Interventional studies performed in emergency medical communication centres: systematic review.

We aimed to both quantitatively and qualitatively describe interventional research performed in emergency medical communication centres. We conducted a systematic review of articles published in MEDLINE, Cochrane Central Register of Controlled Trials and Web of Science. Studies evaluating therapeutic or organizational interventions directed by call centres in the context of emergencies were included. Studies of call centre management for general practice or nonhealthcare agencies were excluded. We assessed general characteristics and methodological information for each study. Quality was evaluated by the Cochrane Risk of Bias tool or the Newcastle-Ottawa Scale. Among 3896 articles screened, we retained 59; 41 studies were randomized controlled trials (69%) and 18 (31%) were before-after studies; 41 (69%) took place in a single centre. For 33 (56%), 22 (37%) and 4 (7%) studies, the models used were simulation training, patient-based or experimental, respectively. The main topic was cardiac arrests (n = 45, 76%), with outcome measures of cardiopulmonary resuscitation quality and dispatch assistance. Among randomized controlled trials, risk of bias was unclear or high for selective reporting for 37 (90%) studies, low for blinding of outcomes for 34 (83%) and low for incomplete outcomes for 31 (76%). Regarding before-after studies, quality was high in 9 (50%) studies. Few interventional studies have been performed in call centres. Studies mainly involved simulation and focussed on cardiac arrest. The quality of studies needs improvement to allow for a better recognition and understanding of emergency medical call control.

Implementing an Evidence-based Tobacco Control Program at Five 2-1-1 Call Centers: An Evaluation Using the Consolidated Framework for Implementation Research.

Introduction: The Smoke-Free Homes (SFH) Program is an evidence-based intervention offered within 2-1-1 information and referral call centers to promote smoke-free homes in low-income populations. We used the Consolidated Framework for Implementation Research to conduct a mixed-methods analysis of facilitators and barriers to scaling up SFH to five 2-1-1 sites in the United States. Methods: Data were collected from staff in 2015-2016 via online surveys administered before (N = 120) and after SFH training (N = 101) and after SFH implementation (N = 79). Semi-structured telephone interviews were conducted in 2016 with 25 staff to examine attitudes towards SFH, ways local context affected implementation, and unintended benefits and consequences of implementing SFH. Results: Post-implementation, 79% of respondents reported that SFH was consistent with their 2-1-1's mission, 70% thought it led to more smoke-free homes in their population, 62% thought it was easy to adapt, and 56% thought participants were satisfied. Composite measures of perceived appropriateness of SFH for 2-1-1 callers and staff positivity toward SFH were significantly lower post-implementation than pre-implementation. In interviews, staff said SFH fit with their 2-1-1's mission but expressed concerns about intervention sustainability, time and resources needed for delivery, and how SFH fit into their workflow. Conclusions: Sites' SFH implementation experiences were affected both by demands of intervention delivery and by SFH's perceived effectiveness and fit with organizational mission. Future implementation of SFH and other tobacco control programs should address identified barriers by securing ongoing funding, providing dedicated staff time, and ensuring programs fit with staff workflow. Implications: Smoke-free home policies reduce exposure to secondhand smoke. Partnering with social service agencies offers a promising way to scale up evidence-based smoke-free home interventions among low-income populations. We found that the SFH intervention was acceptable and feasible among multiple 2-1-1 delivery sites. There were also significant challenges to implementation, including site workflow, desire to adapt the intervention, time needed for intervention delivery, and financial sustainability. Addressing such challenges will aid future efforts to scale up evidence-based tobacco control interventions to social service agencies such as 2-1-1.

After-hours/on-call experience during primary care nurse practitioner education utilizing standard scenarios and simulated patients.

BACKGROUND AND PURPOSE: Few nurse practitioner (NP) programs include an after-hours/on-call component in their clinical preparation of NP students. This role is expected in many primary and specialty care practices, and is one that students feel unprepared to competently navigate. METHODS: Utilizing simulated callers as patients or parents, NP students participated in a simulated after-hours/on-call experience that included receiving the call, managing the patient, and submitting documentation of the encounter. Students completed pre- and postparticipation evaluations, and were evaluated by the simulated patient callers and faculty using standardized evaluation tools. CONCLUSIONS: NP students rated the experience as an educationally valuable experience despite feeling anxious and nervous about the experience. Several essential skills were identified including critical thinking, clear communication, self-confidence, and access to resources. After participation NP students were more receptive to an NP position with an on-call component. IMPLICATIONS FOR PRACTICE: Inclusion of a simulated on-call experience is a feasible component of NP education and should be added to the NP curriculum.