Emergency Healthcare Settings Research Articles

Enhancing emergency medical response through IoT: A focus on security and privacy

The healthcare industry is globally crucial. With an increasing demand for quality services, there is a need for innovative technologies like the Internet of Things (IoT) to enhance rapid and effective emergency response. This research explores IoT applications in emergency healthcare response, focusing on theoretical frameworks and design principles. It investigates the integration of IoT technologies into these systems while prioritising data security and privacy without relying on experimental data. The study offers innovative ideas for future research, highlighting the significance of addressing privacy and ethics in healthcare IoT usage. It emphasises protecting sensitive health data and promoting responsible IoT implementation in emergency healthcare settings. In conclusion, the study affirms the potential of IoT in enhancing emergency healthcare responses while emphasising the necessity of addressing privacy and ethical concerns within healthcare applications of these technologies. This research seeks to contribute to the ongoing development of IoT in healthcare by emphasising the importance of safeguarding patient information and ensuring that ethical considerations are at the forefront of implementation efforts.

Ethical Awareness and Practices Among Emergency Department Personnel in Riyadh's Tertiary Hospitals: A Cross-Sectional Analysis.

Ethical dilemmas in healthcare, particularly in emergency medical services (EMS), present significant challenges for healthcare workers (HCWs), necessitating a profound understanding of ethics and decision-making. This study assesses the ethical awareness and practices among HCWs in emergency departments of tertiary hospitals in Saudi Arabia, aiming to identify areas of strength and opportunities for improvement. A cross-sectional survey was conducted among 256 HCWs, including physicians, nurses, and administrative staff, in emergency departments across tertiary hospitals in Riyadh, Saudi Arabia. The questionnaire evaluated participants' knowledge of healthcare ethics, their experiences with ethical dilemmas, and the sources from which they derived their ethical understanding. The majority of participants exhibited a commendable level of ethical knowledge and practice, with frequent encounters of ethical or legal issues highlighting the pervasive nature of ethical challenges in emergency healthcare settings. Key sources of ethical knowledge included experiential learning and academic lectures, with a notable emphasis on practical experience. Despite the satisfactory level of ethical awareness, areas requiring further educational focus were identified, emphasizing the need for enhanced ethics training tailored to the emergency medical context. The findings underline the critical importance of incorporating ethics into the core of healthcare education and ongoing professional development for HCWs. Establishing a culture of continuous ethical dialogue and learning is essential for fostering patient-centered care and making informed ethical decisions in the fast-paced environment of emergency services. The study advocates for revising current ethics training programs to ensure they are comprehensive, relevant, and accessible, preparing HCWs to effectively address both current and future ethical challenges.

Mapping clinical interactions in an Australian tertiary hospital emergency department for patients presenting with risk of suicide or self-harm: Network modeling from observational data.

Reliable assessment of suicide and self-harm risk in emergency medicine is critical for effective intervention and treatment of patients affected by mental health disorders. Teams of clinicians face the challenge of rapidly integrating medical history, wide-ranging psychosocial factors, and real-time patient observations to inform diagnosis, treatment, and referral decisions. Patient outcomes therefore depend on the reliable flow of information through networks of clinical staff and information systems. This study aimed to develop a quantitative data-driven research framework for the analysis of information flow in emergency healthcare settings to evaluate clinical practice and operational models for emergency psychiatric care. We deployed 2 observers in a tertiary hospital emergency department during 2018 for a total of 118.5 h to record clinical interactions along patient trajectories for presentations with risk of self-harm or suicide (n = 272 interactions for n = 43 patient trajectories). The study population was reflective of a naturalistic sample of patients presenting to a tertiary emergency department in a metropolitan Australian city. Using the observational data, we constructed a clinical interaction network to model the flow of clinical information at a systems level. Community detection via modularity maximization revealed communities in the network closely aligned with the underlying clinical team structure. The Psychiatric Liaison Nurse (PLN) was identified as the most important agent in the network as quantified by node degree, closeness centrality, and betweenness centrality. Betweenness centrality of the PLN was significantly higher than expected by chance (>95th percentile compared with randomly shuffled networks) and removing the PLN from the network reduced both the global efficiency of the model and the closeness centrality of all doctors. This indicated a potential vulnerability in the system that could negatively impact patient care if the function of the PLN was compromised. We developed an algorithmic strategy to mitigate this risk by targeted strengthening of links between clinical teams using greedy cumulative addition of network edges in the model. Finally, we identified specific interactions along patient trajectories which were most likely to precipitate a psychiatric referral using a machine learning model trained on features from dynamically constructed clinical interaction networks. The main limitation of this study is the use of nonclinical information only (i.e., modeling is based on timing of interactions and agents involved, but not the content or quantity of information transferred during interactions). This study demonstrates a data-driven research framework, new to the best of our knowledge, to assess and reinforce important information pathways that guide clinical decision processes and provide complementary insights for improving clinical practice and operational models in emergency medicine for patients at risk of suicide or self-harm. Our findings suggest that PLNs can play a crucial role in clinical communication, but overreliance on PLNs may pose risks to reliable information flow. Operational models that utilize PLNs may be made more robust to these risks by improving interdisciplinary communication between doctors. Our research framework could also be applied more broadly to investigate service delivery in different healthcare settings or for other medical specialties, patient groups, or demographics.

