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Performance of the Interagency Integrated Triage Tool in a resource-constrained emergency department during the COVID-19 pandemic 在 COVID-19 大流行期间,机构间综合分诊工具在资源有限的急诊科的使用情况
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-08-17 DOI: 10.1016/j.auec.2023.07.005
Rob Mitchell , Wilma Sebby , Donna Piamnok , Alyxandra Black , Wips Amono , Sarah Bornstein , Colin Banks , Gerard O’Reilly , Peter Cameron

Background

The Interagency Integrated Triage Tool (IITT) is a three-tier triage instrument recommended by the World Health Organization, but only the pilot version of the tool has been comprehensively assessed for its validity and reliability. This study sought to evaluate the performance of the IITT in a resource-constrained emergency department (ED) during the COVID-19 pandemic.

Methods

This prospective observational study was conducted at ANGAU Memorial Provincial Hospital in Lae, Papua New Guinea. The study period commenced approximately six weeks after introduction of the IITT, coinciding with a major COVID-19 wave. The primary outcome was sensitivity for the detection of time-critical illness, defined by eight pre-specified conditions. Secondary outcomes included the relationship between triage category and disposition. Inter-rater reliability was assessed using Cohen’s Kappa.

Results

There were 759 eligible presentations during the study period. Thirty patients (4.0%) were diagnosed with one of the eight pre-specified time-critical conditions and 21 were categorised as red or yellow, equating to a sensitivity of 70.0% (95%CI 50.6–85.3). There was a clear association between triage category and disposition, with 22 of 53 red patients (41.5%), 72 of 260 yellow patients (27.7%) and 22 of 452 green patients (4.9%) admitted (p = <0.01). Negative predictive values for admission and death were 95.1% (95%CI 92.7–96.9) and 99.3% (95%CI 98.1–99.9) respectively. Among a sample of 106 patients, inter-rater reliability was excellent (κ = 0.83) and the median triage assessment time was 94 seconds [IQR 57–160].

Conclusion

In this single-centre study, the IITT’s sensitivity for the detection of time-critical illness was comparable to previous evaluations of the tool and within the performance range reported for other triage instruments. There was a clear relationship between triage category and disposition, suggesting the tool can predict ED outcomes. Health service pressures related to COVID-19 may have influenced the findings.

背景机构间综合分诊工具(IITT)是世界卫生组织推荐的一种三级分诊工具,但目前仅对该工具的试用版进行了全面的有效性和可靠性评估。本研究旨在评估 COVID-19 大流行期间,IITT 在资源有限的急诊科(ED)中的表现。研究期间从引入 IITT 约六周后开始,恰逢 COVID-19 大流行。主要结果是检测时间紧迫疾病的灵敏度,由八个预先指定的条件定义。次要结果包括分流类别与处置之间的关系。研究期间共有 759 名符合条件的患者前来就诊。有 30 名患者(4.0%)被诊断出患有预先指定的八种时间危重症之一,21 名患者被分为红色或黄色,灵敏度为 70.0%(95%CI 50.6-85.3)。分诊类别与处置之间存在明显关联,53 名红色患者中有 22 名(41.5%)、260 名黄色患者中有 72 名(27.7%)和 452 名绿色患者中有 22 名(4.9%)被收治(p = <0.01)。入院和死亡的阴性预测值分别为 95.1%(95%CI 92.7-96.9)和 99.3%(95%CI 98.1-99.9)。结论在这项单中心研究中,IITT对时间紧迫疾病的检测灵敏度与之前对该工具的评估结果相当,也在其他分诊工具的性能范围之内。分诊类别与处置之间存在明确的关系,表明该工具可以预测急诊室的结果。与 COVID-19 相关的医疗服务压力可能会影响研究结果。
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引用次数: 0
Implementing community paramedicine: A known player in a new role. A narrative review 实施社区辅助医疗:众所周知的新角色。叙述性回顾
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-08-09 DOI: 10.1016/j.auec.2023.07.003
Evelien Spelten , Brodie Thomas , Julia van Vuuren , Ruth Hardman , David Burns , Peter O’Meara , Louise Reynolds

Background

Community Paramedicine is a model of care which is effective and accepted by health professionals and the community. Community paramedicine delivers low acuity primary care to disadvantaged communities and addresses service gaps. We aimed to identify successful implementation of community paramedicine models and signalled opportunities and challenges.

