Assessment of cricoid pressure application by emergency department staff

Objective: To assess the accuracy of cricoid force applied by ED staff working in two hospitals based on the New South Wales central coast. Methods: A prospective, observational study of 38 doctors and 69 nurses working in the ED. Each staff member was asked to demonstrate cricoid pressure using a model based on a set of weighing scales. Five attempts were measured and a mean value calculated for each participant. Subgroup analysis was also performed for specific variables of interest. Results: Twenty‐seven (25%) participants applied the target cricoid force. Of the 80 participants who were outside of the target range, 50 (63%) applied less than the target range and 30 (37%) applied more than the target range. No statistically significant difference was demonstrated for sex, age, qualification or years of experience and the ability to apply cricoid force within the target range. More candidates (27) applied the target range than those who correctly identified it (12). When methods of instruction were compared there was no difference between candidates with one and more than one modality of instruction (t‐test: t (105) = ?0.09, P = 0.9; 95% confidence interval [CI]?0.66–0.6) and the mean cricoid force applied. Those who had greater than one form of instruction applied correct cricoid force at the target range more often than those who had received only one form of instruction, this result was significant. (χ² = 4.24, d.f. = 1, P = 0.04; odds ratio = 2.6; 95% CI 1.03–6.41). Conclusion: The application of cricoid force by ED staff participating in the present study is unreliable, often providing inadequate protection against regurgitation. Training using a model integrating the concept of force is recommended. The role of cricoid pressure in rapid sequence induction needs to be further investigated.     

急诊科分级培训及考核的实践与效果

目的探讨分级培训及考核机制在急诊科中的应用效果。方法将80名急诊护士根据护龄分为成长护士、适任护士、熟练护士、精通护士和专科护士,根据分级不同分别制订培训目标、培训内容和培训方式,并实施考核。结果分级培训后,除专科护士外,其他各级护士考核成绩均提高(P0.01)。成长护士对分级培训满意度最高,专科护士对分级培训满意度最低。结论急诊科实施分级培训及考核可以有效提高护士的业务素质。     

Practice makes perfect? Evaluation of cricoid pressure task training for use within the algorithm for rapid sequence induction in critical care

Objective: To assess task training in cricoid pressure application suitable for incorporation into the algorithm for rapid sequence induction in acute care. Method: A blinded prospective direct observational study of 110 critical care staff of two hospitals in regional New South Wales. Each participant was instructed to apply blinded cricoid force within the target range of 30–40 N to a cricoid model mounted on a weighing scale and the result recorded. After up to 3 min of unblinded practice without coaching on the same model a repeat blinded application of force was recorded. The pre‐ and post‐intervention results were compared. Results: At the pre‐intervention stage, 22 participants (20%) applied initial pressure within the target range, increasing to 57 (52%) at the post‐intervention stage (χ² = 24.19, d.f. = 1, P < 0.01; odds ratio [OR] = 0.23; 95% confidence interval [CI] 0.12–0.44). The post‐intervention results show a significant improvement in the number of participants achieving the target range in both nursing (χ² = 20.42, d.f. = 1, P < 0.01; OR = 0.18; 95% CI 0.08–0.42) and medical subgroups (χ² = 4.68, d.f. = 1, P = 0.03; OR = 0.34; 95% CI 0.11–1.02). The number applying force sufficient to prevent regurgitation, that is 30 N or greater, rose from 71 to 97 (65% to 88%) (χ² = 17.02, d.f. = 1, P < 0.01; OR = 0.24; 95% CI 0.11–0.51). The number applying in excess of 44 N fell from 41 to 25 (37% to 21%) (χ² = 5.54, d.f. = 1, P < 0.02; OR = 2.02; 95% CI 1.08–3.81). Conclusion: The application of cricoid force by critical care staff can be significantly improved by up to 3 min of practice on a simple task trainer.     

Paramedics and triage: Effect of one training session on triage in the emergency department

This 3-stage intervention study enrolled all adult patients referred to a universitybased emergency department (ED) during randomly assigned 1-week preeducation or posteducation periods. Triage decisions recorded by ED paramedics (n=8) both before and after an educational training session were compared to decisions made by emergency physicians (EPs). Triage decisions of paramedics and EPs in the preeducation phase showed poor consistency (κ =0.317, κ=0.388). Triage decisions in the posteducation phase increased slightly but were still found to be low. On the other hand, consistency between the triage assessments recorded by paramedics and EPs of the general appearance of patients increased from low in the preeducation phase to moderate in the posteducation phase (κ =0.327, κ=0.500, respectively). The training session was associated with a slight increase in the consistency of triage decisions recorded by paramedics and EPs.     

