1 University at Buffalo School of Social Work , Buffalo, New York.
2 Emergency Medicine Department, Erie County Medical Center , Buffalo, New York.
J Palliat Med. 2018 Jul;21(7):987-991. doi: 10.1089/jpm.2017.0332. Epub 2018 Apr 9.
Nursing home (NH) residents account for over 2.2 million emergency department visits yearly; the majority are cared for and transported by prehospital providers (emergency medical technicians and paramedics).
The purpose of this study was to investigate prehospital providers' perceptions of emergency calls at life's end. This article focuses on perceptions of end-of-life calls in long-term care (LTC).
This pilot study employed a descriptive cross-sectional design. Concepts from the symbolic interaction theory guided the exploration of perceptions and interpretations of emergency calls in LTC facilities.
SETTING/SUBJECTS: A purposeful sample of prehospital providers was developed from one agency in a small northeastern U.S. city.
Semistructured interviews were conducted with 43 prehospital providers to explore their perceptions of factors that trigger emergency end-of-life calls in LTC facilities. Qualitative data analysis involved iterative coding in an inductive process that included open, systematic, focused, and axial coding.
Interview themes illustrated the contributing factors as follows: care crises; dying-related turmoil; staffing ratios; and organizational protocols. Distress was crosscutting and present in all four themes.
The findings illuminate how prehospital providers become mediators between NHs and emergency departments by managing tension, conflict, and challenges in patient care between these systems and suggest the importance of further exploration of interactions between LTC staff, prehospital providers, and emergency departments. Enhanced communication between LTC facilities and prehospital providers is important to address potentially inappropriate calls and transport requests and to identify means for collaboration in the care of sick frail residents.
养老院（NH）居民每年的急诊就诊量超过 220 万次；其中大多数由院前提供者（急救医疗技术员和护理人员）护理和转运。
本研究旨在调查院前提供者对生命末期急诊电话的看法。本文重点关注长期护理（LTC）中临终关怀电话的看法。
本试点研究采用描述性横截面设计。符号互动理论的概念指导了对 LTC 设施中紧急呼叫的看法和解释的探索。
地点/受试者：从美国东北部一个小城市的一个机构中确定了一个有目的的院前提供者样本。
对 43 名院前提供者进行了半结构化访谈，以探讨他们对触发 LTC 设施中紧急临终关怀电话的因素的看法。定性数据分析涉及在一个归纳过程中进行迭代编码，包括开放、系统、集中和轴向编码。
访谈主题说明了以下促成因素：护理危机；与死亡相关的混乱；人员配备比例；和组织协议。痛苦是贯穿所有四个主题的。
研究结果阐明了院前提供者如何通过管理 NH 和急诊科之间的紧张、冲突和患者护理方面的挑战，成为两者之间的调解人，并表明进一步探索 LTC 工作人员、院前提供者和急诊科之间相互作用的重要性。加强 LTC 设施和院前提供者之间的沟通对于解决潜在不适当的电话和转运请求以及确定在照顾生病脆弱居民方面合作的方法非常重要。