Methods

A narrative review was conducted. We identified 14 literature reviews from four databases EMBASE, CINAHL, PubMed, Cochrane. The results from the thematic analysis were structured along the quadruple aim for healthcare redesign framework.

Results

The reviews supported acceptability of the model. Patients are satisfied and there is evidence of cost reduction. Long term evidence of the positive effects of community paramedicine on patient, community health and the health system are lacking. Equally, there is unfamiliarity about the role and how it is part of an integrated health model.

Conclusions

Community paramedicine could alleviate current stresses in the healthcare system and uses an available workforce of registered paramedics. To facilitate integration, we need more evidence on long-term effects for patients and the system. In addition, the unfamiliarity with the model needs to be addressed to enhance the uptake of the model.

背景社区辅助医疗是一种有效的医疗模式,得到了医疗专业人员和社区的认可。社区辅助医疗为弱势社区提供低危急值初级医疗服务,弥补了服务缺口。我们旨在确定社区辅助医疗模式的成功实施情况,并指出机遇与挑战。我们从 EMBASE、CINAHL、PubMed 和 Cochrane 四个数据库中确定了 14 篇文献综述。根据医疗保健重新设计框架的四重目标对专题分析结果进行了结构化处理。患者感到满意,有证据表明成本有所降低。社区辅助医疗对患者、社区健康和医疗系统产生积极影响的长期证据尚缺。同样,人们也不熟悉社区辅助医疗的作用以及它如何成为综合医疗模式的一部分。为了促进整合,我们需要更多关于对患者和系统的长期影响的证据。此外,还需要解决对该模式不熟悉的问题,以提高该模式的普及率。
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引用次数: 0
Integrative virtual nursing simulation in teaching cardiopulmonary resuscitation: A blended learning approach 心肺复苏教学中的综合虚拟护理模拟:混合学习法
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-08-08 DOI: 10.1016/j.auec.2023.07.006
Yan Li , Yunling Lv , Ramil D. Dorol , Junxiao Wu , Anna Ma , Qian Liu , Jin Zhang

Background

Online learning resources facilitated educational development during the COVID-19 pandemic. This study focuses on the integration of online virtual simulation with interactive exercises and offline low-fidelity simulation for the first time to explore the impact on CPR skills.

Methods

First year nursing students from a medical college participated as volunteers in this study. They were divided randomly into two groups with both having a cardiopulmonary resuscitation (CPR) lesson with the same timings and objectives. The experimental group (n = 36) adopted a blended learning method, with virtual simulation and low-fidelity simulation as resources; the control group (n = 36) used the same method without virtual simulation. The same lecturers taught both classes. Students’ self-directed learning (SDL) and critical thinking skills were assessed before and after the intervention and their CPR skills were examined afterward.

Results

The experimental group exhibited significantly greater improvement in their SDL abilities and CPR skills. By contrast, we found no statistical differences in their critical thinking abilities.

Conclusions

During CPR training, blended learning method was used to integrate virtual nursing simulation in teaching, which effectively improved students' SDL and CPR skills.

背景在线学习资源促进了COVID-19大流行期间的教育发展。本研究首次将在线虚拟仿真与互动练习和离线低保真仿真相结合,以探讨对心肺复苏技能的影响。他们被随机分为两组,每组都有一堂时间和目标相同的心肺复苏(CPR)课。实验组(36 人)采用混合学习法,以虚拟仿真和低保真仿真为资源;对照组(36 人)采用相同方法,不使用虚拟仿真。两个班级由相同的讲师授课。干预前后对学生的自主学习(SDL)和批判性思维能力进行了评估,干预后对他们的心肺复苏技能进行了检查。结论在心肺复苏培训中,采用混合式学习法将虚拟护理模拟融入教学,有效提高了学生的 SDL 能力和心肺复苏技能。
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引用次数: 0
As loud as a construction site: Noise levels in the emergency department 像建筑工地一样吵闹急诊室的噪音水平
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-31 DOI: 10.1016/j.auec.2023.07.004
Corey Adams , Ramya Walsan , Rebecca McDonnell , Anthony Schembri

Background

The Emergency Department (ED), while being an integral part of healthcare systems, frequently experiences noise levels surpassing the World Health Organization's recommended thresholds. These excessive noise levels could considerably compromise the safety and wellbeing of both patients and staff.