Reliability of ChatGPT for performing triage task in the emergency department using the Korean Triage and Acuity Scale.

Artificial intelligence (AI) technology can enable more efficient decision-making in healthcare settings. There is a growing interest in improving the speed and accuracy of AI systems in providing responses for given tasks in healthcare settings. This study aimed to assess the reliability of ChatGPT in determining emergency department (ED) triage accuracy using the Korean Triage and Acuity Scale (KTAS). Two hundred and two virtual patient cases were built. The gold standard triage classification for each case was established by an experienced ED physician. Three other human raters (ED paramedics) were involved and rated the virtual cases individually. The virtual cases were also rated by two different versions of the chat generative pre-trained transformer (ChatGPT, 3.5 and 4.0). Inter-rater reliability was examined using Fleiss' kappa and intra-class correlation coefficient (ICC). The kappa values for the agreement between the four human raters and ChatGPTs were .523 (version 4.0) and .320 (version 3.5). Of the five levels, the performance was poor when rating patients at levels 1 and 5, as well as case scenarios with additional text descriptions. There were differences in the accuracy of the different versions of GPTs. The ICC between version 3.5 and the gold standard was .520, and that between version 4.0 and the gold standard was .802. A substantial level of inter-rater reliability was revealed when GPTs were used as KTAS raters. The current study showed the potential of using GPT in emergency healthcare settings. Considering the shortage of experienced manpower, this AI method may help improve triaging accuracy.

Cloud-Based Digital Twins’ Storage in Emergency Healthcare

In a medical emergency situation, real-time patient data sharing may improve the survivability of a patient. In this paper, we explore how Digital Twin (DT) technology can be used for real-time data storage and processing in emergency healthcare. We investigated various enabling technologies, including cloud platforms, data transmission formats, and storage file formats, to develop a feasible DT storage solution for emergency healthcare. Through our analysis, we found Amazon AWS to be the most suitable cloud platform due to its sophisticated real-time data processing and analytical tools. Additionally, we determine that the MQTT protocol is suitable for real-time medical data transmission, and FHIR is the most appropriate medical file storage format for emergency healthcare situations. We propose a cloud-based DT storage solution, in which real-time medical data are transmitted to AWS IoT Core, processed by Kinesis Data Analytics, and stored securely in AWS HealthLake. Despite the feasibility of the proposed solution, challenges such as insufficient access control, lack of encryption, and vendor conformity must be addressed for successful practical implementation. Future work may involve Hyperledger Fabric technology and HTTPS protocol to enhance security, while the maturation of DT technology is expected to resolve vendor conformity issues. By addressing these challenges, our proposed DT storage solution has the potential to improve data accessibility and decision-making in emergency healthcare settings.

