scholarly journals MP42: Evaluating clinical and situational factors related to the likelihood of physician authorization for time-sensitive procedures during mandatory paramedic patches

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S57-S58
Author(s):  
D. Kelton ◽  
S. Doran ◽  
M. Davis ◽  
K. Van Aarsen ◽  
J. Momic
Keyword(s):  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Situational Factors ◽  
Prehospital Setting ◽  
Audio Recordings ◽  
Close Proximity ◽  
Transcutaneous Pacing ◽  
Symptomatic Bradycardia ◽  
Efficient Care ◽  
The Impact

Introduction: Delegation of controlled medical acts by physicians to paramedics is an important component of the prehospital care framework. Where directives indicate that physician input is needed before proceeding with certain interventions, online medical control (a “patch”) exists to facilitate communication between a paramedic and a Base Hospital Physician (BHP) to request an order to proceed with that intervention. The clinical and logistical setting will contribute to the decision to proceed with or withhold an intervention in the prehospital setting. The aim of this study was to examine the impact of various clinical and situational factors on the likelihood of a patch request being granted. Methods: Prehospital paramedic calls that included a mandatory patch point (excluding requests exclusively for termination of resuscitation and those records which were unavailable) were identified through review of all patch records from January 1, 2014 to December 31, 2017 for Paramedic Services in our region. Written Ambulance Call Reports (ACRs) and audio recordings of paramedic patches were obtained and reviewed. Results: 214 patch records were identified and screened for inclusion. 91 ACRs and audio patch records were included in the analysis. 51 of 91 (56%) patch requests were granted by the BHP. Of the 40 paramedic requests that were not granted, the most commonly cited reason was close proximity to hospital (22/40; 55%) followed by low likelihood of the intervention making a clinical impact in the prehospital setting (11/40; 27.5%). Requests for certain interventions were more likely to be granted than other requests. All requests to perform needle thoracostomy for possible tension pneumothorax, administer atropine for symptomatic bradycardia and treat hemodynamically unstable hyperkalemia were granted (2/2, 3/3 and 7/7, respectively), while requests for synchronized cardioversion (7/19; 37%) and transcutaneous pacing (2/6; 33%) were approved less than half of the time. Conclusion: This retrospective review suggests that requests to perform certain critical and potentially time sensitive interventions are more likely to be granted which calls into question the requirement for a mandatory patch point for these procedures. Furthermore, the interplay between proximity to hospital and the decision to proceed with an intervention potentially informs future modifications to directives to facilitate timely, safe and efficient care.

scholarly journals MP43: Evaluating factors related to quality of audio transmission during mandatory paramedic patches and technical barriers to efficient communication in the prehospital setting

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S58-S58
Author(s):  
D. Kelton ◽  
S. Doran ◽  
M. Davis ◽  
K. Van Aarsen ◽  
J. Momic
Keyword(s):  
Prehospital Care ◽  
Prehospital Setting ◽  
Chi Square ◽  
Audio Quality ◽  
Audio Recordings ◽  
Efficient Communication ◽  
Transmission Quality ◽  
Audio Transmission ◽  
The Impact ◽  
Made In