Methods

To evaluate noise levels throughout the ED environment, this study utilized dosimeters to measure noise levels over a 24-hour period in six distinct locations, including the ED Waiting Room and Treatment areas.

Results

The study found that noise exceeded the WHO recommendations in all six areas of the ED for the entire 24-hour period. Peak noise levels were recorded up to 102.8 dB, which is as loud as noise levels at a construction site. The ED Waiting Room exhibited high peak and average noise levels, indicating the urgent need for quality improvement efforts. These findings align with the results of previous research, thereby suggesting that noise levels in the ED have remained problematic for more than a decade.

Conclusion

The findings of this study underscore the importance of addressing excessive noise levels in the ED to create a safe and therapeutic hospital environment for both patients and staff. Healthcare organizations must implement proactive measures to address excessive noise levels in the ED.

背景急诊科(ED)是医疗保健系统中不可或缺的一部分,但其噪音水平经常超过世界卫生组织建议的阈值。为了评估整个急诊室环境的噪音水平,本研究使用剂量计测量了急诊室候诊室和治疗区等六个不同地点 24 小时的噪音水平。记录到的噪音峰值高达 102.8 分贝,与建筑工地的噪音水平相当。急诊室候诊室的峰值和平均噪音水平都很高,这表明急需提高质量。这些发现与之前的研究结果一致,从而表明急诊室的噪音水平十多年来一直存在问题。结论本研究的结果强调了解决急诊室噪音水平过高问题的重要性,以便为患者和员工创造一个安全和治疗性的医院环境。医疗机构必须采取积极措施解决急诊室噪音过大的问题。
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引用次数: 0
Staff perceptions of barriers to self-harm care in the emergency department: A cross-sectional survey study 急诊科工作人员对自我伤害护理障碍的看法:横断面调查研究
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-27 DOI: 10.1016/j.auec.2023.07.002
Hannah Richards , Gowri Rajaram , Michelle Lamblin , Jonathan Knott , Owen Connolly , Sarah Hetrick , Jo Robinson

Background

Emergency departments (EDs) are often the first point of contact for people with self-harm; however, they do not always receive optimal care. The study objective was to examine the perspectives of ED staff who respond to self-harm presentations, perceived barriers to providing optimal, guideline-concordant care, and staff’s familiarity with existing guidelines.

Methods

An online cross-sectional survey comprising purpose-designed questions concerning self-harm in the ED was completed by 131 staff (83.2% nurses) from two hospitals in Victoria, Australia. Survey results were analysed using Stata version 16 and frequencies and percentages were calculated.

Results

Respondents reported knowledge of how to appropriately manage a person presenting with self-harm. However, lack of space (62.3%) and time (78.7%) to conduct the appropriate assessments, lack of self-harm training (71.8%), and limited awareness of or access to guidelines and recommendations for self-harm management within the ED (63.6%), were identified as primary barriers to their ability to appropriately manage these presenters.

Conclusions

Improvements to the ED environment and processes, as well as the provision of regular self-harm specific education and training for all ED staff are needed. Implementation of best-practice standards should prioritise guideline-concordant care, with a particular focus on the education needs of nursing staff.

