Emergency Services, Illawarra Shoalhaven Local Health District, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Sydney, Australia; Illawarra Health and Medical Research Institute, Australia; Faculty of Medicine and Health, University of Wollongong, Australia.
Faculty of Medicine and Health, University of Wollongong, Australia.
Australas Emerg Care. 2021 Dec;24(4):255-263. doi: 10.1016/j.auec.2020.08.007. Epub 2020 Sep 24.
In response to increasing emergency department presentations and wait times in Australia, multiple strategies and models of care have been implemented with varying results. One effective strategy has been the implementation of pre-hospital blood collection by paramedics when they insert an intravenous cannula. This research aims to determine the efficiency of and barriers to wider implementation of a pre-hospital blood collection trial in a regional context. In particular, to evaluate the impact of the pre-hospital blood collection on time to pathology results and error rates, and paramedic opinion.
This retrospective controlled cohort study was conducted over 12 months from August 2018. Emergency and pathology data were used to determine the haemolysis and error rates, as well as the time to result availability of pre-hospital blood collection samples compared to in hospital samples arrived by ambulance. To determine the facilitators and barriers to wider implementation a survey of 48 paramedics was conducted following completion of the 12-month trial. The survey was informed by the Theoretical Domains Framework, a behavior change theory associated with improved uptake when applied.
Overall 237 samples were collected. There was a 65% (51min) reduction in time taken for samples to be received at pathology and a 38% (50min) improvement in time taken for results to return from pathology for patients arrived by ambulance. There were no labelling errors in the pre-hospital blood collection group or change in haemolysis rates. The majority (79%) of paramedics who completed the survey were optimistic about the protocol improving patient outcomes and 89% regarded the change in practice as acceptable. Three main themes emerged: 1. Training, environmental challenges and adequate equipment; 2. increased efficiency and improved patient care and 3. Prerequisites to implementing a new practice. Integration of Quantitative and Qualitative data resulted in 10 key influencers of behavior that need to be addressed in any future implementation.
The introduction of pre-hospital phlebotomy reduced the time to blood results availability by 38% and resulted in fewer labelling errors. Wider implementation is supported by paramedics, but more training is required.
为应对澳大利亚急诊就诊人数增加和等待时间延长的问题，已实施了多种策略和护理模式，但结果不尽相同。一种有效的策略是，当护理人员插入静脉内导管时，由护理人员在院前进行血液采集。本研究旨在确定在区域背景下，更广泛地实施院前血液采集试验的效率和障碍。具体而言，评估院前血液采集对病理结果和错误率的影响，以及护理人员的意见。
这是一项为期 12 个月的回顾性对照队列研究，于 2018 年 8 月开始。利用急诊和病理数据，确定了与通过救护车送达的院内样本相比，院前采集样本的血液溶血和错误率以及结果可获得时间。为了确定更广泛实施的促进因素和障碍，在完成 12 个月的试验后，对 48 名护理人员进行了调查。调查的依据是理论领域框架，这是一种与应用相关的行为改变理论，可提高采用率。
共采集了 237 个样本。通过救护车送达的患者样本送达病理科的时间缩短了 65%（51 分钟），从病理科返回结果的时间缩短了 38%（50 分钟）。在院前采集血液样本组中没有标签错误，血液溶血率也没有变化。完成调查的大多数（79%）护理人员对该方案改善患者结局持乐观态度，89%的人认为该实践的改变是可以接受的。三个主要主题出现：1. 培训、环境挑战和足够的设备；2. 提高效率和改善患者护理；3. 实施新实践的前提。定量和定性数据的整合产生了 10 个需要在任何未来实施中解决的行为主要影响因素。
院前采血可将血液结果的可得时间缩短 38%，并减少标签错误。护理人员支持更广泛的实施，但需要更多的培训。
