- Email: [email protected]
Air versus ground: Which method of transport is better for short- and intermediate-range interfacility transport?
RESEARCH FORUM ABSTRACTS
ing specialized care, HT can provide rapid, safe, and effective care to stroke ",actims during transport.
46 Emergency Department Staff Evaluationof EMS Provider Performance
Conclusion: Overall transport times ,.,.'ere similar for air versus ground. Air transport minimizes the time spent in transport.
48 Thrombosis Practice Variation in the Diagnosis and Treatment of Deep Vein Presentingto the Emergency Department:A Call for
Carroll RF, Drescher MJ/Universi~ of Connecticut School of Medicine, Farmington, CT Study objective: We recently reported problematic areas of the emergency department and emergency medical sen'aces (EMS) interface from the perspective of the EMS provider. We undertook this study to identify areas of satisfaction or dissatisfaction with key aspects of EMS performance from the ED staffs perspective. Methods: Dunng a 2-month period, we conducted a survey of 85 ED staff, consisting of registered nurses, emergency medicine residents, and emergency medicine attending physicians. To date, a total of 63 responses were received (21 registered nurses, 21 residents, and 21 attending physicians) The study was muhicentered invoh,'ing 3 teaching hospitals affiliated with an emergency medicine residency program. All 3 hospitals share the same EMS system. The survey addressed 2 major areas: (1) radio and communications, and (2) ED/EMS interactions with regard to patient care. The respondents quantified their satisfaction in these areas using a 5-point Likert scale to evaluate the completion of duties. The scale used was as follows: 1=almost never, 2=not usually, 3=sometimes, 4=usually, and 5=almost always We interpreted scores _>4 as good and scores <4 as inferior. Results: Our survey evaluated 15 aspects of the EMS provider's role We identified 2 areas for which EMS satisfaction was high, based on scores consistently above 4 These aspects are (1) accurate and pertinent verbal report presented by EMS (mean satisfaction [MS] 4.15; confidence interval [CI[ 4.01 to 4.30, n= 63); (2) verbal reports by EMS given in a professional manner (MS 4.22; CI 4 0 7 to 4.38; n=63). We have identified 5 areas that scored consistently below 4. These areas of dissatisfaction with EMS performance are (1) organization and efficiency of radio reports (MS 357~ CI 3.36 to 3.78; n=63); (2) appropriateness of EMS request for medication adminis+ tratlon (MS 2.87; CI 2.43 to 3.32; n=63); (3) patients arrive via EMS v,ath the proper medical histories and medication lists (MS 3 6 5 ; CI 3.43 to 3.87; n=63); (4) EMS remains available in the ED for questions (MS 348; C1 3.27 to 3 68; n=63); and (5) EMS ability to recognize and identify major disease processes (MS 3.81; CI 3.64 to 3.98; n=63). Conclusion: There are several areas of the EMS prmqder's responsibilities that show room for improvement from the perspective of the ED staff. We believe that many of the problems we identified can be corrected by further educating the EMS providers based on the evaluations of the ED personnel. Further research is needed to determine which interventions will be most effective to this end. This stud)" is timited to our local EMS system, and whether the data can be generalized to other settings needs to be evaluated.
147 AirShort-Versus Ground:Which Method of Transport Is Bener for and Intermediate-Range Interfacility Transport? Huertas L, O'Connor RE, Tinkoff 6H/Cfiristiana Care Health System, Newark, DE Study objective: Phymcians must often determine whether air or ground transport is more appropriate for interfacility patient transport. Air transport is perceived as being much quicker, but it is also more expensive. We conducted this stud)' to determine the best mode of transport based on time and distance considerations. Methods: This prospective observational study was conducted at a rertia D" care facility. Members of the team responsible for interfacility transports collected data. Only incoming transports cared for by this team were included. The transport team was dispatched from the receiving hospital to pick up the patient from the sending hospnal. Sampling was consecutive. The sending and receiving physicians determined whether air or ground transport was used. Ground transport was stationed at the receiving hospital and air transport was stationed elsewhere. Transport distances were classified as being either greater or less than 100 miles. Statistical analysis was performed using the t test corrected for multiple comparisons and Z2 Results: A total of 243 transports were studied: 11 by air and 232 by ground Forty-eight transports were more than 100 miles: 8 by air and 40 by ground. The time from activatton to departure of the transport team was 19 minutes by air and 1.8 minutes by ground (P= 001). Time interval to the sending facility was 41 minutes by ground and 27 by air (P=.Ot). For distances more than 100 miles, time to (29 x'ersus 72 minutes) and from (29 versus 57 minutes) the receiving facility was shorter by air (P=.01). Overall time from dispatch to arrival at the receixang hospital was 122 minutes by ground and 112 minutes by atr (P=NS).
