Clinical decision-making described by Swedish prehospital emergency care nurse students – An exploratory study

Nilsson, Tomas; Lindström, Veronica

doi:10.1016/j.ienj.2015.10.006

Cited by 24 publications

(12 citation statements)

References 15 publications

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“…Studies show that paramedics with a longer education are better at clinical decision-making [6,10,15]. However, there are no international standards or regulations for paramedics or prehospital emergency care nurses [16] which makes it difficult to generalize the results of the studies.…”

Section: Introductionmentioning

confidence: 99%

The accuracy of preliminary diagnoses made by paramedics – a cross-sectional comparative study

Koivulahti

Tommila

Haavisto

2020

Scand J Trauma Resusc Emerg Med

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Background: Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient's outcome. The research in this area is relatively scarce and there are no previous studies in Finland describing the accuracy of preliminary diagnoses made by paramedics. The aim of this study was to evaluate whether paramedics are making accurate preliminary diagnoses for the patients they are transporting to hospital. In addition, the aim was to describe the variables related to an accurate preliminary diagnosis. Methods: A cross-sectional comparative approach was used and conducted through a questionnaire to gather data from the paramedics. A total of 71 paramedics participated in the study and 378 patient cases were included. The paramedics were asked to describe the basic information of a case, to state their preliminary diagnosis, and give their own educational background. The accuracy of the paramedic's preliminary diagnosis was compared with the discharge diagnosis of the ED physicians retrieved from hospital's patient records. Logistic regression analysis and a binomial test were used to test the statistical significance. Results: The agreement between the paramedics' preliminary diagnosis vs. hospital diagnosis was 70% (n = 261). Diagnostic accuracy varied according to the medical condition from mental diseases and intoxication (86%, p = 0, 000), cerebral strokes (81%, p = 0,007) to infections (31% p = 0,029). The educational background of a bachelordegree-level paramedic (p = 0,016, 95% Cl 1,7-139,6) and a good self-assessment value (p = 0,003, 95% Cl 1,2-2,7) were related to making a correct diagnosis. Conclusions: Paramedics are able to determine preliminary diagnoses at satisfactory level. The relationship between educational background and diagnostic accuracy suggests that there is a definitive need for a specific prehospital nursing education.

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Section: Introductionmentioning

confidence: 99%

The accuracy of preliminary diagnoses made by paramedics – a cross-sectional comparative study

Koivulahti

Tommila

Haavisto

2020

Scand J Trauma Resusc Emerg Med

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“…According to the National Board of Health and Welfare, prehospital emergency services are defined as medical care provided by healthcare professionals within or adjacent to the ambulance. 14 The main objective of these services is to provide treatment to people who are in dire need of medical care and performing timely transfer to the nearest medical center. 15 Prehospital services are represented by a symbolic star with six arms that comprise the following: early identification, early reporting, early response, optimization of care provided at the scene, care during transfer, and transporting to a definitive care center.…”

Section: Prehospital Emergency Medical Servicesmentioning

confidence: 99%

Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges

2019

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Clinical decision support systems are interactive computer systems for situational decision making and can improve decision efficiency and safety of care. We investigated the role of these systems in enhancing prehospital care. This narrative review included full-text articles published since 2000 that were available in databases/e-journals including Web of Science, PubMed, Science Direct, and Google Scholar. Search keywords included "clinical decision support system," "decision support system," "decision support tools," "prehospital care," and "emergency medical services." Non-journal articles were excluded. We revealed 14 relevant studies that used such a support system in prehospital emergency medical service. Owing to the dynamic nature of emergency situations, decision timing is critical. Four key factors demonstrated the ability of clinical decision support systems to improve decision-making, reduce errors, and improve the safety of prehospital emergency activity: computer-based, offer support as a natural part of the workflow, provide decision support in the time and place of decision making, and offer practical advice. The use of clinical decision support systems in prehospital care resulted in accurate diagnoses, improved patient triage and patient outcomes, and reduction of prehospital time. By improving emergency management and rescue operations, the quality of prehospital care will be enhanced.

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“…Nationally, ambulance clinicians (ACs) within the Swedish AS consist of at least one registered nurse (RN) and one emergency medical technician (EMT). However, some county councils have decided to crew their ambulances with at least one specialist ambulance nurse (SAN) together with an RN or EMT [2,3]. Physicians within the AS in Sweden mainly operate in the helicopter emergency medical services (HEMS) and rarely in land-based ambulances.…”

Section: Introductionmentioning

confidence: 99%

Quality Is in the Eye of the Beholder—A Focus Group Study from the Perspective of Ambulance Clinicians, Physicians, and Managers

2019

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Quality within all areas of healthcare should be systemically monitored and ensured. However, the definition of quality is complex and diverse. In the ambulance service (AS), quality has traditionally been defined as response time, but this measurement eliminates the possibility of addressing other characteristics of quality, such as the care provided. This study aimed to explore what constitutes quality in the context of the ambulance service as experienced by ambulance clinicians, physicians, and managers. A focus group study was conducted with 18 participants. The three focus groups were analyzed with the focus group method developed by Kreuger and Casey. The participants highlighted patient involvement, information and care, as well as adherence to policies, regulations, and their own standards as representing quality in the AS. This study demonstrates that quality is in the eye of the beholder. As quality seems to be viewed similarly by patients and ambulance clinicians, physicians, and managers, stakeholders should aim for a paradigm shift where patients’ experience of the care is just as important as various time measures.

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Clinical decision-making described by Swedish prehospital emergency care nurse students – An exploratory study

Cited by 24 publications

References 15 publications

The accuracy of preliminary diagnoses made by paramedics – a cross-sectional comparative study

The accuracy of preliminary diagnoses made by paramedics – a cross-sectional comparative study

Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges

Quality Is in the Eye of the Beholder—A Focus Group Study from the Perspective of Ambulance Clinicians, Physicians, and Managers

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