Exploring the use of pre-hospital pre-alerts and their impact on patients, Ambulance Service and Emergency Department staff: a mixed-methods study.

338 Provider Opinions of Emergency Department HIV Testing Before and After Program Implementation

BackgroundAmbulance clinicians use pre-alert calls to inform receiving emergency departments (EDs) of the arrival of a critically unwell patient that will require a specialised response. Little is known about how...

Background: The National Association of Emergency Medical Services (EMS) Physicians emphasizes the importance of high quality communication between EMS providers and emergency department (ED) staff for providing safe, effective care. The Joint Commission has identified ineffective handoff communication as a contributing factor in 80% of serious medical errors. The quality of handoff communication from EMS to ED teams for critically ill pediatric patients needs further exploration.Objective: This study assessed the quality of handoff communication between EMS and ED staff during pediatric medical resuscitations.Methods/Design: We conducted a retrospective review of video recordings of pediatric patients who required critical care (“resuscitation”) in the ED between January 2014 and February 2016 at a Level 1 pediatric trauma center. Handoff quality between EMS and emergency department teams was assessed for completeness, timeliness, and efficiency. Institutional review board approval was obtained.Results: Sixty-eight resuscitations were reviewed; 28% presented in cardiac arrest, requiring cardiopulmonary resuscitation (CPR). Completeness of information communicated was variable and included chief complaint (88%), prehospital interventions (81%), physical exam findings (63%), medical history (59%), age (56%), and weight (20%). Completeness of specific vital sign reporting included: respiratory rate (53%), heart rate (43%), oxygen saturation (39%), and blood pressure (31%). Timeliness of communication included median patient handoff and report times of 50 seconds [IQR 30,74] and 108 seconds [IQR 62,252], respectively. Inefficient communication occurred in 87% of handoffs, including interruptions by ED staff (51%), questions from the ED physician team leader asking for information already communicated (40%), and questions by ED physician team leader requesting information not yet communicated (65%). When comparing non-CPR to CPR cases, only timeliness of patient handoff was significantly different for those patients receiving prehospital CPR.Conclusion: Handoff communication between EMS and ED teams during pediatric resuscitation was frequently incomplete and inefficient. Future educational and quality improvement interventions could aim to improve the quality of handoff communication for this patient population.

EMS and Information Sharing: Challenges and Innovations in Getting Patient Data From the Ambulance to the Emergency Department and Back

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

BackgroundAmbulance clinicians use pre-alert calls to inform receiving Emergency Departments (EDs) of the imminent arrival of a patient who they perceive will require non-standard ED response. Although some pre-alert decisions...

BackgroundPatient health-related social needs (HRSN) complicate care and drive poor outcomes in emergency department (ED) settings. This study sought to understand what HRSN information is available to ED physicians and staff, and how HRSN-related clinical actions may or may not align with patient expectations.MethodsWe conducted a qualitative study using in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. We asked ED providers, ED staff, and ED patients from one health system in the mid-Western United Stated about HRSN information availability during an ED encounter, HRSN data collection, and HRSN data use. Interviews were recorded, transcribed, and analyzed using modified thematic approach.ResultsWe conducted 24 interviews (8 per group: ED providers, ED staff, and ED patients) from December 2022 to May 2023. We identified three themes: (1) Availability: ED providers and staff reported that HRSNs information is inconsistently available. The availability of HRSN data is influenced by patient willingness to disclose it during an encounter. (2) Collection: ED providers and staff preferred and predominantly utilized direct conversation with patients to collect HRSNs, despite other methods being available to them (e.g., chart review, screening questionnaires). Patients’ disclosure preferences were based on modality and team member. (3) Use: Patients wanted to be connected to relevant resources to address their HRSNs. Providers and staff altered clinical care to account for or accommodate HRSNs. System-level challenges (e.g., limited resources) limited provider and staff ability to address patients HRSNs.ConclusionsIn the ED, HRSNs information was inconsistently available, collected, or disclosed. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. Accounting for such difference in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.

The Impact of Professionalism on Transfer of Care to the Emergency Department

BackgroundAmbulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving emergency department (ED) or other clinical...

Objective:Increased numbers of older people with palliative care needs accessing the Emergency Department (ED) has challenged traditional care delivery processes. A doctoral Experience-based Co-design (EBCD) study sought to understand and...