Introduction: Delegation of controlled medical acts by physicians to paramedics is an important component of the prehospital care framework. Where directives indicate that physician input is needed before proceeding with certain interventions, online medical control (a “patch”) exists to facilitate communication between a paramedic and a Base Hospital Physician (BHP) to request an order to proceed with that intervention. The quality and clarity of audio transmission is paramount for effective and efficient communication. The aim of this study was to examine the impact of audio transmission quality on the results of paramedic patch calls. Methods: Prehospital paramedic calls that included a mandatory patch point (excluding requests exclusively for termination of resuscitation and those records which were unavailable) were identified through review of all patch records from January 1, 2014 to December 31, 2017 for Paramedic Services in our region. Written Ambulance Call Reports (ACRs) and audio recordings of paramedic patches were obtained and reviewed. Pre-specified patch audio quality metrics, markers of transmission quality and comprehension as well as the resulting orders from the BHP were extracted. Differences between groups was compared using chi-square analyses. Results: 214 records were identified and screened initially. 91 ACRs and audio records were included in the analysis. At least one explicit reference to poor or inadequate call audio quality was made in 55/91 (60.4%) of calls and on average, 1.4 times per call. Of the 91 audited call records, 48 of 91 (52.7%) patches experienced an interruption of the call. Each time a call was interrupted, re-initiation of the call was required, introducing a mean [IQR] delay of 81 [33-68] seconds to re-establish verbal communication. Order requests made by paramedics in calls with no interruptions were approved in 30 of 43 patches (70%) while those requests made in calls with one or more interruptions were approved in only 21 of 48 cases (44%) (Δ26.0%; 95%CI 5.6-43.5%, p = 0.01). Conclusion: This retrospective review suggests that audio quality and interruptions of patch calls may impact a physician's ability to approve orders for interventions in the prehospital setting. Focus on infrastructure and technology underlying this important mode of communication may be a fruitful avenue for future improvements in systems where this may be an issue.

Shifting Landscapes: The Impact of Centralized and Decentralized Nursing Station Models on the Efficiency of Care

2017 ◽  
Vol 10 (5) ◽  
pp. 80-94 ◽  
Author(s):  
Lindsey Fay ◽  
Allison Carll-White ◽  
Aric Schadler ◽  
Kathy B. Isaacs ◽  
Kevin Real
Keyword(s):  
Team Approach ◽  
Culture Of Care ◽  
Hospital Design ◽  
Unit Design ◽  
Quantitative Results ◽  
Nursing Station ◽  
Efficient Care ◽  
The Impact ◽  
Integrated Team ◽  
Data Collection Approach

Objective: The focus of this research was to analyze the impact of decentralized and centralized hospital design layouts on the delivery of efficient care and the resultant level of caregiver satisfaction. Background: An interdisciplinary team conducted a multiphased pre- and postoccupancy evaluation of a cardiovascular service line in an academic hospital that moved from a centralized to decentralized model. This study examined the impact of walkability, room usage, allocation of time, and visibility to better understand efficiency in the care environment. Method: A mixed-methods data collection approach was utilized, which included pedometer measurements of staff walking distances, room usage data, time studies in patient rooms and nurses’ stations, visibility counts, and staff questionnaires yielding qualitative and quantitative results. Results: Overall, the data comparing the centralized and decentralized models yielded mixed results. This study’s centralized design was rated significantly higher in its ability to support teamwork and efficient patient care with decreased staff walking distances. The decentralized unit design was found to positively influence proximity to patients in a larger design footprint and contribute to increased visits to and time spent in patient rooms. Conclusion: Among the factors contributing to caregiver efficiency and satisfaction are nursing station design, an integrated team approach, and the overall physical layout of the space on walkability, allocation of caregiver time, and visibility. However, unit design alone does not solely impact efficiency, suggesting that designers must consider the broader implications of a culture of care and processes.

Evaluation of the Effect of Prehospital Application of Continuous Positive Airway Pressure Therapy in Acute Respiratory Distress

2010 ◽  
Vol 25 (1) ◽  
pp. 87-91 ◽  
Author(s):  
G. Scott Warner
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Data Collection ◽  
Length Of Stay ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Prehospital Setting ◽  
Rural Setting ◽  
Icu Length Of Stay ◽  
The Impact

AbstractObjective:The impact of the use of mask continuous positive airway pressure (CPAP) on patients with acute respiratory distress in the prehospital, rural setting has not been defined. The goal was to test the use of CPAP using the Respironics® WhisperFlow® CPAP in patients presenting with acute respiratory distress. This was a collaborative evaluation of CPAP involving a rural EMS agency and the regional medical center. Patient outcomes including the overall rate of intubation-both in the field and in the emergency department (ED), and length of stay in the hospital and Intensive Care Unit (ICU) were tracked.Methods:The study was an eight-month, crossover, observational, non-blinded study.Results:During the four months of baseline data collection, 7.9% of patients presenting with respiratory distress were intubated within the first 48 hours of care. Their average ICU length of stay was 8.0 days. During the four months of data collection when CPAP was available in the prehospital setting, intubation was not required for any patients in the field or in the ED. Admissions to the ICU decreased. Those patients admitted to the ICU, the average ICU length of stay deceased to 4.3 days.Conclusions:The use of the CPAP in the prehospital setting is beneficial for patients in acute respiratory distress.

