Emergency Care Staff Research Articles

Exploring the burden of paediatric acute otitis media with discharge in the UK: a qualitative study

BackgroundAcute otitis media with discharge (AOMd) results from a tympanic membrane perforation secondary to a middle ear infection. Currently, the impact of AOMd on children and young people (CYP) and...

Brief admission by self-referral for individuals with self-harm and suicidal ideation: a qualitative study based on focus groups exploring relatives’ experiences

ABSTRACT Purpose Brief Admission by self-referral (BA) is a standardized crisis-management intervention for individuals with self-harm and risk for suicide. This study explored relatives’ experiences of BA. Relatives’ perspectives may contribute to an increased understanding of the effects of BA given the relatives’ role as support and informal caregivers as well as being co-sufferers. Methods Fourteen relatives to adults with access to BA within one Swedish region participated in focus groups analysed with reflexive thematic analysis. Results We generated themes evolving around three meaning-based concepts: access (A low threshold to a safe back-up is crucial and obstacles may easily break faith), independence (Trust in their ability with care and respect), and recovery (The rest and relational recovery we all get are needed and invaluable). Conclusions BA brings considerable value to users and relatives, by supporting them to take care of themselves and each other. Communication and involvement of relatives may enhance users’ ability to overcome obstacles to accessing BA. Implementation and adherence may be strengthened by supervision of BA staff and education of emergency care staff. Resources are needed to improve access. Mapping hurdles to BA, support through peers and targeted psychoeducation may improve recovery for BA users and their relatives.

How much more corridor care can emergency care staff take?

How much more corridor care can emergency care staff take?

Interventions to reduce interpersonal stigma towards patients with a mental dysregulation for ambulance and emergency department healthcare professionals: review protocol for an integrative review

IntroductionWorldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department...

FTP6.6 Same Day Emergency Care Satisfaction Survey, Patients and Staff Respond

Abstract Surgical Same Day Emergency Care (SDEC) Satisfaction Survey - SDEC was introduced to the hospital in 2021. Aims Methodology Results Conclusion Abstract presented at World Society of Emergency Surgery, 2022.

What if It Were Me? A Qualitative Exploratory Study of Emergency Nurses’ Clinical Decision Making Related to Obstetrical Emergencies in the Context of a Post-Roe Environment

IntroductionPrevious research describes a significant knowledge deficit in obstetrical care in emergency settings. In a post-Roe environment, additional medicolegal challenges are documented across the obstetrics and gynecology landscape, but an understudied care setting is the emergency department, where patients may present to a practice environment where there is limited or no obstetrical care available. It is unknown how emergency nurses make decisions around these types of presentations. The purpose of this study was to explore the clinical decision-making processes of emergency nurses in the care of patients with obstetrical emergencies in the context of limited or absent access to abortion care and the impact of those processes on patient care. MethodsQualitative exploratory approach using interview data (n = 13) and situational analysis was used. ResultsSituational mapping uncovered human elements comprised nurses, providers, pregnant people, and families; nonhuman elements comprised legislation, education, and legal understanding. Social worlds mapping included challenges of inexperience, conflict about clinical responsibility, uncertainty about the meaning of legislation, and passivity around implications for patient care. Positional mapping yielded both the overlapping discourses around the phenomenon of interest and the area of silence around abortion-limiting legislation. DiscussionWe found that emergency nurses in states with abortion care-limiting laws had significant self-reported deficits in both education and training around the management of obstetrical emergencies. In this sample, there was a surprising lack of awareness of care-limiting legislation and the clinical, ethical, and legal implications for both emergency care staff and for patients.

Supporting ethical end-of-life care during pandemic: Palliative care team perspectives.

Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges. To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves. A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view. Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network. The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded. The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care. Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies.

General Health among Eastern Romanian Emergency Medicine Personnel during the Russian-Ukrainian Armed Conflict.

