New and emerging roles in out of hospital emergency care: A review of the international literature

Cooper, Simon; Grant, Julie

doi:10.1016/j.ienj.2008.11.004

Cited by 46 publications

(41 citation statements)

References 32 publications

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“…We have summarised the characteristics and findings of the seven systematic reviews [146][147][148][149][150][151]173 (Tables 10 and 11). Data on the 12 papers 174-185 not included in the systematic reviews were extracted in to summary tables (Tables 12-14).…”

Section: Resultsmentioning

confidence: 99%

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk 146 Cooper and Grant, 2009 147 Evans, 2014 148 Hill, 2014 149 Mikolaizak, 2013 150 Tohira, 2014 151 Adams, 2005 152 ✓ ✓ …”

Section: Management Of Patients With Urgent Care Problems By Ambulancmentioning

confidence: 99%

“…Six of the systematic reviews [146][147][148]150,151,187 found evidence that prehospital professionals can successfully reduce the number of patients transported to EDs and provide autonomous care and appropriate referral in the community setting. The evidence is predominated by schemes to provide ambulance paramedics with extended and enhanced clinical skills.…”

Section: Effectivenessmentioning

confidence: 99%

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What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Section: Resultsmentioning

confidence: 99%

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk 146 Cooper and Grant, 2009 147 Evans, 2014 148 Hill, 2014 149 Mikolaizak, 2013 150 Tohira, 2014 151 Adams, 2005 152 ✓ ✓ …”

Section: Management Of Patients With Urgent Care Problems By Ambulancmentioning

confidence: 99%

Section: Effectivenessmentioning

confidence: 99%

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What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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“…Extensive knowledge and competence are necessary so that the demands of medicine and care can be balanced Forsgren et al, 2009). Such competence in out-of-hospital emergency care has an impact on patient safety (Cooper and Grant, 2009). Forsgren et al (2009) argue that the rational modelling structure by which the triage model is constructed cannot distinguish all parameters that an experienced nurse would take into account.…”

Section: Discussionmentioning

confidence: 99%

Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions

Sundström

Dahlberg

2011

International Emergency Nursing

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“…4 As assessments and treatments of patients in prehospital emergency medical care are becoming more advanced and complex, prehospital emergency care is on the eve of a new and emerging role. 5 Many organizations are searching for alternatives to Accident and Emergency (A&E) treatments, 6 but according to a recent systematic review, prehospital personnel's preparedness for this task is poor. 7 Another future task will include "clinical pathways".…”

Section: Introductionmentioning

confidence: 99%

Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

Hagiwara

Henricson

Jönsson

et al. 2011

Prehosp. Disaster med.

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Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient. Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/ Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials. Results: Use of the DST in prehospital care may have the possibility to decrease "time to definitive care" and improve diagnostic accuracy among prehospital personnel, but more studies are needed. Conclusions:The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care. IntroductionPrehospital patient assessment is different compared to assessments provided in hospitals. Often, the ambulance personnel are sent to medical emergencies with very little background information. The person who initiates the call for help sometimes is not able to describe the situation, and therefore, the ambulance personnel have difficulties preparing themselves for the task. The ambulance personnel's work situation has been described as "extreme". "They have routinely required working in environments of extreme and constant uncertainty." 1 These environmental factors lead to great strain on the prehospital caregiver's ability when assessing patients. In addition, there have been very few randomized controlled trials (RTC) that have evaluated prehospital care. 2 When 14 ambulance nurses in Sweden were asked about factors that influence their decision-making, several factors that were crucial for the decision were elicited. Important factors included: (1) time of day; (2) season and weather; (3) amount of time before other resources could arrive to the scene; (4) if there was threat of security; (5) stress; (6) environment; (7) diagnosis and; (8) type of patient assessed. 3 A qualitative study by Wireklint Sundström described the need of an "open mind" in the performance of prehospital assessments, and noted that prehospital caregivers must put their preconceived ideas aside when they meet and assess patients. 4 As assessments and treatments of patients in prehospital emergency medical care are becoming more advanced and complex, prehospital emergency care is on the eve of a new and emerging role. 5 Many organizations are searching for alternatives to Accident and Emergency (A&E) treatments, 6 but according to a recent systematic review, prehospital personnel's preparedness for this task is poor. 7 Another future task ...

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New and emerging roles in out of hospital emergency care: A review of the international literature

Cited by 46 publications

References 32 publications

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions

Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

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