Pleural Disease in the Intensive Care Unit

2000 ◽  
Vol 15 (2) ◽  
pp. 63-89
Author(s):  
Michael A. Jantz ◽  
Steven A. Sahn
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pleural Effusion ◽  
Critically Ill ◽  
Bronchopleural Fistula ◽  
Tension Pneumothorax ◽  
Respiratory Physiology ◽  
Critically Ill Patient ◽  
Pleural Disease ◽  
The Impact

Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including re-expansion pulmonary edema.

Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care

2018 ◽  
Vol 33 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Timmy Li ◽  
Jeremy T. Cushman ◽  
Manish N. Shah ◽  
Adam G. Kelly ◽  
David Q. Rich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Barriers To Care ◽  
Prehospital Care ◽  
Heart Association ◽  
Living Alone ◽  
Stroke Patients ◽  
Publication Type ◽  
Stroke Treatment ◽  
Significant Difference ◽  
The Impact

AbstractIntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED).MethodsA retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers.ResultsBarriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159).ConclusionsBarriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ.LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med.2018;33(5):501–507.

Work–life balance: a systematic literature review and bibliometric analysis

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kumari Rashmi ◽  
Aakanksha Kataria
Keyword(s):  
Content Analysis ◽  
Bibliometric Analysis ◽  
Work Life ◽  
Situational Factors ◽  
Work Life Balance ◽  
Future Research ◽  
Life Balance ◽  
Content Type ◽  
Research Themes ◽  
The Impact

Purpose The purpose of this paper is to provide a clear view of current dynamics and research diversification of extant literature in the field of work-life balance (WLB). This paper provides a systematic and critical analysis of WLB literature using bibliometric analysis.Design/methodology/approach Scopus database has been used for carrying out this review that is based on 945 research papers published from 1998 to 2020. The prominence of the research is assessed by studying the publication trend, sample statistics, theoretical foundation, the highly cited research articles and journals, most commonly used keywords, research themes of top four recognized clusters, sub-themes within each cluster and thematic overview of WLB corpus formed on the premise of bibliographic coupling. Additionally, content analysis of recently published papers revealed emerging research patterns and potential gaps.Findings Major findings indicate that the research area consists of four established and emerging research themes based on clusters formed as (1) flexible work arrangements, (2) gender differences in WLB, (3) work–life interface and its related concepts, and (4) WLB policies and practices. Emerging themes identified through content analysis of recent articles include gender discrepancy, the impact of different forms of contextual (situational) factors and organizational culture.Originality/value This research paper is the first of its kind on the subject of WLB as it provides multifariousness of study fields within the WLB corpus by using varied bibliographic mapping approaches. It also suggests viable avenues for future research.

Situational and Ecological Predictors of Conducted Energy Weapon Application Severity

2021 ◽  
pp. e20210019
Author(s):  
Victoria A. Sytsma ◽  
Erick Laming ◽  
Ethan Pohl
Keyword(s):  
Use Of Force ◽  
Mediating Effect ◽  
Multiple Use ◽  
Resistance Level ◽  
Empirical Examination ◽  
Risk Of Injury ◽  
Ecological Predictors ◽  
Close Proximity ◽  
Research Findings ◽  
The Impact

Despite being touted as a “less lethal” use-of-force option, conducted energy weapons (CEWs) do pose some risk of injury to civilians, and thus warrant empirical examination. CEWs provide users with multiple use modes constituting various levels of severity; yet apart from the work of Somers and colleagues, almost no research exists investigating these levels of severity. Further, research findings on the impact of suspect resistance on CEW deployment are somewhat mixed. We contribute an innovative application of environmental criminology in a Canadian setting by exploring situational and ecological predictors of CEW application severity, with special attention being paid to reasons cited for CEW use and the impact of subject resistance level. Using all 393 Ontario Provincial Police CEW-related use-of-force reports over a two-year period, we find probe deployment to be the most common level of CEW application severity, irrespective of subject resistance level, and even when officers and subjects are in close proximity to one another. Application of CEW for the purpose of effecting an arrest is consistently the strongest predictor of CEW application severity without any mediating effect of subject resistance level or presence of a weapon. The impact of applying CEWs for the purpose of effecting arrests on CEW application severity is partially mediated by lighting visibility. Results are discussed.

