Emergency medicine journal : EMJ
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We analysed Twitter feeds at an emergency medicine scientific conference to determine the (1) accuracy of disseminated educational messages and the (2) use in providing rapid feedback to speakers. Most speakers were happy for key messages to be tweeted, and the majority of tweets (34/37) represented these accurately. It is important that speakers and conference organisers consider Twitter use and its potential benefits and disadvantages.
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Clinical leadership and organisational culture are important contextual factors for successful Quality Improvement (QI) programmes. The relationship between these and with organisational performance is complex and poorly understood. We aimed to explore the relationship between leadership, culture of innovation, and clinical engagement in QI for organisations participating in a large-scale national ambulance Quality Improvement Collaborative (QIC). ⋯ Although participants reported a lack of organisational culture of innovation, considered a prerequisite for QI, the collaborative achieved significant wide-scale improvements in prehospital care for myocardial infarction and stroke. We postulate that improvement was mediated through a 'QI subculture' developed from ASCQI's distributed leadership and network. Further research is needed to understand success factors for QI in different complex healthcare environments.
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Decisions made by ambulance staff are often time-critical and based on limited information. Wrong decisions could have serious consequences for patients but little is known about areas of risk associated with decisions about patient care. We aimed to examine system influences on decision making in the ambulance service setting focusing on paramedic roles. ⋯ A range of decisions are made by ambulance staff in complex, time bound changing conditions. Training and development and access to alternative options to ED conveyance were identified as particularly important issues.
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Research collaborations with patient and professional groups can ensure health research funders are aware of what matters to patients, carers and clinicians. Increasing service user involvement in research improves research quality, accountability and provision of patient-centred services. There is little evidence about involving service users in trials or pre-hospital emergency care research. Most research involving service users concerns a condition or treatment rather than service delivery or point of entry to the healthcare system. The SAFER 2 trial evaluates a complex intervention enabling paramedics to assess older people who fall and call 999 and, where appropriate, refer them to a community care pathway. ⋯ The principles and processes of the SOP provided a model that could be replicated across each trial site. We found it necessary to tailor and adapt.
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The SAFER 2 study is an RCT looking to improve the care provided by ambulance service to elderly patients who fall, by providing paramedics with a complex intervention consisting of a paramedic training programme, referral pathway to Falls Prevention Services, clinical support, a clinical decision flowchart and referral feedback. The study received confirmation of funding in December 2008; originally, patient recruitment was scheduled to finish in December 2011. ⋯ Evaluation of the study was delayed due to issues with ethical approval, site participation and patient eligibility screening and recruitment. Other studies, in other areas of research, have had similar issues, including the COnStRUCT and Family Links studies, which were set-back due to issues with NHS R&D approvals and attribution of costs.