Implementation of health care quality indicators for out-of-hospital emergencies: a systematic review. / Utilización e implementación de indicadores de calidad para evaluar la atención en las emergencias extrahospitalarias: revisión sistemática.

ABSTRACT: Although many health care quality indicators have been defined for establishing a common, homogeneous, and reliable system for assessing emergency department care, less information is available on the use of indicators of quality in attending emergencies outside the hospital. We aimed to identify and analyze quality indicators that have appeared in the literature on out-of-hospital emergencies. This systematic review of the literature followed the ations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We developed protocols for searching 5 databases to locate studies using quality indicators to evaluate care in out-of-hospital emergencies. Studies were published between July 2017 and July 2018 in either English or Spanish. We identified 22 studies naming 333 quality indicators in out-of-hospital emergencies. The indicators were classified as clinical or nonclinical; within each of these 2 sets, we also identified domains, or subcategories. As nonclinical quality identifiers were more numerous in the literature, it seems that they are the ones most often used to assess out-of-hospital emergency care at this time. This finding leaves the door open to designing and implementing new indicators able to measure quality of care in this clinical setting.

RESUMEN: Aunque son muchos los indicadores de calidad (IC) definidos para establecer un sistema común, homogéneo y fiable de evaluación sobre la actividad en los servicios de urgencias, es escasa la información acerca de los IC relacionados con las emergencias atendidas en el ámbito extrahospitalario. El objetivo de este trabajo es identificar y analizar, a través de la literatura científica publicada, los IC específicos de dicha atención ante emergencias fuera del contexto hospitalario. Se realizó una revisión sistemática de la literatura según las recomendaciones PRISMA. Se exploraron 5 bases de datos y se elaboraron protocolos de búsqueda para localizar estudios que aportasen información sobre IC para evaluar la atención en emergencias extrahospitalarias, entre noviembre de 2017 y julio de 2018, tanto en inglés como en español. Se analizaron un total de 22 estudios y se identificaron un total de 333 IC en emergencias extrahospitalarias que fueron clasificados en clínicos y no clínicos, con sus subdominios correspondientes para cada grupo. El número de IC no clínicos identificados en la búsqueda fue superior, pudiendo concluir que son los más utilizados para evaluar la atención en las emergencias extrahospitalarias en la actualidad y dejando la puerta abierta para el diseño e implementación de nuevos IC capaces de evaluar la actividad fuera del contexto hospitalario.

Measuring the levels of burnout syndrome and empathy of Spanish emergency medical service professionals.

BACKGROUND: to determine the prevalence of burnout syndrome among Spanish emergency medical service professionals and establish any possible relationships between their levels of empathy and sociodemographic and/or working conditions. METHOD: 550 professionals participated in this descriptive study by responding to the Maslach Burnout Inventory and the Basic Empathy Scale. RESULTS: respondents were, on average, 40.9 years old (SD=9.03) and 63.4% were female. Their average length of service was 11.6 years (SD=8.1); 57.9% were physicians, 22.4% nurses, and 7.2% technical staff. Of the 337 who said they had children, 51% said that parenthood affected their emotional state when attending emergency situations involving children. Participants generally considered themselves to be competent (x˙=4.2; SD=0.7) and occupationally motivated (x˙=3.8; SD=1.1). More experienced participants presented fewer signs of burnout and empathy and more signs of competence (p<0.001). Occupational category appeared to significantly affect the presentation of burnout syndrome (p<0.05). Prehospital emergency medical services (PEMS) staff tended to rate their ability to perform their work and interact professionally with their patients more positively than emergency department staff. CONCLUSION: Spanish emergency medical service staff present similar levels of burnout to other healthcare providers but have higher levels of empathy. We found no significant differences in the presentation of burnout between physicians and nurses, but compared to emergency department staff, PEMS professionals appeared to be more confident in their abilities. Educational activities are required to improve professionals' ability to cope with their work and structural workplace interventions could help reinforce healthcare professionals' ability to tolerate intense workloads and to maintain their sense that their work is rewarding.

Handover of Patients From Prehospital Emergency Services to Emergency Departments: A Qualitative Analysis Based on Experiences of Nurses.

