5 results
Decision-Making During a Disaster-Scenario Tabletop Exercise by Prelicensure Student Nurses – A Replication Study
- Cathleen A. Evans, Joan Perks, Linda O’Kane
-
- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 17 / 2023
- Published online by Cambridge University Press:
- 10 May 2022, e152
-
- Article
- Export citation
-
Objective:
“Determine which clients to recommend for discharge in a disaster situation” is a Registered Nurse Activity Statement on the National Council Licensing Exam test plan. The activity statement raised the nursing education research question: could senior student nurses transfer their learning to a novel circumstance, with a high degree of risk, making decisions using patient assessments and determining resource needs? A study with a descriptive quantitative approach was designed with 2 aims. The first was to describe students’ transfer of learning for basic disaster and medical-surgical knowledge and make recommendations for patient dispositions. The second aim was to describe students’ attitudes about their transfer of learning during the tabletop exercise.
Methods:A researcher-designed disaster-scenario tabletop exercise and 3 instruments with subject-matter-expert feedback captured participants’ decisions. Eligible senior student nurses volunteered to participate in the replicated study that was extended to 2 universities. Participant decisions and attitude responses were statistically analyzed.
Results:Descriptive and difficulty index statistics described students’ transfer of learning for basic disaster and medical-surgical topics, patient disposition recommendations, and attitudes. The cut-score for optimal transfer of learning was difficulty index (DI) ≤ .49.
Conclusions:Students had positive attitudes and transferred learning to most decisions. Decision DIs ≤ .49 were remediated.
On the Way Out: An Analysis of Patient Transfers from Four Large-Scale North American Music Festivals Over Two Years
- Sheila A. Turris, Christopher W. Callaghan, Haddon Rabb, Matthew Brendan Munn, Adam Lund
-
- Journal:
- Prehospital and Disaster Medicine / Volume 34 / Issue 1 / February 2019
- Published online by Cambridge University Press:
- 27 December 2018, pp. 72-81
- Print publication:
- February 2019
-
- Article
- Export citation
-
Introduction
Music festivals are globally attended events that bring together performers and fans for a defined period of time. These festivals often have on-site medical care to help reduce the impact on local health care systems. Historically, the literature suggests that patient transfers off-site are frequently related to complications of substance use. However, there is a gap in understanding why patients are transferred to hospital when an on-site medical team, capable of providing first aid services blended with a higher level of care (HLC) team, is present.
ObjectiveThe purpose of this study is to better understand patterns of injuries and illnesses that necessitate transfer when physician-led HLC teams are accessible on-site.
MethodsThis is a prospective, descriptive case series analyzing patient encounter documentation from four large-scale, North American, multi-day music festivals.
Results/DiscussionOn-site medical teams that included HLC team members were present for the duration of each festival, so every team was able to “treat and release” when clinically appropriate. Over the course of the combined 34 event days, there were 10,406 patient encounters resulting in 156 individuals being transferred off-site for assessment, diagnostic testing, and/or treatment. A minority of patients seen were transferred off-site (1.5%). The patient presentation rate (PPR) was 16.5/1,000. The ambulance transfer rate (ATR) was 0.12/1,000 attendees, whereas the total transfer-to-hospital rate (TTHR), when factoring in non-ambulance transport, was 0.25/1,000. In contrast to existing literature on transfers from music festivals, the most common reason for transfer off-site was for musculo-skeletal (MSK) injuries (53.8%) that required imaging.
ConclusionThe presence of on-site HLC teams impacted the case mix of patients transferred to hospital, and may reduce the number of transfers for intoxication. Confounding preconceptions, patients in the present study were transferred largely for injuries that required specialized imaging and testing that could not be performed in an out-of-hospital setting. These results suggest that a better understanding of the specific effects on-site HLC teams have on avoiding off-site transfers will aid in improving planning for music festivals. The findings also identify areas for further improvement in on-site care, such as integrated on-site radiology, which could potentially further reduce the impact of music festivals on local health services. The role of non-emergency transport vehicles (NETVs) deserves further attention.