背景急诊科(ED)通常是自残者的第一接触点;然而,他们并不总能得到最佳护理。本研究旨在探讨急诊科工作人员在应对自残患者时所持的观点、在提供与指南相一致的最佳护理时所遇到的障碍,以及工作人员对现有指南的熟悉程度。方法来自澳大利亚维多利亚州两家医院的 131 名工作人员(83.2% 为护士)完成了一项在线横断面调查,调查内容包括专门设计的有关急诊科自残患者的问题。调查结果受访者表示了解如何妥善处理出现自我伤害的患者。然而,缺乏进行适当评估的空间(62.3%)和时间(78.7%)、缺乏自残方面的培训(71.8%)以及对急诊室内自残管理指南和建议的了解或获取途径有限(63.6%)被认为是影响他们适当管理这些患者的主要障碍。最佳实践标准的实施应优先考虑与指南相一致的护理,并特别关注护理人员的教育需求。
{"title":"Staff perceptions of barriers to self-harm care in the emergency department: A cross-sectional survey study","authors":"Hannah Richards ,&nbsp;Gowri Rajaram ,&nbsp;Michelle Lamblin ,&nbsp;Jonathan Knott ,&nbsp;Owen Connolly ,&nbsp;Sarah Hetrick ,&nbsp;Jo Robinson","doi":"10.1016/j.auec.2023.07.002","DOIUrl":"10.1016/j.auec.2023.07.002","url":null,"abstract":"<div><h3>Background</h3><p>Emergency departments (EDs) are often the first point of contact for people with self-harm; however, they do not always receive optimal care. The study objective was to examine the perspectives of ED staff who respond to self-harm presentations, perceived barriers to providing optimal, guideline-concordant care, and staff’s familiarity with existing guidelines.</p></div><div><h3>Methods</h3><p>An online cross-sectional survey comprising purpose-designed questions concerning self-harm in the ED was completed by 131 staff (83.2% nurses) from two hospitals in Victoria, Australia. Survey results were analysed using Stata version 16 and frequencies and percentages were calculated.</p></div><div><h3>Results</h3><p>Respondents reported knowledge of how to appropriately manage a person presenting with self-harm. However, lack of space (62.3%) and time (78.7%) to conduct the appropriate assessments, lack of self-harm training (71.8%), and limited awareness of or access to guidelines and recommendations for self-harm management within the ED (63.6%), were identified as primary barriers to their ability to appropriately manage these presenters.</p></div><div><h3>Conclusions</h3><p>Improvements to the ED environment and processes, as well as the provision of regular self-harm specific education and training for all ED staff are needed. Implementation of best-practice standards should prioritise guideline-concordant care, with a particular focus on the education needs of nursing staff.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 1","pages":"Pages 15-20"},"PeriodicalIF":1.8,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000489/pdfft?md5=542a252986e47d3b0758c48f21e81054&pid=1-s2.0-S2588994X23000489-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10265846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Secondary traumatic stress in partners of paramedics: A scoping review 辅助医务人员伴侣的二次创伤应激:范围界定审查
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-12 DOI: 10.1016/j.auec.2023.06.002
Matthew A. Hill , Jessica L. Paterson , Amanda L. Rebar

Background

Paramedics experience post-traumatic stress in their work, and many paramedics turn to their intimate partner for support. However, exposure to traumatic event details can leave partners vulnerable to secondary traumatic stress. Despite substantial research into reducing stress and improving support for paramedics, few studies have investigated their partners’ trauma experiences and support needs. This scoping review aimed to examine evidence regarding secondary traumatic stress in paramedic partners.

Methods

The MEDLINE, PsychINFO, CINAHL, EMCare, and Sociology Source Ultimate databases were searched up to November 9, 2022. The results sections of studies published in English involving a sample of paramedic partners that examined the impact of paramedics’ work-related exposure to trauma on their intimate partner were extracted for analysis. This scoping review was guided by the Joanna Briggs Institute methodology. Key themes were generated using a framework synthesis approach.

Results

Five qualitative studies and one quantitative study were included, indicating a paucity of literature regarding secondary traumatic stress in paramedic partners. Post-traumatic stress experienced by paramedics can crossover to paramedic partners in the form of secondary traumatic stress; furthermore, it can have widespread effects on couple functioning. While paramedic partners appear to recognise the need for effective coping strategies, they perceive that little support is available to them. Notably, effective strategies aimed at reducing secondary traumatic stress in paramedic partners are limited.