BACKGROUND: During the transfer of patients, both ambulance and hospital emergency service professionals need to exchange necessary, precise, and complete information for an effective handover. Some factors threaten a quality handover such as excessive caseload, patients with multiple comorbidities, limited past medical history, and frequent interruptions. PURPOSE: To explore the viewpoint of nurses on their experience of patient handovers, describing the essential aspects of the process and areas for improvement, and establishing standardized elements for an effective handover. METHODS: A qualitative research method was used. RESULTS: Nurses identified the need to standardize the patient transfer process by a written record to support the verbal handover and to transmit patient information adequately, in a timely manner, and in a space free of interruptions, in order to increase patient safety. CONCLUSIONS: An organized method does not exist. The quality of handovers could be enhanced by improvements in communication and standardizing the process.

Efectividad de medidas no farmacológicas para la disminución del dolor y el miedo en niños durante la venopunción en urgencias: dispositivos de vibración más frío frente a distracción / Effectiveness of non-pharmacological measures for reducing pain and fear in children during venipuncture in the emergency department: a vibrating cold devices versus distraction

Objetivos: Evaluar la efectividad de medios no farmacológicos en el manejo del dolor y el miedo en los niños, y la ansiedad del acompañante, durante la realización de venopunción en urgencias. Método: Estudio cuasiexperimental con tres grupos: en uno se combinó distracción dirigida y dispositivo de vibración más frío, en otro solo se usó distracción dirigida y en otro no se usó distracción ni dispositivo alguno. Resultados: El dolor y la ansiedad del acompañante fueron similares entre los grupos en que se usó alguna medida de control del dolor, y mayor en el que no se usó ninguna. No se encontraron cambios en el miedo. Conclusiones: La distracción dirigida puede ser útil para el manejo del dolor en el paciente pediátrico, y disminuye la ansiedad de los acompañantes. Los dispositivos de vibración más frío no aportan beneficio adicional. El miedo no mejora con el uso de ninguna de estas medidas

Objective: To assess the effectiveness of a physical method of managing pain and fear in children and anxiety in the accompanying adult during venous puncture in the emergency department. Methods: Quasi-experimental study of 3 groups: one group used a combination of directed distraction by means of a vibration device with ice pack, a second group received only distraction, and no strategy was used in the third. Results: Pain and adult anxiety were similar in the 2 groups in which a pain management strategy was applied. Pain and adult anxiety were greater when no strategy was adopted. We detected no differences in the level of the children’s fear. Conclusions: Directed distraction can be useful for managing pain in children and it reduces the anxiety experienced by accompanying adults. The use of a vibration device with ice does not add benefits. Fear is not reduced by any of these measures

Effectiveness of non-pharmacological measures for reducing pain and fear in children during venipuncture in the emergency department: a vibrating cold devices versus distraction. / Efectividad de medidas no farmacológicas para la disminución del dolor y el miedo en niños durante la venopunción en urgencias: dispositivos de vibración más frío frente a distracción.

OBJECTIVES: To assess the effectiveness of a physical method of managing pain and fear in children and anxiety in the accompanying adult during venous puncture in the emergency department. MATERIAL AND METHODS: Quasi-experimental study of 3 groups: one group used a combination of directed distraction by means of a vibration device with ice pack, a second group received only distraction, and no strategy was used in the third. RESULTS: Pain and adult anxiety were similar in the 2 groups in which a pain management strategy was applied. Pain and adult anxiety were greater when no strategy was adopted. We detected no differences in the level of the children's fear. CONCLUSION: Directed distraction can be useful for managing pain in children and it reduces the anxiety experienced by accompanying adults. The use of a vibration device with ice does not add benefits. Fear is not reduced by any of these measures.

OBJETIVO: Evaluar la efectividad de medios no farmacológicos en el manejo del dolor y el miedo en los niños, y la ansiedad del acompañante, durante la realización de venopunción en urgencias. METODO: Estudio cuasiexperimental con tres grupos: en uno se combinó distracción dirigida y dispositivo de vibración más frío, en otro solo se usó distracción dirigida y en otro no se usó distracción ni dispositivo alguno. RESULTADOS: El dolor y la ansiedad del acompañante fueron similares entre los grupos en que se usó alguna medida de control del dolor, y mayor en el que no se usó ninguna. No se encontraron cambios en el miedo. CONCLUSIONES: La distracción dirigida puede ser útil para el manejo del dolor en el paciente pediátrico, y disminuye la ansiedad de los acompañantes. Los dispositivos de vibración más frío no aportan beneficio adicional. El miedo no mejora con el uso de ninguna de estas medidas.

