Data processing in prehospital emergency medicine

Information about the use of data processing systems in prehospital emergency medicine were collected, using a questionnaire sent to all German rescue helicopter bases. Twenty-seven of the 42 German rescue helicopter bases returned the questionnaire. At present, only 15 of them take advantage of electronic data processing. All of them enter their data manually by keyboard, automatic data transfer by means of a bar code reader is available at one base only. The stored data are used for statistical analysis (n=15), quality assessement (n=10), administration (n=10), research (n=9) and education (n=7). Based on the data of this survey, one fifth of those who replied use their computer only for administrative purposes, the other also manage patient and mission data with their computer systems.Today, documentation of a rescue mission consists of patient data, vital data, mission data and information about the procedures carried out. The use of a computer system, however, requires more time and work than a handwritten record, when most of the data have to be entered manually using a keyboard. Future developments may include automated data transfer and digitization of handwritten documents to decrease the workload of the staff. For the automation of data trabsfer, configuration and synchronisation a standardized interface in all medical devices is required. There is a clear need for the use of data processing systems in emergency medicine.     

医院护理应急体系的构建与效果

目的探讨医院护理应急体系的构建方法及效果。方法建立护理应急指挥组织、应急救护小组及专家指导小组,建立应急救护信息系统,制订应急救护预案,培训应急救护技能,开展救护技术研究。结果各项应急救护任务高质量完成,危重病人护理质量考核合格率及护士急救技能考核成绩显著提高,差异具有统计学意义（P〈0．05或P〈0．01）。结论建立完善的护理应急体系可有效提高突发事件应急保障能力。     

Information technology and public health management of disasters--a model for South Asian countries

This paper highlights the use of information technology (IT) in disaster management and public health management of disasters. Effective health response to disasters will depend on three important lines of action: (1) disaster preparedness; (2) emergency relief; and (3) management of disasters. This is facilitated by the presence of modern communication and space technology, especially the Internet and remote sensing satellites. This has made the use of databases, knowledge bases, geographic information systems (GIS), management information systems (MIS), information transfer, and online connectivity possible in the area of disaster management and medicine. This paper suggests a conceptual model called, "The Model for Public Health Management of Disasters for South Asia". This Model visualizes the use of IT in the public health management of disasters by setting up the Health and Disaster Information Network and Internet Community Centers, which will facilitate cooperation among all those in the areas of disaster management and emergency medicine. The suggested infrastructure would benefit the governments, non-government organizations, and institutions working in the areas of disaster and emergency medicine, professionals, the community, and all others associated with disaster management and emergency medicine. The creation of such an infrastructure will enable the rapid transfer of information, data, knowledge, and online connectivity from top officials to the grassroots organizations, and also among these countries regionally. This Model may be debated, modified, and tested further in the field to suit the national and local conditions. It is hoped that this exercise will result in a viable and practical model for use in public health management of disasters by South Asian countries.     

Measuring and Improving Quality in Emergency Medicine

The findings are presented of a consensus committee created to address the measuring and improving of quality in emergency medicine. The objective of the committee was to critically evaluate how quality in emergency medicine can be measured and how quality improvement projects can positively affect the care of emergency patients. Medical quality is defined as "the care health professionals would want to receive if they got sick." The literature of quality improvement in emergency medicine is reviewed and analyzed. A summary list of measures of quality is included with four categories: condition-specific diseases, diagnostic syndromes, tasks/procedures, and department efficiency/efficacy. Methods and tools for quantifying these measures are examined as well as their accuracy in assessing quality and adjusting for differences in environment, and patient populations. Successful strategies for changing physician behavior are detailed as well as barriers to change. Examples are given of successful quality improvement efforts. Also examined is how to address the emergency care needs of vulnerable populations such as older persons, women, those without health insurance, and ethnic minorities.     

Making Recording and Analysis of Chief Complaint a Priority for Global Emergency Care Research in Low‐income Countries

The chief complaint is a patient's self‐reported primary reason for presenting for medical care. The clinical utility and analytical importance of recording chief complaints have been widely accepted in highly developed emergency care systems, but this practice is far from universal in global emergency care, especially in limited‐resource areas. It is precisely in these settings, however, that the use of chief complaints may have particular benefit. Chief complaints may be used to quantify, analyze, and plan for emergency care and provide valuable information on acute care needs where there are crucial data gaps. Globally, much work has been done to establish local practices around chief complaint collection and use, but no standards have been established and little work has been done to identify minimum effective sets of chief complaints that may be used in limited‐resource settings. As part of the Academic Emergency Medicine consensus conference, “Global Health and Emergency Care: A Research Agenda,” the breakout group on data management identified the lack of research on emergency chief complaints globally—especially in low‐income countries where the highest proportion of the world's population resides—as a major gap in global emergency care research. This article reviews global research on emergency chief complaints in high‐income countries with developed emergency care systems and sets forth an agenda for future research on chief complaints in limited‐resource settings.     