(1) Background: The aim of the current study is to identify the relations between worries, threat perceptions, anxiety states, and general health in a sample of Emergency unit staff during the Russian Ukrainian armed conflict. The sample consisted of 372 Emergency Care staff (M age = 39.41; 77.2% women), physicians, and nurses from North-eastern Romania. (2) Methods: Participants completed an online survey including scale measuring worries, recent anxiety symptoms, and general health. The survey was distributed and completed in the next month after the outbreak of the war. (3) Results: The results showed that the worries, perceived threats, and anxiety symptoms during the last period are negatively related to general health. Women presented higher levels of worries, perceived threats, and anxiety symptoms, compared to men, while for general health, women presented lower scores. Concerning the differences between different professional categories, the results showed that trainees presented higher scores on worries, perceived threats, and anxiety symptoms, as well as lower scores on general health. The implications of these results for improving health and quality of life are discussed. (4) Conclusions: The level of stress increases beyond the borders where the war takes place, thus indirectly affecting the Emergency Care staff involved in the care of victims. Clinical implications of these results for interventions designed to monitor quality of life and to prevent unwanted consequences of exposure to traumatic life events are discussed.

Emergency care: need for reform from the inpatient perspective

Die interdisziplinäre zentrale Notaufnahme (ZNA) als neuer Goldstandard der stationären Notfallversorgung setzt sich zunehmend durch. Nicht alle Notfallpatientinnen und -patienten, deren Beschwerden mit den Mitteln einer Notaufnahme abgeklärt werden müssen, werden letztlich auch stationär aufgenommen. Für alle anderen Notfälle müssen frühzeitig korrekte Allokationsentscheidungen getroffen und präferierte Pfade zur Abklärung und Behandlung angeboten werden, welche die Krankenhausnotaufnahmen entlasten. Qualifikationsanforderungen an das Personal der Notfallversorgung sind bisher sehr uneinheitlich für die drei Sektoren. Es gilt zudem, gemeinsam qualitätssichernde Maßnahmen für die Zusammenarbeit zwischen ambulantem und stationärem Sektor sowie dem Rettungsdienst zu etablieren.

What are the barriers and facilitators to effective health promotion in urgent and emergency care? A systematic review

BackgroundThere are potential health gains such as reducing early deaths, years spent in ill-health and costs to society and the health and care system by encouraging NHS staff to use encounters with patients to help individuals significantly reduce their risk of disease. Emergency department staff and paramedics are in a unique position to engage with a wide range of the population and to use these contacts as opportunities to help people improve their health. The aim of this research was to examine barriers and facilitators to effective health promotion by urgent and emergency care staff.MethodsA systematic search of the literature was performed to review and synthesise published evidence relating to barriers and facilitators to effective health promotion by urgent and emergency care staff. Medical and social science databases were searched for articles published between January 2000 and December 2021 and the reference lists of included articles were hand searched. Two reviewers independently screened the studies and assessed risk of bias. Data was extracted using a bespoke form created for the study.ResultsA total of 19 papers were included in the study. Four themes capture the narratives of the included research papers: 1) should it be part of our job?; 2) staff comfort in broaching the topic; 3) format of health education; 4) competency and training needs. Whilst urgent and emergency care staff view health promotion as part of their job, time restraints and a lack of knowledge and experience are identified as barriers to undertaking health promotion interventions. Staff and patients have different priorities in terms of the health topics they feel should be addressed. Patients reported receiving books and leaflets as well as speaking with a knowledgeable person as their preferred health promotion approach. Staff often stated the need for more training.ConclusionsFew studies have investigated the barriers to health promotion interventions in urgent and emergency care settings and there is a lack of evidence about the acceptability of health promotion activity. Additional research is needed to determine whether extending the role of paramedics and emergency nurses to include health promotion interventions will be acceptable to staff and patients.

Hyponatremia and stroke mimic: a case report.

The differential diagnosis of acute stroke is often a challenge for the emergency care staff. In medical literature, about 30% of patients presenting in an emergency department with suspected stroke at initial assessment are actually stroke mimic. We report here a case of a 61-year-old woman who got admitted at the emergency service for an acute stroke that was actually a symptomatic hyponatremia due to a Schwartz-Bartter syndrome associated with an undiagnosed breast cancer. It is very important to quickly identify and manage patients presenting with a high probability of acute stroke even though many other pathological conditions can present with the same clinical onset. Electrolyte disturbances are one of those stroke mimic conditions that are usually reversible if properly identified and treated on time.

Preparing for reopening: An emergency care perspective.