Examining the validity and fidelity of a virtual reality simulator for basic life support training

BackgroundVirtual reality (VR) offers an immersive and practical method for training medical skills, especially in emergency healthcare settings. However, it is unclear whether learning in VR will translate into real-world performance benefits. To explore these potential transfer effects, we examined the validity and fidelity of a bespoke VR environment for Basic Life Support (BLS) training, a generic skill in medical training programmes.MethodsTwenty-two medical trainees performed standardised BLS procedures within two simulation conditions: one in VR, using a Pico Neo 3 standalone system; the other in a real-world synthetic environment, which included a physical mannequin and resuscitation equipment. Patterns of task behaviour, workload, sense of presence, and visual attention were derived from user self-report questionnaires, video recordings, and eye-tracking data.ResultsData showed that the VR training environment was sufficiently high in face validity to immerse the participants, and that trainees were displaying realistic task behaviours and procedural actions. However, the fidelity of user interactions and movements in VR proved atypical, which seemed to disrupt participants’ attentional and motor responses.ConclusionsResults suggest that VR may have limitations for improving physical skills in the context of BLS training, yet be potentially valuable for developing task procedures and/or perceptual abilities.

A Case Study of Critical Reasons Behind Hospital Nurses Turnover Due to Challenges Across System Levels.

PurposeThe aim of this study was to analyze how critical factors at different levels in a health-care system interact and impact nurses’ intention to leave and decision to quit their job at a hospital unit.MethodsA case study of assistant and registered nurses’ intentions to leave as well as staff turnover at a smaller Swedish public hospital was performed. Employee surveys and interviews with assistant and registered nurses who had quit their job at four units in the hospital during the period 2012–2019 were performed. Critical factors regarding nurses’ intention to leave and staff turnover are analyzed by combining narrative methods with a critical incidence technique.ResultsThree main themes emerge from the analysis of factors contributing to the decision to quit, namely lack or loss of buffering factors, not owning your spare time and not feeling valued by and listened to by upper management.ConclusionDecision-makers, including hospital management, need to consider how supportive factors in nurses’ closest work environment that promote staff retention may be impacted by decisions at higher levels, such as health-care reorganizations and stricter governance. In this context, upper management adopting a servant leadership approach might contribute to employees to a greater extent feeling valued and being listened to. Finally, the results indicate that individual nurses’ recovery, ability to work and ability to coordinate their personal life with their work life need to be supported by policies and decisions at higher levels in order to retain nurses in intensive and emergency health-care settings.

Change in perception and behavior of patients/attendant and healthcare workers after ?ntroduction of low-cost violence prevention interventions at emergency department of a tertiary care hospital in Karachi

Background: Objective of the study was to assess the effect of the intervention on patients/attendant’s awareness of their rights and responsibilities, Healthcare Workers (HCWs) experiences on patients/attendant’s behavior, and their ability to be responsive to them. Methods: This Quasi-Experimental Pre-Post-study was conducted in September 2019 to February 2020 at the Emergency department [ED] of a public sector hospital for 6 months. Pamphlets and Posters on the rights and responsibilities of patients/attendants and HCWs and awareness videos were introduced. HCWs were trained on de-escalation skills, communication, information sharing, and improving responsiveness towards patients and attendants. The assessments were done before and after the interventions with a gap of two month. The qualitative aspect was assessed through 12 Focus Group Discussions (FGDs) and thematic analysis was conducted. The effect of intervention on HCWs responsiveness was done using quantitative tools. All HCWs in emergency department (ED) and a total of 200 patients and attendants were interviewed before and after the intervention. Data analysis was done by applying paired T-test (for HCWs) and independent T-test (for patients and attendants. Results: There was a significant positive difference (<0.001) in the overall score of responsiveness of HCWs as reported by the patients and attendants. Conclusion: The qualitative assessment revealed that interventional training assisted HCWs in better understanding the patient's expectation; however, the patient and attendant educational component was less effective in changing their behavior. Conclusion: Violence in emergency healthcare settings is inevitable; however, its impact and intensity can be reduced significantly by building the capacity of HCW’s in prevention and de-escalation skills. Training on the component of responsiveness related to autonomy, confidentiality, respect, and reduce waiting showed improvement at the end.

Structural Inequities and Barriers to Accessing Kidney Healthcare Services in the United States: A Focus on Uninsured and Undocumented Children and Young Adults.