Conclusion

Further research is required to quantify secondary traumatic stress severity in paramedic partners and explore relationships between post-traumatic stress, secondary traumatic stress, and couple functioning. Further, evaluation of partner support needs and barriers to accessing support is warranted.

背景医务辅助人员在工作中会经历创伤后应激反应,许多医务辅助人员会向他们的亲密伴侣寻求支持。然而,接触创伤事件的细节会使伴侣容易受到二次创伤应激的影响。尽管对减轻护理人员的压力和改善对他们的支持进行了大量研究,但很少有研究对其伴侣的创伤经历和支持需求进行调查。本范围综述旨在研究有关辅助医务人员伴侣二次创伤应激的证据。方法检索了截至 2022 年 11 月 9 日的 MEDLINE、PsychINFO、CINAHL、EMCare 和 Sociology Source Ultimate 数据库。我们提取了以英文发表的、涉及护理人员伴侣样本的研究结果部分进行分析,这些研究探讨了护理人员在工作中受到的创伤对其亲密伴侣的影响。本范围界定综述以乔安娜-布里格斯研究所(Joanna Briggs Institute)的方法为指导。结果共纳入了五项定性研究和一项定量研究,这表明有关辅助医务人员伴侣二次创伤压力的文献很少。医护人员所经历的创伤后应激会以二次创伤应激的形式传递给医护人员的伴侣;此外,它还会对夫妻功能产生广泛的影响。虽然辅助医务人员的伴侣似乎认识到需要采取有效的应对策略,但他们认为可以获得的支持很少。值得注意的是,旨在减少辅助医务人员伴侣二次创伤压力的有效策略非常有限。结论需要进一步研究辅助医务人员伴侣二次创伤压力的严重程度,并探讨创伤后压力、二次创伤压力和夫妻功能之间的关系。此外,还需要对伴侣的支持需求和获得支持的障碍进行评估。
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引用次数: 0
Relationship between transition shock in novice emergency room nurses, quality of nursing care, and adverse patient events: The mediating role of emotional exhaustion 急诊室护士新手的过渡期冲击、护理质量和患者不良事件之间的关系:情绪衰竭的中介作用
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-11 DOI: 10.1016/j.auec.2023.07.001
Leodoro J. Labrague

Background

Transition shock, experienced during the first two years of employment, has been attributed to decreased clinical performance and an overall decrease in work productivity among newly graduated nurses, as well as compromised patient safety outcomes. This study tested the intermediary effect of emotional exhaustion on the association between transition shock in novice emergency room (ER) nurses, adverse patient events, and nursing care quality.

Methods

A descriptive study was carried out involving 303 novice ER nurses from various emergency units in five different hospitals in Central Philippines, utilizing four standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

Results

Transition shock in novice ER nurses was associated with an increased incidence of adverse patient events (β = 0.3897, p = 0.0005) and poorer nursing care quality (β = −0.2146, p = 0.0021). Furthermore, emotional exhaustion partially mediated the association between transition shock and the two patient-related outcomes: adverse patient events (β = 0.0477, 95 % CI = 0.0078–0.0997) and nursing care quality (β = −0.0142, 95 % CI = −0.0412 to −0.0095).

Conclusions

Transition shock in novice ER nurses contributed to heightened emotional exhaustion, which subsequently led to an increased incidence of adverse patient events and a decline in the quality of nursing care.