,Turris SA ,Callaghan CW ,Rabb H ,Munn MB .Lund A On the Way Out: An Analysis of Patient Transfers from Four Large-Scale North American Music Festivals Over Two Years Prehosp Disaster Med.2019 ;34(1):72–81.
MP13: Accuracy of Korean triage and acuity scale when pain severity is used as a modifier
- M. Kim, J. Park
-
- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
- Published online by Cambridge University Press:
- 11 May 2018, pp. S44-S45
- Print publication:
- May 2018
-
- Article
-
- You have access Access
- Export citation
-
Introduction: Accurate triage is important because under-triage may delay critical care for emergent patients and over-triage may inhibit efficient management of emergency department (ED) resources. In Korea, the Korean Triage and Acuity Scale (KTAS) was developed based on the CTAS in 2015. The purpose of this study was to evaluate the accuracy of KTAS in predicting patient’s severity when degree of pain was used as a modifier. Methods: This was a retrospective observational cohort study, conducted in an ED of urban tertiary university hospital with more than 90,000 visits per year. We studied adult patients who visited the ED from January 2016 to June 2016. Patients were devided into pain group and non-pain group according to whether the degree of pain was used as a modifier in the KTAS evaluation. We used acute area registration, emergency procedure, emergency operation, hospitalization, intensive care unit admission, and hospital mortality as markers to determine urgent patients. To evaluate discriminative ability of KTAS, the odds ratios of each KTAS values compared to KTAS 3 for the urgent patients were calculated. And to compare the predictive power of KTAS for urgent patients between the two groups, the area under the receiver operating characteristic (ROC) curves were compared by DeLongs method. Results: There were 9,175 (37.8%) patients in the pain group and 15,078 (62.2%) patients in the non-pain group. When KTAS was assessed as 2, only 20.3% of the patients in the pain group were registered to the acute area, while 71.2% of the patients in the non-pain group were registered to the acute area (p<0.001). And the proportion of emergency procedure, admission, ICU admission, and mortality was also higher in patients with pain group. Similarly, in the patients of KTAS 3, the proportion of urgent patients was higher in the non-pain group except emergency operation. The odds ratio for the occurrence of urgent patients decreased as the KTAS value increased in both groups, however, the difference between the odds ratios of each KTAS was more evident in the non-pain group. In pain group, compared to patients with KTAS 3, the odds ratio (95% CI) for acute area registration were 2.32 (1.92-2.80), 0.61 (0.51-0.73), and 0.35 (0.23-0.53) for patients with KTAS 2, 4, 5, respectively; in non-pain group, odds ratio were 5.59 (5.09-6.13), 0.28 (0.25-0.32), and 0.13 (0.10-0.16). The non-pain group showed better predictive power of KTAS for acute area registration than pain group; AUC (95% CI), 0.864 (0.861-0.867) vs. 0.810 (0.802-0.818), p<0.0001). The predictability of KTAS was also higher in non-pain group for emergency procedure, emergency operation, admission, and ICU admission. Conclusion: We have confirmed that the use of pain severity as a modifier in KTAS is a factor affecting accuracy. The acuity level is overestimated when pain severity is used as modifier in KTAS evaluation.
MP001: Low acuity emergency department access: are other options available?