The population of children living in poverty and lacking healthcare insurance has increased in the United States of America in the last decade. Several factors have been responsible for this trend including illegal immigration, socioeconomic deprivation, young age, racial segregation, environmental degradation, and discriminatory housing policies. These systemic barriers have contributed to the exclusion of families from essential healthcare services. They are also contributory to the development of chronic illnesses (such as dialysis-dependent kidney disease) that are debilitating and frequently require considerable therapeutic resources. This unfortunate scenario creates a never-ending vicious cycle of poverty and diseases in a segment of society. For pediatric nephrologists, the challenges of caring for uninsured children with chronic kidney disease are all too familiar. Federally funded healthcare programs do not cover this patient population, leaving them the option of seeking care in emergency healthcare settings. Presentation with a critical illness often necessitates urgent placement of vascular catheters and the choice of acute hemodialysis. Adverse social environment influences the need for protracted chronic hemodialysis and a delay in kidney transplantation. Consequently, there is greater comorbidity, recurrent hospitalization, and a higher mortality rate. New policies should address the deficit in health insurance coverage while promoting social programs that will remove structural barriers to health care resources for undocumented children and young adults.

Assessment of knowledge and skills of cardiopulmonary resuscitation among health workers at Nakuru County Referral Hospital

Background: Cardiopulmonary resuscitation is critical in the emergency healthcare settings. Effective cardiopulmonary resuscitation improves the patients’ outcomes hence reducing mortality related to cardiac arrest. The aim of the study was to assess the knowledge and skills of cardiopulmonary resuscitation among health workers at Nakuru County Referral Hospital.Methods: The study adopted an analytic cross-sectional design. A census sampling technique was used to recruit respondents in the study. Questionnaires and checklists were used to collect data. Chi-square tests and multiple regression analysis were done to determine the significant association between demographic characteristics, knowledge and skills of cardiopulmonary resuscitation.Results: The study found that slightly above half 54.3% (n=88) of the respondents had low knowledge on cardiopulmonary resuscitation. Results revealed that age of respondent (p=0.038) and level of education (p=0.000) were significant. Cross tabulation showed that older respondents (>40 years) and those with a high level of education (degree and or masters) were more two and three times more likely to have a high knowledge of cardiopulmonary resuscitation. The study found out that majority 61.1% (n=99) of the respondents had poor CPR practice. Cross tabulation showed that respondents with high knowledge were four times (OR=4.303) more likely to have good practice.Conclusions: The study concluded that the performance of cardiopulmonary resuscitation is attributable to low CPR knowledge. The study recommends that more emphasis be placed on continuous professional development, and supervision be done after training to ensure that health workers follow the recommended guidelines.

Assessment of Interpersonal Communication Skills Among Emergency Medical Professionals in Pune, India

Introduction: Effective interpersonal communication is one of the most important skills for healthcare providers to master, in order to deliver high quality patient care. Doctors need to communicate with a wide range of people including peers, administration staff, patients, their family members and caregivers. Of course, the most significant is doctor-patient communication as it forms the foundation of the healthcare delivery system.Poor inter-personal communication skills can jeopardize the patient care process and hence it is expected that healthcare professionals undergo formal training both as part of their medical curriculum and on the job Continued Medical Education. Studies have shown that effective interpersonal communication skills help improve overall healthcare outcomes especially while managing difficult encounters and breaking bad news.Designing training programs with contemporary relevance requires regular needs assessment. It is essential to evaluate the baseline levels of inter-personal communication skills amongst practicing professionals to devise appropriate training strategies.Objective: To assess inter-personal communication skills among Emergency Medical Professionals in Pune.Methodology: The study was conducted among 140 Emergency Medical Professionals (EMPs) employed in various hospitals in the city of Pune, India. A questionnaire tool designed in 2019 by Piyush Ranjan et al was utilized to assess inter-personal communication skills among Emergency Medical Professionals.The tool was administered through online mode. The respondents were given one-day deadline to revert with responses. Any queries pertaining to the questionnaire were clarified during data collection. 131 respondents reverted with completely filled questionnaire. Conclusion: It relies on self-assessment to assess interpersonal communication skills and has a limited sample size. Yet, the study is an eye-opener to the incidents of conflicts in emergency healthcare settings and the barriers that prevent a healthy doctor patient relationship

Self-perceived functional ability and performance-based testing of physical function in older women with or without long-term back pain \u2013 results of the H70 study