Where's the Beef? The Promise and the Reality of Clinical Documentation

Physician-generated emergency department clinical documentation (information obtained from clinician observations and summarized decision processes inclusive of all manner of electronic systems capturing, storing, and presenting clinical documentation) serves four purposes: recording of medical care and communication among providers; payment for hospital and physician; legal defense from medical negligence allegations; and symptom/disease surveillance, public health, and research functions. In the consensus development process described by Handler, these objectives were balanced with the consideration of efficiency, often evaluated as physician time and clinical documentation system costs, in recording the information necessary for their accomplishment. The consensus panel session participants and authors recommend that 1) clinical documentation be electronically retrievable; 2) selection and implementation be evidence-based and grounded on valid metrics (research is needed to identify these metrics); 3) the user interface be crafted to promote clinical excellence through high-quality information collection and efficient charting techniques; 4) the priorities for integration of clinical information be standardized and implemented within enterprises and across health and information systems; 5) systems use accepted standards for bidirectional, real-time clinical data exchange, without limiting the location or number of simultaneous users; 6) systems fully utilize existing electronic sources of specific patient information and general medical knowledge; 7) systems automatically and reliably capture appropriate data that support electronic billing for emergency department services; and 8) systems promote bedside documentation and mobile access.     

Development of a PHC nursing information system in Korea.

WHO has established collaborating centres at educational institutions throughout the world to assist with WHO research. In 1988 a WHO Collaborating Centre was inaugurated at Yonsei University College of Nursing in Korea. Since then two important research projects have been completed for establishing a data bank of human resources of nursing for primary health care (PHC) in Korea. Both projects strengthen the PHC nursing information systems in Korea and, as such, are beginning to develop PHC networks throughout Korea, passing on information to an international network system. Below, the rationale behind the two projects, the methodology and the results.     

Decision support systems to manage outcomes

It is essential that outcomes are evaluated and actions are taken to resolve problematic decision support issues. Many organizations are planning a transition to clinical information systems that will have data repositories and integrated databases within their systems. These transitions take years to complete, and systems must be put into place to collect data and report outcomes during the interim period. Careful and strategic planning is important so that the most effective use of existing technology and the most appropriate systems are implemented to manage outcomes. Multidisciplinary teams that use the most efficient technologic approaches will best meet the challenge to provide the most cost-effective care with the best quality outcomes.     

Arrhythmias in the office

The incidence of patients who present to the office with arrhythmia and hemodynamic instability is unknown. Emergency medical systems data, based on ambulance runs, are available only for patients who have had a cardiac arrest. When faced with an unstable or potentially unstable patient, however, we must be prepared to act quickly, safely, and accurately. This article addresses the general approach to such a patient; provides necessary information on office emergency preparation, including training, rapid response team protocol, and the use of automated external defibrillators; and addresses the identification and initial office management of the various rhythms that are capable of threatening a patient's life.     

Implementing electronic medical record systems in developing countries

The developing world faces a series of health crises including HIV/AIDS and tuberculosis that threaten the lives of millions of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. In this paper we explain why information systems are important in many healthcare projects in the developing world. We discuss pilot projects demonstrating that such systems are possible and can expand to manage hundreds of thousands of patients. We also pass on the most important practical lessons in design and implementation from our experience in doing this work. Finally, we discuss the importance of collaboration between projects in the development of electronic medical record systems rather than reinventing systems in isolation, and the use of open standards and open source software.     

