Notärztliche Einsatzdokumentation in der Simulation

Bergrath, Sebastian; Rörtgen, Daniel; Skorning, Max; Fischermann, Harold; Beckers, Stefan; Mutscher, Christina; Brokmann, Jörg Christian; Rossaint, Rolf

doi:10.1007/s00101-010-1790-y

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…26 In a simulation study, Bergrath et al were able to show that, especially in the simulated polytrauma scenario, documentation quality suffered under the dynamic situation. 27 In this study, both groups showed a high number of undocumented criteria; in contrast to Brokmann et al, 22 a better documentation of the collected parameters by the tele-EMS physicians could not be shown. This might be because the CSR-and NEXUS-criteria are not included in the tele-EMS physicians checklist-based documentation system.…”

Section: Choice Of Immobilization Devicecontrasting

confidence: 86%

Immobilization in Emergency Medical Service – Are CSR and NEXUS-Criteria Considered? A Matched-Pairs Analysis Between Trauma Patients Treated by Onsite EMS Physicians and Patients Treated by Tele-EMS Physicians

Hofstetter¹,

Schröder²,

Beckers³

et al. 2023

OAEM

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Background:The NEXUS-low-risk criteria (NEXUS) and Canadian C-spine rule (CSR) are clinical decision tools used for the prehospital spinal clearance in trauma patients, intending to prevent over-as well as under immobilization. Since 2014, a holistic telemedicine system is part of the emergency medical service (EMS) in Aachen (Germany). This study aims to examine whether the decisions to immobilize or not by EMS-and tele-EMS physicians are based on NEXUS and the CSR, as well as the guideline adherence concerning the choice of immobilization device. Methods: A single-site retrospective chart review was undertaken. Inclusion criteria were EMS physician and tele-EMS physician protocols with traumatic diagnoses. Matched pairs were formed, using age, sex and working diagnoses as matching criteria. The primary outcome parameters were the criteria documented as well as the immobilization device used. The evaluation of the decision to immobilize based on the criteria documented was defined as secondary outcome parameter. Results: Of a total of 247 patients, 34% (n = 84) were immobilized in the EMS physician group and 32.79% (n = 81) in the tele-EMS physician group. In both groups, less than 7% NEXUS or CSR criteria were documented completely. The decision to immobilize or not was appropriately implemented in 127 (51%) in the EMS-physician and in 135 (54, 66%) in the tele-EMS physician group. Immobilization without indication was performed significantly more often by tele-EMS physicians (6.88% vs 2.02%). A significantly better guideline adherence was found in the tele-EMS physician group, preferring the vacuum mattress (25, 1% vs 8.9%) over the spineboard. Conclusion:It could be shown that NEXUS and CSR are not applied regularly, and if so, mostly inconsistently with incomplete documentation by both EMS-and tele-EMS physicians. Regarding the choice of the immobilization device a higher guideline adherence was shown among the tele-EMS physicians.

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Section: Choice Of Immobilization Devicecontrasting

confidence: 86%

Immobilization in Emergency Medical Service – Are CSR and NEXUS-Criteria Considered? A Matched-Pairs Analysis Between Trauma Patients Treated by Onsite EMS Physicians and Patients Treated by Tele-EMS Physicians

Hofstetter¹,

Schröder²,

Beckers³

et al. 2023

OAEM

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“…This particularly affects the collection of medical history and physical examination results [24]. A video-based error analysis, as conducted by Bergrath et al, of documentation by physicians, following simulation, showed that 20% of the information was missing and 22% of the documented information was incorrect [25]. …”