BackgroundThe proportion of older adults is increasing rapidly, and the majority are female. In 2050, the number of persons aged 60 years and over is estimated to reach 2.1 billion worldwide, constituting one-third of the total population of Europe. Long-term back pain is a disabling and common condition, primarily affecting older women. Although standardized functional evaluations are essential in the screening of older adults, self-rated activities of daily living capture a different aspect of the person’s ability in the context of his or her environment and social support system. This study aimed to describe how older women with or without long-term back pain self-rate their activities of daily living (ADL) and instrumental activities of daily living (IADL) in relation to their performance-based testing of physical function, including walking test, leg muscle strength, balance, and endurance.MethodThis study is part of the Gothenburg H70 Birth Cohort Studies in Sweden (H70 studies) and uses data from the 1944 birth cohort examined in 2015–16 at age 70. In the present study, only female participants were included in the analysis, and all cases of dementia (n = 17) and cases of acute and sub-acute back pain excluded (n = 181), leaving an effective sample of 446 female participants.ResultsWomen with long-term back pain self-perceived their ADL and IADL as being as good as those without back pain, although they performed poorer in all performance-based tests and perceived themselves as less physically fit.ConclusionThe discrepancy between self-perceived functional ability (ADL/IADL) and performance-based testing of functioning based on clinical tests calls for further investigation to incentivize person-centered care in older women with long-term back pain in municipal or emergency health-care settings.

Substance use in psychiatric crisis: relationship to violence.

Substance use and psychiatric illness, particularly psychotic disorders, contribute to violence in emergency healthcare settings. However, there is limited research regarding the relationship between specific substances, psychotic symptoms and violent behaviour in such settings. We investigated the interaction between recent cannabinoid and stimulant use, and acute psychotic symptoms, in relation to violent behaviour in a British emergency healthcare setting. We used electronic medical records from detentions of 1089 individuals under Section 136 of the UK Mental Health Act (1983 amended 2007), an emergency police power used to detain people for 24-36 h for psychiatric assessment. The relationship between recent cannabinoids and/or stimulant use, psychotic symptoms, and violent behaviour, was estimated using logistic regression. There was evidence of recent alcohol or drug use in 64.5% of detentions. Violent incidents occurred in 12.6% of detentions. Psychotic symptoms increased the odds of violence by 4.0 [95% confidence intervals (CI) 2.2-7.4; p < 0.0001]. Cannabinoid use combined with psychotic symptoms increased the odds of violence further [odds ratios (OR) 7.1, 95% CI 3.7-13.6; p < 0.0001]. Recent use of cannabinoids with stimulants but without psychotic symptoms was also associated with increased odds of violence (OR 3.3, 95% CI 1.4-7.9; p < 0.0001). In the emergency setting, patients who have recently used cannabinoids and exhibit psychotic symptoms are at higher risk of violent behaviour. Those who have used both stimulants and cannabinoids without psychotic symptoms may also be at increased risk. De-escalation protocols in emergency healthcare settings should account explicitly for substance use.

The Face of Workplace Violence: Experiences of Healthcare Professionals in Surgical Hospital Wards.

Background Though workplace violence (WPV) is a global problem for healthcare professionals, research within in-hospital care has mainly focused on WPV in emergency healthcare settings. Thus, the number of qualitative studies that explores experiences of WPV in general hospital wards with a longer length of stay is limited. Aim The aim of this study was to explore how healthcare professionals in surgical hospital wards experience and manage WPV perpetrated by patients or visitors. Method The study applied a qualitative, inductive approach using focus group interviews for data collection. A purposeful sample of 16 healthcare professionals working in surgical wards was included. Data were analysed using a thematic analysis. Findings. The analysis resulted in four main themes: workplace violence characteristics, partly predictable yet not prevented, approaching workplace violence, and consequences from workplace violence. During the focus group interviews, the healthcare professionals described various acts of physical violence, verbal abuse, and gender discrimination perpetrated by patients or their visitors. Despite the predictability of some of the incidents, preventive strategies were absent or inadequate, with the healthcare professionals not knowing how to react in these threatful or violent situations. They experienced that WPV could result in negative consequences for the care of both the threatful or violent person and the other patients in the ward. WPV caused the healthcare professionals to feel exposed, scared, and unprotected. Conclusion and clinical implications. Exposure to WPV is a problem for healthcare professionals in surgical wards and has consequences for the patients. Preventive strategies, guidelines, and action plans are urgently needed to minimise the risk of WPV and to ensure a safe work and care environment.

