Australasian Emergency Care最新文献_第7页

Older women's view on frailty and an Emergency Department evidence-based Frailty Intervention Team (FIT) program: An evaluation using the Reach, Effectiveness, Adoption, Implementation, Maintenance RE-AIM framework 老年妇女对虚弱的看法和急诊科基于证据的虚弱干预小组(FIT)计划:使用覆盖面、有效性、采用、实施、维持RE-AIM框架的评估

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-09-01 DOI: 10.1016/j.auec.2023.02.003

Kristie J. Harper , Melinda Williamson , Deborah Edwards , Jenna Haak , Annette Barton , Susan Slatyer

Background

Older women have higher levels of frailty resulting in disability and reduced quality of life. Presentation to an Emergency Department (ED) is an opportunity to address frailty and provide tailored interventions to promote function. An ED allied health team integrated frailty assessment and interventions into care through a ‘Frailty Intervention Team’ (FIT) program.

Methods

A prospective study informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to evaluate the FIT program tailored to female older adults. The purpose of this project was to evaluate the FIT program over a three-month period and use the findings to further develop the intervention.

Results

Over three-months, 192 older females (>70 years) were identified with mild frailty and discharged directly home. Ninety percent were offered the FIT program with 83.3 % accepting all recommended frailty management strategies. Ninety percent of patients were satisfied with the FIT program, however staff and patient barriers to provision of frailty services were identified.

Conclusions

The FIT program was largely adopted by staff and accepted by older female patients with mild frailty in the ED. However, program effectiveness was limited by gaps in communication about frailty in the ED and implementation of frailty management strategies after discharge.

背景老年妇女的虚弱程度较高，导致残疾和生活质量下降。向急诊科（ED）介绍是一个解决虚弱问题并提供量身定制的干预措施以促进功能的机会。ED联合健康团队通过“虚弱干预团队”（FIT）计划将虚弱评估和干预纳入护理。方法根据覆盖、有效性、采用、实施、维护（RE-AIM）框架进行前瞻性研究，以评估针对女性老年人的FIT计划。该项目的目的是在三个月的时间内评估FIT计划，并利用调查结果进一步制定干预措施。结果在三个多月的时间里，192名年龄较大的女性（＞70岁）被确认为轻度虚弱，并直接出院回家。90%的人接受了FIT计划，83.3%的人接受所有推荐的虚弱管理策略。90%的患者对FIT计划感到满意，但工作人员和患者在提供虚弱服务方面存在障碍。结论FIT计划在很大程度上被工作人员采用，并被ED中患有轻度虚弱的老年女性患者所接受。然而，该计划的有效性受到ED中关于虚弱的沟通和出院后虚弱管理策略实施方面的差距的限制。

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引用次数: 0

Implementation of a pragmatic emergency department patients’ own medications (POM) procedure to improve medication safety: An interrupted time series 实施实用的急诊科患者自用药(POM)程序以提高用药安全性:中断时间序列

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-09-01 DOI: 10.1016/j.auec.2023.02.004

Simone E. Taylor , Emily Joules , Andrew Harding

Background

Patients’ Own Medications (POMs) are useful to inform clinical decision-making, best possible medication history documentation, and ensure timely medication administration. A procedure was developed for managing POMs specifically in the emergency department (ED) and short stay unit. This study evaluated the impact of this procedure on process and patient safety outcomes.

Methods

An interrupted time-series was undertaken in a metropolitan ED/short stay unit between November 2017 and September 2021. Pre-implementation and during each of four post-implementation time-periods, data were collected at unannounced times on approximately 100 patients taking medications prior to presentation. Endpoints included proportion of patients with POMs stored in green POMs bags, in standardised locations, and proportion who self-medicated without nurses knowing.

Results

Following procedure implementation, POMs were stored in standardised locations for 45.9 % of patients. Proportion of patients with POMs stored in green bags increased from 6.9 % to 48.2 % (difference 41.3 %, p < 0.001). Patient self-administration without nurses’ knowledge declined from 10.3 % to 2.3 % (difference 8.0 %, p = 0.015). POMs were infrequently left in ED/short stay unit after discharge.

Conclusions

The procedure has standardised POMs storage, but room for further improvement remains. Although POMs were not locked away and were readily available to clinicians, patient self-medication without nurses’ knowledge declined.

