Splint Quality Assessment and Improvement Among Emergency Department Staff.

The purpose of this quality improvement project is to assess and improve the quality of splint application in the emergency department (ED), as well as the splint application confidence level of the ED staff. Consistent and high-quality splint application is critical in fracture stabilization and prevention of further injury. Significantly high turnover and a lack of formal training of ED staff has led to poor splint application, and in some cases, patient injuries related to the splints themselves. These injuries include pain, edema, and skin complications (A. P. Carino, 2017). A random, Likert-based analysis was performed on 20 ED-applied splints. Once analysis was complete, training courses were implemented to improve splint application techniques. Using the same Likert-based tool, applications of 20 posttraining splints were analyzed. In addition, ED staff confidence levels were scored before and after the training courses. Overall, statistically significant improvement was achieved in splint application quality and staff confidence. Correct splint applications increased from 50% to 95% after the educational sessions. Staff confidence in splint application also increased, from 35% to 77.1%. Quality splint application affects all patients. The higher risk population is more likely to suffer the consequences of poor splint application. This project had a positive impact on the region's marginalized patient population. These patients have limited resources, including lack of transportation, financial limitations, and typically are at higher risk for complications due to comorbidities.

Implementation of a Team-Focused High-Performance CPR (TF-HP-CPR) Protocol Within a Rural Area EMS System.

Team-focused, high-performance cardiopulmonary resuscitation (TF-HP-CPR) improves the return of spontaneous circulation (ROSC) among patients with out-of-hospital cardiac arrest (OHCA) events. In 2010, the American Heart Association began endorsing TF-HP-CPR (). A rural-area Virginia emergency medical services (EMS) system receives assistant medical oversight from an emergency nurse practitioner (ENP). The ENP is responsible for assisting the physician medical director in promoting continuous quality improvement (QI) within the EMS system. In January 2018, a QI project implemented a TF-HP-CPR protocol. The QI project encompassed the provision of education for EMS personnel about TF-HP-CPR with mock code evaluations. The protocol incorporated a newly designated blind insertion airway device and integrated the routine monitoring of end-tidal carbon dioxide (ETCO2) values. The QI project also introduced postresuscitation attempt report cards that were completed by the team leader at the conclusion of each CPR event. A random 16-week sample of patients with OHCA just before implementation of the QI project was analyzed and compared with patients who experienced an OHCA event within a 16-week period after implementation of the TF-HP-CPR protocol. The preimplementation group had 13 patients compared with 11 patients in the postimplementation group. The rate of ROSC in the preimplementation group was 38.46% compared with 54.55% in the postimplementation group. Although the rate of ROSC increased by 16.09%, the findings were not statistically significant (p = 0.6824) and were perceived to be likely due to the small sample sizes. The implementation of a TF-HP-CPR protocol improved the rate of ROSC among patients with OHCA; however, the findings were not statistically significant. A more extensive study is essential for further evaluation.