Missed nursing care in emergency departments: A scoping review

BackgroundPatient safety is a global health priority. Errors of omission, such as missed nursing care in hospitals, are frequent and may lead to adverse events. Emergency departments (ED) are especially vulnerable to patient safety errors, and the significance missed nursing care has in this context is not as well known as in other contexts.AimThe aim of this scoping review was to summarize and disseminate research about missed nursing care in the context of EDs.MethodA scoping review following the framework suggested by Arksey and O’Malley was used to (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; (5) collate, summarize, and report the results; and (6) consultation.ResultsIn total, 20 themes were derived from the 55 included studies. Missed or delayed assessments or other fundamental care were examples of missed nursing care characteristics. EDs not staffed or dimensioned in relation to the patient load were identified as a cause of missed nursing care in most included studies. Clinical deteriorations and medication errors were described in the included studies in relation to patient safety and quality of care deficiencies. Registered nurses also expressed that missed nursing care was undignified and unsafe.ConclusionThe findings from this scoping review indicate that patients’ fundamental needs are not met in the ED, mainly because of the patient load and how the ED is designed. According to registered nurses, missed nursing care is perceived as undignified and unsafe.     

Communication between residential aged care facilities and the emergency department: A review of the literature

BackgroundWestern countries have encountered an increase in elderly patients transferred from residential aged care facilities to emergency departments. This patient cohort frequently experiences impaired physical and cognitive function. Emergency department staff require important clinical and personal patient information to provide quality care. International studies show that documentation and handover deficiencies are common.ObjectiveThe purpose of this literature review was to explore transitional communication practices, and to consider the specific patient information deemed essential for the management of residents in the emergency department.MethodsA literature review was conducted to examine the studies exploring the documentation accompanying elderly people who were transferred from residential aged care facilities to emergency departments. Scopus, OVID Medline and Cinahl Plus data bases were searched using combinations of the following key words: ‘nursing home’, ‘long-term care’, ‘skilled nursing facility’, ‘aged care facility’, ‘communication’, ‘documentation’, ‘emergency department’, ‘emergency room’, ‘hospital’, ‘acute’, ‘transfer’, and ‘transition’. Additional data was located with the use of Google Scholar. Review of titles and exclusion of duplicates identified 69 relevant studies. These 69 papers were independently reviewed by three members of the research team for eligibility for inclusion in the review, and seven papers were retained.ResultsThere is currently no consensus regarding what information is essential when residents are transferred from aged care facilities to emergency departments, and practices vary. Key information which should accompany the resident has been reported by various authors and include the reason for transfer, past medical history, current medications, cognitive function and advance directives. Some authors also suggest that facility contact details are essential. Without agreement by key stakeholders as to what constitutes ‘essential transfer information’, clinical practices will continue to vary and resident care will be affected.ConclusionThis paper identifies frequent communication deficits in the information provided to the emergency department from aged care facilities. There is an imperative to identify suitable items of information which health care professionals agree are essential. Future research should focus on methods to improve the transfer of information between facilities, including consensus regarding what information is essential transfer data.     

预见性护理在急性左心衰患者急诊护理中的效果分析

目的 探究在急性左心衰患者急诊护理中应用预见性护理的临床效果.方法 选取2021年5月至2022年6月期间本院确诊的急性左心衰患者60例作为研究对象.按照随机分配原则将患者分为对照组和观察组,每组各30例.对照组采用常规护理,观察组采用预见性护理.分析比较两组的生命体征指标、生存指标以及护理满意度.结果 观察组的舒张压、收缩压、心率和射血分数均显著优于对照组(P＜0.05).观察组的SF-36量表评分显著高于对照组(P＜0.05).观察组的护理满意度显著高于对照组(P＜0.05).结论 对急性左心衰患者实施预见性护理,能够改善患者的生命体征指标,提高患者的生存质量和护理满意度.     

Factors associated with imaging overuse in the emergency department: A systematic review

Background

Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED.