OCTOBER 1999, PART 2 34:4 ANNALSOF EMERGENCYMEDICINE
Practice Guidelines Rowe BH. Kelly KD. Ewanchuk M. Edmonds ML, Voaklander DC, Holroyd BR/University of Alberta. Alberta Centre for Injury Control and Research.Edmonton.Alberta. Canada Stud)" objectwes: To examine the diagnostic and treatment approaches of patients proven deep vein thrombosis (DVT) presenting to emergency departments. Methods: Compurenzed records of all patients presenting to all 5 EDs in one regional health authority were searched to identify" D~,q's (International Classification of Diseases-ninth n".asion, code 451 ) Data were abstracted from charts by a single coder usmg a standardized form: physicians were una'.s~areof the study at the time of panenr presentation. Results: A total of 607 records were identified dunng the 2 ),ears (1996-1997); 439 (72%) were proven DVTs Gender ratio was 1:1 : mean age was 58 I years. Most patients (56%) presented pnmanly to the ED for assessment of leg sTmptoms. DVTs were located primanly in proximal veins (74%): isolated distal (25%) and isolated iliac (1%) vein DVTs ,..,'ere less c o m m o n Of 428 patients who had diagnostic testing performed, the use of venography was high (o,.x'rall 70%), Considerable diagnostic variation existed; initial ED investigation was more commonly venography (62%; range among the 5 sites: 33% to 82%) than ultrasound (38%: site range 18% to 67%), Testing using n-dimers (overall 3%; range 0 to 5%) was rare, Using multr,'anate analyses, hospital site. past histo D' of pulmonary embolism, diabetes, and presence of calf edema were significant predictors of venogram use All patients were hospitalized and most (78%; site range 62% to 92%) received intravenous hepanm low molecular weight heparin ,.,,.asrarely used (5%). Conclusion: Compliance with current diagnostic and treatment recommendations for DVT are low. Prospective. muhicentered studies are required to confirm this finding and guidelines may be required to reduce practice variation. In addition to impro',ang care, the potential for resource savings exists vr
49 Documentation of the Emergency Evaluationof the Adult Sexual AssaultVictim Plewa MC. Oubich EM/Medicat College of Ohio, St Vincent Mercy Medical Center, Toledo, OH Stud)' objectives: To assess the completeness of documentation for histonca], examination, and treatment elements in the evaluation of adult female sexual assault victims before and after implementation of the sexual assault nurse examiner (SANE) program. Methods: Retrospective cfian review of adult female sexual assault vmtims treated m an urban community teaching hospital emergency department 2 years before and 1 3,'ear after the SANE program. Measurements included SANE or physician documentation of 47 elements Groups vtere compared wuh 95% confidence intervals. Results: Documentation was greater in SANE (31l than physician (57) charts for tetanus status (61% [42% to 78%1 versus 23% i13% to 36%D, recent coitus (81% [63% to 93%1 versus 46% [32% to 59%1). clothing change (94% 179% to 99%] versus 61% [48% to 74%])+ bathing (97% 183% to 100%1 versus 70% [57% to 82%1), voiding (94% [79% to 99%1 versus 47% 134% to 61%]), ingestion (87% [70% to 96%] versus 30% [ 18% to 43%1). anal penetration (97% [83% to 100%1 versus 74% [60% to 84%1), penetration wnh object t94% [70% to 96%1 versus 16% [7% to 28%]), ejaculation (90% 174% to 98%1 versus 68% [55% to 80%1). condom use (94% I79% to 99%1 versus 46% [32% to 59%1), other barrier (foam, spermicide, or tampon: 90% [74% to 98%] versus 14% 16% to 26%1), menstrual bleeding (90% [73% to 98%] versus 19% [9% to 32%]. debris (70% 151% to 85%] versus 15% [7% to 28%]), blood (87% [69% to 96%] versus 51% [37% to 65%]), semen (67% I47% to 83%1 versus 34% [22% to 48%]). wounds (93% [78% to 99%] versus 66% [52% to 78%]), wet prep for sperm (58% [39% to 75%f versus 28% {17% to 42%1), and HIV testing (58% I39% to 75%] versus 25% [14% to 38%]) Documemation was less in SANE than physician charts for drug/alcohol use (23% [10% to 41%1 versus 60% [46% to 72%]). prior pregnancy (16% [5% to 34%] versus 53% [39% to 66%]). and use of restraints (0 versus 51% [37% to 64%]). Documentation ',.,'as poc~r t,<50%) in both groups for present treatment of sexually transmitted disease (0 versus 26% [16% to 40%]). birth control (35% [19% to 55%] versus 37% I24% to 50%13. loss of consciousness (48% [30% to 67%1 versus 44% [31% to 58%13. fondling (0 versus 14% 16% to 26%]), kissing (0 versus 12% [5% to 24%]), and weapon use (26% [12% to 45%] versus 40% [28% to 54%]). Conclusion: Implementation of the SANE program resulted in improved medical record
S 39
ing specialized care, HT can provide rapid, safe, and effective care to stroke ",actims during transport.