Australia is rapidly moving towards 'living with COVID-19', with relaxation of some public health measures. The number of severe cases of COVID-19 may be mitigated by vaccination, but 'living with COVID-19' will be associated with higher number of patients seeking emergency care. This impending impact on the emergency care system requires recognition, monitoring and co-ordinated management. Current challenges include a lack of emergency care monitoring systems, staff shortages and patient flow processes that are quickly overwhelmed by large numbers, particularly in a system already operating at capacity. Effective monitoring systems are required for health systems to proactively detect and respond to stresses. Additional solutions include public health messaging and clinical innovation to facilitate care of the right patient in the right place at the right time. Optimising staff numbers and morale, and efficient patient flow, are integral steps to increasing capacity within the emergency care system.

'Acknowledge me as a capable person': How people with mental ill health describe their experiences with general emergency care staff - A qualitative interview study.

People with mental ill health attend general emergency care more often than others for physical and psychiatric care needs. Staff in general emergency care report they lack knowledge and strategies to meet with and care for people with mental ill health. This study aimed to describe how people with mental ill health experience encounters with staff in general emergency care. We conducted individual semi-structured interviews with 11 people with mental ill health about their experiences in general emergency care and subjected the interview data to qualitative content analysis. Our results show the importance to people with mental ill health of being acknowledged as capable persons, and how this relates to their experiences of being recognized, ignored, or dismissed by staff in general emergency care. Even small, ordinary aspects of staff/patient interactions can have major impacts on a person's recovery and well-being. The study is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidelines.

Evaluating Improvement in Acute Stroke Management following Pre-hospital Initiation of Acute Stroke Service

Prehospital notification of the stroke team in alerting incoming acute stroke patient has been practiced in several countries worldwide. Currently this is not practiced in Malaysia. This study evaluates feasibility and impact to stroke team door to review time when prehospital notification is employed. Duration of case control study was between June 2018 to January 2019. Control phase consists of conventionally activating stroke team after in-hospital assessment by emergency medical officer. This was then followed by an intervention phase where on scene activation of stroke team was done by the Prehospital Emergency Care (PHC) staff. Training of PHC staff in recognising an acute stroke was based on identification of BE-FAST (Balance, Eyes, Face, Arm and Speech Test) abnormalities. The objectives were to compare the mean between two groups for acute stroke team review time, door to computerised tomography (CT) scan and door to thrombolysis time. Thirty-nine patients were analysed (control n=29, intervention n=10). Results were insignificant (p>0.05). Mean time in minutes for control phase vs. intervention phase was as follows: Door to stroke team review time, 25.96 + 39.16 vs. 15.9 + 13.14, door to CT scan was 43.04 + 40.00 vs. 25.8 + 11.35. Only 3 patients underwent thrombolytic therapy during study period. Limitation was non-parametric data with lack of number of acute stroke cases responded during the intervention period. With continual training of pre-hospital staff in detecting acute stroke, feasibility can be improved.

Covid-19 1 year on: The challenge for low-middle income countries.

Covid-19 1 year on: The challenge for low-middle income countries.

The impact of the COVID-19 pandemic on child health and the provision of Care in Paediatric Emergency Departments: a qualitative study of frontline emergency care staff

BackgroundThe COVID-19 pandemic and subsequent public health guidance to reduce the spread of the disease have wide-reaching implications for children’s health and wellbeing. Furthermore, paediatric emergency departments (EDs) have rapidly adapted provision of care in response to the pandemic. This qualitative study utilized insight from multidisciplinary frontline staff to understand 1) the changes in paediatric emergency healthcare utilization during COVID-19 2) the experiences of working within the restructured health system.MethodsFifteen semi-structured interviews were conducted with frontline staff working in two paediatric EDs and two mixed adult and children EDs. Participants included emergency medicine clinicians (n = 5), nursing managerial staff (n = 6), social workers (n = 2) and nursing staff (n = 2). Thematic Analysis (TA) was applied to the data to identify key themes.ResultsThe pandemic and public health restrictions have had an adverse impact on children’s health and psychosocial wellbeing, compounded by difficulty in accessing primary and community services. The impact may have been more acute for children with disabilities and chronic health conditions and has raised child protection issues for vulnerable children. EDs have shown innovation and agility in the structural and operational changes they have implemented to continue to deliver care to children, however resource limitations and other challenges must be addressed to ensure high quality care delivery and protect the wellbeing of those tasked with delivering this care.ConclusionsThe spread of COVID-19 and subsequent policies to address the pandemic has had wide-reaching implications for children’s health and wellbeing. The interruption to health and social care services is manifesting in myriad ways in the ED, such as a rise in psychosocial presentations. As the pandemic continues to progress, policy makers and service providers must ensure the continued provision of essential health and social services, including targeted responses for those with existing conditions.