背景患者自己的药物（POM）有助于为临床决策提供信息，尽可能好地记录用药史，并确保及时用药。制定了一个程序来管理POM，特别是在急诊科（ED）和短期住院病房。本研究评估了该程序对过程和患者安全结果的影响。方法在2017年11月至2021年9月期间，在大都市急诊/短期住院单位进行中断时间序列。在实施前和实施后的四个时间段中，每一个时间段都在未宣布的时间收集了大约100名患者在用药前的数据。终点包括储存在绿色聚甲醛袋中、标准化位置的聚甲醛患者比例，以及在护士不知情的情况下自行服药的比例。结果手术实施后，45.9%的患者将POM储存在标准化位置。储存在绿色袋子中的POM患者比例从6.9%增加到48.2%（差异41.3%，p＜0.001）。在护士不知情的情况下，患者自行给药的比例从10.3%下降到2.3%（差异8.0%，p＝0.015）。出院后，POM很少留在急诊室/短期住院室。结论该程序具有标准化的聚甲醛储存，但仍有进一步改进的空间。尽管POM没有被锁起来，临床医生也很容易获得，但在护士不知情的情况下，患者自行用药的情况有所减少。

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引用次数: 0

Unscheduled emergency department presentations with diabetes: Identifying high risk characteristics 未安排的糖尿病急诊科表现:识别高风险特征

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-09-01 DOI: 10.1016/j.auec.2022.12.001

Julie Gale , Wayne Varndell , Steven James , Lin Perry

Background

Unscheduled emergency department (ED) presentation by patients with diabetes has seldom been examined. This study aimed to determine the frequency and associated characteristics of presentations in this population.

Methods

Using a prospective cross-sectional design, data were collected from patients with diabetes presenting and/or admitted to a tertiary metropolitan hospital in New South Wales, Australia (December 2016-September 2017). A screening interview including brief measures of cognitive and executive function, and clinical details from healthcare records were utilised; details around unscheduled presentations within 90 days were extracted. Independent associations with ED presentation were determined.

Results

Unscheduled ED presentations were common; 35.4% had at least one within 90 days, and for 20.1% this occurred within 28 days. The screening tool contributed little towards identifying risk of unscheduled presentation. Those attending any community or outpatient follow-up appointment within the first 28 (OR 0.42, 95% CI 0.23–0.76; p = 0.004) or 90 days (OR 0.25; 0.13–0.47; p < 0.001) from the index presentation were less likely to present within that same period.

Conclusions

Findings indicated the magnitude of unscheduled ED presentation, care complexity and the value of targeted and timely follow-up. Alternative service support may help maintain and improve diabetes self-management and will require effectiveness and cost-effectiveness evaluation.

背景糖尿病患者的非计划急诊（ED）表现很少被检查。本研究旨在确定该人群中表现的频率和相关特征。方法采用前瞻性横断面设计，从澳大利亚新南威尔士州一家三级大都市医院（2016年12月至2017年9月）的糖尿病患者中收集数据。使用了筛查访谈，包括认知和执行功能的简要测量，以及医疗记录中的临床细节；提取了90天内未安排的演示的详细信息。确定了与ED表现的独立相关性。结果非计划ED表现较为常见；35.4%的患者在90天内至少有一次，20.1%的患者在28天内发生。筛查工具对识别计划外演示的风险几乎没有贡献。在指数显示后的前28天（or 0.42，95%CI 0.23-0.76；p=0.004）或90天（or 0.25；0.13-0.47；p<；0.001）内参加任何社区或门诊随访的患者在同一时期内出现的可能性较小。结论s指标显示了计划外ED表现的严重程度、护理的复杂性以及有针对性和及时随访的价值。替代服务支持可能有助于维持和改善糖尿病自我管理，并需要进行有效性和成本效益评估。

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引用次数: 0

The impact of COVID-19 pandemic on revisits to emergency department COVID-19大流行对急诊科就诊的影响

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-09-01 DOI: 10.1016/j.auec.2023.01.002

Myeong Namgung , Dong Hoon Lee , Sung Jin Bae , Ho Sub Chung , Keon Kim , Choung Ah Lee , Duk Ho Kim , Eui Chung Kim , Jee Yong Lim , Sang Soo Han , Yoon Hee Choi

Aim

This study presents the impact of COVID-19 on revisits to the emergency department comparing revisit rates and characteristics between the pre-COVID-19 and COVID-19 periods.

Methods

This multi-center retrospective study included patients over 18 years of age who visited emergency departments during the pre-COVID-19 period and the COVID-19 pandemic. The revisit rates were analyzed according to five age groups; 18–34, 35–49, 50–64, 65–79, and ≥ 80 years, and three revisit time intervals; 3, 9, and 30 days. Also, we compared the diagnosis and disposition at revisit between the study periods.