[Efficacy and safety of endotracheal intubation performed in moving vs motionless environments]. / Estudio comparativo de la eficacia y seguridad de la intubación endotraqueal en movimiento y en estático.

OBJECTIVES: To compare the efficacy and safety of endotracheal intubation (ETI) in a simulated clinical environment in motion vs a motionless one. MATERIAL AND METHODS: Clinical simulation trial of ETI with 3 endotracheal tubes (Airtraq, Fast-trach, Macintosh laryngoscope) in mannequins with realistic physiological responses (MetiMan) in 2 scenarios: an environment in motion vs a motionless one. Thirty-six physicians expert in prehospital ETI participated. Outcome variables were successful intubation, effective intubation, number of attempts, maximum apnea time, and total maneuver time. The safety variables were the presence of bradycardia, tachycardia, or high or low systolic blood pressures (ie, 20% variation from baseline); hypoxemia (decrease in oxygen saturation to <90% or 10% below baseline), tube placement in the esophagus or main bronchus, and dental trauma. RESULTS: No statistically significant differences between the 2 scenarios were found in the numbers of successful ETI (motionless, 71 [65.7%]; in motion, 67 [62.0%]; P=.277) or effective ETI (motionless, 104 [96.3%]; in motion, 105 [97.2%]; P=.108). Likewise, the number of attempts were similar (motionless, 91 [84.2%]; in motion, 90 [83.3%]; P=.305). Nor did we see differences in the mean (SD) maximum apnea times (motionless, 14.0 [5.6] seconds; in motion, 14.9 [8.1] seconds; P=.570) or mean total maneuver times (motionless, 236.7 [73.4] seconds; in motion, 210.3 [77.9] seconds; P=.164). The prevalences of bradycardia, tachycardia, high or low systolic blood pressure, hypoxemia, placements in the esophagus or bronchus, and dental trauma also did not differ significantly between the 2 scenarios. CONCLUSION: Neither efficacy nor safety variables differed significantly when ETI was performed in mannequins in a motionless environment vs one simulating ambulances in motion.

OBJETIVO: Evaluar la eficacia y seguridad de la intubación endotraqueal (IET) en movimiento en comparación con la realización en estático. METODO: Ensayo de simulación clínica con maniquíes con respuesta fisiológica MetiMan® que comparó la IET en dos escenarios, intubar en estático (IE) y en movimiento (IM), utilizando 3 dispositivos de IET (Airtraq®, Fast-trach® y Laringoscopio Macintosh®). Treinta y seis médicos expertos en intubación prehospitalaria fueron los intervinientes. Las variables de resultado fueron la intubación efectiva y exitosa, el número de intentos, el tiempo máximo de apnea (TMA) y el tiempo total de la técnica (TTT). Las variables de seguridad fueron la presencia de bradi- y taquicardia, hiper- e hipotensión, hipoxemia, tubo endotraqueal (TET) alojado en esófago o en bronquio y el traumatismo dental. RESULTADOS: No hubo diferencias estadísticamente significativas en el porcentaje de IET exitosa [IE: 71 (65,7%) vs IM: 67 (62,0%); p = 0,277] ni de efectividad (IE: 104 (96,3%) vs IM: 105 (97,2%); p = 0,108), en el número de intentos [IE: 91 (84,2%) vs IM: 90 (83,3%); p = 0,305], en la media de TMA [IE: 14,0 (DE 5,6) segundos vs IM: 14,9 (DE 8,1) segundos; p = 0,570], TTT [IE: 236,7 (DE 73,4) segundos vs IM: 210,9 (DE 77,9) segundos; p = 0,164]. Tampoco se demostró aumento o descenso de un 20% de las cifras iniciales de la frecuencia cardiaca o de la presión arterial sistó- lica, la saturación de oxígeno inferior a 90% o descenso de un 10% de la basal, intubación esofágica o bronquial ni trauma dental, entre ambos escenarios. CONCLUSIONES: No se encontraron diferencias significativas en términos de eficacia ni seguridad entre la IET en movimiento y en dinámico en un escenario simulado.

