated regional system of care for LVO-AIS, dubbed “Code LVO”, which includes the auto-launching of an interfacility transport to the referring hospital for presumed strokes with an NIHSS of >/= 10 and last known well time (LKWT) of </=24 hours. We retrospectively reviewed a QA database for transfer patients with an ASPECTS of >/= 6 and proximal anterior circulation LVO on a CTA at the referring hospital to identify the door-in-door-out (DIDO) times, thrombectomy attempt rate, and mortality of patients before and after Code LVO implementation. Wilcoxon Rank-Sum was used to analyze median DIDO times and Fisher’s exact was used to analyze the proportion of DIDO times of < 90 minutes, < 60 minutes, thrombectomy attempt rate, and mortality. Results: There were 51 pre- Code LVO versus 12 post Code-LVO transfers. The median DIDO times were significantly reduced post-Code LVO (80 vs 127 minutes, p=0.001). The proportion of DIDO times < 90 minutes and < 60 minutes were significantly improved (58% vs 16%, p=0.005 and 17% vs 0%, p=0.034, respectively). Mortality was numerically, but not significantly, reduced (17% vs 22%). Median DIDO times were significantly shorter in those undergoing thrombectomy (97 vs 136 minutes, p=0.008) and numerically longer in those who died (138 vs 112 minutes, p=0.24). Conclusions: Auto-launching of interfacility transport within an integrated regional system care for LVO-AIS decreases DIDO times and may improve outcomes. Further study is needed to outline its value, in terms of patient outcomes, resource utilization, and safety.

Experiencing Stress among Nurses during Resuscitation Procedure and Legal Obligations for Healthcare Workers in Slovenia

Nurses are always part of the team that performs resuscitation procedures. In this paper the authors explore the influence that resuscitation procedures on nurses who perform them. For data collection, the authors used a survey with a convenience sample of nurses who work in emergency settings. For statistical processing of data, the authors used the calculation of frequency, standard deviation, means, and median. Authors used Spearman's rank correlation coefficient and calculated the p-value. The respondents in the survey completed the Post-Code Stress Scale. The results show that the majority of the respondents experienced resuscitation cases as burdensome situations; however, the level of stress was moderate. Nurses still experience some physical and psychological symptoms during resuscitations.

Communication in Medical Resuscitation and the Post-Code Debrief

During high-stakes situations, such as resuscitations, effective communication among providers is of utmost importance to ensuring the best potential patient outcomes. Families can be present in resuscitations, adding an additional complexity and another point of communication focus. After resuscitations, a debriefing session is important to provide an opportunity for reflection and for future improvements. This chapter will focus on principles for improved communication during resuscitations.

The Decline of the Code

This chapter describes the decline of the Production Code and its replacement by the current rating system. Two Supreme Court rulings contributed to the end of the Production Code. In 1948, the court ruled that the major motion picture companies could no longer control the theaters in their distribution system, making it possible for independently produced and foreign films without a Code Seal to obtain first-run screenings. And in 1952 the court overturned the ban on Roberto Rossellini’s The Miracle and ruled that motion pictures were entitled to the guarantees of free speech and free press. The liberalization of public attitudes in the post-Code years, the influx of more explicit foreign films, and the impact of TV on box-office receipts all contributed to the decline of the Code, as did several groundbreaking movies. In 1953, Otto Preminger’s ‘racy’ comedy (by 1953 standards), The Moon Is Blue, became one of the first major US movies to be released without a Code Seal. In 1964, Sidney Lumet’s The Pawnbroker successfully challenged the Code ban on nudity, and in 1966, Mike Nichols’s Who’s Afraid of Virginia Woolf? broke the taboo on vulgar language. In 1966, Jack Valenti became head of the MPAA and soon replaced the Production Code with the precursor of today’s rating system.