背景刚毕业的护士在入职头两年经历的过渡期冲击被认为会导致临床表现下降、工作效率整体降低以及患者安全结果受损。本研究测试了情绪衰竭对急诊室(ER)新手护士的过渡性休克、患者不良事件和护理质量之间关系的中介效应。方法采用四种标准化量表,对菲律宾中部五家不同医院的 303 名急诊室新手护士进行了描述性研究。结果急诊室新手护士的过渡休克与患者不良事件发生率增加(β = 0.3897,p = 0.0005)和护理质量下降(β = -0.2146,p = 0.0021)有关。此外,情绪衰竭在一定程度上调节了过渡期冲击与患者不良事件(β = 0.0477, 95 % CI = 0.0078-0.0997)和护理质量(β = -0.0142, 95 % CI = -0.0412 to -0.0095)这两个患者相关结果之间的关系。
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引用次数: 0
Educational programs for implementing ultrasound guided peripheral intravenous catheter insertion in emergency departments: A systematic integrative literature review 急诊科实施超声引导外周静脉导管插入的教育计划:系统综合文献综述。
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-07-07 DOI: 10.1016/j.auec.2023.06.001
Renee Stone , Rachel M. Walker , Nicole Marsh , Amanda J. Ullman

Background

Ultrasound-guided peripheral intravenous catheter insertion has been identified as an effective method to improve the success rate of cannulation, thereby improving patient experience. However, learning this new skill is complex, and involves training clinicians from a variety of backgrounds. The aim of this study was to appraise and compare literature on educational methods in the emergency setting used to support ultrasound guided peripheral intravenous catheter insertion by different clinicians, and how effective these current methods are.

Review methods

A systematic integrative review was undertaken using Whittemore and Knafl’s five stage approach. The Mixed Methods Appraisal Tool was used to assess the quality of the studies.

Results

Forty-five studies met the inclusion criteria, with five themes identified. These were: the variety of educational methods and approaches; the effectiveness of the different educational methods; barriers and facilitators of education; clinician competency assessments and pathways; clinician confidence assessment and pathways.

Conclusions

This review demonstrates that a variety of educational methods are being used in successfully training emergency department clinicians in using ultrasound guidance for peripheral intravenous catheter insertion. Furthermore, this training has resulted in safer and more effective vascular access. However, it is evident that there is a lack of consistency of formalised education programs available. A standardised formal education program and increased availability of ultrasound machines in the emergency department will ensure consistent practices are maintained, retained, therefore leading to safer practice as well as more satisfied patients.

背景:超声引导下的外周静脉导管插入已被确定为提高插管成功率的有效方法,从而改善患者体验。然而,学习这项新技能是复杂的,需要培训来自不同背景的临床医生。本研究的目的是评估和比较不同临床医生在急诊环境中用于支持超声引导的外周静脉导管插入的教育方法的文献,以及目前这些方法的有效性。审查方法:使用Whittemore和Knafl的五阶段方法进行系统的综合审查。使用混合方法评估工具来评估研究的质量。结果:45项研究符合纳入标准,确定了5个主题。这些是:教育方法和途径的多样性;不同教育方法的有效性;教育的障碍和促进者;临床医生能力评估和途径;临床医生信心评估和途径。结论:这篇综述表明,在成功培训急诊科临床医生使用超声引导进行外周静脉导管插入方面,正在使用各种教育方法。此外,这种训练带来了更安全、更有效的血管通路。然而,很明显,现有的正规教育计划缺乏一致性。标准化的正规教育计划和增加急诊科超声波机的可用性将确保维持和保留一致的做法,从而带来更安全的做法和更满意的患者。
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引用次数: 1
Occupational violence in a tertiary emergency department: A retrospective descriptive study 三级急诊科的职业暴力:一项回顾性描述性研究。
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-06-16 DOI: 10.1016/j.auec.2023.05.003
Alexander Joyce , Richard Pellatt , Jamie Ranse , Amy Doumany , Emma Hall , Amy Sweeny , Gerben Keijzers

Objective

Occupational violence in emergency departments (EDs) impacts staff and patients. Most hospitals have a response mechanism called a ‘Code Black’ or similar. We aimed to determine the incidence of Code Black activations in a tertiary ED and describe contributory factors, management strategies and adverse events.

Methods

Descriptive study in a tertiary ED in South-East Queensland in 2021. Adult patients for who a Code Black had been activated were eligible. Data were obtained from a prospectively collected Code Black database, supplemented with retrospective electronic medical records.