Estudio comparativo de la eficacia y seguridad de la intubación endotraqueal en movimiento y en estático / Efficacy and safety of endotracheal intubation performed in moving vs motionless environments

Objetivo: Evaluar la eficacia y seguridad de la intubación endotraqueal (IET) en movimiento en comparación con la realización en estático. Método: Ensayo de simulación clínica con maniquíes con respuesta fisiológica MetiMan® que comparó la IET en dos escenarios, intubar en estático (IE) y en movimiento (IM), utilizando 3 dispositivos de IET (Airtraq®, Fast-trach® y Laringoscopio Macintosh®). Treinta y seis médicos expertos en intubación prehospitalaria fueron los intervinientes. Las variables de resultado fueron la intubación efectiva y exitosa, el número de intentos, el tiempo máximo de apnea (TMA) y el tiempo total de la técnica (TTT). Las variables de seguridad fueron la presencia de bradi- y taquicardia, hiper- e hipotensión, hipoxemia, tubo endotraqueal (TET) alojado en esófago o en bronquio y el traumatismo dental. Resultados: No hubo diferencias estadísticamente significativas en el porcentaje de IET exitosa [IE: 71 (65,7%) vs IM: 67 (62,0%); p = 0,277] ni de efectividad (IE: 104 (96,3%) vs IM: 105 (97,2%); p = 0,108), en el número de intentos [IE: 91 (84,2%) vs IM: 90 (83,3%); p = 0,305], en la media de TMA [IE: 14,0 (DE 5,6) segundos vs IM: 14,9 (DE 8,1) segundos; p = 0,570], TTT [IE: 236,7 (DE 73,4) segundos vs IM: 210,9 (DE 77,9) segundos; p = 0,164]. Tampoco se demostró aumento o descenso de un 20% de las cifras iniciales de la frecuencia cardiaca o de la presión arterial sistólica, la saturación de oxígeno inferior a 90% o descenso de un 10% de la basal, intubación esofágica o bronquial ni trauma dental, entre ambos escenarios. Conclusiones: No se encontraron diferencias significativas en términos de eficacia ni seguridad entre la IET en movimiento y en dinámico en un escenario simulado (AU)

Objective: To compare the efficacy and safety of endotracheal intubation (ETI) in a simulated clinical environment in motion vs a motionless one. Method: Clinical simulation trial of ETI with 3 endotracheal tubes (Airtraq, Fast-trach, Macintosh laryngoscope) in mannequins with realistic physiological responses (MetiMan) in 2 scenarios: an environment in motion vs a motionless one. Thirty-six physicians expert in prehospital ETI participated. Outcome variables were successful intubation, effective intubation, number of attempts, maximum apnea time, and total maneuver time. The safety variables were the presence of bradycardia, tachycardia, or high or low systolic blood pressures (ie, 20% variation from baseline); hypoxemia (decrease in oxygen saturation to < 90% or 10% below baseline), tube placement in the esophagus or main bronchus, and dental trauma. Results: No statistically significant differences between the 2 scenarios were found in the numbers of successful ETI (motionless, 71 [65.7%]; in motion, 67 [62.0%]; P=.277) or effective ETI (motionless, 104 [96.3%]; in motion, 105 [97.2%]; P=.108). Likewise, the number of attempts were similar (motionless, 91 [84.2%]; in motion, 90 [83.3%]; P=.305). Nor did we see differences in the mean (SD) maximum apnea times (motionless, 14.0 [5.6] seconds; in motion, 14.9 [8.1] seconds; P=.570) or mean total maneuver times (motionless, 236.7 [73.4] seconds; in motion, 210.3 [77.9] seconds; P=.164). The prevalences of bradycardia, tachycardia, high or low systolic blood pressure, hypoxemia, placements in the esophagus or bronchus, and dental trauma also did not differ significantly between the 2 scenarios. Conclusion: Neither efficacy nor safety variables differed significantly when ETI was performed in mannequins in a motionless environment vs one simulating ambulances in motion (AU)