Articles: emergency-department.
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The PhOEBE (Pre-Hospital Outcomes for Evidence Based Evaluation) research programme aims to develop new ways of measuring how well ambulance services meet the needs of the patients who call them and the quality of the care they provide. Measuring how services are performing is important as it allows us to monitor if standards are being maintained, assess what works well and identify problems early so improvements can be made. The first stages of our programme have focused on identifying the range of possible measures and from these narrowing it down to a small number that we will then develop in more detail. ⋯ This event not only provided the project with valuable information about which of our potential measures are considered important but also demonstrated that a PPI led initiative can enhance a lay audience's understanding of ambulance service performance issues. Despite some challenges in communication the event proved the PPI ref group as valued research collaborators. We continue to develop a more proactive PPI-led model of involvement capable of meeting the needs of the PhOEBE programme.
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Members of the public are increasingly turning to ambulance services for help with urgent problems that could successfully be managed in primary care. The reasons for this are complex, and it is unclear whether variation exists across different global settings and between ambulance systems. ⋯ There is evidence to suggest socioeconomic and demographic characteristics traditionally associated with minority status and deprivation are associated with ambulance use for primary care problems. The role of formal and informal care-givers in influencing risk management warrants deeper exploration. There is a lack of consensus in the literature on what defines 'inappropriate' ambulance use, and from who's perspective this should be determined. Further work needs to explore these conflicts.
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Whether a cardiac arrest treated by the ambulance service results in return of spontaneous circulation (ROSC), is dependent on the actions of the emergency call handler and their ability to induce bystander CPR. The objective was to develop an Utstein style reporting tool as a stand-alone software reporting module that also allows users and researchers to enrich current data collection by integrating standardised call handling data from the software version of the Medical Priority Dispatch System protocol (ProQA) into current Utstein based reports, resulting in a more accurate and detailed analysis of the specific stages of call taking. ⋯ The newly developed reporting tool makes analysis and comparison of Emergency Medical Dispatch resuscitation data possible and meaningful using universal measurements. It allows for more detailed evaluation between cardiac arrest variables, including comparison between individual staff and centres, with a view to identifying areas for performance and system improvements.
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A shift from a predominantly emergency service, towards one where a wide range of conditions are managed and treated on scene presents numerous challenges for ambulance services and clinicians. The effective management of a broad range of patients and conditions in the ambulance setting will have an impact on other parts of the health service including emergency departments and primary care. ⋯ Decisions regarding the most appropriate care for patients presenting to the ambulance service are best informed by access to accurate and complete health information and records. An understanding of patients' pre-existing medical conditions, recent treatments and health information is needed for the selection of the most appropriate care; this information is often difficult to obtain in the ambulance service setting.
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A cardiac arrest occurs when the heart stops beating suddenly. It is one of the most extreme medical emergencies. 60,000 people suffer an out of hospital cardiac arrest (OHCA) in the UK each year, with resuscitation attempted in less than half, and less than 10% surviving to hospital discharge. The Cardiac Arrest Individual Registry and Outcomes (CAIRO) Programme includes a comprehensive patient registry: the CAIRO database. This registry will allow us to confidentially link data from different sources to track each cardiac arrest patient from their initial collapse through to hospital discharge and, with the patient's consent, subsequently in the community through follow-up assessments of progress. ⋯ To determine whether it is feasible to set up the CAIRO database in this patient population, by linking sources of routinely collected data. To chart the patient pathway and estimate the completeness of the data obtained from routine data sources Conditional on sufficient data being available to allow meaningful analysis; OBJECTIVE 1: To compare the survival to hospital discharge, ICU stay, complications and neurological outcomes in patients in whom the arterial oxygen concentration in the first 24 hours following cardiac arrest was or was not maintained between 60 mm Hg to 200 mm Hg. OBJECTIVE 2: To compare the survival to hospital discharge of patients who were or were not transported or transferred to a cardiac care centre within 12 hours of the cardiac arrest. OBJECTIVE 3: To compare the survival to 1-year of patients who underwent coronary angiography within 8 hours of the cardiac arrest or more than 8 hours after the cardiac arrest. OBJECTIVE 4: To compare the healthcare resource use to 1-year of patients who were or were not within 5 miles of the receiving heart attack centre when they had an OHCA.