46 Emergency Department Staff Evaluationof EMS Provider Performance
Conclusion: Overall transport times ,.,.'ere similar for air versus ground. Air transport minimizes the time spent in transport.
48 Thrombosis Practice Variation in the Diagnosis and Treatment of Deep Vein Presentingto the Emergency Department:A Call for
Carroll RF, Drescher MJ/Universi~ of Connecticut School of Medicine, Farmington, CT Study objective: We recently reported problematic areas of the emergency department and emergency medical sen'aces (EMS) interface from the perspective of the EMS provider. We undertook this study to identify areas of satisfaction or dissatisfaction with key aspects of EMS performance from the ED staffs perspective. Methods: Dunng a 2-month period, we conducted a survey of 85 ED staff, consisting of registered nurses, emergency medicine residents, and emergency medicine attending physicians. To date, a total of 63 responses were received (21 registered nurses, 21 residents, and 21 attending physicians) The study was muhicentered invoh,'ing 3 teaching hospitals affiliated with an emergency medicine residency program. All 3 hospitals share the same EMS system. The survey addressed 2 major areas: (1) radio and communications, and (2) ED/EMS interactions with regard to patient care. The respondents quantified their satisfaction in these areas using a 5-point Likert scale to evaluate the completion of duties. The scale used was as follows: 1=almost never, 2=not usually, 3=sometimes, 4=usually, and 5=almost always We interpreted scores _>4 as good and scores <4 as inferior. Results: Our survey evaluated 15 aspects of the EMS provider's role We identified 2 areas for which EMS satisfaction was high, based on scores consistently above 4 These aspects are (1) accurate and pertinent verbal report presented by EMS (mean satisfaction [MS] 4.15; confidence interval [CI[ 4.01 to 4.30, n= 63); (2) verbal reports by EMS given in a professional manner (MS 4.22; CI 4 0 7 to 4.38; n=63). We have identified 5 areas that scored consistently below 4. These areas of dissatisfaction with EMS performance are (1) organization and efficiency of radio reports (MS 357~ CI 3.36 to 3.78; n=63); (2) appropriateness of EMS request for medication adminis+ tratlon (MS 2.87; CI 2.43 to 3.32; n=63); (3) patients arrive via EMS v,ath the proper medical histories and medication lists (MS 3 6 5 ; CI 3.43 to 3.87; n=63); (4) EMS remains available in the ED for questions (MS 348; C1 3.27 to 3 68; n=63); and (5) EMS ability to recognize and identify major disease processes (MS 3.81; CI 3.64 to 3.98; n=63). Conclusion: There are several areas of the EMS prmqder's responsibilities that show room for improvement from the perspective of the ED staff. We believe that many of the problems we identified can be corrected by further educating the EMS providers based on the evaluations of the ED personnel. Further research is needed to determine which interventions will be most effective to this end. This stud)" is timited to our local EMS system, and whether the data can be generalized to other settings needs to be evaluated.
147 AirShort-Versus Ground:Which Method of Transport Is Bener for and Intermediate-Range Interfacility Transport? Huertas L, O'Connor RE, Tinkoff 6H/Cfiristiana Care Health System, Newark, DE Study objective: Phymcians must often determine whether air or ground transport is more appropriate for interfacility patient transport. Air transport is perceived as being much quicker, but it is also more expensive. We conducted this stud)' to determine the best mode of transport based on time and distance considerations. Methods: This prospective observational study was conducted at a rertia D" care facility. Members of the team responsible for interfacility transports collected data. Only incoming transports cared for by this team were included. The transport team was dispatched from the receiving hospital to pick up the patient from the sending hospnal. Sampling was consecutive. The sending and receiving physicians determined whether air or ground transport was used. Ground transport was stationed at the receiving hospital and air transport was stationed elsewhere. Transport distances were classified as being either greater or less than 100 miles. Statistical analysis was performed using the t test corrected for multiple comparisons and Z2 Results: A total of 243 transports were studied: 11 by air and 232 by ground Forty-eight transports were more than 100 miles: 8 by air and 40 by ground. The time from activatton to departure of the transport team was 19 minutes by air and 1.8 minutes by ground (P= 001). Time interval to the sending facility was 41 minutes by ground and 27 by air (P=.Ot). For distances more than 100 miles, time to (29 x'ersus 72 minutes) and from (29 versus 57 minutes) the receiving facility was shorter by air (P=.01). Overall time from dispatch to arrival at the receixang hospital was 122 minutes by ground and 112 minutes by atr (P=NS).
