Coggins Andrew, Ebrahimi Nargus, Kemp Ursula, O'Shea Kelly, Fusi Michael, Murphy Margaret
Department of Emergency Medicine, Westmead Hospital, Sydney, Australia.
Department of Emergency Medicine, Westmead Hospital, Sydney, Australia.
Australas Emerg Care. 2019 Jun;22(2):69-75. doi: 10.1016/j.auec.2019.04.001. Epub 2019 Apr 30.
In the Emergency Department cervical spine immobilisation precautions are frequently used. There is controversy in regard to the balance of risks and benefits of routine immobilisation in conscious patients.
A prospective multi-methods evaluation in a tertiary trauma referral centre. The objectives were to investigate current practices and rate of concordance with established international guidelines. A provider survey focused on current knowledge, skills and attitudes and was disseminated to nurses, doctors and paramedics treating trauma patients. Additionally, clinical data were collected on a cohort of immobilised trauma patients. Demographic data were analysed using SPSS and content analysis was completed by manifest coding.
The response rate to the survey was 85.2%. Interdisciplinary providers included nurses (n=46), doctors (n=68) and paramedics (n=41). Content analysis revealed a range of themes for improving care. Themes identified included improved application of guidelines, tailored use of equipment in low-risk patients, improved access to radiology results, and staff education. The series of five case vignettes provided to participants revealed a high level of variance in intended approaches to immobilisation. In the cohort of trauma patients (n=54), the median age was 54 years and the most common mechanism of injury was falls (40.7%). Median time spent with immobilisation was 325min. Adherence to a recognised decision tool was 35/54 (64.8%). Precautions were initiated by paramedics in 42/54 (77.8%).
Despite widespread dissemination of guidelines, observed approaches to patient immobilisation appear to be highly variable in this trauma centre. Reducing variation for low-risk patients is likely to improve the patient journey and minimise the risk of prolonged immobilisation. Further assessment of the causes of variation could define goals for targeted translational change.
在急诊科，颈椎固定预防措施经常被采用。对于意识清醒患者常规固定的风险与益处的平衡存在争议。
在一家三级创伤转诊中心进行前瞻性多方法评估。目的是调查当前的做法以及与既定国际指南的符合率。对治疗创伤患者的护士、医生和护理人员进行了一项关于当前知识、技能和态度的提供者调查。此外，收集了一组接受固定的创伤患者的临床数据。使用SPSS分析人口统计学数据，并通过显性编码完成内容分析。
调查的回复率为85.2%。跨学科提供者包括护士（n = 46）、医生（n = 68）和护理人员（n = 41）。内容分析揭示了一系列改善护理的主题。确定的主题包括更好地应用指南、在低风险患者中针对性使用设备、更便捷地获取放射学结果以及工作人员教育。提供给参与者的一系列五个病例 vignettes 显示，固定的预期方法存在很大差异。在创伤患者队列（n = 54）中，中位年龄为54岁，最常见的受伤机制是跌倒（40.7%）。固定的中位时间为325分钟。遵守公认决策工具的比例为35/54（64.8%）。42/54（77.8%）的预防措施由护理人员启动。
尽管指南已广泛传播，但在这个创伤中心，观察到的患者固定方法似乎差异很大。减少低风险患者的差异可能会改善患者就医过程，并将长期固定的风险降至最低。对差异原因的进一步评估可以确定有针对性的转化变革目标。