深圳市急救医疗中心对院前急救人员的培训与考核

目的:探讨深圳市急救医疗中心对院前急救人员的培训与考核。方法:总结深圳市急救医疗中心对院前急救人员培训考核方法及效果。结果:深圳市急救医疗中心已探索出适合深圳特点的系统有效的培训和考核办法。以点带面,进行全员知识和技能的培训。突击检查与定期检查结合,对院前急救工作进行全面考核。院前急救病历检查,评估救治的质量。指挥指导突发公共卫生事件应对演练,提高全市的应对能力。结论:全面的培训考核取得良好效果,保证了急救工作的顺利开展。     

Blood pressure measurements on children in the emergency department

Background: There is no consensus on routine blood pressure (BP) measurement for children presenting to the ED. By contrast, BP measurements are performed routinely in adult ED. With increasing childhood obesity, and the knowledge that elevated BP in childhood correlates with hypertension in adulthood, routine BP measurement in children should be considered. Objective: To review the current practice of BP measurement in children presenting to the ED of Princess Margaret Hospital for Children, Perth, Western Australia, a tertiary referral paediatric centre. Method: A prospective observational study of 504 children presenting to the ED over a 6 month period in 2003. Results: In total, 114 children (22.6%) had their BP measured. A total of 35 (30.7%) had a BP above the 95th percentile for age and sex. In total, 19 (54.3%) of 35 with abnormal BP had their BP remeasured. Only one child of 10 with consecutive hypertensive measurements was followed up. BP measurement was more common in children aged 2 years and above, and in higher triage category patients. Conclusions: The present study demonstrates that BP measurement in the ED is both relatively infrequent and inconsistent. Further research into this area is required to determine the usefulness and feasibility of routine BP measurements in children presenting to the ED. This might improve the quality of health care and positively impact on public health for the future.     

Paediatric emergency department design: Does it affect staff,patient and community satisfaction?

Objectives: To assess the change in perception of the standard of paediatric care following the opening of a dedicated paediatric emergency area in an established tertiary hospital emergency department on patients and families, hospital staff and the general practitioners of the local community. Methods: A questionnaire was circulated to the relevant parties prior to and 6 months after the opening of the paediatric department. The surveys were circulated to the families/custodians of the paediatric attendees, general practitioners who refer paediatric patients and the medical and nursing staff both within the emergency department and the inpatient paediatric ward. The questions related to the physical environment, perceived level of care and the overall satisfaction with treatment. Results: The most striking change was in the patient family group who showed an increase in their level of satisfaction with the physical environment and their overall care. The general practitioner group showed only a slight improvement, while the inpatient staff showed no notable changes. The emergency department staff developed a higher level of confidence and satisfaction when dealing with this population group. Conclusion: The change in the physical environment in which we treat our paediatric emergencies seemed to enhance the level of satisfaction of our attendees. Staff appear to be more confident when dealing with these patients in a dedicated paediatric area. The effect has not yet flowed on to the inpatient staff and general practitioners, perhaps reflecting a small exposure of these individuals to the survey subject matter.     

深化急诊科健康教育工作的做法和成效

为了深化急诊科的健康教育工作．制定了急诊科健康教育工作的具体措施和激励制度,将健康教育工作与个人月质量考评分及奖金挂勾,实施9个月取得了良好的效果。提高了科内护士整体健康教育水平．促进了患健康知识水平及满意度提高．明确了急诊科下一步健康教育工作的方向。提示健康教育工作的落实和深化,关键在于护理管理与护士的共同努力;良好的健康教育工作措施和制度,能促进健康教育工作持续、稳定、有效地开展．     

粤港两地部分急诊科医护人员对哀伤关顾认识的调查分析

目的 调查粤港两地部分急诊科医护人员对哀伤关顾的认识情况,为国内开展哀伤关顾护理提供理论依据.方法 自行设计对哀伤关顾的认识调查问卷,对香港各大联网医院的急诊科医护人员、本省各地区赴港学习的急诊科专科护士和本院急诊科医护人员进行调查,了解他们对哀伤关顾的认识情况.结果 香港急诊科医护人员对哀伤关顾的认识(100.0％)、参加过哀伤关顾培训(100.0％)、实施过哀伤关顾(100.0％)以及具备的哀伤关顾技能(100.0％)都比较好,并认为有必要开展哀伤关顾(98.8％)和愿意加入哀伤关顾小组(86.3％);而赴港学习的本省急诊科专科护士和本院急诊科医护人员对哀伤关顾的认识、参加过哀伤关顾培训、实施哀伤关顾以及所具备的哀伤关顾技能基本处于较少或无的状态,对于是否有必要开展哀伤关顾和愿意加入哀伤关顾小组,赴港学习的本省急诊科专科护士有92.6％认为有必要,85.2％愿意加入;而本院急诊科医护人员84.1％认为有必要,63.2％愿意加入.结论 国内医护人员对哀伤关顾的认识以及对病人实施哀伤关顾较少,学习并引进香港以及国外关于哀伤关顾的知识,结合本国国情发展和完善本土哀伤关顾文化非常重要.     