Post-war Kosovo: Part 2. Assessment of emergency medicine leadership development strategy

Since the return of the refugee population to Kosovo, attempts at development of an emergency medical system in Kosovo have met with varied success, and have been hampered by unforeseen barriers. These barriers have been exacerbated by the lack of detailed health system assessments. A multimodal approach of data collection and analysis was used to identify potential barriers, and determine the appropriate level of intervention for emergency medicine (EM) development in Kosovo. The four step, multi-modal, data collection tool utilized: 1) demographic and health systems data; 2) focus group discussions with health-care workers; 3) individual interviews with key individuals in EM development; and 4) Q-Analysis of the attitudes and opinions of EM leaders. Results indicated that Emergency Medicine in Kosovo is under-developed. This method of combined quantitative and qualitative analysis identified a number of developmental needs in the Kosovar health system. There has been little formal training, the EMS system lacks organization, equipment, and a reliable communication system, and centralized emergency centers, other than the center at Prishtina Hospital, are inadequate. Group discussions and interviews support the desire by Kosovar health-care workers to establish EM, and highlight a number of concerns. A Q-methodology analysis of the attitudes of potential leaders in the field, supported these concerns and identified two attitudinal groups with deeper insights into their opinions on the development of such a system. This study suggests that a multi-modal assessment of health systems can provide important information about the need for emergency health system improvements in Kosovo. This methodology may serve as a model for future, system-wide assessments in post-conflict health system reconstruction.     

Standardized nursing vocabularies: a foundation for quality care

OBJECTIVES: To describe the importance of standardized nursing vocabularies as a foundation for quality in health care decision-making. DATA SOURCES: Literature, online sources, and committee documents. CONCLUSIONS: Several standardized vocabularies are recognized by the American Nurses Association Committee for Nursing Practice Information Infrastructure. Vendors also have integrated the vocabularies into their information systems. Future efforts include developing an international nursing reference terminology. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses face quality of care issues that impact decision-making at the point of care. To describe their practice, oncology nurses must strive to use nursing data that are standardized, documented, and made visible by inclusion in computer-based systems.     

Information Technology Principles for Management, Reporting, and Research

Information technology holds the promise to enhance the ability of individuals and organizations to manage emergency departments, improve data sharing and reporting, and facilitate research. The Society for Academic Emergency Medicine (SAEM) Consensus Committee has identified nine principles to outline a path of optimal features and designs for current and future information technology systems. The principles roughly summarized include the following: utilize open database standards with clear data dictionaries, provide administrative access to necessary data, appoint and recognize individuals with emergency department informatics expertise, allow automated alert and proper identification for enrollment of cases into research, provide visual and statistical tools and training to analyze data, embed automated configurable alarm functionality for clinical and nonclinical systems, allow multiexport standard and format configurable reporting, strategically acquire mission-critical equipment that is networked and capable of automated feedback regarding functional status and location, and dedicate resources toward informatics research and development. The SAEM Consensus Committee concludes that the diligent application of these principles will enhance emergency department management, reporting, and research and ultimately improve the quality of delivered health care.     

Emergency medicine and the developing world

The developing countries of the world represent a new environment in which to apply the unique expertise and knowledge of emergency medicine. With an understanding of the cultural, political and economic forces that affect health care in developing countries, American emergency physicians should consider collaboration with their counterparts in developing countries in such areas as prehospital care systems, trauma care, disaster management, poison information and management systems, and education related to clinical services, administration, and research methods in emergency medicine. Such collaboration can broaden the field of emergency medicine and fulfill individual humanitarian goals.     

Discharge of the older person from the emergency department - the perceptions of health professionals

Aims of study. This study aimed to examine the management of the older person in preparation for discharge home from an emergency department by exploring the perceptions of health professionals on procedures undertaken particularly in relation to the planned support, supply of medications, dressings, and contact information given to patients. An additional aim related to the perceived satisfaction levels of older patients and their carers. Background. It is imperative that older patients are adequately prepared for discharge home from the emergency department so as to avoid unnecessary anxiety, increase in health problems and possible re‐attendance or admission to hospital. Design. The sample in this study comprised the total population (n = 222) of all medical and nursing staff in both the emergency department and the primary care area. Methods. The method adopted was a survey approach which employed the use of standardized questionnaires comprising both open and closed questioning styles. Results. The data obtained identified results similar to previous research in that a discrepancy exists between hospital and community staff in relation to the procedures undertaken when discharging older people from the emergency department, such as arranging follow‐up care and appointments and giving the patient relevant contact numbers and dressings. Conclusion. The findings of this study support previous research in that there is a need to provide patients with planned support, aids and appliances, clear instructions and relevant contact numbers on discharge from the emergency department. Relevance to clinical practice. Good quality discharge planning is essential for a continuum of care for older people discharged from the emergency department. While patient education is often difficult in the busy emergency department, the provision of relevant information to older patients prior to discharge is essential particularly in relation to prescribed medications and wound care.     

