急诊科如何应对救护车预报警电话？对英国急诊科预报警管理的定性探索。

How do emergency departments respond to ambulance pre-alert calls? A qualitative exploration of the management of pre-alerts in UK emergency departments.

作者信息

Long Jaqui, Sampson Fiona C, Coster Joanne, O'Hara Rachel, Bell Fiona, Goodacre Steve

机构信息

SCHARR, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.

SCHARR, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK

出版信息

Emerg Med J. 2024 Sep 17;42(1). doi: 10.1136/emermed-2023-213854.

DOI:10.1136/emermed-2023-213854

PMID:39288976

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11874362/

Abstract

BACKGROUND

Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response ('pre-alerts') have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke). However, little is known about their usefulness for other patients and the processes involved in ED responses to them. This study aimed to understand how pre-alerts influence patient care in the ED.

METHODS

We undertook non-participant observation (162 hours, 143 pre-alerts) and semi-structured interviews with staff (n=40) in six UK EDs between August 2022 and April 2023 focusing on how ED staff respond to pre-alert calls and what influences their response. Observation notes and interview transcripts were imported into NVivo and analysed using a thematic approach.

RESULTS

Pre-alert calls involved significant time and resources for ED staff but they were valued as they enabled staff to prepare for a patient's arrival (practically and psychologically). High demand and handover delays at ED created additional pre-alerts due to ambulance clinician concerns about the impact of long waits on patients.Despite the risk of pre-alert fatigue from calls for patients considered not to require a special response, ED clinicians appreciated timely pre-alert information, perceiving a higher risk from underalerting than overalerting. Variation in ED response was influenced by individual and organisational factors, particularly the resources available at the time of pre-alert. Unclear ED processes for receiving, documenting and sharing information about pre-alerts increased the risk of information loss.

CONCLUSION

Improving processes for receiving and sharing pre-alert information may help ED clinicians prepare appropriately for incoming patients. Alternative routes for ambulance clinicians to seek advice on borderline pre-alert patients may help to improve the appropriateness of pre-alerts.

摘要

背景

救护车向急诊科（ED）发出呼叫，提醒其有危急病例正在送往该机构，需要特殊应对措施（“预报警”），这已被证明能改善需要立即进行时间紧迫治疗的患者（如中风患者）的治疗效果。然而，对于预报警对其他患者的作用以及急诊科对其的应对流程，人们了解甚少。本研究旨在了解预报警如何影响急诊科的患者护理。

方法

2022年8月至2023年4月期间，我们在英国的六个急诊科进行了非参与性观察（162小时，143次预报警），并对工作人员（n = 40）进行了半结构化访谈，重点关注急诊科工作人员如何应对预报警呼叫以及哪些因素影响他们的反应。观察记录和访谈转录本被导入NVivo，并采用主题分析法进行分析。

结果

预报警呼叫占用了急诊科工作人员大量的时间和资源，但他们认为这些呼叫很有价值，因为它们能让工作人员（在实际和心理上）为患者的到来做好准备。由于救护车临床医生担心长时间等待对患者的影响，急诊科的高需求和交接班延迟导致了额外的预报警。尽管对于被认为不需要特殊应对的患者的呼叫存在预报警疲劳的风险，但急诊科临床医生仍赞赏及时的预报警信息，认为警报不足比警报过度带来的风险更高。急诊科反应的差异受个人和组织因素的影响，特别是预报警时可用的资源。急诊科接收、记录和共享预报警信息的流程不明确，增加了信息丢失的风险。