Errors of Omission in the Treatment of Prehospital Chest Pain Patients

Rittenberger, Jon C.; Beck, Paul W.; Paris, Paul M.

doi:10.1080/10903120590891688

Cited by 48 publications

(26 citation statements)

References 13 publications

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“…These rates are consistent with previous studies conducted in other settings that have shown similarly poor adherence rates to OOH chest pain protocols, even for patients with suspected cardiac ischemia. [30][31][32] These findings suggest that OOH providers may exercise significant discretionary decision-making for patients with chest pain, which in turn may help explain why the presence of both local and statewide protocols do not attenuate disparities in care.…”

Section: Discussionmentioning

confidence: 94%

Influence of Sex on the Out‐of‐hospital Management of Chest Pain

Meisel

Armstrong

Mechem

et al. 2010

Academic Emergency Medicine

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Section: Discussionmentioning

confidence: 94%

Influence of Sex on the Out‐of‐hospital Management of Chest Pain

Meisel

Armstrong

Mechem

et al. 2010

Academic Emergency Medicine

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“…The difference was not statistically significant (p = 0.730), but it gives a hint about the DSTs impact on the time spent in hospital before definitive care. 60,61 In addition, one study aimed to evaluate if paramedics could be helpful in determining if patients required emergency care showed paramedics failed to predict which patients do and do not require ED care. 62 One of the main findings is the lack of RCTs in evaluation of DSTs in prehospital care.…”

Section: Discussionmentioning

confidence: 99%

Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

Hagiwara

Henricson

Jönsson

et al. 2011

Prehosp. Disaster med.

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Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient. Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/ Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials. Results: Use of the DST in prehospital care may have the possibility to decrease "time to definitive care" and improve diagnostic accuracy among prehospital personnel, but more studies are needed. Conclusions:The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care. IntroductionPrehospital patient assessment is different compared to assessments provided in hospitals. Often, the ambulance personnel are sent to medical emergencies with very little background information. The person who initiates the call for help sometimes is not able to describe the situation, and therefore, the ambulance personnel have difficulties preparing themselves for the task. The ambulance personnel's work situation has been described as "extreme". "They have routinely required working in environments of extreme and constant uncertainty." 1 These environmental factors lead to great strain on the prehospital caregiver's ability when assessing patients. In addition, there have been very few randomized controlled trials (RTC) that have evaluated prehospital care. 2 When 14 ambulance nurses in Sweden were asked about factors that influence their decision-making, several factors that were crucial for the decision were elicited. Important factors included: (1) time of day; (2) season and weather; (3) amount of time before other resources could arrive to the scene; (4) if there was threat of security; (5) stress; (6) environment; (7) diagnosis and; (8) type of patient assessed. 3 A qualitative study by Wireklint Sundström described the need of an "open mind" in the performance of prehospital assessments, and noted that prehospital caregivers must put their preconceived ideas aside when they meet and assess patients. 4 As assessments and treatments of patients in prehospital emergency medical care are becoming more advanced and complex, prehospital emergency care is on the eve of a new and emerging role. 5 Many organizations are searching for alternatives to Accident and Emergency (A&E) treatments, 6 but according to a recent systematic review, prehospital personnel's preparedness for this task is poor. 7 Another future task ...

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“…Another study has indicated that deviations from protocols were common and that the care documented for pre-hospital patients with chest pain was variable [58].…”

Section: Influence Of Demographic Variables On Pre-hospital Treatmentmentioning

confidence: 99%