Zurich to Berlin-"Where" Are We Now with the Concussion in Sport Group?

The Concussion in Sport Group recently published its highly anticipated fifth consensus statement on sports-related concussion. The latest iteration features a new organizational format-the "11 Rs" and has input from a wider range of health care professionals, organizations, and experts in the field from both the sport concussion area and from related areas outside of sport. The stated objective of this current document is to "build on the principles outlined in previous statements and develop further conceptual understanding of sports-related concussion." Its intended audience is "physicians and health care providers who are involved in athlete care, whether at a recreational, elite, or professional level." We review significant updates including recommendations for sideline evaluation, return to play, and return to learn in athletes with sports-related concussion.

A Descriptive, Retrospective Study of After-hours Calls in Hospice and Palliative Care.

AIMS: Few studies have described after-hours calls in hospice patient care. This retrospective study examines the timing of after-hours telephone triage services; the reasons for access to after-hours hospice and palliative care services; and the predominant nursing interventions offered in after-hours calls in hospice and palliative care. METHODS: A fixed coding scheme was used to code a de-identified after-hours triage phone log of all calls between July 2005 and June 2006 (n=4,434) from a Pennsylvania hospice and palliative care services organization. Descriptive statistics were used to identify call timing pattern, call reasons, and predominant nursing interventions. RESULTS: Triage services were utilized most frequently to request assistance with signs and symptoms control (25.7%), report death (17.8%), and to request a home visit (15.3%). The top nursing interventions included updating case managers or supervisors about the needs of follow-up (29.5%), coordinating home visits (20.5%), and instructing caregivers or patients on how to control new signs and symptoms (19.8%). CONCLUSIONS: A better understanding of when and why patients and their family caregivers utilize after-hours hospice triage services can assist in the design of future proactive interventions to improve care, and enhance training for new and existing hospice triage nurses.

The role of the non-ICU staff nurse on a medical emergency team: perceptions and understanding.

OBJECTIVE: Medical emergency teams (METs) have been shown to contribute to a decrease in in-hospital cardiac arrests, unplanned ICU admissions, and overall hospital mortality rates. But their use is relatively new and our understanding of them is incomplete; in particular, the role of the non-ICU staff nurse during a MET call has received scant attention. To better understand the role of such nurses, and possibly to increase the effectiveness of these teams, we sought to determine the nursing staff's familiarity with and perceptions of the MET at one hospital. METHODS: After examining survey formats used in previous studies of nurses' perceptions of and attitudes toward METs, a 30-item survey was developed, consisting of 13 demographic and background items and 17 items based on a 5-point Likert agreement scale. In August 2008, the survey was distributed to the 388 nurses at Allegheny General Hospital in Pittsburgh, Pennsylvania, for whom the MET is a possible resource-that is, non-ICU staff nurses working outside critical care units or the ED. Responses were anonymous and voluntary. Data were entered and analyzed using Microsoft Excel software. RESULTS: One hundred and thirty-one surveys (34%) were returned. Nearly all of the respondents (97%) were familiar with the MET, and a majority (72%) had participated in a MET call. Initiating the call (77%) and relaying the patient's history (84%) were the most common actions. A majority of respondents agreed or strongly agreed that use of the MET improved patient care (92%) and nurses' working conditions (83%). But only 41% agreed or strongly agreed that they were comfortable with their role as a member of the MET, and 39% reported neutral feelings about this. Just 41% agreed or strongly agreed that they felt prepared to administer nursing care during a MET call. A majority (52%) agreed or strongly agreed that an increase in experience corresponded to an increase in preparedness, but only 28% agreed or strongly agreed that their MET education had prepared them for their role. Nearly a third (31%) reported that they'd been hesitant to call a MET, citing physician discouragement as the most common reason. CONCLUSIONS: Nurses felt that the MET improved both patient care and their working conditions, something that other studies have found may contribute to nurse retention and recruitment. But the role of the non-ICU staff nurse during a MET call remains unclear; nurses were neutral about their level of understanding of and comfort with their roles as members of the MET. More specific guidelines and further education may help the non-ICU staff nurse feel more valued as a team member and better prepared to administer nursing care during a MET call. Intimidation by other team members proved not to be a significant factor in nurse participation on the team, but the data may not have accurately described the unique relationship between the non-ICU staff nurse and the responding ICU nurses. Some non-ICU staff nurses were hesitant to call the team, for reasons that included physician discouragement; this could seriously undermine the effectiveness of the MET and indicates that better interprofessional education is needed. KEYWORDS: bedside nurse, medical emergency team, non-ICU staff nurse, nurse attitudes, patient crisis, patient safety, rapid response system, survey.