Results

The revisit rates increased with age in both study periods and the revisit rates among all age groups were higher in the COVID-19 period. The proportion of infectious and respiratory diseases decreased during the COVID-19 period. The ICU admission rate and mortality at the revisit among patients aged ≥ 80 years were lower in the COVID-19 period than in the pre-COVID-19 period.

Conclusion

The revisit rates increased with age in both study periods and there were several changes in the diagnosis and disposition at the revisit in the COVID-19 period.

目的本研究比较了新冠肺炎前和新冠肺炎期间的重访率和特征，介绍了新冠肺炎对急诊室重访的影响。方法这项多中心回顾性研究包括18岁以上的患者，他们在新冠肺炎疫情前和新冠肺炎大流行期间到急诊室就诊。根据五个年龄组对重访率进行分析；18-34年、35-49年、50-64年、65-79年和≥80年，三次重访时间间隔；3、9和30天。此外，我们还比较了两个研究期间再次就诊时的诊断和处置情况。结果两个研究阶段的重访率均随年龄的增长而增加，新冠肺炎期间各年龄组的重访比率均较高。新冠肺炎期间，传染病和呼吸道疾病的比例有所下降。新冠肺炎期间，年龄≥80岁的患者的ICU入院率和再访时死亡率低于新冠肺炎之前。结论新冠肺炎期间，两个研究期的再访率均随年龄的增长而增加，在再访时的诊断和处置发生了一些变化。

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引用次数: 0

Assessing student paramedics' measurements of fatigue and quality of cardiopulmonary resuscitation on a simulated cardiac arrest case 评估学生护理人员对模拟心脏骤停病例的疲劳测量和心肺复苏质量

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-09-01 DOI: 10.1016/j.auec.2022.12.002

Anthony Weber , Shannon Delport , Aldon Delport

Objective

The International Liaison Committee on Resuscitation (ILCOR) and the Australian Resuscitation Council (ARC) recommend that high-quality cardiopulmonary resuscitation (CPR) is the key to performance outcomes, emphasising compression and rotation through this process. The proposed study has a two-stage approach to evaluating cardiopulmonary resuscitations effectiveness by out-of-hospital practitioners. The first stage aimed to evaluate the influence of providing real-time biofeedback using the Q-CPR system on the provision of CPR by student paramedics. Secondly, the study quantified the effects of physical fatigue on maintaining quality cardiopulmonary resuscitation performed by paramedic students.

Methods

Forty paramedic students completed cardiopulmonary resuscitation on an instrumented manikin with and without audio-visual biofeedback (Q-CPR within the Phillips MRx defibrillator) in a balanced cross-over fashion. To quantify the quality of cardiopulmonary resuscitation concerning the percentage of applied compressions that meet the current ARC guidelines in terms of rate, depth, and recoil time, a manikin feedback system (SimMan 3 G; Laerdal, Norwegian) was used.

Results

When using the Q-CPR prompt with bio-feedback, overall, the depth and fatigue levels increased significantly, highlighting a correlation between correct depth and increased fatigue.

Conclusions

Audio prompts improved compression depth; however, fatigue levels increased. The depth during manual compression compared to the Q-CPR prompt was not statistically significant.

目的国际复苏联络委员会（ILCOR）和澳大利亚复苏理事会（ARC）建议，高质量的心肺复苏（CPR）是取得成绩的关键，强调在这个过程中进行按压和旋转。这项拟议的研究采用两阶段方法来评估院外从业者的心肺复苏效果。第一阶段旨在评估使用Q-CPR系统提供实时生物反馈对学生护理人员提供CPR的影响。其次，该研究量化了身体疲劳对维持护理学生心肺复苏质量的影响。方法40名护理学生在装有和不带有视听生物反馈（Phillips MRx除颤器内的Q-CPR）的仪器化人体模型上以平衡交叉的方式完成心肺复苏。为了量化心肺复苏的质量，即在速率、深度和反冲时间方面符合当前ARC指南的按压百分比，使用了人体模型反馈系统（SimMan 3G；挪威Laerdal）。结果当使用带有生物反馈的Q-CPR提示时，总体而言，深度和疲劳水平显著增加，突出了正确的深度与疲劳增加之间的相关性。结论音频提示压缩深度提高；然而，疲劳程度增加了。与Q-CPR提示相比，手动按压过程中的深度没有统计学意义。