Parametric Versus Nonparametric Statistical Tests: The Length of Stay Example

Objectives: This study examined selected effects of the proper use of nonparametric inferential statistical methods for analysis of nonnormally distributed data, as exemplified by emergency department length of stay (ED LOS). The hypothesis was that parametric methods have been used inappropriately for evaluation of ED LOS in most recent studies in leading emergency medicine (EM) journals. To illustrate why such a methodologic flaw should be avoided, a demonstration, using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), is presented. The demonstration shows how inappropriate analysis of ED LOS increases the probability of type II errors. Methods: Five major EM journals were reviewed, January 1, 2004, through December 31, 2007, and all studies with ED LOS as one of the reported outcomes were reviewed. The authors determined whether ED LOS was analyzed correctly by ascertaining whether nonparametric tests were used when indicated. An illustrative analysis of ED LOS was constructed using 2006 NHAMCS data, to demonstrate how inferential testing for statistical significance can deliver differing conclusions, depending on whether nonparametric methods are used when indicated. Results: Forty‐nine articles were identified that studied ED LOS; 80% did not perform a test of normality on the ED LOS data. Data were not normally distributed in all 10 of the studies that did perform such tests. Overall, 43% failed to use appropriate nonparametric methods. Analysis of NHAMCS data confirmed that failure to use nonparametric bivariate tests results in type II statistical error and in multivariate models with less explanatory power (a smaller R² value). Conclusions: ED LOS, a key ED operational metric, is frequently analyzed incorrectly in the EM literature. Applying parametric statistical tests to such nonnormally distributed data reduces power and increases the probability of a type II error, which is the failure to find true associations. Appropriate use of nonparametric statistics should be a core component of statistical literacy because such use increases the validity of ED research and quality improvement projects. ACADEMIC EMERGENCY MEDICINE 2010; 17:1113–1121 © 2010 by the Society for Academic Emergency Medicine     

Factors influencing nurses' attitudes towards the use of computerized health information systems in Kuwaiti hospitals

Title. Factors influencing nurses’ attitudes towards the use of computerized health information systems in Kuwaiti hospitals Aim. This paper reports a survey of nurses’ attitudes towards computerized health information systems, the characteristics that influence these attitudes and the level of nurses’ skills in computer use. Background. The use of such systems in developed countries and in some developing countries has already become a reality. However, nurses as a group of care providers have been found to resist computerization, seeing computerized health information systems as dehumanizing, confusing and uncaring. Nurses with more computer experience tend to have more positive views; education and training positively influence attitudes; and younger and less experienced nurses may have more positive attitudes. Methods. A structured questionnaire was used to measure the attitudes of nurses working in Kuwait towards computerization. A random sample of 574 nurses working in Ministry of Health hospitals were sent a questionnaire, and 530 replies were received (response rate 92·3%). The data were collected from November 2002 to January 2003. Findings. Respondents generally had positive attitudes toward computerized health information systems. Analysis of variance revealed statistically significant differences in attitudes in relation to nationality, level of education, previous experience in computer use, and computer skills (P < 0·05). Multiple regression analysis showed that gender, nationality, education levels, and duration of computer use were statistically significant predictors of attitudes toward computerized health information systems (P < 0·05). Conclusion. With adequate computerized health information system training, the implementation of computerized health information systems could be effective for nurses in providing quality health care, as found in other studies.     

Legal issues in emergency radiology. Practical strategies to reduce risk.

Various joint commission and individual state standards affect emergency radiology practice and have legal implications. The ACEP has entered the burgeoning field of practice guidelines; fortunately, their practice guideline preparation system is arguably the most thorough in medicine at this time. This is of great importance to emergency physicians, because practice guidelines are not without their own potential legal, educational, and compliance problems. Trends toward cost-reduction through reduced radiograph utilization are a real phenomenon in all of medicine. It remains to be seen if costs can be reduced without increasing legal exposure. Excellent clinical guidelines are helpful to emergency physicians. The Massachusetts ACEP model, which appears to effectively blend closed claim data into practice guidelines, has built-in educational support and compliance incentives. This model may become a national standard in the future. Pediatric radiology risk management issues, such as the statute of limitations, have been discussed. Emergency physicians should be knowledgeable about the most commonly missed pediatric emergency radiologic diagnoses. Some aspects of common emergency radiology practice patterns are of relevance to a discussion of risk management in emergency radiology. Issues such as emergency physician radiograph interpretation responsibilities and follow-up systems emerge repeatedly in malpractice claims. The use of CQI strategies may prove helpful in improving practice patterns. Communication between emergency physician and radiologists is critical. Good communication requires the development of good rapport and should pay dividends in improved patient care.