Faculty Perceptions and Participation in Distance Education

2011 ◽  
pp. 75-92 ◽  
Author(s):  
Kim E. Dooley ◽  
Jane Magill
Keyword(s):  
Distance Education ◽  
Training Programs ◽  
Faculty Perceptions ◽  
Faculty Training ◽  
Release Time ◽  
Additional Time ◽  
Close Proximity ◽  
The Impact ◽  
And Training ◽  
Faculty Responsibility

Motivating faculty members to teach at a distance has been a challenge for most colleges and universities. What will be the impact of teaching using technology on faculty responsibility? Is teaching students through any or all distance education methods really nothing more than adapting traditional classroom approaches? What are the attitudes and barriers to using technologies often associated with distance education? In this chapter the authors present data obtained from an extensive survey of faculty opinions on teaching at a distance, as well as several case studies describing incentives and training made available for distance education. To enhance participation in distance education, faculty must have the competence, attitude that distance education is important and valuable, and infrastructure available to facilitate the additional time and effort to convert courses. Faculty training programs cannot be “one-shot” and should include personnel in close proximity to faculty, preferable on their own equipment. Release time is an important incentive to encourage participation.

Attitude and subjective norm as personal moral obligation mediated predictors of intention to build eco-friendly house

2019 ◽  
Vol 30 (4) ◽  
pp. 678-694 ◽  
Author(s):  
Surendra Kumar Sia ◽  
Alphonsa Jose
Keyword(s):  
Behavioral Intention ◽  
Moral Obligation ◽  
Global Climate ◽  
Subjective Norm ◽  
Situational Factors ◽  
Psychological Variables ◽  
Content Type ◽  
Personal Norm ◽  
The Impact ◽  
The Relationship

Purpose The purpose of this paper is to combine the theory of planned behavior variables with norm activation model to predict the behavioral intention to build eco-friendly houses among adult house owners of Kerala. It was hypothesized that the moral obligation will mediate the relationship of both attitude and subjective norm toward the intention to build eco-friendly houses. Design/methodology/approach Data were collected from 269 adult house owners from Kerala with the help of structured questionnaires. Attitude toward eco-friendly houses was measured using semantic differential scale, subjective norm was measured using items adapted from Ajzen and Jansson and Dorrepaal, personal norm was measured using 7 items adapted from Jansson and Dorrepaal and behavioral intention to build eco-friendly house was measured using 14-item measures which probed the various characteristics of eco-friendly buildings. Data were analyzed using mediation analysis with the help of PROCESS macro plug-in of IBM SPSS. Findings The study revealed that the relationship between subjective norm and behavioral intention to construct eco-friendly houses was fully mediated by personal norm, and the relationship between attitude and behavioral intention was partially mediated by personal norm. Research limitations/implications Eco-friendly houses or sustainable architecture is the requirement of the time. Psychology can play a major role in increasing the choice to opt an eco-friendly alternative. The present study tries to develop a green marketing strategy by understanding the influential psychological variables. The study points to the importance of personal moral obligation of the people in the choice of the eco-friendly houses. The study is limited in itself because it failed to consider any situational factors that may be influential in the intention to build an eco-friendly house. Originality/value Considering the immediacy and potency of global climate change and the role green architecture can play to reduce the impact of the blow, eco-friendly architecture is inevitable. Many psychological studies have been instrumental in shaping and changing individual behaviors. Considering these facts the present study aims to identify the role of psychological variables in determining the intention to build eco-friendly houses. This study will help in identifying the relevant personal variables that can promote eco-friendly construction.

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