{"title":"Assessing student paramedics' measurements of fatigue and quality of cardiopulmonary resuscitation on a simulated cardiac arrest case","authors":"Anthony Weber , Shannon Delport , Aldon Delport","doi":"10.1016/j.auec.2022.12.002","DOIUrl":"10.1016/j.auec.2022.12.002","url":null,"abstract":"<div><h3>Objective</h3><p>The International Liaison Committee on Resuscitation (ILCOR) and the Australian Resuscitation Council (ARC) recommend that high-quality cardiopulmonary resuscitation (CPR) is the key to performance outcomes, emphasising compression and rotation through this process. The proposed study has a two-stage approach to evaluating cardiopulmonary resuscitations effectiveness by out-of-hospital practitioners. The first stage aimed to evaluate the influence of providing real-time biofeedback<span> using the Q-CPR system on the provision of CPR by student paramedics. Secondly, the study quantified the effects of physical fatigue on maintaining quality cardiopulmonary resuscitation performed by paramedic students.</span></p></div><div><h3>Methods</h3><p>Forty paramedic students completed cardiopulmonary resuscitation on an instrumented manikin with and without audio-visual biofeedback (Q-CPR within the Phillips MRx defibrillator) in a balanced cross-over fashion. To quantify the quality of cardiopulmonary resuscitation concerning the percentage of applied compressions that meet the current ARC guidelines in terms of rate, depth, and recoil time, a manikin feedback system (SimMan 3 G; Laerdal, Norwegian) was used.</p></div><div><h3>Results</h3><p>When using the Q-CPR prompt with bio-feedback, overall, the depth and fatigue levels increased significantly, highlighting a correlation between correct depth and increased fatigue.</p></div><div><h3>Conclusions</h3><p>Audio prompts improved compression depth; however, fatigue levels increased. The depth during manual compression compared to the Q-CPR prompt was not statistically significant.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 3","pages":"Pages 211-215"},"PeriodicalIF":1.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10289399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Characteristics and outcomes of patient presentations to the emergency department via police: A scoping review 通过警察向急诊科介绍病人的特点和结果:范围审查

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-09-01 DOI: 10.1016/j.auec.2023.01.004

Rachel Wardrop , Jamie Ranse , Wendy Chaboyer , Julia Crilly

Background

As emergency department (ED) presentations continue to rise, understanding the complexities of vulnerable populations such as people brought in by police (BIBP) is crucial. This review aimed to map and describe the research about people BIBP to the ED.

Design and method

A scoping review, guided by the Joanna Briggs Institute process, was undertaken. The databases CINAHL, Embase and PubMed were searched between November 2017 and July 2022. The Patterns, Advances, Gaps, Evidence for practice, Research recommendations (PAGER) framework was used to guide the analysis.

Results

A total of 21 studies were included in the review, originating mainly from westernised countries. Examination of patterns across studies revealed four themes: routinely collected data is used to describe people BIBP to the ED; a focus on mental health care; the relationship between care delivery and outcomes; and the role of police in providing emergency care.

Conclusion

There is some understanding of the demographic characteristics, clinical characteristics, and outcomes of people BIBP to the ED. Knowledge gaps surrounding sociodemographic factors, prehospital and ED care delivery for people BIBP require further investigation to optimise outcomes for this vulnerable cohort of presenters.

背景随着急诊科（ED）的报告不断增加，了解弱势人群的复杂性至关重要，比如警察带来的人。本综述旨在将关于人BIBP的研究与ED进行映射和描述。设计和方法在乔安娜·布里格斯研究所流程的指导下进行了范围界定审查。在2017年11月至2022年7月期间搜索了CINAHL、Embase和PubMed数据库。模式、进展、差距、实践证据、研究建议（PAGER）框架用于指导分析。结果共纳入21项研究，主要来源于西方国家。对各研究模式的检查揭示了四个主题：常规收集的数据用于描述人们对ED的BIBP；重点关注心理健康护理；护理提供与结果之间的关系；以及警察在提供紧急护理方面的作用。结论人们对BIBP患者的人口统计学特征、临床特征和ED的结果有一定的了解。围绕社会人口统计学因素、BIBP患者院前和ED护理的知识差距需要进一步调查，以优化这一弱势人群的结果。

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引用次数: 1

The role of emergency medical services in the management of in-hospital emergencies: Causes and outcomes of emergency calls – A descriptive retrospective register-based study 急诊医疗服务在院内急诊管理中的作用：紧急呼叫的原因和结果--基于登记的描述性回顾研究

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-08-17 DOI: 10.1016/j.auec.2023.07.007

Henna Myrskykari , Timo Iirola , Hilla Nordquist

Background

Medical emergency teams (METs) are in place in some hospitals in Finland to respond to critical emergency events. However, in hospitals without dedicated METs, staff are instructed to call emergency medical services (EMS) to deal with emergencies. This study examined the reasons for calling EMS to hospitals and the outcomes of these calls.