- J. MacKay, P.R. Atkinson, M. Howlett, E. Palmer, J. Fraser, E. Vaillancourt
-
- Journal:
- Canadian Journal of Emergency Medicine / Volume 18 / Issue S1 / May 2016
- Published online by Cambridge University Press:
- 02 June 2016, p. S66
- Print publication:
- May 2016
-
- Article
-
- You have access Access
- Export citation
-
Introduction: Patients with low-acuity (CTAS level IV and V) complaints often use the emergency department (ED) to access care. This has often been attributed to lack of a primary care (PC) provider. However, simply being registered with a primary care practitioner may not prevent low acuity ED presentation. There is some evidence that a lack of timely access to primary care may contribute to low acuity ED presentations. The Wait Time Alliance, a group of Canadian physicians and their respective professional associations, has recently set a benchmark of same day access to family doctors. It is unclear if this benchmark has been achieved in all jurisdictions. Methods: We performed linked cross sectional surveys to quantify the number of people presenting to a tertiary hospital ED (with 56,000 annual visits) with non-urgent problems who felt unable to access PC. PC practices were also surveyed to assess access using the metric of time to third next available appointment. Sample size calculations were completed. Descriptive statistics were reported. Results: In the patient survey, 381 of 580 patients consented to participate. Of those, 89 patients met eligibility criteria. 32 (35.9%) reported that the wait to see their PC provider was “too long”. 45 (50.5%) patients did not contact their PC office prior to ED presentation. 46 of 72 PC physician surveys were returned; a response rate of 63.8%. The mean time to third next available appointment in the region was 7.7 (95% CI 4.9-10.5) days (median 5 days, range 0-50 days). Conclusion: Fifty percent of low acuity patients did not attempt to access their PC provider prior to ED presentation. The benchmark of same day access to primary care has not been achieved in many practices in this region. Initiatives to promote primary care access would benefit both patients and providers.
Medical Priority Dispatch System Breathing Problems Protocol Key Question Combinations are Associated with Patient Acuity
- Jeff Clawson, Tracey Barron, Greg Scott, A. Niroshan Siriwardena, Brett Patterson, Christopher Olola
-
- Journal:
- Prehospital and Disaster Medicine / Volume 27 / Issue 4 / August 2012
- Published online by Cambridge University Press:
- 24 July 2012, pp. 375-380
- Print publication:
- August 2012
-
- Article
- Export citation
-
Introduction
The Breathing Problems Chief Complaint (CC) protocol in the Medical Priority Dispatch System (MPDS) was the system's most frequently used protocol. While “severe breathing problems” is a significant predictor of cardiac arrest (CA), previous data have demonstrated that the DELTA-level determinant codes in this CC contain patients across a wide spectrum of acuity.
HypothesisThe hypothesis in this study was that certain combinations of caller answers to the breathing problems protocol key questions (KQs) are correlated with different but specific patient acuities.
MethodsThis was a retrospective study conducted at one International Academies of Emergency Dispatch (IAED) Accredited Center of Excellence. Key Question combinations were generated and analyzed from 11 months of dispatch data, and extracted from MPDS software and the computer assisted dispatch system. Descriptive statistics were used to evaluate measures between study groups.
ResultsForty-two thousand cases were recorded; 52% of patients were female and the median age was 61 years. Overall, based on the original MPDS Protocol (before generating KQ combinations), patients with abnormal breathing and clammy conditions were the youngest. The MPDS DELTA-level constituted the highest percentage of cases (74.0%) and the difficulty speaking between breaths (DSBB) condition was the most prevalent (50.3%). Ineffective breathing and not alert conditions had the highest cardiac arrest quotient (CAQ). Based on the KQ combinations, the CA patients who also had the not alert condition were significantly older than other patients. The percentage of CA outcomes in asthmatic patients was significantly higher in DSBB plus not alert; DSBB plus not alert plus changing color; and DSBB plus not alert plus clammy conditions cases, compared to asthmatic abnormal breathing cases.
ConclusionsThe study findings demonstrated that MPDS KQ answer combinations relate to patient acuity. Cardiac arrest patients are significantly less likely to be asthmatic than those without CA, and vice versa. Using a prioritization scheme that accounts for the presence of either single or multiple signs and/or symptom combinations for the Breathing Problems CC protocol would be a more accurate method of assigning DELTA-level cases in the MPDS.
Clawson J, Barron T, Scott G, Siriwardena AN, Patterson B, Olola C. Medical Priority Dispatch System breathing problems protocol key question combinations are associated with patient acuity. Prehosp Disaster Med. 2012;27(4):1-6.