Department of Emergency and Internal Medicine, Skåne University Hospital at Lund, Lund, Sweden.
Department of Clinical Sciences at Lund (IKVL), Lund University, Lund, Sweden.
Scand J Prim Health Care. 2021 Dec;39(4):438-447. doi: 10.1080/02813432.2021.1973250. Epub 2021 Sep 13.
Medical crises occur rather seldom in the primary care setting, but when they do, initial management impacts on morbidity and mortality. Factors that impede the performance of emergency interventions in primary care have not been studied through in-situ simulation. Checklists reportedly improve crisis management.
This randomized controlled trial evaluated emergency intervention performance during two scenarios (hypoglycemia-coma and anaphylaxis-cardiac arrest) simulated at primary care centers, and whether checklist access improved performance.
Twenty-two primary care centers in Southern Sweden participated in the study.
A total of 347 personnel performed 100 simulations, 45 with and 55 without checklist access.
Time and impediments to performance of five emergency interventions in each scenario.
On 28 of the 37 occasions when the adrenalin auto-injector was employed, the administration technique was incorrect. In 9 of 49 scenarios, teams had trouble locating the 30% glucose solution. Median time to supplemental oxygen administration during the first scenario was 186 s compared with 96 s during the second scenario ( < 0.001). Checklist access had no significant impact on time to performance of emergency interventions, aside from shorter time to adequate glucose or glucagon administration (median times 632 s with, 756 s without checklist access; = 0.03).
Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting. Simply providing checklist access does not improve the performance of emergency interventions.KEY POINTSLittle is known about the factors that affect the performance of emergency interventions in the primary care setting.Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting.Simply providing crisis checklist access does not improve the performance of emergency interventions in the primary care setting.
在初级保健环境中，医疗危机相当少见，但一旦发生，初始管理会影响发病率和死亡率。在现场模拟中，尚未研究阻碍初级保健中紧急干预措施实施的因素。据报道，检查表可以改善危机管理。
这项随机对照试验评估了在初级保健中心模拟的两种情况下（低血糖昏迷和过敏反应-心脏骤停）进行紧急干预的表现，以及检查表的使用是否提高了表现。
瑞典南部的 22 个初级保健中心参与了这项研究。
共有 347 名人员进行了 100 次模拟，其中 45 次有检查表，55 次没有检查表。
两种情况下，每个情景中五项紧急干预措施的执行时间和障碍。
在使用肾上腺素自动注射器的 28 次情况下，给药技术不正确。在 49 个方案中，有 9 个方案团队难以找到 30%葡萄糖溶液。在第一个方案中，补充氧气的中位时间为 186 秒，而在第二个方案中为 96 秒（ < 0.001）。除了更短的时间内给予足够的葡萄糖或胰高血糖素外（使用检查表时的中位时间为 632 秒，未使用检查表时为 756 秒； = 0.03），检查表的使用并未对紧急干预措施的实施时间产生显著影响。
不熟悉当地急救设备会阻碍初级保健环境中模拟危机时紧急干预措施的实施。简单地提供检查表并不能提高初级保健环境中紧急干预措施的实施。
对影响初级保健环境中紧急干预措施实施的因素知之甚少。
在初级保健环境中模拟的危机中，不熟悉当地急救设备会阻碍紧急干预措施的实施。
简单地提供危机检查表并不能提高初级保健环境中紧急干预措施的实施。