The Quality of Care in the Emergency Management of Cancer Patients With Febrile Neutropenia: A Records-Based Cohort

IntroductionFebrile neutropenia is one of the most severe oncological emergencies associated with the treatment of cancer. Patients with febrile neutropenia are at grave risk of developing life-threatening sepsis unless there is rapid initiation of treatment. The aim of this study was to evaluate the quality of ED care of patients with febrile neutropenia using the 3 quality dimensions of safety, effectiveness, and timeliness of care.MethodsA retrospective review of all available records of adult cancer patients with febrile neutropenia who presented to 1 urban emergency department in Atlantic Canada was conducted over 5 years.ResultsExamining the 9 quality indicators of the 431 patients included in the study identified areas for improvement in each of the 3 dimensions. More than one third of the participants were unsafely discharged from the emergency department despite the severity of their conditions. Patients in the study were not seen promptly by the physician and did not receive timely treatment during different phases of their visit. Most importantly, the delay in antibiotic administration presented a major risk for this population.DiscussionAspects of care provided to this cohort of febrile neutropenia patients were inconsistent with the recommended evidence. Strengthening ED care is necessary to reduce the gap between evidence-based and actual care. Quality initiatives can be implemented to improve care to become safer, effective, and timely. Nurses who are in direct contact with the patients and who are actively involved in every single process of the health care system are well positioned to lead this change.     

Organisation of in-hospital cardiac arrest teams – A nationwide study

BackgroundIn-hospital cardiac arrests are treated by a team of health care providers. Improving team performance may increase survival. Currently, no international standards for cardiac arrest teams exist in terms of member composition and allocation of tasks.AimTo describe the composition of in-hospital cardiac arrest teams and review pre-arrest allocation of tasks.MethodsA nationwide cross-sectional study was performed. Data on cardiac arrest teams and pre-arrest allocation of tasks were collected from protocols on resuscitation required for hospital accreditation in Denmark. Additional data were collected through telephone interviews and email correspondence. Psychiatric hospitals and hospitals serving outpatients only were excluded.ResultsData on the cardiac arrest team were available from 44 of 47 hospitals. The median team size was 5 (25th percentile; 75th percentile: 4; 6) members. Teams included a nurse anaesthetist (100%), a medical house officer (82%), an orderly (73%), an anaesthesiology house officer (64%) and a medical assistant (20%). Less likely to participate was a cardiology house officer (23%) or a cardiology specialist registrar (5%). Overall, a specialist registrar was represented on 20% of teams and 20% of cardiac arrest teams had a different team composition during nights and weekends. In total, 41% of teams did not define a team leader pre-arrest, and the majority of the teams did not define the tasks of the remaining team members.ConclusionIn Denmark, there are major differences among cardiac arrest teams. This includes team size, profession of team members, medical specialty and seniority of the physicians. Nearly half of the hospitals do not define a cardiac arrest team leader and the majority do not define the tasks of the remaining team members.     

Acute care needs in an Indian emergency department: A retrospective analysis

BACKGROUND: Emergencies such as road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrovascular accident (CVA) are the most common causes of death and disability in India. Robust emergency medicine (EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department (ED) is needed.METHODS: This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences (KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and reviewed.RESULTS: A total of 1 196 ED patient charts were analyzed. Of these patients, 55.35% (n=662) were male and 44.7% (n=534) were female. The majority (67.14%, n=803) were adults, while only 3.85% (n=46) were infants. The most common chief complaints were fever (21.5%, n=257), renal colic (7.3%, n=87), and dyspnea (6.9%, n=82). The most common ED diagnoses were gastrointestinal (15.5%, n=185), pulmonary (12.3%, n=147), tropical (11.1%, n=133), infectious disease and sepsis (9.9%, n=118), and trauma (8.4%, n=101).CONCLUSION: The patient demographics, diagnoses, and distribution of resources identified by this study can help guide and shape Indian EM training programs and faculty development to more accurately reflect the burden of acute disease in India.     

The end-of-life care practices of emergency care nurses and the factors that influence these practices: An integrative review

IntroductionDue to philosophical tensions between end-of-life care and emergency care, nurses in the emergency department face challenges in the provision of end-of-life care. The purpose of this integrative review was to synthesise evidence of the end-of-life care practices of emergency care nurses and the factors that influence these practices.MethodsFor this integrative review, CINAHL, Embase, and MEDLINE databases were systematically searched in April 2020. In total, 30 studies written in English and published between 2010 and 2020 investigating the experiences of nurses caring for a patient that died in the emergency department were included. A constant comparative method was used to analyse and synthesise data.ResultsEnd-of-life care practices prominent in the literature included modifying the environment for privacy, the provision of information to families and the management of symptoms. The culture of emergency care, the nurse’s personal characteristics, the trajectory of death and available resources are factors that appear to determine whether ED nurses immerse themselves in end-of-life care or display distancing behaviours.ConclusionThere is limited evidence articulating the frequency to which specific practices are undertaken and the magnitude to which various factors influence end-oflife care provision. The generation of such knowledge may facilitate the development of initiatives that can optimise end-of-life care in the emergency department.     