OCTOBER 1999, PART 2 34:4 ANNALSOF EMERGENCYMEDICINE
Practice Guidelines Rowe BH. Kelly KD. Ewanchuk M. Edmonds ML, Voaklander DC, Holroyd BR/University of Alberta. Alberta Centre for Injury Control and Research.Edmonton.Alberta. Canada Stud)" objectwes: To examine the diagnostic and treatment approaches of patients proven deep vein thrombosis (DVT) presenting to emergency departments. Methods: Compurenzed records of all patients presenting to all 5 EDs in one regional health authority were searched to identify" D~,q's (International Classification of Diseases-ninth n".asion, code 451 ) Data were abstracted from charts by a single coder usmg a standardized form: physicians were una'.s~areof the study at the time of panenr presentation. Results: A total of 607 records were identified dunng the 2 ),ears (1996-1997); 439 (72%) were proven DVTs Gender ratio was 1:1 : mean age was 58 I years. Most patients (56%) presented pnmanly to the ED for assessment of leg sTmptoms. DVTs were located primanly in proximal veins (74%): isolated distal (25%) and isolated iliac (1%) vein DVTs ,..,'ere less c o m m o n Of 428 patients who had diagnostic testing performed, the use of venography was high (o,.x'rall 70%), Considerable diagnostic variation existed; initial ED investigation was more commonly venography (62%; range among the 5 sites: 33% to 82%) than ultrasound (38%: site range 18% to 67%), Testing using n-dimers (overall 3%; range 0 to 5%) was rare, Using multr,'anate analyses, hospital site. past histo D' of pulmonary embolism, diabetes, and presence of calf edema were significant predictors of venogram use All patients were hospitalized and most (78%; site range 62% to 92%) received intravenous hepanm low molecular weight heparin ,.,,.asrarely used (5%). Conclusion: Compliance with current diagnostic and treatment recommendations for DVT are low. Prospective. muhicentered studies are required to confirm this finding and guidelines may be required to reduce practice variation. In addition to impro',ang care, the potential for resource savings exists vr
49 Documentation of the Emergency Evaluationof the Adult Sexual AssaultVictim Plewa MC. Oubich EM/Medicat College of Ohio, St Vincent Mercy Medical Center, Toledo, OH Stud)' objectives: To assess the completeness of documentation for histonca], examination, and treatment elements in the evaluation of adult female sexual assault victims before and after implementation of the sexual assault nurse examiner (SANE) program. Methods: Retrospective cfian review of adult female sexual assault vmtims treated m an urban community teaching hospital emergency department 2 years before and 1 3,'ear after the SANE program. Measurements included SANE or physician documentation of 47 elements Groups vtere compared wuh 95% confidence intervals. Results: Documentation was greater in SANE (31l than physician (57) charts for tetanus status (61% [42% to 78%1 versus 23% i13% to 36%D, recent coitus (81% [63% to 93%1 versus 46% [32% to 59%1). clothing change (94% 179% to 99%] versus 61% [48% to 74%])+ bathing (97% 183% to 100%1 versus 70% [57% to 82%1), voiding (94% [79% to 99%1 versus 47% 134% to 61%]), ingestion (87% [70% to 96%] versus 30% [ 18% to 43%1). anal penetration (97% [83% to 100%1 versus 74% [60% to 84%1), penetration wnh object t94% [70% to 96%1 versus 16% [7% to 28%]), ejaculation (90% 174% to 98%1 versus 68% [55% to 80%1). condom use (94% I79% to 99%1 versus 46% [32% to 59%1), other barrier (foam, spermicide, or tampon: 90% [74% to 98%] versus 14% 16% to 26%1), menstrual bleeding (90% [73% to 98%] versus 19% [9% to 32%]. debris (70% 151% to 85%] versus 15% [7% to 28%]), blood (87% [69% to 96%] versus 51% [37% to 65%]), semen (67% I47% to 83%1 versus 34% [22% to 48%]). wounds (93% [78% to 99%] versus 66% [52% to 78%]), wet prep for sperm (58% [39% to 75%f versus 28% {17% to 42%1), and HIV testing (58% I39% to 75%] versus 25% [14% to 38%]) Documemation was less in SANE than physician charts for drug/alcohol use (23% [10% to 41%1 versus 60% [46% to 72%]). prior pregnancy (16% [5% to 34%] versus 53% [39% to 66%]). and use of restraints (0 versus 51% [37% to 64%]). Documentation ',.,'as poc~r t,<50%) in both groups for present treatment of sexually transmitted disease (0 versus 26% [16% to 40%]). birth control (35% [19% to 55%] versus 37% I24% to 50%13. loss of consciousness (48% [30% to 67%1 versus 44% [31% to 58%13. fondling (0 versus 14% 16% to 26%]), kissing (0 versus 12% [5% to 24%]), and weapon use (26% [12% to 45%] versus 40% [28% to 54%]). Conclusion: Implementation of the SANE program resulted in improved medical record
S 39