Evaluation of Emergency Department-Based Surveillance Systems at 2 Healthcare Facilities After Hurricane Maria: Puerto Rico, 2017-2018.

Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico. We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period. The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category. The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.

Focused Ultrasound: Applications and Implications for Education

Introduction:Focused or point of care ultrasound applications have been integrated into prehospital assessments, triage capacities, military applications, trauma, and emergency health care settings, and medical school curriculums. Often, the inclusion of focused ultrasound is to answer specific clinical questions. However, the value is ultimately determined by the experience, skills, and training of the operator performing and interpreting the examination. Ultrasound was reserved for traditional imaging providers as little as two decades ago. However, as the application of ultrasound expands within clinical medicine, there is an increasing necessity for associated education and training.Aim:To highlight the applications and uses of focused ultrasound in the current diverse health care landscape while identifying the associated educational considerations, including the undergraduate tertiary education sector.Methods:A search of peer-reviewed published literature was undertaken to determine the range of current usage of ultrasound imaging across professions, and to identify the education and training available.Results:The results discussed within this presentation will highlight identified trends, ultrasound applications, educational considerations, and potential future practices based on the content of the literature explored.Discussion:Technology is rapidly advancing in the field of medical ultrasound with handheld ultrasound scanners now smaller, less expensive, and more accessible than ever before. Paralleled with these advances and the more generous use of ultrasound come the expectation and pressures of competent skill diversity among healthcare staff and specialists. Significantly, sonography is still considered by many as the most technically demanding and operator dependent medical imaging modality available. Therefore, as the application of ultrasound expands within clinical medicine, educational considerations must also align with this expansion to maintain diagnostic accuracy. This means an increasing demand for associated education and training, including in the undergraduate tertiary education sector.

Protective Factors of Suicide and Suicidal Behavior Relevant to Emergency Healthcare Settings: A Systematic Review and Narrative Synthesis of Post-2007 Reviews

Suicide is a major public health concern and, with recent societal changes, such as economic and technological changes, there may be emerging protective factors that mitigate suicide risk that are unrecognized in emergency healthcare. This systematic review aims to identify protective factors for suicide that can feasibly be assessed in time-limited emergency healthcare settings. A systematic review of reviews was conducted via PsycINFO, CINAHL and Medline (2007–2015). Reviews were assessed for methodological quality using AMSTAR. A total of 24 reviews met the inclusion criteria and 8 were assessed as high quality and included in a narrative synthesis. Known protective factors were identified (e.g., social support), along with emerging protective factors (e.g., internet support). The review synthesizes recent research evidence on protective factors and discusses their relevance to emergency healthcare.

BJP ASM Poster Abstracts 2017

Background There is a lack of research available that examines the diverse population of frequent users of Urgent and Emergency Healthcare services throughout England. The motivations and decision-making processes which frequent users take into consideration when selecting episodic treatment from: Out of Hours GPs; NHS111; Ambulance Services and Emergency Departments are not full examined. Most research explores this population by focusing on the patient’s demographics or preliminary diagnosis, rather than their unmet needs that has instigated the urgent and emergency contact. Subjective terminology and arbitrary thresholds are employed across these services to identify these individuals, with little standardisation or clinical justification to the reasons why they have been selected. Through understanding the unmet needs of this heterogenous population, improved individualised patient centred support and management options should be achieved. Aims The aim was to analyse the underlying reasons why frequent users of Urgent and Emergency Healthcare Services in England, select and request episodic instances of care, rather than the consistent approach provided within primary care. Methods A systematic mapping exercise was undertaken to create a comprehensive understanding of how these services are currently working with regard to frequent users. The search produced 5094 articles which were screened against the inclusion criteria, leaving 156 articles to be analysed. Data was extracted and a thematic synthesis was used to analyse this diverse population. From this analysis, a taxonomy of sub-groups of frequent users was formed and their underlying needs identified. Thirty-two clinical semi-structured interviews throughout these services were undertaken, to gain critical feedback on the robustness and viability of the taxonomy. A purposeful sampling method ensured that clinical practitioners that had substantial experience in supporting and managing these complex and vulnerable individuals participated within the research. The qualitative data received from clinicians with knowledge and skills of working with this population prompted adjustments to the original taxonomy. Results The taxonomy sub-divided the main heterogeneous group into 5 main groups: Elderly and Frail; Mental Health; Substance Misuse; Chronic Conditions; and Homeless and Vulnerably Housed. Within each sub-group, unmet needs were identified and further categorised. A hidden population of patients that were accessing urgent and emergency healthcare services due to unresolved pain emerged. This population was categorised into: persistent or chronic pain; acute episodes of severe pain (crisis) and addiction, opioid-induced hyperalgesia or tolerance factors. The reasons attributed to the patients’ frequent contacts were due to the breakdown of their relationship with their GP, polypharmacy issues, access to primary care treatments, perceptions and judgements from clinicians and lack of adequate clinical training around pain management both in primary and acute settings. These high intensity users of urgent and emergency healthcare services are often the most vulnerable and complex members of our society. Conclusion Repeated episodic instances of care, which are often given in urgent and emergency healthcare settings relating to pain management are not proactively allowing individuals to manage their long-term outcomes. Understanding the patients’ unmet needs and what has instigated their frequent contacts to services, could enable clinicians to signpost into other specialised services which will improve the patients’ quality of care. Furthermore, Improved pain management training in both the primary and acute services relating to high intensity users could diminish the negative experiences faced by these individuals and frustrations felt within day to day practice.