Evaluation of staff cultural awareness before and after attending cultural awareness training in an Australian emergency department

IntroductionCultural awareness of emergency department staff is important to ensure delivery of appropriate health care to people from all ethnic groups. Cultural awareness training has been found to increase knowledge about other cultures and is widely used as a means of educating staff, however, debate continues as to the effectiveness of these programs.AimTo determine if an accredited cultural awareness training program affected emergency department staff knowledge, familiarity, attitude of and perception towards Australian Aboriginal and Torres Strait Islander people.MethodOne group pre-test and post-test intervention study compared the cultural awareness of 44 emergency department staff towards Aboriginal and Torres Strait Islander people before and after training. The cultural awareness training was delivered in six hours over three sessions and was taught by an accredited cultural awareness trainer.ResultsThe cultural awareness training changed perception but did not affect attitude towards Aboriginal and Torres Strait Islander people in this group.ConclusionFuture strategies to improve staff cultural awareness need to be investigated, developed, implemented and evaluated.     

急诊科轮转护士系统培训的实践与效果

目的探讨轮转护士在急诊科接受系统培训的方法与效果。方法 37名轮转护士分批到急诊科接受为期3个月的系统培训。结果轮转护士系统培训后临床工作能力、整体护理查房成绩、轮转护士对培训满意度方面均有显著提高(P<0.01)。结论急诊科系统培训显著提高了轮转护士的综合素质,是一种行之有效的培训方法。     

Lost in translation: Maximizing handover effectiveness between paramedics and receiving staff in the emergency department

Objective: The purpose of the present study is to investigate perceptions by paramedics and hospital receiving staff about what enables and constrains handover in the ED. Methods: This is a qualitative study of interviews with 19 paramedics, 15 nurses and 16 doctors (n = 50) from ambulance services and ED in two states of Australia. Results: Three main themes emerged that were evident at both sites and in the three professional groups. These were: difficulties in creating a shared cognitive picture, tensions between ‘doing’ and ‘listening’ and fragmenting communication. Conclusion: Recommendations arising from the present study as to how handover could be improved are the need for a common language between paramedics and staff in the ED, for shared experiences and understanding between the members of the team and for the development of a standardized approach to handover from paramedics to ED receiving staff.     

对急诊科医护人员洗手现状的调查与分析

目的了解急诊科医护人员洗手状况及其影响因素,提出对策。方法对上海某三级甲等医院急诊科医护人员手采样71人次,进行细菌菌落数检测;调查医护人员的洗手行为;观察急诊科的环境、洗手设施。结果医护人员手的细菌菌落数总合格率为67.61%,医护人员执行正确洗手技术比例较低;急诊科洗手设施简陋,不符合卫生洗手要求。结论医护人员应强化洗手意识,加强对洗手知识的学习并认真执行;医院改善急诊科的洗手设施,以减少手的污染。     

Rapid sequence intubation in the emergency department: 5 year trends

Aim

Airway management is a core aspect of emergency medicine. The technique of rapid sequence intubation (RSI) creates continuing debate between anaesthetists and emergency physicians in the UK, although similar complication rates for emergency department (ED) RSI have been shown for both specialties. This study examined prospectively collected data on every ED RSI performed in a university hospital in Glasgow over 5 years.

Methods

Data were prospectively recorded for every attempted RSI in the ED on a dedicated form (as used in previous studies) between January 1999 and December 2003. Immediate complications were specifically sought in the questionnaire, as was the immediate destination on leaving the ED. The χ² test was used for categorical data.

Results

On average, 51 ED RSI were performed annually (range 42–60). Emergency physician RSI for trauma increased from 32% (7/22) in 1999 to 75% (21/28) in 2003 (χ² = 9.32, df = 1, p = 0.002) and for non‐trauma from 62% (18/29) in 1999 to 79% (23/29) in 2003 (χ² = 2.08, df = 1, p = 0.15). Complication rates for emergency physician RSI decreased from 43% (3/7) to 14% (3/21) for trauma (χ² = 2.55, df = 1, p = 0.11) and from 28% (5/18) to 4% (1/23) for non‐trauma (χ² = 4.44, df = 1, p = 0.035). This compares with mean complication rates for anaesthetists for trauma of 17% and for non‐trauma of 22%. Incidence of hypotension decreased in all groups; however, oxygen desaturation is now the most common complication. The rate of ED RSI prior to computed tomography (CT) scans increased in both the trauma (79% v 42%; χ² = 7.42, df = 1, p = 0.0065) and non‐trauma (48% v 17%; χ² = 5.85, df = 1, p = 0.016) groups.

