SMUR or not SMUR ?

Schmutz, Thomas; Guéchi, Youcef; Gendre, Grégoire; Ariosa, Joëlle; Ribordy, Vincent

doi:10.53738/revmed.2021.17.746.1367

Cited by 4 publications

(4 citation statements)

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“…The project management team was supported and listened to by the hospital management, the department’s management and by IT analysts who ensured the collection and adaptation of work tools and the monitoring of indicators. The communication of information to team members was done in an agile mode using team huddles for the dissemination of information 19. The opinions and proposals of field staff were collected to adapt and improve the processes.…”

Section: Designmentioning

confidence: 99%

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No waiting lying in a corridor: a quality improvement initiative in an emergency department

Schmutz,

Le Terrier,

Ribordy

et al. 2023

BMJ Open Qual

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BackgroundOvercrowding in the emergency department (ED) is a global problem and a source of morbidity and mortality and exhaustion for the teams. Despite multiple strategies proposed to overcome overcrowding, the accumulation of patients lying in bed awaiting treatment or hospitalisation is often inevitable and a major obstacle to quality of care. We initiated a quality improvement project with the objective of zero patients lying in bed awaiting care/referral outside a care area.MethodsSeveral plan–do–study–act (PDSA) cycles were tested and implemented to achieve and especially maintain the goal of having zero patients waiting for care outside the ED care area. The project team introduced and adapted five rules during these cycles: (1) no patients lying down outside of a care unit; (2) forward movement; (3) examination room always available; (4) team huddle and (5) an organisation overcrowding plan.ResultsAdaptation of ED organisation in the form of PDSA cycles allowed to obtain a collective team dimension to patient flow management. Since December 2021, despite an increase in activity, no patient is placed in a lying-in waiting area outside a care zone, irrespective of their care level. Vital distress and fragile patients who need to be kept in a supine position are treated immediately. In 2022, waiting time before medical contact was <2 hours for 90% of all patients combined.ConclusionsThe PDSA strategy based on these five measures allowed to remove in-house obstacles to the internal flow of patients and to fight against their installation outside the care area. These measures are easily replicable by other management teams. Quality indicators of EDs are often heterogeneous, but we propose that the absence of patients lying on a stretcher outside a care area could be part of these indicators, and thus contribute to the improvement and safety of care provided to all patients.

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Section: Designmentioning

confidence: 99%

“…The communication of information to team members was done in an agile mode using team huddles for the dissemination of information. 19 The opinions and proposals of field staff were collected to adapt and improve the processes.…”

Section: Designmentioning

confidence: 99%

No waiting lying in a corridor: a quality improvement initiative in an emergency department

Schmutz,

Le Terrier,

Ribordy

et al. 2023

BMJ Open Qual

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“…They therefore provide assessment, triage, delegated medical care and transportation of the patient. However, a prehospital emergency physician supports the management of complex cases [ 3 ]. A distinction should be made between the term “paramedic” and the adjective “paramedical”, as a paramedical profession is any profession that provides care in close collaboration with the physician.…”

Section: Definition Of the Paramedic Profession: Registered Paramedic...mentioning

confidence: 99%

Paramedics in Switzerland: A Mature Profession

Schmutz

Guéchi²,

Dénéréaz³

et al. 2022

IJERPH

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This paper describes how the profession of paramedics has evolved in Switzerland and takes the perspective of public health. Ambulance drivers play an important role in the health system, not only as a response to emergencies, but also by working in an interprofessional and interdisciplinary manner in response to other public health needs, such as home care, triage, telemedicine and interhospital transfers. This pre-hospital system is rapidly evolving and relies on the work of paramedics.

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“…Prehospital physicians can help improve patient outcomes in several cases, such as cardiac arrests [3] and polytrauma [4]. In addition to these specific outcomes, a specialised medical evaluation can be helpful when making appropriate clinical and medicolegal decisions [5]. The impact of these decision-making skills has already been demonstrated in several other settings, including radiological exam prescription [6], futility assessment [7], readmission [8] and mortality [9].…”

Section: Introductionmentioning

confidence: 99%

Association between prehospital physician clinical experience and discharge at scene – retrospective cohort study

Betend,

Suppan,

Chan

et al. 2023

Swiss Med Wkly

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BACKGROUND: Clinical experience has been shown to affect many patient-related outcomes but its impact in the prehospital setting has been little studied. OBJECTIVES:To determine whether rates of discharge at scene, handover to paramedics and supervision are associated with clinical experience. DESIGN, SETTINGS AND PARTICIPANTS: A retrospective study, performed on all prehospital interventions carried out by physicians working in a mobile medical unit (“service mobile d’urgence et de réanimationˮ [SMUR]) at Geneva University Hospitals between 1 January 2010 and 31 December 2019. The main exclusion criteria were phone consultations and major incidents with multiple casualties. EXPOSURE:The exposure was the clinical experience of the prehospital physician at the time of the intervention, in number of years since graduation. OUTCOME MEASURES AND ANALYSIS: The main outcome was the rate of discharge at scene. Secondary outcomes were the rate of handover to paramedics and the need for senior supervision. Outcomes were tabulated and multilevel logistic regression was performed to take into account the cluster effect of physicians. RESULTS: In total, 48,368 adult patients were included in the analysis. The interventions were performed by 219 different physicians, most of whom were male (53.9%) and had graduated in Switzerland (82.7%). At the time of intervention, mean (standard deviation [SD]) level of experience was 5.2 (3.3) years and the median was 4.6 (interquartile range [IQR]: 3.4–6.0). The overall discharge at scene rate was 7.8% with no association between clinical experience and discharge at scene rate. Greater experience was associated with a higher rate of handover to paramedics (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13–1.21) and less supervision (aOR: 0.85, 95% CI: 0.82–0.88). CONCLUSION: In this retrospective study, there was no association between level of experience and overall rate of discharge at scene. However, greater clinical experience was associated with higher rates of handover to paramedics and less supervision.

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SMUR or not SMUR ?

Cited by 4 publications

References 0 publications

No waiting lying in a corridor: a quality improvement initiative in an emergency department

No waiting lying in a corridor: a quality improvement initiative in an emergency department

Paramedics in Switzerland: A Mature Profession

Association between prehospital physician clinical experience and discharge at scene – retrospective cohort study

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