Radiographer commenting of trauma radiographs: a survey of the benefits, barriers and enablers to participation in an Australian healthcare setting.

Radiographer abnormality detection systems that highlight abnormalities on trauma radiographs ('red dot' system) have been operating for more than 30 years. Recently, a number of pitfalls have been identified. These limitations initiated the evolution of a radiographer commenting system, whereby a radiographer provides a brief description of abnormalities identified in emergency healthcare settings. This study investigated radiographers' participation in abnormality detection systems, their perceptions of benefits, barriers and enablers to radiographer commenting, and perceptions of potential radiographer image interpretation services for emergency settings. A cross-sectional survey was implemented. Participants included radiographers from four metropolitan hospitals in Queensland, Australia. Conventional descriptive statistics, histograms and thematic analysis were undertaken. Seventy-three surveys were completed and included in the analysis (68% response rate); 30 (41%) of respondents reported participating in abnormality detection in 20% or less of examinations, and 26(36%) reported participating in 80% or more of examinations. Five overarching perceived benefits of radiographer commenting were identified: assisting multidisciplinary teams, patient care, radiographer ability, professional benefits and quality of imaging. Frequently reported perceived barriers included 'difficulty accessing image interpretation education', 'lack of time' and 'low confidence in interpreting radiographs'. Perceived enablers included 'access to image interpretation education' and 'support from radiologist colleagues'. A range of factors are likely to contribute to the successful implementation of radiographer commenting in addition to abnormality detection in emergency settings. Effective image interpretation education amenable to completion by radiographers would likely prove valuable in preparing radiographers for participation in abnormality detection and commenting systems in emergency settings.

Patient satisfaction with nurse practitioner care in emergency departments in Canada

To measure patient satisfaction with care delivered by nurse practitioners (NPs) in emergency departments (EDs) in Canada using a psychometrically valid survey. All patients who received care from an NP in six participating EDs in Ontario province over a 1-week period were asked to complete a self-administered patient satisfaction survey designed specifically to assess satisfaction with NP care in EDs. One hundred and thirteen patients completed the survey. Principal components analysis of the survey revealed three factors or subscales: Attentiveness, Comprehensive care, and Role clarity. Scores on the three subscales indicated that patients were satisfied with Attentiveness (M = 3.72, SD = 0.38) and Comprehensive care (M = 3.52, SD = 0.49) and had a moderate understanding of Role clarity (M = 2.99, SD = 0.66). Participants with higher income levels reported higher levels of satisfaction with the attentiveness they received, whereas patients with previous experience with an NP reported higher levels of satisfaction with the comprehensive care they received. There was no appreciable increase in patient satisfaction with the NP based on age, gender, education, or health status. These findings indicate that attentiveness, comprehensive care, and role clarity are reflected by the NP in emergency healthcare settings as indicated by the patient's responses to the survey. This study supports that meeting expectations is a critical component of patient satisfaction.