Quality improvement tools to manage emergency callbacks from patients with diabetes in a prehospital setting

Abstract

Diabetes is rising at an alarming rate, as 1 in 10 adults worldwide now lives with the disease. In Qatar, a middle eastern Arab country, diabetes prevalence is equally concerning and is predicted to increase from 17% to 24% among individuals aged 45 and 54 years by 2050. While most healthcare strategies focus on preventative and improvement of in-hospital care of patients with diabetes, a notable paucity exists concerning diabetes in the prehospital setting should ideally be provided. This quality improvement study was conducted in a middle eastern ambulance service and aimed to reduce ambulance callbacks of patients with diabetes-related emergencies after refusing transport to the hospital at the first time. We used iterative four-stage problem-solving models. It focused on the education and training of both paramedics and patients. The study showed that while it was possible to reduce the rate of ambulance callbacks of patients with diabetes, this was short-lived and numbers increased again. The study demonstrated that improvements could be effective. Hence, changes that impacted policy, systems of care and ambulance protocols directed at managing and caring for patients with diabetes-related prehospital emergencies may be required to reify them.

Evaluation of the implementation of the objective structured clinical examination in health sciences education from a low‐income context in Tunisia: A cross‐sectional study

“…The average overall satisfaction scores of health sciences students and educators were determined and represented in the Shewhart charts in Figure 1. In Shewhart charts, the control limits are calculated based on the data and represent the natural boundaries within which the process is considered stable and desirable 16 . The upper control limit (UCL) and lower control limit (LCL) are set at three standard deviations above and below the mean, respectively.…”

“…In Shewhart charts, the control limits are calculated based on the data and represent the natural boundaries within which the process is considered stable and desirable. 16 The upper control limit (UCL) and lower control limit (LCL) are set at three standard deviations above and below the mean, respectively. In Figure 1A , the educators' satisfaction scores varied mostly within the control limits, indicating a stable process.…”

Exploring factors influencing time from dispatch to unit availability according to the transport decision in the pre-hospital setting: an exploratory study

“…It is imperative to acknowledge that wehre other EMS systems uses the National Advisory Committee for Aeronautics (NACA) scale for patient assessment [ 37 , 38 ], the HMCAS adheres to the indications of our Clinical Practice Guidelines (CPG). The CPGs include an alternative methodology more relevant to the region’s operational healthcare operational requirements [ 15 , 39 ].…”

“…Furthermore, its ambulances are staffed by Ambulance Paramedics, who can perform medical assessments, determine provisional diagnoses, interpret electrocardiogram readings, and administer treatment and life-saving interventions such as supraglottic airway management and intravenous therapy. Critical Care Paramedics have a more advanced scope of practice and can perform more complex procedures, such as endotracheal intubation [ 14 , 15 ].HMCAS promotes patient hospital conveyance, refraining from clinician-driven non-conveyance and emphasising patient or next-of-kin-endorsed transportation decisions [ 14 , 15 ]. The reason for this is to avoid potential risks associated with under-triaging cases, particularly in elderly patients who may sometimes present with an ambiguous clinical presentation that conceals serious health issues.Upon receiving a call for service (CFS) via 999, the Emergency Medical Dispatcher (EMD) from the National Command Center (NCC) uses the ‘ProQa™’ software within the Medical Priority Dispatch System (MPDS) to rapidly dispatch the nearest ambulance available, ensuring timely medical intervention and subsequent patient transfer to a suitable healthcare facility [ 16 ].…”

Understanding patient non-transport decision theories in the pre-hospital setting: a narrative review

“…Subsequently, the EMD determines the most appropriate emergency response unit (ERU) for immediate dispatch using the Medical Priority Dispatch Systems (MPDS). After ERU’s arrival on scene, the medical responder assesses and triages the patient, provides them with initial emergency treatment, and transports them to the appropriate healthcare facility to receive definitive care [ 4 – 6 ].…”