Section: Discussionmentioning

confidence: 99%

Quality of Documentation as a Surrogate Marker for Awareness and Training Effectiveness of PHTLS-Courses. Part of the Prospective Longitudinal Mixed-Methods EPPTC-Trial

et al. 2017

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ObjectiveCare for severely injured patients requires multidisciplinary teamwork. A decrease in the number of accident victims ultimately affects the routine and skills. PHTLS (“Pre-Hospital Trauma Life Support”) courses are established two-day courses for medical and non-medical rescue service personnel, aimed at improving the pre-hospital care of trauma patients worldwide. The study aims the examination of the quality of documentation before and after PHTLS courses as a surrogate endpoint of training effectiveness and awareness.MethodsThis was a prospective pre-post intervention trial and was part of the mixed-method longitudinal EPPTC (Effect of Paramedic Training on Pre-Hospital Trauma Care) study, evaluating subjective and objective changes among participants and real patient care, as a result of PHTLS courses. The courses provide an overview of the SAMPLE approach for interrogation of anamnestic information, which is believed to be responsible for patient safety as relevant, among others, “Allergies,” “Medication,” and “Patient History” (AMP). The focus of the course is not the documentation.ResultsIn total, 320 protocols were analyzed before and after the training. The PHTLS course led to a significant increase (p < 0.001) in the “AMP” information in the documentation. The subgroups analysis of “allergies” (+47.2%), “drugs” (+38.1%), and “medical history” (+27.8%) before and after the PHTLS course showed a significant increase in the information content.ConclusionIn summary, we showed that PHTLS training improves documentation quality, which we used as a surrogate endpoint for learning effectiveness and awareness. In this regard, we demonstrated that participants use certain parts of training in real life, thereby suggesting that the learning methods of PHTLS training are effective. These results, however, do not indicate whether patient care has changed.

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“…Incomplete documentation was found in 14% of patient records; although it might not contribute to an HI, it contributes substantially to NM, thus emerging as an important area for improvement in the EMS. One study [ 46 ] simulated the actions of EMS clinicians during medical or traumatic emergency care of a patient. The video-recorded actions were later compared with the documentation, and they revealed missing documentation in 22% of medical cases and 14% of traumatic cases.…”

Section: Discussionmentioning

confidence: 99%

Development of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care

Packendorff,

Magnusson,

Wibring

et al. 2024

Scand J Trauma Resusc Emerg Med

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Background Emergency Medical Services (EMS) are a unique setting because care for the chief complaint is given across all ages in a complex and high-risk environment that may pose a threat to patient safety. Traditionally, a reporting system is commonly used to raise awareness of adverse events (AEs); however, it could fail to detect an AE. Several methods are needed to evaluate patient safety in EMS. In this light, this study was conducted to (1) develop a national ambulance trigger tool (ATT) with a guide containing descriptions of triggers, examples of use, and categorization of near misses (NMs), no harm incidents (NHIs), and harmful incidents (HIs) and (2) use the ATT on randomly selected ambulance records. Methods The ambulance trigger tool was developed in a stepwise manner through (1) a literature review; (2) three sessions of structured group discussions with an expert panel having knowledge of emergency medical service, patient safety, and development of trigger tools; (3) a retrospective record review of 900 randomly selected journals with three review teams from different geographical locations; and (4) inter-rater reliability testing between reviewers. Results From the literature review, 34 triggers were derived. After removing clinically irrelevant ones and combining others through three sessions of structured discussions, 19 remained. The most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (30.4%), the patient is non conveyed after EMS assessment (20.8%), and incomplete documentation (14.4%). The positive triggers were categorized as a near miss (40.9%), no harm (3.7%), and harmful incident (0.2%). Inter-rater reliability testing showed good agreement in both sessions. Conclusion This study shows that a trigger tool together with a retrospective record review can be used as a method to measure the frequency of harmful incidents, no harm incidents, and near misses in the EMS, thus complementing the traditional reporting system to realize increased patient safety.

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Notärztliche Einsatzdokumentation in der Simulation

Cited by 7 publications

References 22 publications

Immobilization in Emergency Medical Service – Are CSR and NEXUS-Criteria Considered? A Matched-Pairs Analysis Between Trauma Patients Treated by Onsite EMS Physicians and Patients Treated by Tele-EMS Physicians

Immobilization in Emergency Medical Service – Are CSR and NEXUS-Criteria Considered? A Matched-Pairs Analysis Between Trauma Patients Treated by Onsite EMS Physicians and Patients Treated by Tele-EMS Physicians

Quality of Documentation as a Surrogate Marker for Awareness and Training Effectiveness of PHTLS-Courses. Part of the Prospective Longitudinal Mixed-Methods EPPTC-Trial

Development of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care

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