Results

There were 386 Code Black events. The incidence of Code Black activation was 11.0 per 1000 adult ED presentations. Individuals requiring Code Black activation were 59.6 % male with a mean age of 40.9 years. The primary diagnosis was mental illness related in 55.1 %. Alcohol was a suspected factor in 30.9 %. When Code Black activation occurred, median length of stay increased. Restraint including physical, chemical or both were used in 54.1 % of Code Blacks.

Conclusion

Occupational violence occurs at a three-fold greater incidence within this ED than reported elsewhere. This study reinforces other literature suggesting an increase in occupational violence, demonstrating the need for dedicated preventative strategies for patients at risk of agitation.

目的:急诊科的职业暴力影响到工作人员和患者。大多数医院都有一种称为“黑色代码”或类似的响应机制。我们旨在确定三级ED中黑代码激活的发生率,并描述促成因素、管理策略和不良事件。方法:2021年昆士兰东南部一所高等教育机构的描述性研究。已激活“黑色代码”的成年患者符合条件。数据来自前瞻性收集的Code Black数据库,并辅以回顾性电子医疗记录。结果:共发生386起Code Black事件。黑代码激活的发生率为11.0/1000成人ED。需要激活“黑色密码”的个体中,59.6%为男性,平均年龄40.9岁。55.1%的患者主要诊断为精神疾病。30.9%的人怀疑酒精是一个因素。当“黑色代码”激活时,中位停留时间增加。54.1%的Code Blacks使用了包括物理、化学或两者兼有的约束措施。结论:本ED内的职业暴力发生率是其他地方报告的三倍。这项研究强化了其他表明职业暴力增加的文献,表明需要为有躁动风险的患者制定专门的预防策略。
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引用次数: 0
Pre-hospital peripheral intravenous catheter insertion practice: An integrative review 院前外周静脉导管插入实践:综合回顾
IF 1.8 4区 医学 Q2 EMERGENCY MEDICINE Pub Date : 2023-06-01 DOI: 10.1016/j.auec.2022.08.006
Eleanor Golling , Thea van de Mortel , Nigel Barr , Peta-Anne Zimmerman

Background

Peripheral intravenous catheters (PIVCs) are widely used within healthcare settings. There is substantial hospital-based research, particularly in Emergency Departments, supporting the need to reduce inappropriate PIVCs due to associated risks. However, there is limited research into pre-hospital practice. This review aims to determine the rates of pre-hospital PIVC insertions, how many remain unused, and to explore paramedic PIVC decision-making.

Methods

A systematic search of research databases was undertaken using an integrative review methodology. Articles published between 2011 and April 2022 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies.

Results

Fifteen studies were included. Rates of PIVC insertions ranged from 21% to 58%. Up to 72% of PIVCs remained unused in the pre-hospital setting. Paramedic decision-making was not well reported, though erring of the side of caution and inserting a “just in case” PIVC was identified.

Conclusion

There are limited articles on pre-hospital PIVC practice, particularly in Australian settings. Research is required to understand factors influencing practice and provide contemporary evidence to inform the development of guidance specific to the pre-hospital setting to reduce the numbers of inappropriate PIVCs.

背景外周静脉导管(PIVC)在医疗机构中广泛使用。有大量基于医院的研究,特别是在急诊科,支持减少因相关风险而导致的不适当PIVC的必要性。然而,对院前实践的研究有限。本综述旨在确定院前PIVC插入率、有多少未使用,并探讨护理人员的PIVC决策。方法采用综合综述方法对研究数据库进行系统检索。收录了2011年至2022年4月期间发表的文章。使用混合方法评估工具来评估研究的质量。结果纳入15项研究。PIVC插入率在21%到58%之间。高达72%的PIVC在住院前环境中未使用。医护人员的决策没有得到很好的报道,尽管发现了谨慎和插入“以防万一”PIVC的错误。结论关于院前PIVC实践的文章有限,尤其是在澳大利亚。需要进行研究,以了解影响实践的因素,并提供当代证据,为制定针对院前环境的指导提供信息,以减少不适当的PIVC的数量。
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引用次数: 1
期刊
Australasian Emergency Care
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