Methods

Descriptive retrospective register-based study of the response and management of in-hospital emergencies by EMS in the wellbeing services county of Southwest Finland. Patient care reports of the EMS and those of the hospitals were analysed.

Results

In total, 138 medical emergencies managed by EMS were included in this study. 108 of these related to patients, and 25 related to hospital personnel. Cardiac arrest (n = 36) and a reduced level of consciousness (n = 29) were the most common in-hospital emergencies. In 68% of in-hospital emergencies managed by the EMS team, after calling 112, hospital personnel implemented various treatment measures. In 72% of cases, follow-up treatment was required.

Conclusions

Hospital personnel are able to initiate medical measures in emergencies, even when no MET is available. Although EMS are important in responding to in-hospital emergencies, they seem to be performing the same role as METs.

背景芬兰的一些医院设立了医疗急救小组（MET），以应对重大突发事件。然而，在没有专门的医疗急救小组的医院里，工作人员会接到指示，呼叫紧急医疗服务（EMS）来处理紧急情况。本研究探讨了医院呼叫急救医疗服务的原因以及这些呼叫的结果。方法对芬兰西南部福利服务县的急救医疗服务对院内紧急情况的响应和管理进行了描述性回顾性登记研究。对急救中心和医院的病人护理报告进行了分析。结果本研究共纳入了 138 起由急救中心处理的医疗紧急情况。其中 108 起与患者有关，25 起与医院人员有关。心脏骤停（36 例）和意识减退（29 例）是最常见的院内急症。在 68% 由急救小组处理的院内急症中，医院人员在拨打 112 后采取了各种治疗措施。在 72% 的病例中，需要进行后续治疗。尽管急救医疗队在应对院内急症方面非常重要，但他们似乎扮演着与急救医疗队相同的角色。

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引用次数: 0

Relationship between transformational leadership, adverse patient events, and nurse-assessed quality of care in emergency units: The mediating role of work satisfaction 急诊科变革型领导力、患者不良事件和护士评估的护理质量之间的关系：工作满意度的中介作用

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-08-17 DOI: 10.1016/j.auec.2023.08.001

Leodoro J. Labrague

Background

Effective leadership plays a pivotal role in healthcare settings, particularly in the fast-paced and high-pressure environment of the emergency room, as it is closely linked to patient safety and the overall quality of care. This study assessed the mediating role of work satisfaction in the relationship between nurses' perceptions of their nurse managers' transformational leadership, reported adverse patient events, and the nurse-assessed quality of care in the emergency units.

Methods

A cross-sectional survey design was carried out involving 283 emergency room nurses from the Philippines, utilizing standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

Results

Emergency room nurses perceived their nurse managers as highly transformational. Nurses' perceptions of transformational leadership in their nurse managers were associated with a reduction in reported adverse patient events and an increase in nurse-assessed nursing care quality. Work satisfaction partially mediated the relationship between transformational leadership and nurse-assessed nursing care quality, but it did not serve as a mediator between transformational leadership and reported adverse patient events.

Conclusion

The results suggested that enhancing transformational leadership behaviors among nurse leaders can foster work satisfaction in ER nurses, which, in effect, contributes to enhanced nursing quality of care provision in emergency settings.

背景有效的领导力在医疗机构中起着举足轻重的作用，尤其是在急诊室这种快节奏、高压力的环境中，因为它与患者安全和整体护理质量密切相关。本研究评估了工作满意度在护士对其护士长变革型领导力的看法、报告的患者不良事件和护士评估的急诊科护理质量之间的中介作用。方法采用横断面调查设计，使用标准化量表，对菲律宾的 283 名急诊科护士进行了调查。结果急诊室护士认为其护士长具有高度变革性。护士对护士长变革型领导力的认知与患者不良事件报告的减少和护士评估的护理质量的提高有关。工作满意度在一定程度上调节了变革型领导与护士评估的护理质量之间的关系，但它并不能调节变革型领导与报告的不良患者事件之间的关系。结果表明，加强护士长的变革型领导行为可以提高急诊室护士的工作满意度，从而有助于提高急诊室的护理质量。

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引用次数: 0

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

Australasian Emergency Care

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

Australasian Emergency Care

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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