Emergency medicine journal : EMJ
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Pain affects 4 out of 5 patients presenting to ambulance services and is often poorly assessed and treated. Currently, patients' pain is assessed by ambulance clinicians using a numerical verbal (zero to ten) pain score (NVPS). Our previous qualitative study showed that NVPS were poorly understood by patients and that a better pain assessment tool was needed. This current study sought to develop and test a novel pain assessment tool 'Patient Reported Outcome Measure for Pain Treatment (PROMPT)' for feasibility of use by ambulance paramedics. ⋯ Preliminary findings suggest that PROMPT is reliable, feasible to use, and has face, content and predictive validity. In order to evaluate the effectiveness of the tool, we are conducting a non-randomised control group study comparing pain management provided by paramedics using the tool with paramedics following their usual practice.
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We developed a new device to quantify capillary refill time (CRT) by applying the pulse oximeter principle, and evaluated the correlation between quantitative CRT (Q-CRT) and hypoperfusion status, as represented by blood lactate levels, in critically ill patients. ⋯ Q-CRT correlated with blood lactate levels in this pilot study. The most useful threshold for Q-CRT was ∼6-8 s. Further study is needed to investigate the potential role of this modality as a non-invasive predictor of hypoperfusion in the emergency department, ICU and operating room settings.
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To analyse the ultrasonographic findings of community-acquired pneumonia (CAP) and its efficacy for diagnosis of CAP compared with chest X-ray (CXR). ⋯ Lung ultrasonography has a better diagnostic sensitivity and accuracy for diagnosing CAP compared with CXR.
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Improving sustained ROSC rates following out-of-hospital cardiac arrest is a key focus for ambulance services. Accordingly, a Quality Improvement (QI) project was initiated whereby an Intensive Care Society post-resuscitation care bundle of evidence-based interventions was adapted for use by pre-hospital clinicians. The objective was to introduce and embed this care bundle, in order to increase its delivery. emermed;32/6/e18-b/EMERMED2015204980TB1T1EMERMED2015204980TB1 Apr & May 2012 Apr & May 2013 Apr & May 2014 No. of patients 96 106 97 Complete Care Bundle 8.3% 32.1% 35.1% 12-Lead ECG 60% 71.7% 81.4% Blood Sugar 43% 94.3% 95.9% Cooling Started 49% 69.8% 62.9% Ventilatory Support 53% 52.8% 73.2% Haemodynamic Support 74% 82.1% 82.5% ⋯ The care bundle model, alongside targeted QI activities, has proved successful in ensuring best-practice care is more routinely provided. These methods promote clinician co-production of practice development, and are adaptive to evolving clinical evidence.
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NHS health policy emphasises the crucial role of patient experience as a core component of high quality care, alongside effectiveness and safety. Patient Reported Experience Measures (PREMs) measure patients' experiences with their healthcare. They are increasingly being seen as valuable for assessing patient outcomes and differences in quality between health care providers. Previous patient surveys to assess ambulance service care have not been implemented routinely or in a standardised way. This research forms part of a doctoral study to develop a PREM for use in UK ambulance services. ⋯ The construction of the PREM has incorporated the views of patients that the measure is ultimately designed for, and conforms to the concept of patient-centred care-the theoretical foundation of the research. Once completed, the PREM will enable ambulance trusts to measure differences in patient experiences, between and within organisations. This can result in positive changes to patient experience through the introduction of feedback, training and education to prehospital clinicians.