A Novel Emergency Telepsychiatry Program in a Canadian Urban Setting: Identifying and Addressing Perceived Barriers for Successful Implementation: Un nouveau programme de télépsychiatrie d'urgence en milieu urbain canadien: Identifier et aborder les obstacles perçus d'une mise en œuvre réussie.

To report on the perceived barriers surrounding the use of telepsychiatry for emergency assessments and our approach to overcoming those barriers to achieve successful implementation of a program to increase access to emergency psychiatric assessment in a Canadian urban setting. We conducted a survey of emergency care staff to inform the implementation of an emergency telepsychiatry program in the urban setting of Winnipeg, Manitoba, where hospitals have variable on-site emergency psychiatric coverage. We analyzed survey responses for perceived barriers we would need to address in implementation. We employed implementation strategies for each barrier and scaled the program to three sites over the first year. Data from the first year were collected including number of telepsychiatry assessments, reasons for referral, wait time, and percentage of patient transfers avoided. Survey respondents (N = 111) had little prior exposure to telepsychiatry, but the majority were open to its use for emergency psychiatric assessments in the region. We identified three categories of perceived barriers: clinical, logistical/technical, and readiness barriers. Implementation planning addressed each barrier, and a hub-and-spoke program was launched. After the first year, the program had one hub serving three spokes, and 243 emergency telepsychiatry assessments had been completed. After 12 months, we were avoiding 65% of patient transfers. By conducting a user survey to identify perceived barriers, and addressing these during implementation, we successfully scaled our emergency telepsychiatry program across our region. Our report of this experience may benefit others attempting to implement a similar program.

A video analysis of clinical handovers between paramedics and emergency care staff.

Aims:Studies examining communication during clinical handovers involving paramedics are rare. A recent National Institute of Health Research (NIHR) report has noted a significant gap in our knowledge and understanding of what happens during clinical handovers between ambulance services and emergency departments. This PhD study has used a video analysis to understand issues in communication and teamwork during these clinical handovers by examining cases of good practice.Methods:A video analysis of 100 examples of handovers from different TV programmes, including 24 Hours in A&E and The Real A&E, was conducted. This methodology emphasised the capturing of real-world practice, without the limitation of semi-structured interviews which are reliant on recall of events. These examples highlighted how interprofessional teamworking and communication were conducted during these high pressured and complex situations. The videos were transcribed verbatim and idiosyncratically to show variances in the style of communication as well as the non-verbal actions used by the staff during the exchange of patient information.Results:The emergent findings demonstrate a variety of interactional strategies that paramedics use when conducting handovers. These strategies often involved a paramedic team member drawing attention to themselves by stating they were ready to do the handover or loudly introducing the patient’s name. This was typically followed by an account of the treatment the paramedic team provided and ended with questions from those receiving the handover. The questions asked by the receiving team would be about the treatment provided and during this exchange the paramedic team would justify the methods used in assisting the patient. When handovers were being taken for high-risk patients, for example ‘haemorrhaging of a femoral artery’, the structure of the handover changed. In such examples, the paramedic team were found to dictate how the receiving team handled continuation of treatment for the patient.Conclusion:The variations in handover examples that have been captured and analysed have been beneficial in understanding the interactions between paramedics and the emergency care team. Initial findings have shown how the structure of communication during handovers can be altered due to situational or contextual factors. These results have highlighted where potential improvements in communication can be made during handovers, which would subsequently increase patient safety and experience.

Emergency care staff urged to use checklist this winter

Emergency care staff urged to use checklist this winter

What's next for England's ambulance services?

Details of the delivery of new ambulance standards were announced in July 2017 at the Health and Care Innovation Expo in Manchester. In this comment, Alistair Quaile examines the implementation, outline and evaluation of the programme, noting potential positive changes for patients, emergency care and ambulance staff.