IntroductionEmergency departments worldwide are faced with in-hospital crowding and fast-paced admissions, creating an increasingly high workload for health care personnel. In recent years, emergency departments have also experienced an increase in emergency admissions, resulting in burdened workplaces. This has led to debates about nurses’ work environment and mental well-being. This study aimed to gain knowledge on the prevalence of depression, anxiety, and stress, as well as insight into the factors influencing the mental well-being of the nursing staff in a Danish emergency department. MethodsThis is a mixed-methods study with an explanatory sequential design. A questionnaire (the Depression, Anxiety, and Stress Scale – 21 Items) was sent to nursing staff (N = 146) in a large emergency department in the Region of Southern Denmark. Afterward, a smaller sample participated in semistructured interviews. The quantitative data were analyzed using descriptive statistics, the Mann–Whitney U test, and the chi-square test. In the qualitative part, a thematic analysis was performed. ResultsCompleted surveys were received from 78 nursing staff (53.4%). Overall, the nursing staff reported severe to extremely severe levels of depression (14.1%), anxiety (23.1%), or stress (47.2%) within a week before completing the survey. Higher levels of psychological distress were significantly associated with fewer years of clinical experience and having previously experienced or received treatment for depression, anxiety, or stress. Ten staff members later volunteered to participate in the interviews. The qualitative results formed 3 themes: (1) high work pace and responsibility, (2) professional community and nursing identity, and (3) culture with an increased focus on mental well-being. DiscussionThe nursing staff reported high mental strain, especially in the forms of high stress and anxiety levels. They explained that their mental health was affected by overcrowding, a pressured work environment, and lack of resources.

Commentary

Background Limited information is available on the extent of Emergency Department (ED) staff knowledge of frailty and frailty screening tools. Educational challenges unique to the ED environment are also little researched. This multi-site staff survey explores frailty knowledge and use of frailty screening tools in Irish emergency departments, as well as detailing educational challenges faced in the ED environment Methods A mixed-methods multi-site survey of twenty-five Irish adult emergency departments, aimed at all grades of ED staff. An anonymous online survey consisting of twenty-five statements across five categories was distributed via staff email at these sites. Five free-text sections were included after each category. Quantitative data were managed and analysed using IBM SPSS Statistics software. Qualitative results were analysed using reflexive thematic analysis Results 181 ED staff (nursing, medical and allied health) across all grades responded to the survey. ED nursing staff made up the largest staff category (n=80, 44%). Less than half of respondents had received training on frailty identification (n=88, 48%,p=0.028), yet the majority felt confident of identifying frailty (n=99, 54%, p=0.007). ED staff aged under 35 years felt nursing staff were the most appropriate group to screen for frailty in ED (N=88, 87%, P=0.017). Most respondents felt overwhelmed by time pressures in ED, which left little opportunity for dedicated teaching (n=77, 45%). A thematic map was created to explore obstacles to frailty screening in ED. Conclusion The opinion of ED staff surveyed was that frailty screening is feasible to undertake in ED but quick, user-friendly frailty screening instruments are lacking. Most ED staff surveyed relied on clinical judgement rather than frailty teaching experience to diagnose frailty syndromes. The provision of inclusive education in ED is challenging. Learning strategies in ED should reflect the demands of the acute care environment and incorporate a flexible, hybrid multi-disciplinary teaching model

Chinese emergency department (ED) staff encountered significant mental stress while fighting the coronavirus disease 2019 (COVID-19) pandemic. We sought to investigate the prevalence and associated factors for depressive symptoms among ED staff (including physicians, nurses, allied health, and auxiliary ED staff). A cross-sectional national survey of ED staff who were on duty and participated in combating the COVID-19 pandemic was conducted March 1–15, 2020. A total of 6,588 emergency medical personnel from 1,060 hospitals responded to this survey. A majority of respondents scored above 10 points on the PHQ-9 standardized test, which is associated with depressive symptoms. Those aged 31–45, those working in the COVID-19 isolation unit, and those with relatives ≤ 16 or ≥70 years old at home all had statistically significant associations with scoring >10 points. Depressive symptoms among Chinese emergency medical staff were likely quite common during the response to the COVID-19 pandemic and reinforce the importance of targeted ED staff support during future outbreaks.

IntroductionHospital emergency department (ED) staff experience high stress levels. Although numerous studies have investigated staff stress in the ED, there is a lack of prospective data. This study aimed to...