急诊科护士长在医疗仪器设备质量控制中的作用

目的探讨急诊科护士长在医疗仪器设备质量控制中发挥的作用。方法通过强化护理人员培训、强化设备使用规范等手段，比较管理前后护理质量的差异。结果通过护士培训考核和患者满意度调查，反映出管理后护理质量有明显提升。结论以护士长负责制的医疗仪器设备管理提高了工作效率，为医护质量的提高奠定了基础。     

Code Critical: Improving Care Delivery for Critically Ill Patients in the Emergency Department

ProblemAlthough certain critically ill patients in emergency departments—such as those experiencing trauma, stroke, and myocardial infarction—often receive care through coordinated team responses, resource allocation and care delivery can vary widely for other high-acuity patients. The absence of a well-defined response process for these patients may result in delays in care, suboptimal outcomes, and staff dissatisfaction. The purpose of this quality improvement project was to develop, implement, and evaluate an ED-specific alert team response for critically ill medical adult and pediatric patients not meeting criteria for other medical alerts.MethodsLean (Lean Enterprise Institute, Boston, MA) principles and processes were used to develop, implement, and evaluate an ED-specific response team and process for critically ill medical patients. Approximately 300 emergency nurses, providers, technicians, unit secretaries/nursing assistants, and ancillary team members were trained on the code critical process. Turnaround and throughput data was collected during the first 12 weeks of code critical activations (n = 153) and compared with historical controls (n = 168).ResultsAfter implementing the code critical process, the door-to-provider time decreased by 62%, door to laboratory draw by 76%, door-to-diagnostic imaging by 46%, and door-to-admission by 19%. A year later, data comparison demonstrated sustained improvement in all measures.DiscussionEmergency nurses and providers see the value of coordinated team response in the delivery of patient care. Team responses to critical medical alerts can improve care delivery substantially and sustainably.     

应急管理路径在急诊手术护理中的应用

目的 运用应急管理路径,提升急诊手术护理水平,提高急救护理质量.方法 调查分析手术室急诊护理中的相关危险因素,制定科学的应急管理路径,启动专项应急管理,观察与评价急诊手术的护理质量.结果 实施与应用各种应急管理路径后,手术室护士急救意识提高,应急应变能力增强,急救护理质量明显提高.结论 应急管理路径的实施有助于提高手术...     

急诊科人文关怀护理研究进展

急诊科作为医院的窗口,人文关怀的实施在推进医院优质护理服务中起着重要作用。本文从人文关怀护理的内涵、急诊科人文关怀护理实施的现状、急诊科护士关怀能力及培养等方面进行综述,为更好地推进急诊科人文关怀护理的实施提供参考。     

综合性医院急诊专业质控管理的实践与思考

目的加强综合性医院急诊质量控制,促进医疗质量持续改进。方法根据上海市急诊质控标准,对浦东新区19家公立医院2008～2010年急诊运行情况进行质控考核。结果持续急诊质控检查使各医院在急诊管理及急诊技能等方面不断改善,质控质量总体呈上升趋势。结论加强急诊质控管理是促进急诊事业发展的有效手段。建设和发展管理严格、配置合理、技术精湛的急诊队伍是我们努力的目标。     

The accuracy of adult limb radiograph interpretation by emergency nurse practitioners: A prospective comparative study

Background

One of the extensions to practice for the emergency nurse practitioner role is to appropriately order and interpret radiographs in the emergency department.

Objective

The aim of the study was to compare the accuracy in interpreting isolated adult limb radiographs between emergency nurse practitioners and emergency physicians.

Design

A prospective comparative study was undertaken.

Setting

Emergency department in a large metropolitan hospital.

Participants

200 adult patients with isolated limb injuries were consented.

Methods

Six emergency nurse practitioners and ten emergency physicians participated. One emergency physician and emergency nurse practitioner independently clinically assessed each patient, determined the need for radiograph and separately recorded their interpretation of the radiograph as either definite fracture, no fracture or possible fracture. A single consultant radiologist reviewed each radiograph and their interpretation was seen as the gold standard. The sensitivity and specificity of emergency physicians and emergency nurse practitioners were calculated. To measure the level of agreement between the two-clinician groups, the weighted Kappa statistic was used.

Results

The sensitivity for the emergency nurse practitioners was 91% and 88% for the emergency physicians. The specificity for the emergency nurse practitioners was 85% and for the emergency physicians 91%. The weighted Kappa on the presence of a fracture between the emergency nurse practitioners and emergency physicians was 0.83.

Conclusions

This study validates the clinical and diagnostic skills of emergency nurse practitioners assessed in the interpretation of isolated adult limb injury radiographs.