Conclusion

Emergency physician performed ED RSI is increasingly common but is not associated with overall higher numbers of RSIs being performed in the ED. Effective pre‐oxygenation should be emphasised during training.     

我院急诊科护士排班方法的改革及效果

目的探索一种适合急诊科护理工作的排班方法。方法对传统的周期性排班方法进行改革,实行相对固定的小组式排班方法,并对急诊科的各项护理工作质量及护士的身心健康情况进行实施前后比较。结果急诊科实施小组式排班方法前后,各项护理工作质量、病人满意度及护士身心健康状况的差异均有显著性意义(均P<0．05)。结论小组式排班方法能合理调配及利用现有的护理人力资源;增强护士的综合素质,培养团队精神;减少医疗纠纷的发生,提高病人满意度;减轻护士的工作压力,促进护士的身心健康。     

综合医院急诊科医护人员心理健康状况调查

目的探讨综合医院急诊科医护人员的心理健康状况,为制定心理干预措施提供依据。方法对综合医院急诊科405名在职医护人员采用症状自评量表进行心理健康状况调查,并与国内常模进行对比分析。结果急诊科医护人员症状自评量表中躯体化、人际关系、焦虑、抑郁、偏执、精神病性因子评分均显著高于常模（P〈0．05）;医生焦虑、抑郁、恐怖、偏执因子评分均显著高于常模（P〈0．05）,焦虑、恐怖因子评分均显著高于护士（P〈0．05）;护士躯体化、强迫、人际关系、抑郁、偏执因子评分均显著高于常模（P〈0．05）。结论综合医院急诊科医护人员的心理健康水平低于一般人群。护士的突出问题是人际关系、躯体化、强迫症状、偏执和抑郁;医生的突出问题是恐怖、焦虑、偏执和抑郁。应针对医护人员的心理问题给予相应的心理干预。     

Review article: Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient

Clinical communication and recognising and responding to a deteriorating patient are key current patient safety issues in healthcare. The aim of this literature review is to identify themes associated with aspects of the hospital clinical handover between paramedics and ED staff that can be improved, with a specific focus on the transfer of care of a deteriorating patient. Extensive searches of scholarly literature were conducted using the main medical and nursing electronic databases, including Cumulative Index to Nursing and Allied Health Literature, Medline and PubMed, during 2011 and again in July 2012. Seventeen peer‐reviewed English‐language original quantitative and qualitative studies from 2001 to 2012 were selected and critically appraised using an evaluation tool based on published instruments. Relevant themes identified were: professional relationships, respect and barriers to communication; multiple or repeated handovers; identification of staff in the ED; significance of vital signs; need for a structured handover tool; documentation and other communication methods and education and training to improve handovers. The issues raised in the literature included the need to: produce more complete and concise handovers, create respectful and effective communication, and identify staff in the ED. A structured handover tool such as ISBAR (a mnemonic covering Introduction, Situation, Background, Assessment and Recommendations) would appear to provide a solution to many of these issues. The recording of vital signs and transfer of these data might be improved with better observation systems incorporating early warning strategies. More effective teamwork could be achieved with further clinical communications training.     

Electronic interface for emergency department management of asthma: A randomized control trial of clinician performance

Objectives: To evaluate the effectiveness of an integrated and dynamic electronic decision support system for management of acute asthma in the ED. Methods: A randomized trial was conducted comparing clinician performance using this electronic interface compared with paper documentation in a simulation scenario. The outcomes were documentation of asthma‐related information and consultation times. Results: Use of this electronic interface was associated with significantly higher rates of documentation in 7 out of 10 variables, including provision of written short‐term asthma management plans. After adjustment for participant seniority, there was no significant difference in consultation times. Conclusion: In a simulation trial, use of this electronic interface was associated with improvements in clinical and discharge documentation. Further studies are required to test this prototype in clinical practice.     

专业护士核心能力培训在急诊科护士培训中的实践

目的探讨专业核心能力培训在急诊科护士培训中的实践效果。方法对本科室护士按照核心能力从低到高分为3个层级,围绕急诊专业护士5个核心能力进行分层级培训。评价培训前后护士综合考核及满意度情况。结果培训后本科室护士专业综合考核成绩优秀率、护士自我评价满意度、急诊科医生及患者对护士护理工作满意度均较培训前明显提高(均P<0.05)。结论采用分层级核心能力培训模式,可以起到优化护理人员能力结构,提高护士专业知识和专业技能,从而提高护理工作质量。